Smoking prevention for ethnically diverse adolescents: 2-year outcomes of a multicultural, school-based smoking prevention curriculum in Southern California

BACKGROUND: Effective school-based curricula are needed to prevent smoking among ethnically diverse adolescents. This study evaluated a multicultural smoking prevention curriculum in ethnically diverse Southern California middle schools. METHODS: Students in 24 middle schools (N = 3157 sixth graders) received the multicultural curriculum, a similar curriculum without references to cultural issues, or a control condition. Odds ratios for experimentation with smoking over a 2-year period were calculated. RESULTS: The multicultural program was associated with a lower risk of smoking between sixth and eighth grade, relative to the control group. Program effects varied according to the ethnic composition of the schools. In schools with predominantly Hispanic populations, the multicultural curriculum was more effective than the control, but the standard curriculum was not. In schools with predominantly Asian or multicultural populations, the standard curriculum was more effective than the control, but the multicultural curriculum was not. Analyses stratified by ethnicity within the schools revealed that the multicultural curriculum was effective among Hispanic students within predominantly Hispanic schools, but not among Hispanic students within predominantly Asian/multicultural schools. CONCLUSIONS: Smoking prevention for adolescents in culturally diverse school contexts is a challenge. In this study, a multicultural curriculum was most effective among Hispanic students in predominantly Hispanic schools. Further research is needed to determine the best ways to prevent smoking in predominantly Asian and multicultural schools.     

Peer acceleration: effects of a social network tailored substance abuse prevention program among high-risk adolescents

OBJECTIVE: To test whether a social network tailored substance abuse prevention program can reduce substance use among high-risk adolescents without creating deviancy training (iatrogenic effects). METHODS: A classroom randomized controlled trial comparing control classes with those receiving an evidence-based substance use prevention program [Towards No Drug Abuse (TND)] and TND Network, a peer-led interactive version of TND. Students (n = 541, mean age 16.3 years) in 75 classes from 14 alternative high schools completed surveys before and approximately 1 year after curriculum delivery. Past-month use of tobacco, alcohol, marijuana and cocaine were assessed. RESULTS: Overall, TND Network was effective in reducing substance use. However, the program effect interacted with peer influence and was effective mainly for students who had peer networks that did not use substances. Students with classroom friends who use substances were more likely to increase their use. CONCLUSIONS: A peer-led interactive substance abuse prevention program can accelerate peer influences. For students with a peer environment that supports non-use, the program was effective and reduced substance use. For students with a peer environment that supports substance use, an interactive program may have deleterious effects.     

The influence of acculturation on drug and alcohol use in a sample of adolescents

This article reports on the associations between acculturation and substance use among 198 ninth-grade Southern California adolescents (mean age=13.8 years). Substance use measures included 30-day (current) and lifetime use of alcohol and other drugs. Acculturation was measured using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) acculturation scale, a multi-dimensional acculturation scale yielding four acculturation strategy scores. Linear regression analyses evaluated the association between acculturation on alcohol and drug use, adjusting for several covariates. Results revealed that the assimilation acculturation strategy was significantly, but negatively associated with current alcohol use, especially among males. The separation acculturation strategy was significantly and positively associated with current alcohol use, especially among females. Marginalization was associated with greater risk for lifetime alcohol and drug use, especially among males, and a greater risk of current drug use among females. The social influence covariates were predictive of both current and lifetime alcohol and drug use. Future studies should incorporate multidimensional acculturation scales in adolescent substance use to understand how different acculturation strategies impact different populations.     

Variation in Family Structure Among Urban Adolescents and Its Effects on Drug Use

Family structure is one factor that can help explain drug use among adolescents. In 2005 a study was conducted with 255 ninth-grade students from an urban, predominantly Latino Los Angeles area high school. Students were 83% Latino, 58% female, and from mostly low SES households. Half of all students reported having ever used alcohol, 30% had ever smoked a cigarette, and 18% had ever used marijuana. Family structure was measured using a single open-ended question and logistic regression was employed to determine the effects of various family structures on the use of alcohol, cigarettes, and marijuana. The presence of older siblings in the home was associated with alcohol and marijuana use, and living with a cousin was associated with marijuana use. Results suggest that influential others, including siblings and cousins, should be included in measures of family structure. Study limitations are noted.     

The role of acculturation, parenting, and family in Hispanic/Latino adolescent substance use: findings from a qualitative analysis

Focus groups were conducted with adolescents and parents as part of a larger study to understand the connection between acculturation and Hispanic/Latino adolescent substance use. Parents (n = 18) were all mothers and had an average age of 42 years. Students (n = 16) were 62% female and had an average age of 14 years. Results are summarized in five categories: culture/ethnic identity, acculturation, parent-child conflict/relationships, gender, and adolescent substance use. Parents and adolescents held similar views in some areas (e.g., pride in ethnic identity and changes in language use), but diverged in others (e.g., indicators of acculturation, gender differences in parenting, and ideas of freedom and independence). Participants in the focus groups did not endorse the association between acculturation and substance use that has been detected in quantitative studies. Implications for substance use prevention and treatment programs are discussed.     

A Comparison of Peer Influence Measures as Predictors of Smoking Among Predominately Hispanic/Latino High School Adolescents

PurposeConsistent evidence has shown that one of the most significant influences on adolescent smoking is peer influence. There is considerable variation, however, in how peer influence is measured. This study constructs social network influence and selection variables from egocentric and sociometric data to compare their associations with smoking, with considerations of perceived smoking norms and adolescent popularity.MethodsLongitudinal data were collected in the 9th and 10th grades in October 2006 and 2007 from predominantly Hispanic/Latino adolescents in seven Southern California schools; among these adolescents, 1,950 completed surveys at both waves. Both cross-sectional (separately for 9th and 10th graders) and longitudinal models were estimated.ResultsAn egocentric measure of perceived friend smoking was strongly and consistently associated with individual smoking (adjusted odds ratio [AOR] ≈ 1.80, p < .001), whereas its sociometric counterpart of friend self-report smoking was only associated with smoking in the 9th-grade cross-sectional models (e.g., AOR = 1.56, p < .001) and rarely in longitudinal models. Popularity, measured by proportion of nominations received by class size, was associated with smoking and becoming a smoker (AOR = 1.67, p < .001), whereas perceived norms were not, in longitudinal models. Friend selection was also associated with becoming a smoker (AOR = 1.32, p = .05).ConclusionsThis study illustrates the utility of egocentric data for understanding peer influence and underscores the importance of perceptions and popularity as mechanisms that influence adolescent smoking.     

The interaction of curriculum type and implementation method on 1-year smoking outcomes in a school-based prevention program

Studies have shown that the effectiveness of programs or curricula may depend in part on who delivers the material. In adolescent health education programs, peer leaders are often recruited to implement programs because they are more persuasive to other adolescents than adults. Teachers also systematically vary how groups are constructed in school-based health education programs. This study compared the effects of three leader and group selection methods within the context of two tobacco prevention programs. Eight schools received a social influences program (Chips) and eight received a program with a multicultural emphasis (Flavor). Within these 16 schools 84 classrooms consisting of 1486 students were randomly assigned to one of three leader and group creation conditions: (i) leaders defined as those who received the most nominations by students and groups created randomly (random group), (ii) same as (i) but groups created by assigning students to the leaders they nominated (network), and (iii) leaders and groups created by teachers (teacher). One year follow-up data showed that main effects of the curriculum and network assignments were non-significant on smoking initiation when entered alone. Interaction terms of curriculum and assignment methods, however, were significant such that the network and teacher conditions were less effective than the random group condition with Chips, and more effective than random group condition with Flavor. These data show that school-based prevention programs should be evaluated in light of who implements the program. Even a peer-led program will be differentially effective based on how leaders are selected and how groups are formed, and this effect may be curriculum dependent.     

Exploring peers as a mediator of the association between depression and smoking in young adolescents

Recent research has suggested that depression causes teens to begin smoking to elevate their mood. Other studies, however, have suggested the reverse causal direction: smoking causes depression. To gain a more complete understanding of the relationship between smoking and depression, potential mediators should be explored. This study explored how peer influences could mediate the relationship between depression and smoking. The methodology of Baron and Kenney was followed to test for mediation and moderation. Peers mediated the relationship between depression and smoking. Separate analyses by gender showed that depression remained significantly associated with smoking when peers were included in the model for girls only. Peer influence was related to depressed affect for both genders. These results provide evidence that peer influences are an important variable to take into consideration when addressing a depression smoking relationship.     

Why smoking prevention programs sometimes fail. Does effectiveness depend on sociocultural context and individual characteristics?

BACKGROUND: School-based smoking prevention programs sometimes fail in unexpected ways. This study tests the hypotheses that both social/cultural contexts and individual dispositional characteristics may interact with program content to produce effects that are variable in potentially predictable ways. METHODS: Students in 24 culturally heterogeneous or primarily Hispanic/Latino middle schools (N = 3,157 6th graders) received a multicultural collectivist-framed social influences (SI) program, an individualist-framed SI program, or a control condition. Three-way linear and nonlinear interactions, program frame x social context x dispositional phenotype, were tested. RESULTS: Three-way interactions were found for the dispositional phenotypes of depression and hostility with social context and program content/frame. In predominantly Hispanic/Latino schools, larger program effects were observed for high depressed and high hostile youth in both the collectivist and individualist framed programs. In culturally mixed schools, prevention effects were greatest for low depressed and low hostile youth, especially in the individualist framed program. In culturally mixed schools, there may have been a negative treatment effect for both programs among adolescents scoring high on depression and hostility. DISCUSSION: Prevention program effects can vary by combination of program content, social setting, and individual dispositional characteristics. The results suggest that prevention program design and implementation should be sensitive to population characteristics at both the individual and sociocultural levels.