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author:("widom, Rachel")
1.  Adolescence to Young Adulthood: When Socio-economic Disparities in Substance Use Emerge 
Substance use & misuse  2013;48(14):1522-1529.
Summary
Background
Our objective was to examine the longitudinal trends of substance use (cigarette, alcohol, and marijuana use) in a cohort of young people by participants’ eventual educational attainment. We aimed to pinpoint the life stages when the socioeconomic disparities in these behaviors emerge.
Methods
The analytic sample included 1,902 participants from Project EAT, a 10-year longitudinal study. Participants were assessed from early adolescence (middle school) through middle young adulthood (mid 20s) and categorized into groups of eventual educational attainment.
Results
Generally, for cigarettes and marijuana, disparities were evident by early adolescence with prevalence of use highest among those who had no secondary education, followed by 2-year college and then 4-year college attendees/graduates. With alcohol, reported use tended to be similar during adolescence for all three education groups, but then diverged during young adulthood. At this stage the 4-year college group reported the most weekly alcohol use, but the no postsecondary education group reported the most daily use.
Conclusions
The points at which disparities in substance use behaviors first emerge and later escalate can offer guidance as to how to craft, and when to target, interventions and policies.
doi:10.3109/10826084.2013.800885
PMCID: PMC4060522  PMID: 23834465
smoking; alcohol; marijuana; young adulthood; adolescence; socio-economic status
2.  High Food Insecurity and Its Correlates Among Families Living on a Rural American Indian Reservation 
American journal of public health  2012;102(7):1346-1352.
Objectives
We examined associations of food insecurity with family sociodemographic characteristics, parents’ and children’s weight, children’s dietary patterns, and the home food environment among American Indian families.
Methods
Participants were a sample of kindergarten-age children and their parents or caregivers (dyad n = 432) living on the Pine Ridge Reservation in South Dakota who enrolled in the Bright Start study. Parents or caregivers completed a questionnaire on their child’s dietary intake, the home food environment, and food security. We assessed food security with a standard 6-item scale.
Results
Almost 40% of families reported experiencing food insecurity. Children from food-insecure households were more likely to eat some less healthful types of foods, including items purchased at convenience stores (P = .002), and food-insecure parents reported experiencing many barriers to accessing healthful food. Food security status was not associated with differences in home food availability or children’s or parents’ weight status.
Conclusions
Food insecurity is prevalent among families living on the Pine Ridge Reservation. Increasing reservation access to food that is high quality, reasonably priced, and healthful should be a public health goal.
doi:10.2105/AJPH.2011.300522
PMCID: PMC3477997  PMID: 22594740
3.  Passive Smoke Exposure Trends and Workplace Policy in the Coronary Artery Risk Development in Young Adults (CARDIA) study (1985–2001) 
Preventive medicine  2007;44(6):490-495.
Objective
There has been reduced active smoking, decreased societal acceptance for smoking indoors, and changing smoking policy since the mid-1980s. We quantified passive smoke exposure trends and their relationship with workplace policy.
Method
We studied 2,504 CARDIA participants (blacks and whites, 18–30 years old when recruited in 1985–86 from four US cities, reexamination 2, 5, 7, 10, and 15 years later) who never reported smoking and attended exams at 10 or 15 years.
Results
In non-smokers with a college degree (n = 1,581), total passive smoke exposure declined from 16.3 hr/wk in 1985/86 to 2.3 hr/wk in 2000/01. Less education tended to be associated with more exposure at all timepoints for example, in high school or less (n = 349) 22.2 hours/wk in 1985/86 to 8.5 hr/wk in 2000/01. Those who experienced an increase in the restrictiveness of self-reported workplace smoking policy from 1995/96 to 2000/01 were exposed to almost 3 hours per week less passive smoke than those whose workplace policies became less restrictive in this time period.
Conclusions
The increasing presence of restrictive workplace policies seemed to be a component of the substantial decline in self-reported passive smoke exposure since 1985.
doi:10.1016/j.ypmed.2007.02.014
PMCID: PMC3902070  PMID: 17433426
Environmental Tobacco Smoke Pollution; Occupational Health; Passive Smoking; Socioeconomic factors
4.  Post Traumatic Stress Disorder (PTSD) and Health Risk Behaviors among Afghanistan & Iraq War Veterans Attending College 
Objective
To determine if post-traumatic stress disorder (PTSD) is associated with health risk behaviors among Operations Enduring and Iraqi Freedom (OEF/OIF) veterans attending college.
Method
Using 2008 Boynton College Student Health Survey data, we tested associations between self-reported PTSD diagnosis and self-reported risk behaviors (n = 406).
Results
We found PTSD diagnosis to be significantly associated with reporting involvement in a physical fight in the past year (ARR = 3.1; 95% CI: 2.2, 4.4) and marginally associated with high risk drinking (ARR = 1.3; 95% CI: 1.1, 1.6). However, no association was seen between PTSD and the tobacco use and other safety behaviors that we examined.
Conclusion
PTSD is likely a factor that contributes to the relationship between military service and certain health risk behaviors.
PMCID: PMC3582213  PMID: 22040585
Veterans; tobacco; alcohol; health behaviors; OEF/OIF
5.  Health Risk Behaviors of Afghanistan and Iraq War Veterans Attending College 
Purpose
The population military veterans attending college is rapidly growing as veterans return from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). We sought to describe patterns of student veterans’ health-related behaviors and how they might differ from their non-veteran peers.
Design
We analyzed data from the 2008 Boynton College Student Health Survey (CSHS).
Setting
CSHS participants completed an anonymous online survey.
Subjects
The CSHS sampled students (n=8,651) attending public, private, two-, and four-year postsecondary educational institutions in Minnesota.
Measures
The CSHS included items on substance use (including alcohol and tobacco), safety, nutrition, and physical activity.
Analysis
We described demographics of OEF/OIF veteran, non-OEF/OIF veteran, and non-veteran students and used poisson regression to compute adjusted relative risks (ARR) with 95% confidence intervals to characterize associations between veteran status and health behaviors.
Results
After controlling for demographics, veteran students reported more safety-, tobacco-, and alcohol-related risk behaviors compared to non-veteran students. For instance, compared to the non-veteran reference group, the ARR for past year smokeless tobacco use and physical fighting among for OEF/OIF veterans was 1.76 [CI: 1.31–2.35] and 1.48 [CI: 1.22–1.79] respectively. Veteran and non-veteran students display similar weight-related behaviors, though OEF/OIF veteran students were more likely to engage in strengthening exercises.
Conclusions
There are specific health risk behaviors which are particularly relevant for veterans attending postsecondary institutions. As veterans enroll in postsecondary education there is a unique window of opportunity for health promotion in this population.
doi:10.4278/ajhp.090826-QUAN-278
PMCID: PMC3579508  PMID: 22040391
Veterans; Young Adult; Tobacco; Substance Abuse; Obesity; Safety
7.  Passive Smoke Exposure and Circulating Carotenoids in the CARDIA Study 
Annals of Nutrition & Metabolism  2010;56(2):113-118.
Background/Aims
Our objective was to assess associations between passive smoke exposure in various venues and serum carotenoid concentrations.
Methods
CARDIA is an ongoing longitudinal study of the risk factors for subclinical and clinical cardiovascular disease. At baseline in 1985/1986, serum carotenoids were assayed and passive smoke exposure inside and outside of the home and diet were assessed by self-report. Our analytic sample consisted of 2,633 black and white non-smoking adults aged 18–30 years.
Results
Greater total passive smoke exposure was associated with lower levels of the sum of the three provitamin A carotenoids, α-carotene, β-carotene, and β-cryptoxanthin (–0.048 nmol/l per hour of passive smoke exposure, p = 0.001), unassociated with lutein/zeaxanthin, and associated with higher levels of lycopene (0.027 nmol/l per hour of passive smoke exposure, p = 0.010) after adjustment for demographics, diet, lipid profile, and supplement use. Exposure in both home and non-home spaces was also associated with lower levels of the provitamin A carotenoid index.
Conclusion
Cross-sectionally, in 1985/86, passive smoke exposure in various venues was associated with reduced levels of provitamin A serum carotenoids.
doi:10.1159/000277662
PMCID: PMC2842165  PMID: 20110671
Carotenoids; Micronutrients; Occupational health; Passive smoking; Smoke exposure; Tobacco smoke pollution
8.  Does the association between depression and smoking vary by body mass index (BMI) category? 
Preventive medicine  2009;49(5):380-383.
Objective
The purpose of this study was to explore how weight might influence the relationship between depression and smoking.
Methods
Data were obtained from a cross-sectional survey representative of women age 40-65 enrolled in Group Health Cooperative, a health plan serving members in Washington and northern Idaho (n = 4,640). We examined the relationships between depression and smoking in normal weight, overweight, and obese women using weighted multiple logistic regression with both minimal and full adjustment.
Results
Current depression was significantly associated with current smoking in obese women (adjusted odds ratio = 2.48, 95% confidence interval = 1.26−4.88) but not in underweight/normal or overweight women. Among ever smokers, obese women, but not other groups, were significantly less likely to have quit smoking in the past.
Conclusions
The association between smoking and depression in middle-aged women appears to be limited to the obese subset and may stem from a lesser likelihood of obese ever smokers to have quit. This population represents an important target for preventive medicine efforts.
doi:10.1016/j.ypmed.2009.07.018
PMCID: PMC2784124  PMID: 19647015
Tobacco use; depression; obesity; tobacco use cessation
9.  Adolescent Smoking Trajectories 
Purpose
To identify distinct smoking trajectories during adolescence and assess how smoking-related factors relate to trajectory membership.
Methods
The sample includes 3637 youth from across the state of Minnesota. Measures include tobacco use, smoking behaviors of parents and friends, youth smoking-related attitudes and beliefs, and home smoking policies. A cohort-sequential design was used to identify smoking trajectories, including five cohorts of youth (ages 12–16) followed for 3 years.
Results
Six distinct trajectories of tobacco use were found: nonsmokers (54%), triers (17%), occasional users (10%), early established (7%), late established (8%), and decliners (4%). Several factors were associated with increased likelihood of being in a smoking trajectory group (vs. the nonsmoking group): parental smoking, friend smoking, greater perceptions of the number of adults and teenagers who smoke, and higher functional meaning of tobacco use. In contrast, higher perceived difficulty smoking in public places, negative perceptions of the tobacco industry, and home smoking policies were associated with less likelihood of being in one of the smoking trajectories (vs. the nonsmoking trajectory).
Conclusions
Adolescents exhibit diverse patterns of smoking during adolescence and tobacco-related influences were strong predictors of trajectory membership.
doi:10.1016/j.jadohealth.2008.02.014
PMCID: PMC2743902  PMID: 18809130
Adolescent smoking; Smoking trajectories; Social influences; Smoking attitudes
10.  Longitudinal patterns of youth access to cigarettes and smoking progression: Minnesota Adolescent Community Cohort (MACC) study (2000 – 2003) 
Preventive medicine  2007;45(6):442-446.
OBJECTIVES
To measure community-level changes in the methods youth use to obtain cigarettes over time and to relate these methods to the progression of smoking.
METHODS
We analyzed 2000-2003 data from the Minnesota Adolescent Community Cohort study, where youth (beginning at age 12), who were living in Minnesota at baseline, were surveyed every six months via telephone. We conducted mixed model repeated measures logistic regression to obtain probabilities of cigarette access methods among past 30-day smokers (n = 340 at baseline).
RESULTS
The probability of obtaining cigarettes from a commercial source in the past month declined from 0.36 at baseline to 0.22 at the sixth survey point while the probability of obtaining cigarettes from a social source during the previous month increased from 0.54 to 0.76 (p for both trends = 0.0001). At the community level, the likelihood of adolescents obtaining cigarettes from social sources was inversely related to the likelihood of progressing to heavy smoking (p < 0.001).
CONCLUSIONS
During this time, youth shifted to greater reliance on social sources and less on commercial sources. A trend toward less commercial access to cigarettes accompanied by an increase in social access may translate to youth being less likely to progress to heavier smoking.
doi:10.1016/j.ypmed.2007.07.016
PMCID: PMC2255062  PMID: 17719080
Adolescence; Smoking; Cigarette use; Tobacco sales

Results 1-10 (10)