We studied the effect of home smoking bans on transitions in smoking behavior during emerging adulthood.
We used latent transition analysis to examine movement between stages of smoking from late adolescence (ages 16–18 years) to young adulthood (ages 18–20 years) and the effect of a home smoking ban on these transitions. We used data from the Minnesota Adolescent Community Cohort study collected in 2004 to 2006.
Overall, we identified 4 stages of smoking: (1) never smokers, (2) experimental smokers, (3) light smokers, and (4) daily smokers. Transition probabilities varied by stage. Young adults with a home ban during late adolescence were less likely to be smokers and less likely to progress to higher use later. Furthermore, the protective effect of a home smoking ban on the prevalence of smoking behavior was evident even in the presence of parental smoking. However, this effect was less clear on transitions over time.
In addition to protecting family members from exposure to secondhand smoke, home smoking bans appear to have the additional benefit of reducing initiation and escalation of smoking behavior among young adults.
We examined the prospective effects of parental education (as a proxy for individual socioeconomic status [SES]) and neighborhood SES on adolescent smoking trajectories and whether the prospective effects of individual SES varied across neighborhood SES.
The study included 3635 randomly recruited adolescents from 5 age cohorts (12–16 years) assessed semiannually for 3 years in the Minnesota Adolescent Community Cohort study. We employed a cohort–sequential latent growth model to examine smoking from age 12 to 18 years with predictors.
Lower individual SES predicted increased levels of smoking over time. Whereas neighborhood SES had no direct effect, the interaction between individual and neighborhood SES was significant. Among higher and lower neighborhood SES, lower individual SES predicted increased levels of smoking; however, the magnitude of association between lower individual SES and higher smoking levels was significantly greater for higher neighborhood SES.
We found evidence for differential effects of individual SES on adolescent smoking for higher and lower neighborhood SES. The group differences underscore social conditions as fundamental causes of disease and development of interventions and policies to address inequality in the resources.
In developed countries, regular breakfast consumption is inversely associated with excess weight and directly associated with better dietary and improved physical activity behaviors. Our objective was to describe the frequency of breakfast consumption among school-going adolescents in Delhi and evaluate its association with overweight and obesity as well as other dietary, physical activity, and sedentary behaviors.
Design: Cross-sectional study. Setting: Eight schools (Private and Government) of Delhi in the year 2006. Participants: 1814 students from 8th and 10th grades; response rate was 87.2%; 55% were 8th graders, 60% were boys and 52% attended Private schools. Main outcome measures: Body mass index, self-reported breakfast consumption, diet and physical activity related behaviors, and psychosocial factors. Data analysis: Mixed effects regression models were employed, adjusting for age, gender, grade level and school type (SES).
Significantly more Government school (lower SES) students consumed breakfast daily as compared to Private school (higher SES) students (73.8% vs. 66.3%; p<0.01). More 8th graders consumed breakfast daily vs.10th graders (72.3% vs. 67.0%; p<0.05). A dose–response relationship was observed such that overall prevalence of overweight and obesity among adolescents who consumed breakfast daily (14.6%) was significantly lower vs. those who only sometimes (15.2%) or never (22.9%) consumed breakfast (p<0.05 for trend). This relationship was statistically significant for boys (15.4 % vs. 16.5% vs. 26.0; p<0.05 for trend) but not for girls. Intake of dairy products, fruits and vegetables was 5.5 (95% CI 2.4-12.5), 1.7 (95% CI 1.1-2.5) and 2.2 (95% CI 1.3-3.5) times higher among those who consumed breakfast daily vs. those who never consumed breakfast. Breakfast consumption was associated with greater physical activity vs. those who never consumed breakfast. Positive values and beliefs about healthy eating; body image satisfaction; and positive peer and parental influence were positively associated with daily breakfast consumption, while depression was negatively associated.
Daily breakfast consumption is associated with less overweight and obesity and with healthier dietary- and physical activity-related behaviors among urban Indian students. Although prospective studies should confirm the present results, intervention programs to prevent or treat childhood obesity in India should consider emphasizing regular breakfast consumption.
Breakfast; Obesity; Adolescent; Diet; Physical activity; Behavior
Sensation seeking tendencies tend to manifest during adolescence and are associated with both health-compromising behaviors and health-enhancing behaviors. The purpose of this study is to evaluate the relationship between sensation seeking and physical activity, a health-enhancing behavior, and between sensation seeking and experimenting with cigarettes, a health compromising-behavior, among a cohort of Mexican origin adolescents residing in the United States with different levels of acculturation.
In 2009, 1,154 Mexican origin youth (50.5% girls, mean age 14.3 years (SD = 1.04)) provided data on smoking behavior, physical activity, linguistic acculturation, and sensation seeking. We conducted Pearson’s χ2 tests to examine the associations between categorical demographic characteristics (i.e. gender, age, country of birth and parental educational attainment) and both cigarette experimentation and physical activity and Student’s t-tests to examine mean differences on the continuous variables (i.e. sensation seeking subscale) by the behaviors. We examined mean differences in the demographic characteristics, acculturation, and both behaviors for each of the sensation seeking subscales using analysis of variance (ANOVA). To examine relationships between the sensation seeking subscales, gender, and both behaviors, at different levels of acculturation we completed unconditional logistic regression analyses stratified by level of acculturation.
Overall, 23.3% had experimented with cigarettes and 29.0% reported being physically active for at least 60 minutes/day on at least 5 days/week. Experimenting with cigarettes and being physically active were more prevalent among boys than girls. Among girls, higher levels of sensation seeking tendencies were associated with higher levels of acculturation and experimentation with cigarettes, but not with physical activity. Among boys, higher levels of sensation seeking tendencies were associated with higher levels of acculturation, experimenting with cigarettes and being physically active.
Our results suggest that interventions designed to prevent smoking among Mexican origin youth may need to address social aspects associated with acculturation, paying close attention to gendered manifestations of sensation seeking.
Smoking behavior; Physical activity; Acculturation; Sensation seeking; Gender; Mexican origin youth
Obesity is emerging as a public health problem among adolescents in India. The aim of this study was to describe specific weight-related concerns among school-going youth in Delhi, India and to assess the prevalence of weight control behaviors, including healthy and unhealthy ones. Differences by weight status, gender, grade level, and school-type (a proxy for SES in this setting) are considered.
This study is cross-sectional by design. A sample of eighth and tenth graders (n = 1818) enrolled in Private (middle-high SES) and Government (low SES) schools (n = 8) in Delhi, India participated. All students' height and weight were measured. Students participated in a survey of weight-related concerns and weight-control behaviors, as well. Mixed-effects regression models were used to test for differences in weight-related concerns and weight-control behaviors across key factors of interest (i.e., weight status, gender, grade level, and SES).
The combined prevalence of obesity and overweight was 16.6%, overall. Controlling one's weight was important to overweight and non-overweight youth, alike (94.2% v. 84.8%, p < 0.001). Significantly more overweight or obese youth reported trying to control their weight last year, compared to those who were not overweight (68.1% v. 18.0%, p < 0.001). Healthy weight control behaviors were more common than unhealthy or extreme practices, although the latter were still prevalent. Half of the overweight or obese students misclassified their weight status, while about 1 in 10 non-overweight youth did the same. Body dissatisfaction was highest among overweight youth and girls.
Interventions to promote healthy weight control should be pertinent to and well-received by school-going youth in India. Healthy weight control practices need to be explicitly encouraged and unhealthy practices reduced. Future interventions should address issues specific to body image, too, as body dissatisfaction was not uncommon among youth.
Young adolescent alcohol users drink at higher rates than their peers throughout adolescence and appear to be less amenable to intervention. This study compares those who reported alcohol use in the past year to those who reported no use in a multiethnic, urban sample of sixth graders in 61 schools in Chicago in 2002 (N = 4,150). Demographic, behavioral, intrapersonal, and socioenvironmental factors were identified based on behavioral theories and potential mediators of the Project Northland Chicago intervention. Single and multiple regression models were created for users and nonusers to determine associations between these factors and alcohol use behavior and intentions. The multiple regression models explained 35% and 56% of the variance in alcohol use behavior and intentions between students for nonusers and users, respectively. Results suggest that primary prevention programs for alcohol use should occur prior to sixth grade, particularly for the substantial group at high risk for early use.
alcohol use; adolescents; nonusers
To study if receptivity and exposure to tobacco marketing are correlated with tobacco use and psychosocial risk factors for tobacco use among a sample of urban Indian youth.
Analysis of cross sectional survey data from Project MYTRI, a group randomized intervention trial, in Delhi and Chennai, India collected from 6th and 8th graders (n=11642), in 32 schools in 2004.
Exposure to tobacco advertisements and receptivity to tobacco marketing were significantly related to increased tobacco use among students.
This association suggests the need to strengthen policy and program-based interventions in India to reduce the influence of such exposures.
tobacco use; youth; schools; receptivity to tobacco marketing; exposure to tobacco advertising
To empirically determine the socioeconomic differences in risk profiles of susceptibility and ever use of tobacco among adolescents in India and to investigate the association between the risk profiles and the psychosocial factors for tobacco use.
Students in 16 private (higher socioeconomic status [SES]; n = 4,489) and 16 government (lower SES; n = 7,153) schools in two large cities in India were surveyed about their tobacco use and related psychosocial factors in 2004. Latent class analysis was used to identify homogenous, mutually exclusive typologies existing within the data.
Overall, 3 and 4 latent classes of susceptibility and ever use of tobacco best described students in higher- and lower- SES schools, respectively. Profiles with various combinations of susceptibility and ever use of tobacco were differentially related to psychosocial factors, with lower- SES students being more vulnerable to increased levels of tobacco use than higher- SES students.
Acknowledging the multiple dimensions of tobacco use behaviors and identifying constellations of risk behaviors will enable more accurate understanding of etiological processes and will provide information for refining and targeting preventive interventions. Additionally, identifying the socioeconomic differences in susceptibility and ever use risk profiles and their psychosocial correlates will enable policy makers to address these inequities through improved allocation of resources.
This study investigates socioeconomic differences in patterns and trends of tobacco consumption over time among youth in India. Additionally, the distribution of tobacco use risk factors across social class was examined. The data were derived from a longitudinal study of adolescents, Project MYTRI. Students in eight private [high socioeconomic status (SES)] (n=2881) and eight government (lower SES) (n=5476) schools in two large cities in India (Delhi and Chennai) were surveyed annually about their tobacco use and related psychosocial risk factors from 2004 to 2006. Results suggest the relationship between SES and tobacco use over time was not consistent. At baseline (in 2004), lower SES was associated with higher prevalence of tobacco use but the relation between SES and tobacco use reversed two years later (2006). These findings were mirrored in the distribution of related psychosocial risk factors by SES at baseline (in 2004), and thereafter in 2006. Implications for prevention scientists and future intervention programs are considered.
India; adolescence; socioeconomic status; tobacco control; longitudinal study; moderation
The goal of this group-randomized trial was to test the effectiveness of an adapted alcohol use preventive intervention for urban, low-income and multi-ethnic settings.
Design and Setting
Sixty-one public schools in Chicago were recruited to participate, were grouped into neighborhood study units, and randomly assigned to intervention or “delayed program” control condition.
The study sample (n=5812 students) was primarily African American, Hispanic and low-income.
Students, beginning in sixth grade (age 12), received three years of intervention strategies (curricula, family interventions, youth-led community service projects, community organizing).
Students participated in yearly classroom-based surveys to measure their alcohol use and related risk and protective factors. Additional evaluation components included a parent survey, a community leader survey, and alcohol purchase attempts.
Overall the intervention, compared with a control condition receiving “prevention as usual,” was not effective in reducing alcohol use, drug use or any hypothesized mediating variables (i.e., related risk and protective factors). There was a nonsignificant trend (p = .066) that suggested the ability to purchase alcohol by young appearing buyers was reduced in the intervention communities compared to the control communities, but this could be due to chance. Secondary outcome analyses to assess the effects of each intervention component indicated that the home-based programs were associated with reduced alcohol, marijuana, and tobacco use combined (p = .01), with alcohol use alone approaching statistical significance (p = .06).
Study results indicate the importance of conducting evaluations of previously validated programs in contexts that differ from the original study sample. Also, the findings highlight the need for further research with urban, low-income adolescents from different ethnic backgrounds to identify effective methods to prevent and reduce alcohol use.
alcohol prevention; urban youth; intervention adaptation
Project Advancing Cessation of Tobacco in Vulnerable Indian Tobacco Consuming Youth (ACTIVITY) is a community-based group randomized intervention trial focused on disadvantaged youth (aged 10–19 years) residing in 14 low-income communities (slums and resettlement colonies) in Delhi, India. This article discusses the findings of Focus Group Discussions (FGDs) conducted to inform the development and test the appropriateness of Project ACTIVITY’s intervention model. The findings of the FGDs facilitated the understanding of factors contributing to increased tobacco uptake and cessation (both smoking and smokeless tobacco) among youth in this setting. Twenty-two FGDs were conducted with youth (10–19 years) and adults in two urban slums in Delhi. Key findings revealed: (i) youth and adults had limited knowledge about long-term health consequences of tobacco use; (ii) socio-environmental determinants and peer pressure were important variables influencing initiation of tobacco use; (iii) lack of motivation, support and sufficient skills hinder tobacco cessation and (iv) active involvement of community, family, religious leaders, local policy makers and health professionals is important in creating and reinforcing tobacco-free norms. The results of these FGDs aided in finalizing the intervention model for Project ACTIVITY and guided its intervention development.
Self-reported tobacco use among young people can underestimate the actual prevalence of tobacco use. Biochemical validation of self-reports is particularly recommended for intervention studies where cessation outcomes are to be measured. Literature on biochemical validation of self-reports of multiple forms of tobacco use in India is sparse, particularly among young people.
The study was conducted during the baseline household survey of a community based tobacco prevention and cessation intervention trial for youth (10–19 years old) residing in slum communities in Delhi, India in 2009. Salivary cotinine measurement on 1224 samples showed that youth were under-reporting use of chewing and smoking tobacco.
Self-reports had a low sensitivity (36.3%) and a positive predictive value of 72.6%. No statistically significant difference in under-reporting was found between youth in the control and intervention conditions of the trial, which will be taken into consideration in assessing intervention outcomes at a later time point.
Biochemical validation of self-reported tobacco use should be considered during prevention and cessation studies among youth living in low-income settings in developing countries like India.
The future results of biochemical validation from Project ACTIVITY (Advancing Cessation of Tobacco in Vulnerable Indian Tobacco Consuming Youth) will be useful to design validation studies in resource-poor settings.
Tobacco; Youth; Saliva; Cotinine; India
In India, 57% of men between 15 and 54 years and 10.8% of women between 15 and 49 years use tobacco. A wide variety of tobacco gets used and the poor and the underprivileged are the dominant victims of tobacco and its adverse consequences. Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) was a tobacco prevention intervention program, a cluster-randomized trial in 32 Indian schools which aimed to decrease susceptibility to tobacco use among sixth- to ninth-grade students in urban settings in India. This culture-specific intervention, which addressed both smokeless and smoked forms of tobacco, was Indian in content and communication. We qualitatively developed indicators which would help accurately measure the dose of the intervention given, received and reached. A multi-staged process evaluation was done through both subjective and objective measures. Training the teachers critically contributed toward a rigorous implementation and also correlated with the outcomes, as did a higher proportion of students participating in the classroom discussions and better peer–leader–student communication. A sizeable proportion of subjective responses were ‘socially desirable’, making objective assessment a preferred methodology even for ‘dose received’. The peer-led health activism was successful. Teachers' manuals need to be concise.
This case study has two aims. First, it describes intervention strategies from two school-based programs (HRIDAY-CATCH and Project MYTRI) designed to prevent tobacco use among adolescents in India. Second, it explains how evidence from randomized controlled trials of these intervention programs was used by HRIDAY(Health Related Information Dissemination Amongst Youth), a local non-governmental organization in Delhi, to advocate for scaling up the Government of India’s(GOI) tobacco control efforts to include school health interventions as one component of India’s National Tobacco Control Program (NTCP).
Growth curve models examined changes in adolescent self-reported parent-child communication conditional on family meal frequency over a 3.5 year period among a population of racially-diverse, low-income adolescents from an urban environment (n = 4750). Results indicated that although both family dinner frequency and adolescent perceptions of parent-child communication scores were characterized by negative linear growth over time (both p < .0001), family dinner frequency was positively associated with adolescent perceptions of parent-child communication scores over time (p < .0001). Study findings suggest that families with teenagers may enhance parent-child communication and ultimately promote healthy adolescent development by making family dinner a priority. Additionally, the communication benefits of family dinner at the beginning of 6th grade may be protective through 8th grade.
adolescents; family dinner; family meals; parent-child communication; race/ethnicity; urban
This paper presents the results of a mediation analysis of Project MYTRI (Mobilizing Youth for Tobacco Related Initiatives in India), a randomized, controlled trial of a multiple component, school-based tobacco prevention program for 6th–9th graders (n=14085) in Delhi and Chennai, India. A mediation analysis identifies how an intervention achieves its effects. In MYTRI, changes in students’ (a) knowledge about the negative health effects of tobacco; (b) beliefs about its social consequences; (c) reasons to use tobacco; (d) reasons not to use tobacco; (e) advocacy skills self-efficacy; and (f) normative beliefs about tobacco use were significantly associated with reductions in students’ intentions to use tobacco and tobacco use behaviors. Changes in students’ perceptions of the prevalence of (a) smoking and (b) chewing tobacco were significantly related to increases, in contrast, in students’ intentions to use and use of tobacco. Implications for intervention design are considered.
The purpose of this study was to determine if parents’ and children’s reports of parenting practices were correlated, if the reports were differentially associated with alcohol use, and which report had the strongest association with alcohol use.
Cross-sectional and longitudinal.
Public schools, Chicago, Illinois.
Participants included 1373 ethnically-diverse students and parents involved in an alcohol use prevention intervention. Surveys were conducted in sixth grade and eighth grade. Mixed-effects regression analyses were used to model relationships cross-sectionally and longitudinally.
Parents’ and children’s perceptions of parenting practices, while significantly correlated, were not strongly associated. Analyses within each parenting domain found parents’ report of parental monitoring and children’s reports of alcohol-specific communication, general communication, and relationship satisfaction were associated with alcohol use behaviors and intentions. After adjusting for all other parenting practices, parents’ report of parental monitoring and children’s report of alcohol-specific communication were most strongly related to alcohol use behaviors and intentions both cross-sectionally and longitudinally.
When comparing results across studies, it is important to identify whose report was used, parent or child, as the results may differ based on reporter. Studies with limited resources may consider using parents’ reports about parental monitoring and using children’s reports for alcohol-specific communication, general communication, and relationship satisfaction.
Parenting; parent-child relationships; alcohol use; early adolescence
Schools are an important setting for interventions aimed at preventing alcohol use and abuse among adolescents. A range of school-based interventions have been developed to prevent or delay the onset of alcohol use, most of which are targeted to middle-school students. Most of these interventions seek to reduce risk factors for alcohol use at the individual level, whereas other interventions also address social and/or environmental risk factors. Not all interventions that have been developed and implemented have been found to be effective. In-depth analyses have indicated that to be most effective, interventions should be theory driven, address social norms around alcohol use, build personal and social skills helping students resist pressure to use alcohol, involve interactive teaching approaches, use peer leaders, integrate other segments of the population into the program, be delivered over several sessions and years, provide training and support to facilitators, and be culturally and developmentally appropriate. Additional research is needed to develop interventions for elementary-school and high-school students and for special populations.
Alcohol and other drug use (AODU); alcohol consumption; alcohol abuse; age of AODU onset; underage drinking; adolescent; risk factors; individual risk factors; social environmental risk factors; elementary school; middle school; high school; school-based prevention; school-based intervention
Few studies have explored the relationship between acculturation and health in non-immigrant populations. The purpose of this study was to investigate the relationship between “westernization” and tobacco use among adolescents living in Delhi, India. A bi-dimensional model of acculturation was adapted for use in this study to examine (a) whether young people's identification with Western culture in this setting is related to tobacco use and (b) whether their maintenance of more traditional Indian ways of living is related to tobacco use, also. Multiple types of tobacco use common in India (e.g., cigarettes, bidis, chewing tobacco) were considered. Socioeconomic status (SES), gender, and grade level were examined as potential effect modifiers of the relationship between “westernization” and tobacco use. The study was cross-sectional by design and included 3,512 students in eighth and tenth grades who were enrolled in 14 Private (higher SES) and Government (lower SES) schools in Delhi, India. A self-report survey was used to collect information on tobacco use and “westernization.” The results suggest that young people's identification with Western influences may increase their risk for tobacco use (p<0.001), while their maintenance of traditional Indian ways of living confers some protection (p<0.001). Importantly, these effects were independent of one another. Boys benefitted more from protective effects than girls, and tenth graders gained more consistent benefits than eighth graders in this regard, too. Negative effects associated with identification with Western ways of living were, in contrast, consistent across gender and grade level. The positive and negative effects of acculturation on adolescent tobacco use generalized across all tobacco products considered here. Future interventions designed to curb youth tobacco use in India may benefit by paying closer attention to cultural preferences of these young consumers.
We assessed the effectiveness of a 2-year multicomponent, school-based intervention designed to reduce tobacco use rates among adolescents in an urban area of India.
Students from 32 schools in Delhi and Chennai, India, were recruited and randomly assigned to an intervention or control group. Baseline, intermediate, and outcome data were collected from 2 cohorts of 6th- and 8th-grade students in 2004; 14|063 students took part in the study and completed a survey in 2004, 2005, or 2006. The intervention consisted of behavioral classroom curricula, school posters, a parental involvement component, and peer-led activism. The main outcome measures were self-reported use of cigarettes, bidis (hand-rolled cigarettes), and chewing tobacco and future intentions to smoke or use chewing tobacco.
Findings showed that students in the intervention group were significantly less likely than students in the control group to exhibit increases in cigarette smoking or bidi smoking over the 2-year study period. They were also less likely to intend to smoke or chew tobacco in the future.
School-based programs similar to the intervention examined here should be considered as part of a multistrategy approach to reducing tobacco use among young people in India.
Each day in India, an estimated 5,500 youth initiate tobacco use, contributing to predictions that by 2020, tobacco will account for 13% of all deaths in India. Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) is a multi-component school-based intervention designed to prevent and reduce tobacco use among adolescents in Delhi and Chennai, India. The intervention was implemented over the 2004-2006 school years and involved 6th and 8th grade students in 32 classrooms. Students participated in peer-led classroom activities involving games, competitions, and other activities intended to target a number of psychosocial risk factors believed to prevent tobacco use among urban Indian youth. To more fully understand how Project MYTRI influenced students' intentions to smoke or chew tobacco, the current study used mediation analysis to investigate whether Project MYTRI altered the psychosocial risk factors as intended, and whether the changes in psychosocial risk factors were, in turn, responsible for altering students' tobacco-use intentions. Multi-level mediation models were estimated using student data from baseline and one-year follow-up surveys. Results indicated that the psychosocial risk factors Knowledge of Health Effects, Normative Beliefs, Reasons to Use Tobacco, and Perceived Prevalence were significant mediators between the intervention activities and students' tobacco use intentions. Evidence of inconsistent mediation was observed for the Perceived Prevalence factor. These findings, combined with those from qualitative research and the second-year student data, will help to illuminate the impact of Project MYTRI on participating youth.
mediation analysis; tobacco prevention; adolescents; India; psychosocial risk factors