To develop more effective anti-smoking programs, it is important to understand the factors that influence people to smoke. Guided by attribution theory, a longitudinal study was conducted to investigate how individuals’ cognitive attributions for smoking were associated with subsequent smoking development and through which pathways.
Middle and high school students in seven large cities in China (N=12,382; 48.5% boys and 51.5% girls) completed two annual surveys. Associations between cognitive attributions for smoking and subsequent smoking initiation and progression were tested with multilevel analysis, taking into account plausible moderation effects of gender and baseline smoking status. Mediation effects of susceptibility to smoking were investigated using statistical mediation analysis (MacKinnon, 2008).
Six out of eight tested themes of cognitive attributions were associated with subsequent smoking development. Curiosity (β=0.11, p<0.001) and autonomy (β=0.08, p=0.019) were associated with smoking initiation among baseline non-smokers. Coping (β=0.07, p<0.001) and social image (β=0.10, p=<.0001) were associated with smoking progression among baseline lifetime smokers. Social image (β=0.05, p=0.043), engagement (β=0.07, p=0.003), and mental enhancement (β=0.15, p<0.001) were associated with smoking progression among baseline past 30-day smokers. More attributions were associated with smoking development among males than among females. Susceptibility to smoking partially mediated most of the associations, with the proportion of mediated effects ranging from 4.3% to 30.8%.
This study identifies the roles that cognitive attributions for smoking play in subsequent smoking development. These attributions could be addressed in smoking prevention programs.
Attributions; Smoking; Attribution Theory; Adolescents; China
Using a network analytic framework, this study introduces a new method to measure peer influence based on adolescents’ affiliations or two-mode social network data. Exposure based on affiliations is referred to as the “affiliation exposure model.” This study demonstrates the methodology using data on young adolescent smoking being influenced by joint participation in school-based organized sports activities with smokers. The analytic sample consisted of 1260 American adolescents from age 10 to 13 in middle schools, and the results of the longitudinal regression analyses showed that adolescents were more likely to smoke as they were increasingly exposed to teammates who smoke. This study illustrates the importance of peer influence via affiliation through team sports.
Culture; acculturation; ethnicity; race; measurement; minority; disparities
A brief motivational interviewing (MI) intervention may be a viable adjunct to school-based substance abuse prevention programs. This article describes the development and implementation of a brief MI intervention with 573 adolescents (mean age 16.8; 40.3% female, 68% Latino) enrolled in eight continuation high schools in Southern California. Study participants were assigned to the MI condition in a randomized controlled trial of Project Toward No Drug Abuse. Data are provided on dosage, topics discussed, and quality of MI determined with the Motivational Interviewing Skill Code (MISC). Results suggest that the protocol was feasible and implemented with adequate fidelity. The study’s limitations are noted.
adolescent; motivational interviewing; substance use; prevention; intervention; telephone; school-based; booster
Injection drug users (IDUs) are at risk for HIV and other bloodborne pathogens through receptive syringe sharing (RSS) and receptive paraphernalia sharing (RPS). Research into the influence of the perceived risk of HIV infection on injection risk behavior has yielded mixed findings. One explanation may be that consequences other than HIV infection are considered when IDUs are faced with decisions about whether or not to share equipment. We investigated the perceived consequences of refusing to share injection equipment among 187 IDUs recruited from a large syringe exchange program in Los Angeles, California, assessed their influence on RSS and RPS, and evaluated gender differences. Two sub-scales of perceived consequences were identified: structural/external consequences and social/internal consequences. In multiple linear regression, the perceived social/internal consequences of refusing to share were associated with both RSS and RPS, after controlling for other psychosocial constructs and demographic variables. Few statistically significant gender differences emerged. Assessing the consequences of refusing to share injection equipment may help explain persistent injection risk behavior, and may provide promising targets for comprehensive intervention efforts designed to address both individual and structural risk factors.
Injection drug use; HIV; gender; perceived consequences; syringe sharing
To investigate the impact of worries on weight concerns and emotional eating and body mass index (BMI) percentile in an ethnically diverse sample of female youth.
This study uses baseline and follow-up data from a brief school-based physical activity intervention trial in minority female youth. Partial correlations adjusted for intervention status, age, and ethnicity were used to assess the relationship among emotional eating, weight concerns, and BMI percentile at follow-up. Multi-level modeling was used to analyze the relationships between baseline worries and follow-up emotional eating, weight concerns, and BMI percentile. Additional analysis assessed whether emotional eating mediated and/or moderated the relationship between baseline worries and follow-up BMI. Data were analyzed using SAS v9.1.
The sample consisted of 404 minority females (67.1% Latina; mean age 12.5±0.6; 60.6% normal weight). Weight concerns were positively correlated with emotional eating and BMI percentile (p< 0.001 for both). Baseline worries significantly predicted emotional eating (p= 0.027) and weight concerns (p< 0.001) but not BMI percentile (p= 0.183) at follow-up. Emotional eating did not mediate the relationship between baseline worries and follow-up BMI percentile; however it did moderate the relationship between baseline worries and follow-up BMI percentile (p= 0.003).
Worries were associated with psychosocial variables but not BMI percentile in this sample. Reducing worries in those with high emotional eating scores may influence future weight gain in Latina females.
psychosocial; minority; youth; BMI; weight concerns; emotional eating; mediation; moderation
Although previous investigations have indicated a role for genetic factors in smoking initiation, the underlying genetic mechanisms are still unknown. In 2,339 adolescents from a Chinese Han population in the Wuhan Smoking Prevention Trial (Wuhan, China, 1998–1999), the authors explored the association of 57 genes in the dopamine pathway with smoking initiation. Using a conservative approach for declaring significance, positive findings were further examined in an independent sample of 603 Caucasian adolescents followed for up to 10 years as part of the Children's Health Study (Southern California, 1993–2009). The authors identified 1 single nucleotide polymorphism (rs2298122) in the calcyon neuron-specific vesicular protein gene (CALY) that was positively associated with smoking initiation in females (odds ratio = 2.21, 95% confidence interval: 1.49, 3.27; P = 8.4 × 10−5) in the Wuhan Smoking Prevention Trial cohort, and they replicated the association in females from the Children's Health Study cohort (hazard rate ratio = 2.05, 95% confidence interval: 1.27, 3.31; P = 0.003). These results suggest that the CALY gene may influence smoking initiation in adolescents, although the potential roles of underlying psychological characteristics that may be components of the smoking-initiation phenotype, such as impulsivity or novelty-seeking, remain to be explored.
adolescent; dopamine; genetic association studies; smoking
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.
Acculturation; adolescents; Latino/Hispanic; qualitative methods; substance use
Socioeconomic status (SES) has been associated with smoking among adolescents, but it is not known which attributes of SES are responsible for the added risk, or whether these associations are consistent in ethnically diverse samples.
This study investigated the associations between SES variables and smoking behavior among an ethnically diverse sample of 1847 8th-grade adolescents in Southern California in 2002. Several aspects of SES were examined: an objective composite measure of family and neighborhood SES, the adolescent’s spending money, and the adolescent’s perception of SES (family’s ability to afford basic necessities, wealth relative to others, and wealth relative to last year).
After controlling for demographic characteristics, smoking behavior of parents and friends, and parental monitoring, low scores on the objective SES index and large amounts of pocket money were associated with an increased risk of smoking.The subjective measures of perceived SES were not associated with smoking.
Results indicate that increased smoking prevention efforts are needed in low-SES areas, and that limiting adolescents’ pocket money may be an effective strategy for preventing smoking.
smoking; adolescence; socioeconomic status
Purpose: Compulsive Internet Use (CIU) has increasingly become an area of research among process addictions. Largely based on data from cross-sectional studies, a positive association between CIU and substance use has previously been reported. This study presents gender and country-specific longitudinal findings on the relationships between CIU and substance use. Methods: Data were drawn from youth attending non-conventional high schools, recruited into two similarly implemented trials conducted in China and the USA. The Chinese sample included 1,761 students (49% male); the US sample included 1,182 students (57% male) with over half (65%) of the US youth being of Hispanic ethnicity. Path analyses were applied to detect the concurrent and predictive relationships between baseline and one-year follow-up measures of CIU level, 30-day cigarette smoking, and 30-day binge drinking. Results: (1) CIU was not positively related with substance use at baseline. (2) There was a positive predictive relationship between baseline CIU and change in substance use among female, but not male students. (3) Relationships between concurrent changes in CIU and substance use were also found among female, but not male students. (4) Baseline substance use did not predict an increase in CIU from baseline to 1-year follow-up. Conclusions: While CIU was found to be related to substance use, the relationship was not consistently positive. More longitudinal studies with better measures for Internet Addiction are needed to ascertain the detailed relationship between Internet addiction and substance use.
compulsive internet use; internet addiction; youth; cigarette smoking; binge drinking; addiction syndrome; addiction specificity
Smoking prevention interventions have been shown to be effective in reducing smoking prevalence in the United States. Further work is needed to address smoking in China, where over one third of the world’s current smokers reside. China, with more than 60% of the male population being smokers, also presents a unique opportunity to test cognitive processes involved in depression, social influences, and smoking. Adolescents at-risk for developing depression may process social information differently from low-risk counterparts.
The Wuhan Smoking Prevention Trial was a school-based longitudinal randomized controlled trial aimed at preventing initiation and escalation of adolescent smoking behaviors. Thousand three hundred and ninety-one male seventh-grade students were assessed with a 200-item paper-and-pencil baseline survey, and it was readministered 1 year later following program implementation.
Friend prevalence estimates were significantly higher among 30-day smokers and among those at highest risk for depression symptoms. The program appeared to be successful in changing the perception of friend smoking prevalence only among adolescents with a comorbidity of high scores of depression symptoms and who have experimented previously with smoking. This Program × Comorbidity interaction on perceived friend smoking prevalence was significant in predicting 30-day smoking 1 year after program implementation.
This study provides evidence that those adolescents with high levels of depressive symptoms may be more sensitive to social influences associated with smoking prevalence. Individual Disposition × Social Environmental Influences may be important when developing future effective prevention programming.
Injection drug users (IDUs) are at risk for HIV and other bloodborne pathogens via syringe and paraphernalia sharing, and women are at elevated risk. Consequences of injection risk behavior such as the risk of becoming infected with HIV have been relatively well studied, though less is known about the consequences of refusing to share injection equipment. We conducted in-depth qualitative interviews with 26 IDUs recruited from a syringe exchange program in Los Angeles, California, USA to understand the consequences that IDUs associate with refusing to share injection equipment and to determine whether these perceived consequences differ by gender. Perceived consequences were organized into four domains using a Social Ecological framework: microsystem (perceived risk of HIV, drug withdrawal or forgoing drug use), exosystem (trust and social norms), mesosystem (precarious housing and shelter policies), and macrosystem (syringe access/inconvenience, economic and legal consequences). Gender differences were identified in some, but not all areas. Effective public health interventions among IDUs will benefit from a holistic perspective that considers the environmental and social rationality (Kowalewski et al., 1997) of decisions regarding injection risk behavior, and assists individuals in addressing the consequences that they perceive to be most salient.
HIV; injection drug use; gender; qualitative methods; perceived consequences; behavioral theory
Injection drug users (IDUs) are at risk for HIV and viral hepatitis, and risky injection behavior persists despite decades of intervention. Cognitive behavioral theories (CBT) are commonly used to help understand risky injection behavior. We review findings from CBT-based studies of injection risk behavior among IDUs. An extensive literature search was conducted in Spring 2007. In total 33 studies were reviewed—26 epidemiological and 7 intervention studies. Findings suggest that some theoretical constructs have received fairly consistent support (e.g., self-efficacy, social norms), while others have yielded inconsistent or null results (e.g., perceived susceptibility, knowledge, behavioral intentions, perceived barriers, perceived benefits, response efficacy, perceived severity). We offer some possible explanations for these inconsistent findings, including differences in theoretical constructs and measures across studies and a need to examine the environmental structures that influence risky behaviors. Greater integration of CBT with a risk environment perspective may yield more conclusive findings and more effective interventions in the future.
HIV risk behavior; injection drug use; Cognitive Behavioral Theory; literature review
To prospectively investigate associations between overweight and depressive symptoms in Asian and Hispanic adolescents.
Data included 780 Hispanic and 375 Asian students. Structural equation model was used to prospectively explore moderation effects of gender, ethnicity, and acculturation on associations of overweight, body image dissatisfaction, and depressive symptoms.
Significant mediation effect was found only in Asian girls (mediation effect=0.16, P<0.05) and girls with high acculturation (mediation effect=0.17, P<0.05). Overweight significantly predicted higher body image dissatisfaction, which in turn was significantly related to depressive symptoms.
Our findings help understanding the association of overweight and experience of depressive symptoms.
overweight; depressive symptoms; body image; acculturation
This study examined the role of family structure and functioning in predicting substance use among Hispanic/Latino adolescents, surveyed in 9th and 10th grade. The sample (N=1433) was half female, mostly of Mexican descent, and the majority was born in the U.S. Living with a single father was associated with less parental monitoring and less family cohesion (γ = −0.07, −0.06, respectively). Living with a single mother was associated with less parental monitoring (γ = −0.10). Living with neither parent was associated with less communication (γ = −0.08), less parental monitoring (γ = −0.09), more family conflict (γ = 0.06), and less family cohesion (γ = −0.06). Less monitoring was associated with substance use at follow-up (β = −0.17). Low rates of parental monitoring appear to mediate the association between parental family structure and substance use. Results suggest that improving basic parenting skills, and offering additional social support and resources to assist parents in monitoring adolescents may help prevent substance use. These interventions may be particularly beneficial for single parents.
Adolescents; Hispanic/Latino; Family function; Family structure; Structural Equation Modeling
Acculturation; Biculturalism; Context; Culture
To design more effective health communication messages for smoking cessation and prevention, it is important to understand people’s own perceptions of the factors that influence their decisions to smoke. Studies have examined cognitive attributions for smoking in Western countries but not in the Chinese cultural context. In a study of 14,434 Chinese adolescents, exploratory factor analysis grouped 17 cognitive attributions into 8 factors: curiosity, coping, social image, social belonging, engagement, autonomy, mental enhancement, and weight control. The factors were ranked based on the participants’ self-reports of importance and by the strength of their associations with smoking behavior. Among all smokers, curiosity was the most frequently-ranked attribution factor at the early stages of smoking but not for daily smoking. Coping was highly-ranked across smoking stages. Social image and social belonging were more highly-ranked at earlier stages, whereas engagement and mental enhancement were ranked more highly at later stages of smoking. More attributions were associated with smoking among males than among females. This information could be useful for the development of evidence-based anti-smoking programs in China.
Attributions; Smoking; Attribution Theory; Adolescents; China
Emotional eating is conceptualized as eating in response to negative affect. Data from a larger study of physical activity was employed to examine the associations among specific emotions/moods and emotional eating in an adolescent sample. Six-hundred and sixty-six students of diverse backgrounds from 7 middle schools in Los Angeles County participated. Cross-sectional analysis revealed no gender differences in emotional eating, and showed that perceived stress and worries were associated with emotional eating in the total sample. Gender stratified analyses revealed significant associations of perceived stress, worries and tension/anxiety to emotional eating for girls, while only confused mood was related to emotional eating in boys. These findings bear potential implications for the treatment and prevention of pediatric obesity and eating disorders because they suggest that interventions would benefit from incorporation of stress-reduction techniques and promotion of positive mood.
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.
acculturation; drug use; alcohol use; adolescents
To better understand the relation between emotional eating and dietary choices, dietary correlates of emotional eating were investigated in an adolescent sample. Participants were 617 predominantly Latino middle school students from seven schools in Los Angeles County. Analyses of cross-sectional data revealed that emotional eating was associated with increased frequency of intake of sweet high energy-dense foods, such as cake and ice cream, salty high energy-dense foods like chips, and soda. Gender stratified analyses revealed an association between emotional eating and more frequent fruit and vegetable intake in boys only, and a positive association between emotional eating and salty high energy-dense intake in both boys and girls. These data support previous literature that reports a preference for high energy-dense food in emotional eating, and shows that this association may be generalizable to Latino youth. Considering that emotional eating may lead to overeating because it often takes place in the absence of hunger, it may be appropriate to develop interventions to teach youth healthier substitutions and regulate mood by means other than eating in order to reduce risk for obesity, especially in high risk populations, such as Latinos.
Emotional eating; adolescence; dietary choices; high-energy dense; Latino
Emotional eating has often been linked to overweight and/or obesity. Multiple group SEM analyses were conducted using cross-sectional data from 517 minority students in Los Angeles County. Results showed no differences in emotional eating between normal weight and overweight students. Perceived stress was indeed a significant correlate of emotional eating, independent of BMI status, as indicated by the lack of a modifying effect of BMI status. Findings highlight the fact that emotional eating is not an issue only for overweight and obese persons. This study shows that some children in this population at increased risk for obesity and related chronic disease have already incorporated emotional eating as a learned response to stress by the time that they enter adolescence.
Emotional eating; perceived stress; adolescents; moderation; structural equation model; BMI