Perceptions of ceremonial and nonceremonial uses of tobacco by American-Indian adolescents in California

BackgroundAmerican-Indian adolescents have the highest tobacco use prevalence of all ethnic groups in the United States. Although much has been written about the role of tobacco in traditional Native-American cultures, little is known about modern-day perceptions of tobacco among American-Indian adolescents.MethodsThis study conducted focus groups of 40 American-Indian adolescents in urban and rural areas of Southern California. Participants discussed the role of traditional ceremonial tobacco use in their lives, the use of commercial tobacco as a substitute for sacred tobacco, the perceived safety of traditional versus commercial tobacco, and the perceptions of American-Indian imagery in tobacco advertising.ResultsMany American-Indian adolescents may be introduced to traditional tobacco use at early ages. Smoking is viewed as a sign of respect for the elders, but there are acceptable ways for adolescents to participate in ceremonies without inhaling smoke. Commercial cigarettes often are substituted for homegrown tobacco at ceremonies and events. Traditional tobacco was perceived as less dangerous than commercial tobacco because it does not contain chemical additives. However, respondents still perceived that smoking traditional tobacco and breathing tobacco smoke conferred health hazards. Participants found the use of American-Indian imagery in tobacco advertising offensive and stereotypical. Indian casinos were mentioned frequently as places where smoking occurred.ConclusionsContinued health education efforts are needed to decrease habitual use of commercial tobacco products and secondhand smoke exposure among American-Indian youth. Further research is needed to identify ways for American-Indian youth to participate in their cultural traditions while minimizing their risk for tobacco-related diseases.     

Stressful life events, smoking behavior, and intentions to smoke among and multiethnic sample of sixth graders

Objectives. Adolescent smoking has been associated with stressful life events. However, few studies have examined the associations between stress, smoking intentions, and smoking behavior among a multiethnic sample of adolescents. Methods. We compiled a checklist of stressful life events relevant to multiethnic youth and administered it to 1,074 sixth-grade students in urban Los Angeles. Results. The most frequently reported stressful events were similar across ethnic groups and generations in the USA: test taking, chores, and arguments with friends. The events reported as the most severe were disturbances in family life, such as: death, arguments between parents, and illness or injury. Whites and Latinos had reported higher levels of ever smoking and intentions to smoke than Asian/Pacific Islanders (PIs). On the positive family-related events scale Latinos scored higher than did whites or Asian/PIs. Whites scored higher than Latinos or Asian/PIs on both negative peer-related and negative personal-related events. Associations were observed between total stress, stressful life events, and smoking behavior and intention to smoke. Total stress was associated with ever smokers, smoking intentions within the next year and in high school over the entire sample. Negative peer-related events were associated with intention to smoke within the next year, among Latinos. Among Asian/PIs negative peer-related events were associated with intention to smoke within the next year and in high school. Negative school-related events were significantly associated with ever smoking and intentions to smoke in the next year and marginally associated with intentions to smoke in high school among children born in the USA whose parents were also born in the USA. Negative peer-related events and positive personal-related events were significantly associated with intentions to smoke in the next year among children born in the USA whose parents were immigrants. Conclusions. Results suggest that negative peer- and school-related events may lead to increased risk of smoking behavior and intentions to smoke among multicultural adolescents.     

Tobacco cessation in adolescent females in Appalachian communities

Adolescents who live in tobacco-growing areas use tobacco at earlier ages and more frequently than other youth. These adolescents, like all tobacco users, have many health risks. To be successful, cessation efforts targeting these youth must reflect the cultural, social, and economic import of tobacco in their communities. Six focus groups with girls aged 12 to 14 who lived in tobacco-growing communities in Appalachian Ohio, Tennessee, and Virginia and 20 interviews with key informants were conducted. Barriers identified by informants included community norms around tobacco use, family use of tobacco, school practices and policies, peer influences, youth attitudes, and logistical difficulties with cessation program efforts. Key findings indicated: (1) the social community in tobacco-growing communities is a significant influence in tobacco use; (2) family is important among young people in tobacco-growing communities and influences cessation positively and negatively; (3) parental smoking was an influence to smoke (4) some parents condone and even facilitate tobacco use by their children, but others actively discourage use; and (5) concern for the health of younger brothers and sisters elicits a strongly protective reaction from youth in discussions of health risks related to secondhand smoke. Youth in tobacco-growing regions have many similarities to others, but they also have unique cultural characteristics pertinent in the development and delivery of tobacco cessation programs.     

Substance use,generation and time in the United States: The modifying role of gender for immigrant urban adolescents

Although immigrant youth have lower rates of substance use than US born youth, whether substance use varies by generation and time in the US is unclear. This study examines adolescent alcohol, tobacco and marijuana use by generation/time in US (i.e., first generation, in US ≤4 years; first generation, in US >4 years; second generation; and third generation or higher). Data come from a 2008 survey of Boston, Massachusetts public high school students (n = 1485). Multivariable logistic regression models were used to examine the association between generation/time in the US and risk of past 30-day substance use, adjusting for age and race/ethnicity. To determine whether the associations differed by gender, we fit gender stratified regression models. The prevalence of substance use was lowest among immigrants who had been in the US ≤4 years. Among girls, generation/time in US was not related to alcohol use or to tobacco use. For boys, being an immigrant regardless of number of years in the US, as well as second generation was associated with a significantly lower risk of tobacco use, compared to third generation youth. Additionally, immigrant boys who had been in the US ≤4 years had a significantly lower risk of alcohol use. Among both boys and girls, all first and second generation youth were significantly less likely to report marijuana use compared to third generation youth. Immigrant youth have a lower risk of alcohol, tobacco and marijuana use relative to US born youth; however the protective effect of foreign nativity on alcohol was eroded much more quickly than for tobacco or marijuana. The effects of generation and time in US on substance use differ by gender and the particular substance.     

Psychosocial correlates of alternate tobacco product use during early adolescence

BACKGROUND: The objective was to assess psychosocial correlates of alternate tobacco product (chew/snuff, cigar, pipe, bidi, kretek) use. METHODS: Measures of alternate tobacco product use, cigarette smoking, environmental smoking exposure, and depression were included in a school-based self-report survey completed by 1,107 ninth graders. RESULTS: The current (past 30 days) use rate for one or more alternate tobacco products was 8.3% and the current use rate for cigarettes was 11%; 45% of current cigarette smokers also used alternate tobacco products. After controlling for demographic factors and current cigarette smoking, adolescents exposed to peers who smoke and those with greater depressive symptoms were two to three times more likely to currently use an alternate tobacco product than adolescents without exposure to peer smoking and those with lesser depressive symptoms. CONCLUSIONS: Social and psychological associations with alternate tobacco product use should be further evaluated as this information could be helpful in developing anti-tobacco messages targeted to high-risk youth.     

Sexual Behavior and Drug Use Among Asian and Latino Adolescents: Association with Immigrant Status

This paper contributes new evidence on the association between immigrant status and health by describing and attempting to explain patterns of co-occurring sex and drug use behaviors among Asian and Latino adolescents in the United States. Nine patterns of sex and drug use behaviors were identified from a cluster analysis of data from 3,924 Asian and Latino youth (grades 7–12) who participated in the National Longitudinal Study of Adolescent Health (Add Health). The relationship between immigrant status and risk cluster membership was evaluated with multinomial logistic regression. Compared to foreign-born youth, U.S. born Asian and Latino adolescents were more likely to engage in sex and drug risk behaviors. Family and residential characteristics associated with immigrant status partly accounted for this finding. The results indicate that among Asian and Latino adolescents, assimilation to U.S. risk behavior norms occurs rapidly and is evident by the second generation.     

Influence of Maternal Birthplace on Postpartum Health and Health Services Use

This study examined differences in health status, rates of postpartum depression, perceptions of health services, unmet service needs, and barriers to service use among women born in and outside of Canada at 6 weeks following postpartum discharge from hospital. A secondary analysis of data gathered for a longitudinal cross-sectional survey of postpartum health and service use was conducted. Data from participants recruited from two urban hospitals were used for this analysis (n = 1,045). Analyses examined differences between women born in and outside of Canada. Immigrant women were significantly more likely to experience fair/poor postpartum health status and risk for postpartum depression. Immigrant women were also more likely to rate community health services as fair/poor, and were less likely to be able to get care for emotional health problems. Postpartum health services need to be responsive and accessible in order to meet the needs of immigrant women.     

Parents,teachers and peer relations as predictors of risk behaviors and mental well-being among immigrant and Israeli born adolescents

This study examines the roles of parents (monitoring, involvement and support at school), teachers (support) and peers (excess time spent with friends, peer rejection at school) in predicting risk behaviors (smoking and drinking) and mental well-being among 3499 Israeli-born and 434 immigrant adolescents ages 11, 13 and 15, in the 2006 WHO Health Behavior in School-Aged Children cross-national survey. Structural Equation Modeling (SEM) showed that for native Israeli youth, in line with previous developmental literature, all three relationships – parents, teachers and peers – have a significant impact on both mental well-being and risk behaviors. However, for immigrant adolescents, it was the school environment (parental support at school, teacher support and peer relationships) that proved to be the significant predictor of risk behaviors and mental health outcomes. These findings suggest that the school is an important social support in the health and mental well-being of immigrant schoolchildren.     

Correlates and Predictors of Tobacco Use Among Immigrant and Refugee Youth in a Western Canadian City

Background Tobacco control is a priority of the British Columbia Ministry of Health as illnesses associated with tobacco use are the leading cause of preventable death in the province. As a result of increased immigration, British Columbia’s demographic profile is becoming more diverse and necessitates approaches to health promotion and disease prevention that are culturally relevant. In order to develop culturally relevant anti-smoking messages and resources for immigrant and refugee youth, surveys were administered to 194 youth to better understand their attitudes towards smoking and to explore predictors of tobacco use. Results Twelve percent of respondents reported smoking all or part of a cigarette within the past 30 days. Male respondents were three times more likely to smoke than female respondents. Logistic regression analysis showed that immigrant and refugee youth were more likely to be non-smokers if they did not have a father who smokes, drank alcohol less frequently and had fewer close friends who smoke. Implications These findings support previous research studies that relate youth smoking to social influences and demonstrate a need to address gender differences, the confluence of smoking and drinking and the significance of family and peer pressure on smoking when designing culturally relevant anti-smoking resources.     

The effect of immigrant generation on smoking

Immigrants to the US are not only an increasingly significant demographic group but overall they also have lower socioeconomic status (SES) than the native-born. It is known that tobacco use is a major health risk for groups that have low SES. However, there is some evidence that tobacco use among certain immigrant groups is lower than among the respective native-born ethnic group, and that immigrant assimilation is positively related to tobacco use. We investigated the relationship between immigrant generation and daily smoking, using the Tobacco Use Supplement of the Current Population Survey (TUS-CPS), 1995-96, a national data set representative of the US general and immigrant populations. Our multivariate logistic regression analysis of the relationship between immigrant generation and daily smoker status (n = 221,798) showed that after controlling for age, gender, race/ethnicity, SES variables (i.e. equivalized household income, education, occupation), and central-city residence, the odds of being a daily smoker were highest among US-born individuals of US-born parents (reference group) and lowest among foreign-born individuals (95% CI: 0.54-0.62). Being a second-generation immigrant (i.e. US born) with two immigrant parents also conferred a protective effective from smoking (95% CI: 0.64-0.77). However, having only one foreign-born parent was not protective against smoking. Testing for interaction effects, we also found that being foreign born and being second generation with two immigrant parents were especially protective against smoking among females (vis-à-vis males); racial/ethnic minorities (vis-à-vis whites); and low-income individuals (vis-à-vis high-income individuals). We discuss possible mechanisms that may explain the protective effect against smoking of being foreign born and being second generation with two immigrant parents, including differences in the stage of the tobacco epidemic between immigrants' countries of origin and the US, the "healthy immigrant effect", and anti-smoking socialization in immigrant families.     

Food Hardship and Obesity in a Sample of Low-Income Immigrants

Very little work has examined the relationship between food hardship (having inconsistent financial resources to buy food) and obesity among immigrant groups. A cross-sectional study was conducted in a low-income, multi-racial/ethnic adult sample in greater Boston, MA (n = 828). Modified Poisson regression models estimated the association between food hardship obesity (BMI ≥ 30) among adults reporting food hardship; interactions were tested by place of birth. Body mass index (BMI) was based on anthropometric height and weight. In adjusted models, those experiencing food hardship were more likely to be obese (RR 1.17, CI 1.07, 1.29) than those not experiencing food hardship. Participants from Haiti reporting food hardship were more likely to be obese than those not reporting hardship (RR 1.58, CI 1.23, 2.04); this was not the case among other groups (US born, Puerto Rican, Latin American, Other). The relationship between food hardship and weight may vary among immigrant subgroups.     

Racial disparities in tobacco use and social influences in a rural southern middle school

This study investigated racial differences of tobacco use and social exposure to tobacco products in a sample of middle school students. Questionnaires were administered in January 2005 to 290 students in a Mississippi Delta-area middle school. The participants were 51.0% female and 56.6% African American. Unadjusted odds ratios revealed that Caucasian students were statistically more likely than were African American students to (1) have ever tried smoking, (2) have ever been a daily smoker, (3) have smoked in the past 30 days, (4) live with someone who smokes, (5) have seen a parent or guardian smoke, and (6) have friends who smoke. In contrast, African Americans were more likely to report "no one is allowed to smoke" in their home. Caucasian females had the highest rates of smoking, as well as the highest exposure to social smoking behaviors. This study not only showed that Caucasians were indeed smoking more but also that African American adolescents do not have the same exposure to social smoking, particularly African American females. Of particular interest was why the differences eventually dissipate and smoking rates are virtually the same in adulthood. A greater understanding of the impact of exposure to tobacco use on an adolescent's own tobacco use is vital to prevention efforts, especially in regard to racial differences. Future research on youth tobacco prevention and cessation programs should focus on sociocultural and racial differences in the development of tobacco use in adolescents.     

Immigration Generation Status and its Association with Suicide Attempts,Substance Use,and Depressive Symptoms among Latino Adolescents in the USA

This study investigated the relation between suicide attempts and immigrant generation status using the Latino subset of the National Longitudinal Study of Adolescent Health, a school-based, nationally representative sample. This study also examined whether generation status predicted risk factors associated with elevated suicide behaviors, namely illicit substance use, problematic alcohol use, and depressive symptoms. Finally, hypothesizing that elevated depressive symptoms and substance use mediate the relation between immigrant generation status and suicide attempts among Latino adolescents, a path model was tested. Our findings revealed immigrant generation status was a determinant for suicide attempts, problematic alcohol use, repeated marijuana use, and repeated other drug use for Latino adolescents. US-born Latinos with immigrant parents (i.e., second-generation youth) were 2.87 (95% CI, 1.34, 6.14) times more likely to attempt suicide, 2.27 (95% CI, 1.53, 3.35) times more likely to engage in problematic alcohol use, 2.56 (95% CI, 1.62, 4.05) times more likely to engage in repeated marijuana use, and 2.28 (95% CI, 1.25, 4.17) times more likely to engage in repeated other drug use than were foreign-born youth (i.e., first-generation youth). Later-generations of US-born Latino youth with US-born parents were 3.57 (95% CI, 1.53-8.34) times more likely to attempt suicide, 3.34 (95% CI, 2.18-5.11) times more likely to engage in problematic alcohol use, 3.90 (95% CI, 2.46, 6.20) times more likely to engage in repeated marijuana use, and 2.80 (95% CI, 1.46, 5.34) times more likely to engage in repeated other drug use than were first-generation youth. Results from the path analysis indicated that repeated other drug use may mediate the effect of generation status on suicide attempts.     

Impacts of Family Rewards on Adolescents’ Mental Health and Problem Behavior: Understanding the Full Range of Effects of a Conditional Cash Transfer Program

This paper examines the effects of Opportunity New York City–Family Rewards, the first holistic conditional cash transfer (CCT) program evaluated in the USA, on adolescents’ mental health and problem behavior (key outcomes outside of the direct targets of the program) as well as on key potential mechanisms of these effects. The Family Rewards program, launched by the Center for Economic Opportunity in the Mayor’s Office of the City of New York in 2007 and co-designed and evaluated by MDRC, offered cash assistance to low-income families to reduce economic hardship. The cash rewards were offered to families in three key areas: children’s education, family preventive health care, and parents’ employment. Results that rely on the random assignment design of the study find that Family Rewards resulted in statistically significant reductions in adolescent aggression and rates of substance use by program group adolescents as well as their friends, relative to adolescents in the control condition, but no statistically significant impacts on adolescent mental health. One possible mechanism for the benefits to adolescent behavior appears to be time spent with peers, as fewer adolescents in the program group spent time with friends and more adolescents in the program group spent time with family. Findings are discussed with regard to their implication for conditional cash transfer programs as well as for interventions targeting high-risk youth.     

Substance use by indigenous and non-indigenous primary school students

OBJECTIVE: Recent Australian research with adolescents aged 13 to 17 years has found that Indigenous youth are more likely than non-Indigenous adolescents to smoke tobacco and cannabis, although they may be less likely to use alcohol. The objective of this study was to examine whether this pattern exists among younger children. METHOD: A school-based, self-report survey was conducted in primary schools that had high proportions of Aboriginal and Torres Strait Islander children. Four schools were located in metropolitan Brisbane and three in Far North Queensland (sample n = 507 students: 270 girls, 237 boys, aged 9-13 years). RESULTS: Significant numbers of these children had started to experiment with recreational drugs. Twenty-two per cent had attempted to smoke at least one cigarette, 14% smoked in the preceding year, while 3% had smoked more than 10 cigarettes in their lives. Thirty-eight per cent had had at least one drink of alcohol, while 6% had smoked marijuana at least once. There was no significant association between Indigenous/non-Indigenous background and risk of smoking tobacco or marijuana, while Indigenous children were less likely than non-Indigenous children to report experience with alcohol. CONCLUSIONS: Contrary to data from secondary school students, Indigenous youth in primary schools were not more likely than non-Indigenous children to have experimented with tobacco or marijuana, or to be frequent tobacco smokers. It appears therefore that the excessive uptake of drug use among Indigenous youth occurs in the early stages of secondary school. This finding underlines the importance of preventive education in primary schools, especially for Indigenous children who have a high risk of making the transition to drug use in adolescence.     

Truancy’s Effect on the Onset of Drug Use among Urban Adolescents Placed at Risk

PurposeTo examine the relationship between truancy and the onset of drug use.MethodsDiscrete time survival analysis was used to assess the effect of truancy on initiation of drug use after adjusting for several potential confounders from age 11 to 15 years, using data from the Denver Youth Survey, a longitudinal sample of youth who grew up in socially disorganized neighborhoods of Denver, CO.ResultsIn this population, truancy was a significant predictor of initiation of alcohol, tobacco, and marijuana use. The robust effect of truancy persisted after controlling for potential confounders, including school performance, school isolation, association with delinquent peers, personal delinquent values, parental monitoring, and family attachment.ConclusionsAlthough this study cannot point to a causal relationship, we argue that the effect may be at least in part due to the unsupervised, unmonitored time with peers that truancy affords a young person. Truancy prevention is a field of research that needs much more attention. Keeping youth in school every day is likely to have many beneficial effects, and effective truancy prevention efforts may also help to prevent or delay the onset of drug use among adolescents.     

Social influences, and attitudes and beliefs associated with smoking among border Latino youth

BACKGROUND: Adolescent smoking rates have declined among all ethnic groups since the late 1990s. However, despite the recent declines and intervention efforts, today smoking remains a serious problem among youth, with a quarter of adolescents being current smokers by the time they complete 12th grade. This problem is particularly prevalent among Latino youth, who have among the highest rates of lifetime and past-30-day use. The purpose of this study was to examine the association between psychosocial factors and the smoking behavior of Latino youth living along the Mexico-US border. METHODS: A convenient sample of 2471 middle and high school Latino students was surveyed in fall 2000. Logistic regression analysis was used to examine the association between study risk factors and youth smoking behavior. RESULTS: The strongest predictor of lifetime and past-30-day smoking was peer influence; however, the strength of the association was greater with recent use. There were also differences in the influence of family and attitudes and beliefs between the 2 groups. CONCLUSIONS: These differences need to be taken into consideration to guide development of tailored prevention and control interventions aimed at this specific group. These efforts should address social influences to smoke, particularly those from peers; promote changes in attitudes and beliefs toward smoking; increase understanding of the addictive nature of nicotine; and provide development of skills young people need to resist social and environmental pressures to smoke. Strict control and enforcement measures are needed to completely eliminate the sale of cigarettes to minors.     

The Association Among Adolescents' Tobacco Use,Their Beliefs and Attitudes,and Friends' and Parents' Opinions of Smoking

Objective: To examine adolescents' attitudes toward smoking, the presence of a false consensus effect, and the influence of peer and parental attitudes about smoking choices on being a susceptible, never smoker; an experimenter; and a current smoker. Methods: Data from The Robert Wood Johnson Foundation's 1996 National Study of Tobacco Price Sensitivity, Behavior, and Attitudes Among Teenagers and Young Adults (RWJF survey) were used to produce national estimates of the tobacco use behaviors and attitudes of adolescents enrolled in high school. Three logistic regression models were estimated to examine which psychosocial variables were associated with three different stages of smoking uptake. Results: Positive attitudes toward tobacco use were associated with a greater likelihood of being a susceptible, never smoker (OR = 1.50), an experimenter (OR = 1.27), and a current smoker (OR = 2.96). Those respondents who believed that 50% or more of all adolescents smoked were more likely to be current smokers (OR = 1.45). The importance of the opinions of one's friends and parents about his/her choice to smoke was also found to be associated with smoking behavior. Conclusions: Preventing the initiation and continuation of smoking among adolescents will require interventions that address individual attitudes with respect to tobacco and will also need to present a clear picture of adolescent smoking. In addition, prevention and intervention messages should emphasize the importance of parental opinions on youth tobacco use regardless of parental tobacco use behavior.     

Trajectories or Parental Monitoring and Communication and Effects on Drug Use Among Urban Young Adolescents

PurposeIdentify the number and characteristics of heterogeneous trajectories of parental monitoring and communication among a sample of urban, racial/ethnic minority youth and examine the effects of these patterns on alcohol, cigarette and marijuana use.MethodsThe study sample (n=2,621) was predominantly African American or Hispanic (38% and 32%, respectively) and low-income (67% received free, or reduced price, lunch). They completed classroom-based surveys when in 6th-8th grades. Multilevel general growth mixture modeling was used to identify the heterogeneous trajectories of parental monitoring and communication and estimate the effects of these distinct patterns on drug use in 8th grade.ResultsFour trajectories of parental monitoring and communication were identified: (1) High (76.4%), (2) Medium (9.1%), (3) Decreasing (6.0%) and (4) Inconsistent (8.5%). Relative to those with high monitoring/communication, youth in the decreasing and inconsistent trajectories were at significantly greater risk for past year and past month alcohol and marijuana use and having ever smoked a cigarette. After controlling for family composition, only youth in the decreasing trajectory were significantly more likely to report substance use in 8th grade.ConclusionsFindings support the role of parents in preventing drug use during early adolescence and suggest that efforts to improve the level and consistency of parental monitoring and communication may be a fruitful target for prevention. Many youth initiate use of alcohol, tobacco or marijuana in this critical developmental period and considered with the health and social consequences of use, engaging parents in preventing drug use should remain a priority for prevention.     

Cell Phone Use among Homeless Youth: Potential for New Health Interventions and Research

Cell phone use has become nearly ubiquitous among adolescents in the United States. Despite the potential for cell phones to facilitate intervention, research, and care for homeless youth, no data exists to date on cell phone use among this population. In 2009, a survey of cell phone use was conducted among a non-probability sample of 169 homeless youth in Los Angeles, CA. Levels of ownership and use, instrumental uses (connecting to case workers, employers) and patterns of connecting to various network types were assessed (family, home-based peers, street-based peers). Differences in socio-demographic characteristics and cell phone ownership were assessed via t test and chi-square statistics. Sixty-two percent of homeless youth own a cell phone; 40% have a working phone. Seventeen percent used their phone to call a case manager, 36% to call either a potential or current employer. Fifty-one percent of youth connected with home-based peers on the phone and 41% connected to parents. Cell phones present new opportunities for intervention research, connecting homeless youth to family and home-based peers who can be sources of social support in times of need. Moreover, cell phones provide researchers and providers with new avenues to maintain connections with these highly transient youth.