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1.  Long-Term Efficacy of Click City ® : Tobacco: A School-Based Tobacco Prevention Program 
Nicotine & Tobacco Research  2013;16(1):33-41.
Introduction:
Click City ® : Tobacco is an innovative, computer-based tobacco prevention program designed to be implemented in 5th-grade classrooms with a booster in 6th grade. The program targets etiological mechanisms predictive of future willingness and intentions to use tobacco and initiation of tobacco use. Each component was empirically evaluated to assure that it changed its targeted mechanism. This paper describes long-term outcomes for students who participated in a randomized controlled efficacy trial of the program.
Methods:
A total of 26 middle schools were stratified and randomly assigned to the Click City ® : Tobacco program or Usual Curriculum. The 47 elementary schools that fed into each middle school were assigned to the same condition as their respective middle school. In Click City ® : Tobacco schools, 1,168 students from 24 elementary schools and 13 middle schools participated. In Usual Curriculum schools, 1,154 students from 23 elementary schools and 13 middle schools participated. All participating students completed baseline, post-6th grade program, and 7th grade assessments.
Results:
As compared to students in schools that continued with their usual curriculum, intentions and willingness to smoke increased less from baseline to 6th grade and from baseline to 7th grade, among students in schools that used the Click City ® : Tobacco curriculum. Changes in mechanisms were also in the expected direction. The program was particularly efficacious for at-risk students.
Conclusions:
Results provide evidence to support the long-term efficacy of Click City ® : Tobacco. Program development, based on an empirical evaluation of each component, most likely played a role in the success of the program.
doi:10.1093/ntr/ntt106
PMCID: PMC3864488  PMID: 23884322
2.  Randomized Controlled Trial of MyLastDip: A Web-Based Smokeless Tobacco Cessation Program for Chewers Ages 14–25 
Nicotine & Tobacco Research  2013;15(9):1502-1510.
Introduction:
Use of smokeless tobacco (ST) is a significant public health problem for young adults, many of whom want to quit. We describe the outcome of a Randomized Controlled Trial (RCT) examining the efficacy of two web-based ST cessation interventions targeting young chewers.
Methods:
One thousand seven hundred and sixteen ST users wanting to quit were recruited online to the MyLastDip program and randomly assigned to one of two fully automated web-based ST cessation interventions: (a) an Enhanced Condition (N = 857) with tailored treatment recommendations and interactive features, or (b) a Basic Condition (N = 859) that provided an online ST cessation guide in static text.
Results:
Assessment completion rates at 3 months, 6 months, and for both 3 and 6 months were 73%, 71%, and 65%, respectively. No significant differences were found between conditions. Using complete case analysis for repeated point prevalence (3- and 6-month assessments), all tobacco abstinence was 28.9% for participants in the Enhanced Condition and 25.6% in the Basic Condition. Using intent-to-treat analysis, abstinence rates were 35.2% versus 32.3%. Similar results were obtained for ST abstinence. Participants reported being satisfied with their programs and the Enhanced Condition participants were relatively more engaged. Differences in program engagement were not related to tobacco abstinence at 6 months.
Conclusions:
Both web-based ST cessation programs encouraged robust levels of absolute tobacco and ST abstinence at follow-up. The absence of between-group differences was discussed in terms of composition of the control condition and implications for next steps in treatment development and testing.
doi:10.1093/ntr/ntt006
PMCID: PMC3741058  PMID: 23410803
3.  Smoking Trajectories Across High School: Sensation Seeking and Hookah Use 
Nicotine & Tobacco Research  2013;15(8):1400-1408.
Introduction:
This study investigated the associations of trajectories of cigarette smoking over the high school years with the prior development of childhood sensation seeking and the subsequent use of cigarettes and hookah at age 20/21.
Methods:
Participants (N = 963) were members of a cohort-sequential longitudinal study, the Oregon Youth Substance Use Project. Sensation seeking was assessed across 4th–8th grades and cigarette smoking was assessed across 9th–12th grades. Cigarette and hookah use was assessed at age 20/21 for 684 of the 963 participants.
Results:
Four trajectory classes were identified: Stable High Smokers (6%), Rapid Escalators (8%), Experimenters (15%), and Stable Nonsmokers or very occasional smokers (71%). Membership in any smoker class versus nonsmokers was predicted by initial level and growth of sensation seeking. At age 20/21, there was a positive association between smoking and hookah use for Nonsmokers and Experimenters in high school, whereas this association was not significant for Stable High Smokers or Rapid Escalators.
Conclusions:
Level and rate of growth of sensation seeking are risk factors for adolescent smoking during high school (Stable High Smokers, Rapid Escalators, and Experimenters), suggesting the need for interventions to reduce the rate of increase in childhood sensation seeking. For those who were not already established smokers by the end of high school, hookah use may have served as a gateway to smoking.
doi:10.1093/ntr/nts338
PMCID: PMC3715388  PMID: 23322766
4.  A Randomized Clinical Trial of a Web-Based Tobacco Cessation Education Program 
Pediatrics  2013;131(2):e455-e462.
OBJECTIVES:
We report the results of a randomized clinical trial of a 3-hour, web-based, tobacco cessation education program, the Web-Based Respiratory Education About Tobacco and Health (WeBREATHe) program, for practicing pediatric respiratory therapists (RTs), registered nurses (RNs), and nurse practitioners (NPs).
METHODS:
Two hundred fifteen RTs (n = 40), RNs (n = 163), and NPs (n = 12) employed at the Children’s Hospital of Philadelphia and the Children’s Hospital, University of Colorado at Denver, participated in this study. All study activities were completed online. After consenting, participants were randomly assigned to either the training (intervention) or delayed training (control) condition. The training condition consisted of a 3-hour continuing education unit course plus ongoing online resources. Participants were assessed at baseline, 1 week, and 3 months after enrollment.
RESULTS:
Participants in the training condition were more likely to increase their tobacco cessation intervention behaviors than their delayed training counterparts (F[1, 213] = 32.03, P < .001). Training participants showed significantly greater levels of advise (F[1, 213] = 7.22, P < .001); assess (F[1, 213] = 19.56, P < .001); and particularly assist/arrange (F[1213] = 35.52, P < .001). In addition, training condition participants rated the program highly on measures of consumer satisfaction.
CONCLUSIONS:
The WeBREATHe program is the first evidence-based education program in tobacco cessation designed specifically for pediatric RTs, RNs, and NPs. Engagement in WeBREATHe increased participants’ tobacco cessation-related behaviors.
doi:10.1542/peds.2012-0611
PMCID: PMC3557402  PMID: 23319529
tobacco; smoking; cessation; continuing education; respiratory therapy; nursing
5.  Do faxed quitline referrals add value to dental office-based tobacco-use cessation interventions? 
Background
The Ask, Advise, Refer (AAR) model of intervening with patients who use tobacco promotes a brief office-based intervention plus referral to a tobacco quitline. However, there is little evidence that this model is effective. The primary aim of this study was to evaluate the effects on patients’ tobacco us of two levels of a dental office-based intervention compared with usual care.
Methods
The authors randomly assigned 68 private dental clinics to one of three conditions: 5 A’s (Ask, Advise, Assess, Assist, Arrange); 3 A’s (AAR model); or Usual Care, and they enrolled 2,160 participants.
Results
At the 12-month assessment, compared with those in usual care, participants in the two intervention conditions combined were more likely to report cessation of tobacco use, as measured by 9-month prolonged abstinence (3% vs. 2%; F (1,66) = 3.97, P<.10) and 12-month point prevalence (12% vs. 8%; F (1,66) = 7.32, P<.01). There were no significant differences between participants in the clinics using the 5 A’s and 3 A’s strategies.
Conclusions
The results of this study are inconclusive as to whether referrals to a quitline add value to brief dental office-based interventions. Patients receiving telephone counseling quit tobacco use at higher rates, but only a small percentage of those proactively referred actually received counseling.
Clinical Implications
The results confirm previous research that training dental practitioners to provide brief tobacco-use cessation advice and assistance results in a change in their behavior, and that these practitioners are effective in helping their patients to quit using tobacco.
PMCID: PMC3780769  PMID: 20675426
Tobacco smoking; tobacco; chewing; tobacco-use cessation; smoking cessation; education; dentistry; dental hygienists
6.  Chronic psychosocial stressors and salivary biomarkers in emerging adults 
Psychoneuroendocrinology  2011;37(8):1158-1170.
Summary
We investigated whole saliva as a source of biomarkers to distinguish individuals who have, and who have not, been chronically exposed to severe and threatening life difficulties. We evaluated RNA and DNA metrics, expression of 37 candidate genes, and cortisol release in response to the Trier Social Stress Test, as well as clinical characteristics, from 48 individuals stratified on chronic exposure to psychosocial stressors within the last year as measured by the Life Events and Difficulties Schedule. Candidate genes were selected based on their differential gene expression ratio in circulating monocytes from a published genome-wide analysis of adults experiencing different levels of exposure to a chronic stressor.
In univariate analyses, we observed significantly decreased RNA integrity (RIN) score (P = 0.04), and reduced expression of glucocorticoid receptor-regulated genes (Ps < 0.05) in whole saliva RNA from individuals exposed to chronic stressors, as compared to those with no exposure. In those exposed, we observed significantly decreased BMI (P < 0.001), increased ever-smoking and increased lifetime alcohol abuse or dependence (P ≤ 0.03), and a reduction of cortisol release. In post hoc multivariate analyses including clinical and biospecimen-derived variables, we consistently observed significantly decreased expression of IL8 (Ps < 0.05) in individuals exposed, with no significant association to RIN score. Alcohol use disorders, tobacco use, a reduced acute stress response and decreased salivary IL8 gene expression characterize emerging adults chronically exposed to severe and threatening psychosocial stressors.
doi:10.1016/j.psyneuen.2011.11.010
PMCID: PMC3774595  PMID: 22172638
Human; Saliva; Gene expression; IL8; qPCR
7.  Pubertal Timing, Social Competence, and Cigarette Use: A Test of the Early Maturation Hypothesis 
The Journal of Adolescent Health  2012;51(2):150-155.
Purpose
The timing of pubertal maturation has been associated with cigarette use, but the exact mechanisms by which maturation influences cigarette use are unclear. One hypothesis posited to explain this association is the early maturation hypothesis, that boys and girls who mature earlier than their peers have developed physically before their social resources have fully developed, leaving them ill-equipped to deal with challenges that may arise when entering physical maturity. This prospective study examines the relations between pubertal timing, social competence, and cigarette use in a sample of 1013 boys and girls, followed from 5th through 12th grade.
Methods
Latent growth modeling (LGM) was utilized to predict cigarette use across high school years (grades 9–12) from pubertal timing assessed in 5th grade (for girls) and 6th grade (for boys) as mediated by social competence across grades 6 to 8.
Results
Earlier pubertal maturation predicted cigarette use in 9th grade and increased cigarette use across high school. Earlier maturation also predicted lower social competence in 6th grade. For girls, social competence partially mediated the relation between pubertal timing and cigarette use.
Conclusions
The data supported the early maturation hypothesis for both boys and girls, as earlier maturers were more likely to smoke in 9th grade and had lower social competence in 6th grade. However, social competence partially mediated cigarette use for girls only. The mechanisms by which negative outcomes are associated with pubertal maturation appear to differ by gender.
doi:10.1016/j.jadohealth.2011.11.021
PMCID: PMC3405903  PMID: 22824445
gender differences; pubertal timing; substance use; adolescence; social competence
8.  Feasibility of ecological momentary assessment of hearing difficulties encountered by hearing aid users 
Ear and Hearing  2012;33(4):497-507.
Objectives
Measurement of outcomes has become increasingly important to assess the benefit of audiologic rehabilitation, including hearing aids, in adults. Data from questionnaires, however, are based on retrospective recall of events and experiences, and often can be inaccurate. Questionnaires also do not capture the daily variation that typically occurs in relevant events and experiences. Clinical researchers in a variety of fields have turned to a methodology known as ecological momentary assessment (EMA) to assess quotidian experiences associated with health problems. The objective of this study was to determine the feasibility of using EMA to obtain real-time responses from hearing aid users describing their experiences with challenging hearing situations.
Design
This study required three phases: (1) develop EMA methodology to assess hearing difficulties experienced by hearing aid users; (2) utilize focus groups to refine the methodology; and (3) test the methodology with 24 hearing aid users. Phase 3 participants carried a personal digital assistant (PDA) 12 hr per day for 2 wk. The PDA alerted participants to respond to questions four times a day. Each assessment started with a question to determine if a hearing problem was experienced since the last alert. If “yes,” then up to 23 questions (depending on contingent response branching) obtained details about the situation. If “no,” then up to 11 questions obtained information that would help to explain why hearing was not a problem. Each participant completed the Hearing Handicap Inventory for the Elderly (HHIE) both before and after the 2-wk EMA testing period to evaluate for “reactivity” (exacerbation of self-perceived hearing problems that could result from the repeated assessments).
Results
Participants responded to the alerts with a 77% compliance rate, providing a total of 991 completed momentary assessments (mean = 43.1 per participant). A substantial amount of data was obtained with the methodology. Notably, participants reported a “hearing problem situation since the last alert” 37.6% of the time (372 responses). The most common problem situation involved “face-to-face conversation” (53.8% of the time). The next most common problem situation was “telephone conversation” (17.2%) followed by “TV, radio, iPod, etc.” (15.3%), “environmental sounds” (9.7%), and “movies, lecture, etc.” (4.0%). Comparison of pre- and post-EMA mean HHIE scores revealed no significant difference (p>.05), indicating that reactivity did not occur for this group. It should be noted, however, that 37.5% of participants reported a greater sense of awareness regarding their hearing loss and use of hearing aids.
Conclusions
Results showed participants were compliant, gave positive feedback, and did not demonstrate reactivity based on pre- and post-HHIE scores. We conclude that EMA methodology is feasible with patients who use hearing aids and could potentially inform hearing healthcare (HHC) services. The next step is to develop and evaluate EMA protocols that provide detailed daily patient information to audiologists at each stage of HHC. The advantages of such an approach would be to obtain real-life outcome measures, and to determine within- and between-day variability in outcomes and associated factors. Such information currently is not available from patients who seek and use HHC services.
doi:10.1097/AUD.0b013e3182498c41
PMCID: PMC3383355  PMID: 22531573
hearing disorders; hearing aids; rehabilitation; experience sampling
9.  Early Adolescent Cognitions as Predictors of Heavy Alcohol Use in High School 
Addictive behaviors  2010;36(5):448-455.
The present study predicts heavy alcohol use across the high school years (age 14 through 18) from cognitions regarding the use of alcohol assessed in middle school. Using Latent Growth Modeling, we examined a structural model using data from 1011 participants in the Oregon Youth Substance Use Project. In this model, social images and descriptive norms regarding alcohol use in grade 7 were related to willingness and intention to drink alcohol in grade 8 and these variables were subsequently related to the intercept and slope of extent of heavy drinking across the high school years (grades 9 through 12). Across the sample, both descriptive norms and social images influenced the intercept of heavy drinking (in the 9th grade) through willingness to drink alcohol. Multiple sample analyses showed that social images also were directly related to the intercept of heavy drinking, for girls only. Results suggest that cognitions regarding alcohol use in middle school predict subsequent heavy drinking in high school. These findings emphasize the need for prevention programs targeting changing students’ social images and encouraging a more accurate perception of peers’ use when students are in middle school.
doi:10.1016/j.addbeh.2010.12.011
PMCID: PMC3102557  PMID: 21195554
cognitions; heavy alcohol use; adolescence; predictors
10.  Using the Implicit Association Test to Assess Children's Implicit Attitudes toward Smoking 
Journal of applied social psychology  2010;40(9):2387-2406.
The development and psychometric properties of an Implicit Association Test (IAT) measuring implicit attitude toward smoking among fifth grade children were described. The IAT with “sweets” as the contrast category resulted in higher correlations with explicit attitudes than did the IAT with “healthy foods” as the contrast category. Children with family members who smoked (versus non-smoking) and children who were high in sensation seeking (versus low) had a significantly more favorable implicit attitude toward smoking. Further, implicit attitudes became less favorable after engaging in tobacco prevention activities targeting risk perceptions of addiction. Results support the reliability and validity of this version of the IAT and illustrate its usefulness in assessing young children's implicit attitude toward smoking.
doi:10.1111/j.1559-1816.2010.00663.x
PMCID: PMC3090631  PMID: 21566676
11.  Parenting and Trajectories of Children’s Maladaptive Behaviors: A 12-year Prospective Community Study 
This study investigated how parenting accounted for inter-individual differences in developmental trajectories of different child behaviors across childhood and adolescence. In a cohort sequential community sample of 1,049 children, latent class growth analysis was applied to three parent-reported dimensions (monitoring, positive parenting, inconsistent discipline) across 12 annual assessments (ages 6–18). Four longitudinal parenting styles (authoritative, authoritarian, indulgent, uninvolved) were differentiated on the basis of levels and rates of change in the constituent parenting dimensions. Multi-group analyses demonstrated that these parenting styles were differentially related to changes in parent- and child-reported measures of children’s alcohol and cigarette use, antisocial behavior, and internalizing symptoms, with the authoritative parenting class being related to the most optimal long-term development. Practical implications and future research suggestions are discussed.
doi:10.1080/15374416.2011.563470
PMCID: PMC3086657  PMID: 21534057
adolescence; parenting; community sample; internalizing; externalizing; latent class growth analysis; developmental trajectories
12.  Short-term Efficacy of Click City®: Tobacco: Changing Etiological Mechanisms Related to the Onset of Tobacco Use 
This paper described the short-term results from an ongoing randomized controlled efficacy study of Click City®: Tobacco, a tobacco prevention program designed for 5th graders, with a booster in sixth grade. Click City®: Tobacco is an innovative school-based prevention program delivered via an intranet, a series of linked computers with a single server. The components of the program target theoretically based and empirically supported etiological mechanisms predictive of future willingness and intentions to use tobacco and initiation of tobacco use. Each component was designed to change one or more etiological mechanisms and was empirically evaluated in the laboratory prior to inclusion in the program. Short-term results from 47 elementary schools (24 schools who used Click City®: Tobacco, and 23 who continued with their usual curriculum) showed change in intentions and willingness to use tobacco from baseline to one-week following the completion of the 5th grade sessions. The results demonstrate the short-term efficacy of this program and suggest that experimentally evaluating components prior to including them in the program contributed to the efficacy of the program. The program was most efficacious for students who were most at risk.
doi:10.1007/s11121-010-0192-3
PMCID: PMC3042027  PMID: 21286810
school-based prevention; tobacco prevention; component evaluation
13.  The Relation of Change in Hostility and Sociability During Childhood to Substance Use in Mid Adolescence 
In a cohort-sequential longitudinal study (N = 1,075), we related change in children's hostility and sociability assessed from 1st-8th grade to their use of cigarettes, alcohol, and marijuana assessed from 9th-12th grade. Children who were more hostile at 1st grade, and had higher rates of growth of hostility, used more of all three substances at 9th grade, and those with higher initial levels of hostility increased their use of cigarettes and marijuana from 9th to 12th grade. Children who were more sociable at 1st grade used more alcohol at 9th grade. These findings demonstrate the significance of individual differences in the development of personality traits for the prediction of later substance use and have implications for prevention.
doi:10.1016/j.jrp.2009.12.006
PMCID: PMC2854561  PMID: 20401178
trait change; adolescent substance use; hostility; sociability
14.  Do Trajectories of Household Risk in Childhood Moderate Pubertal Timing Effects on Substance Initiation in Middle School? 
Developmental psychology  2010;46(4):853-868.
Previous research on pubertal timing has either evaluated contextual predictors of early puberty or negative adjustment outcomes associated with off-time development, especially early maturation. In this study, we integrated these 2 lines of research by evaluating the moderating influence of early childhood household risk on associations between early puberty and 8th-grade substance use in a longitudinal sample of 1,070 participants. We determined trajectories of early childhood household risk using group-based trajectory analysis. Rates of early maturation were higher but not significantly so in groups with high household risk. Early timing was associated with higher rates of substance initiation only among individuals with a history of high household risk.
doi:10.1037/a0019667
PMCID: PMC2956585  PMID: 20604607
substance use; pubertal timing; family conflict; relationship quality; trajectory analysis
15.  Validity of Recall of Tobacco Use in Two Prospective Cohorts 
American Journal of Epidemiology  2010;172(7):828-835.
This project studied the convergent validity of current recall of tobacco-related health behaviors, compared with prospective self-report collected earlier at two sites. Cohorts were from the Oregon Research Institute at Eugene (N = 346, collected 19.5 years earlier) and the University of Pittsburgh, Pennsylvania (N = 294, collected 3.9 years earlier). Current recall was examined through computer-assisted interviews with the Lifetime Tobacco Use Questionnaire from 2005 through 2008. Convergent validity estimates demonstrated variability. Validity estimates of some tobacco use measures were significant for Oregon subjects (age at first cigarette, number of cigarettes/day, quit attempts yes/no and number of attempts, and abstinence symptoms at quitting; all P < 0.03). Validity estimates of Pittsburgh subjects’ self-reports of tobacco use and abstinence symptoms were significant (P < 0.001) for all tobacco use and abstinence symptoms and for responses to initial use of tobacco. These findings support the utility of collecting recalled self-report information for reconstructing salient lifetime health behaviors and underscore the need for careful interpretation.
doi:10.1093/aje/kwq179
PMCID: PMC2945825  PMID: 20720099
data collection; mental recall; prospective studies; reproducibility of results; retrospective studies; tobacco use disorder
16.  Genome-wide Linkage of Cotinine Pharmacokinetics Suggests Candidate Regions on Chromosomes 9 and 11 
Characterizing cotinine pharmacokinetics is a useful way to study nicotine metabolism because the same liver enzyme is primarily responsible for the metabolism of both, and the clearances of nicotine and cotinine are highly correlated. We conducted a whole-genome linkage analysis to search for candidate regions influencing quantitative variation in cotinine pharmacokinetics in a large-scale pharmacokinetic study with 61 families containing 224 healthy adult participants. The strongest linkage signal was identified at 135 cM of chromosome 9 with LOD=2.81 and P=0.0002; two other suggestive linkage peaks appear at 31.4 and 73.5 cM of chromosome 11 with LOD=1.96 (P=0.0013) and 1.94 (P=0.0014). The confidence level of the linkage between the three genome regions and cotinine pharmacokinetics is statistically significant with a genome-wide empirical probability of P=0.029.
doi:10.1002/ajmg.b.30859
PMCID: PMC2693302  PMID: 18785207
pharmacokinetics; nicotine; dependence; linkage analysis
17.  Women helping chewers: Effects of partner support on 12-month tobacco abstinence in a smokeless tobacco cessation trial 
Nicotine & Tobacco Research  2009;11(3):332-335.
Introduction:
Social support has been relatively unstudied in smokeless tobacco cessation research; partner support could encourage quitting, buffer the stress of quitting and withdrawal, and counteract tobacco cues.
Methods:
Using 12-month follow-up data, we examined the impact of social support provided by female partners (n = 328) of male participants in a smokeless tobacco cessation program.
Results:
The ratio of positive support to negative support that participants reported receiving from their partners was significantly related to point prevalence 12-month tobacco abstinence (odds ratio [OR] = 1.43, 95% CI = 1.11–1.84, p < .01)—a finding consistent with the 6-month follow-up—and it was related to repeated point prevalence tobacco abstinence at both 6 and 12 months (OR = 1.43, 95% CI = 1.09–1.88, p < .05).
Discussion:
These 12-month follow-up results provide additional evidence that partner support can help encourage long-term tobacco abstinence among participants in smokeless tobacco cessation programs.
doi:10.1093/ntr/ntn022
PMCID: PMC2666371  PMID: 19264861
18.  The 5A's vs 3A's plus proactive quitline referral in private practice dental offices: preliminary results 
Tobacco Control  2007;16(4):285-288.
Aims
The primary aim of our randomised control trial (RCT) was to evaluate the relative efficacy of two dental office based interventions compared to usual care. One intervention consisted of a combination of dental practitioner advice to quit and proactive telephone counselling (3A's), and the other arm consisted of a dental practitioner delivered intervention based on the 5A's of the Clinical Practice Guideline (5A's).
Method
2177 tobacco using patients were enrolled from 68 dental practices in Mississippi. We collected 3‐month outcome data from 76% (n = 1652) of participants.
Results
Smokers in the two intervention conditions quit at a higher rate than those in usual care; χ2 (1, n = 1381)  = 3.10, p<0.05. Although not significant, more patients in the 5A's condition quit than those in the 3A's. Of patients in the 3A's Condition, 50% reported being asked by their dentist or hygienists about fax referral to the quitline, and 35% were referred. Quitline counsellors contacted 143 (70%) referred participants.
Conclusion
These results suggest that there are both advantages and disadvantages to the use of quitlines as an adjunct to brief counselling provided by dental practitioners. Patients receiving quitline counselling quit at higher rates than those who did not; however, only a small percentage of patients received counselling from the quitline. Therefore, it appears that dental professionals may be most effective in helping their patients to quit by regularly providing the 5A's plus proactively referring only those patients who are highly motivated to a quitline for more intensive counselling.
doi:10.1136/tc.2007.020271
PMCID: PMC2598528  PMID: 17652247
smoking cessation; quitlines; dental; randomised control trial
19.  The Development of Children’s Intentions to Use Alcohol: Direct and Indirect Effects of Parent Alcohol Use and Parenting Behaviors 
The purpose of this study was to explore the effect of parent alcohol use and parenting behavior on the development of children’s intentions to use alcohol in grades 1 through 8. We hypothesized that the effect of parent alcohol use on children’s intention to use alcohol would be mediated through parenting behavior, specifically monitoring /supervision, positive parenting, and inconsistent discipline. Using cohort-sequential latent growth modeling (LGM), we tested three models examining the effect of the development of parent alcohol use on the development of children’s intentions to use alcohol as mediated by the development of each of the three parenting behaviors. We used multiple group analyses to explore gender differences. The effect of growth in parent alcohol use on the growth in children’s intentions was mediated only by parent monitoring/supervision and was significant only for girls. The effect of inconsistent discipline was directly related to growth in intentions for both boys and girls. Although parent alcohol use was related to less positive parenting, positive parenting was unrelated to children’s intentions to use alcohol.
doi:10.1037/0893-164X.22.3.326
PMCID: PMC2596584  PMID: 18778126
Alcohol intentions; children; parent alcohol use; parenting behavior; LGM cohort-sequential modeling
20.  Childhood Predictors of Adolescent Marijuana Use: Early Sensation Seeking, Deviant Peer Affiliation, and Social Images 
Addictive behaviors  2008;33(9):1140-1147.
This study examined psychosocial mechanisms by which children’s early sensation seeking may influence their later marijuana use. In a longitudinal study, 4th and 5th grade elementary school children (N = 420) were followed until they were in 11th and 12th grades in high school with annual or biennial assessments. Sensation seeking (assessed over the first 4 assessments) predicted affiliating with deviant peers and level of favorable social images of kids who use marijuana (both assessed over the subsequent 3 assessments). Affiliation with deviant peers and the growth in social images predicted marijuana use in 11th and 12th grades. Affiliation with deviant peers mediated the effect of early sensation seeking on subsequent marijuana use. The theoretical and applied significance of this influence of early sensation seeking is discussed.
doi:10.1016/j.addbeh.2008.04.010
PMCID: PMC2562768  PMID: 18547739
marijuana; sensation seeking; adolescence; childhood; social images; deviant peer affiliation
21.  Pubertal Timing and Substance Use: The Effects of Gender, Parental Monitoring and Deviant Peers 
Purpose
Early pubertal timing is associated with early initiation of cigarettes and alcohol; we evaluated parental monitoring and affiliation with deviant peers in a moderated, mediational model of this relationship for both genders.
Methods
We tested a prospective model explaining the process through which pubertal timing is related to early use of cigarettes and alcohol for 360 fourth and fifth graders, following them for four years.
Results
We found a relation between early pubertal maturation and trying cigarettes and alcohol without parents’ knowledge for both boys and girls. In addition, for both genders, parental monitoring moderated the association between pubertal timing and trying alcohol, but not trying cigarettes. Affiliation with deviant peers mediated the effect of pubertal timing on both alcohol and cigarette initiation for girls only.
Conclusions
While pathways to substance use differ by gender, both early maturing girls and boys should be regarded as high-risk populations for initiation of substances, and intervention programs may be more effective if they are targeted accordingly.
doi:10.1016/j.jadohealth.2007.11.002
PMCID: PMC2435092  PMID: 18486864
Substance use; Pubertal timing; Adolescence; Gender differences; Parental monitoring; Deviant peers
22.  Personality Predictors of the Development of Elementary-School Children’s Intentions to Drink Alcohol 
The authors tested a mediation model in which childhood hostility and sociability were expected to influence the development of intentions to use alcohol in the future through the mediating mechanisms of developing attitudes and norms. Children in 1st through 5th grades (N = 1,049) from a Western Oregon community participated in a longitudinal study involving four annual assessments. Hostility and sociability were assessed by teachers= ratings at the first assessment, and attitudes, subjective norms and intentions were assessed by self-report at all four assessments. For both genders, latent growth modeling demonstrated that sociability predicted an increase in intentions to use alcohol over time, whereas hostility predicted initial levels of these intentions. These personality effects were mediated by the development of attitudes and subjective norms, supporting a model wherein childhood personality traits exert their influence on the development of intentions to use alcohol through the development of these more proximal cognitions.
doi:10.1037/0893-164X.20.3.288
PMCID: PMC2674640  PMID: 16938066
Personality; children; alcohol intentions; attitudes; subjective norms
23.  The Effect of Subjective Normative Social Images of Smokers on Children’s Intentions to Smoke 
This paper expands the literature on peers’ influence on youth’s behaviors through the examination of the effect of subjective normative social images of smokers (perceived peers’ social images of smokers) on subsequent intentions to smoke and the relation between subjective normative social images and the youth’s own social images, or prototypes. Data are from the two oldest cohorts (fourth and fifth graders at the first assessment) and from the first five assessments of the Oregon Youth Substance Use Project, an ongoing longitudinal study. Results showed that both children’s subjective normative social images and prototypes uniquely predicted intentions to smoke cigarettes at the subsequent assessment. Across time, subjective normative social images were more positive than the youth’s own prototypes, and subjective normative social images and children’s own prototypes were reciprocally related over time. Results provide support for subjective normative social images as a risk factor for children’s smoking and suggest targeting this mechanism in smoking prevention programs for children.
doi:10.1080/14622200801975819
PMCID: PMC2435094  PMID: 18418781
Peer influences; Subjective normative social images; Smoking; Children
24.  The Effect of Early Cognitions On Cigarette and Alcohol Use in Adolescence 
The present study predicts cigarette and alcohol use in adolescence from the development of children’s cognitions in the elementary years, beginning in the second through the fifth grade. Using Latent Growth Modeling, we examined a model using data from 712 participants in the Oregon Youth Substance Use Project, who were in the second through fifth grade at the first assessment and followed for six annual or semi-annual assessments over seven years. Growth in children’s prototypes and subjective norms in the elementary years (T1 through T4) were related to their substance use in adolescence (T6) through their willingness and intentions (T5) to smoke and drink. Across the sample, for both substances, the intercept and slope of prototypes were either indirectly related to use through willingness or directly related to use. Both the intercept and slope of subjective norms were indirectly related to use of both substances through both willingness and intentions, and directly related to cigarette use. Results suggest that elementary children have measurable cognitions regarding substance use, which develop during the elementary years, and predict use later in adolescence. These findings emphasize the need for prevention programs targeting changing children’s social images of substance users and encouraging more accurate perceptions of peers’ use.
doi:10.1037/0893-164X.22.1.96
PMCID: PMC2518527  PMID: 18298235
alcohol; smoking; children; adolescence; cognitions
25.  Environmental and Genetic Determinants of Tobacco Use: Methodology for a Multidisciplinary, Longitudinal Family-Based Investigation1 
This article describes the ongoing collaborative effort of six research teams to operationalize and execute an integrative approach to the study of gene × environment interactions in the development of tobacco dependence. At the core of the project is a longitudinal investigation of social and behavioral risk factors for tobacco use in individuals who were, on average, 13 years of age at intake and for whom smoking outcomes extending from early adolescence to young adulthood have been characterized previously (current average age of the cohort is 29 years). The conceptual framework for the integrative approach and the longitudinal investigation on which the study is based is presented. A description is also provided of the methods used to: (a) recruit participants and families to provide DNA samples and information on tobacco use; (b) assess participants for relevant tobacco-related phenotypes including smoking history, current use of tobacco, and nicotine metabolism; (c) assess the quality of the DNA samples collected from participants for genome-wide scanning and candidate gene analysis; (d) examine several research questions concerning the role of genetic and environmental factors in the onset and maintenance of tobacco use; and (e) ensure adherence to local and federal guidelines for ethical and legal investigations of genotypic associations with tobacco-related phenotypes in families. This investigation is unique among ongoing studies of the genetics of tobacco dependence in the extent to which equal importance has been assigned to both phenotypic and genotypic measurements.
PMCID: PMC2587265  PMID: 14578134

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