Predictors of smoking and smokeless tobacco use in college students: a preliminary study using web-based survey methodology

Cigarette smoking and smokeless tobacco (SLT) use are associated with numerous health hazards and economic costs, and rates of tobacco use have recently increased among young adults. In this study, the authors compared predictors of smoking and SLT use among college students (N = 21,410) from 13 Texas universities using a Web-based survey. Results revealed that sex, belonging to a fraternity or sorority, participation in intercollegiate sports, peer influences, and ethnicity predicted smoking and SLT use. Although common factors predicted both lifetime and current smoking and SLT use, patterns of prediction differed across dependent variables. The authors discuss implications for developing tobacco prevention programs targeting specific risk factors salient to the young adult population.     

Predictors of Smoking and Smokeless Tobacco Use in College Students: A Preliminary Study Using Web-Based Survey Methodology

Cigarette smoking and smokeless tobacco (SLT) use are associated with numerous health hazards and economic costs, and rates of tobacco use have recently increased among young adults. In this study, the authors compared predictors of smoking and SLT use among college students (N = 21,410) from 13 Texas universities using a Web-based survey. Results revealed that sex, belonging to a fraternity or sorority, participation in intercollegiate sports, peer influences, and ethnicity predicted smoking and SLT use. Although common factors predicted both lifetime and current smoking and SLT use, patterns of prediction differed across dependent variables. The authors discuss implications for developing tobacco prevention programs targeting specific risk factors salient to the young adult population.     

A tobacco and alcohol use profile of San Francisco's Chinese community

Relatively little is known about Asian American tobacco and alcohol use patterns. This is particularly true of Chinese living in the United States--either U.S.-born or non-U.S.-born Chinese. This article presents data from a research project studying tobacco and alcohol use patterns in San Francisco's Chinese community. Data were secured both from focus groups and a self-report telephone survey of a random sample of 1,808 Chinese residents in San Francisco. This results indicate that the prevalence of both tobacco and alcohol use is lower for San Francisco's Chinese population than for the general population. Moreover, those persons who report smoking tend to be different from those who report consuming alcohol. The study concludes that specific, culturally relevant tobacco and alcohol prevention programs should be designed to better reach this target population.     

Does Telephone Audio Computer-Assisted Self-Interviewing Improve the Accuracy of Prevalence Estimates of Youth Smoking? Evidence from the UMass Tobacco Study

Despite their advantage for obtaining representative samplesof adolescents, telephone surveys have been regarded as an inferiormethod for collecting data on youth tobacco use because theyyield lower estimates than school-based, self-administered surveys.Although no gold standard for smoking estimates exists, thelower estimates in telephone surveys have been attributed tounderreporting due to youths’ concern that parents orothers may overhear their responses. Telephone audio computer-assistedself-interviewing (T-ACASI) is a cost-effective method for obtaininga representative sample of youths and provides increased privacyfor the respondent. We hypothesize that using T-ACASI wouldencourage youths to report more fully smoking behavior comparedto traditional interviewer-administered telephone methods. Ouranalysis further assesses whether respondent age, gender, race/ethnicity,and parental attitude toward smoking moderated the relationshipbetween survey mode and smoking reports. Using data from a statewidetobacco use survey that randomly assigned youth respondentsto either T-ACASI or interviewer-administered modes, we findthat youths were more likely to report smoking behaviors inT-ACASI mode and that this was especially true for girls, particularlythose who believed their parents would disapprove strongly oftheir smoking. The findings suggest that traditional telephonesurveys may underestimate smoking prevalence in most girls bya factor of two, and that a technique for ensuring privacy forthese respondents is an important component of effective telephonesurvey methodology.     

The American Stop Smoking Intervention Study. Conceptual framework and evaluation design.

Reducing tobacco use, especially cigarette smoking, is a public health priority. The American Stop Smoking Intervention Study (ASSIST) was initiated in 1991 to prevent and reduce tobacco use primarily through policy-based approaches to alter the social-political environment. This article describes the conceptual design, research framework, evaluation components, and analytic strategies that are guiding the evaluation of this demonstration research endeavor. The ASSIST evaluation is a unique analysis of the complex relationships between the social context, public health activity at the state level, tobacco use, and individual behavior. The measures of tobacco control activity developed for this evaluation may be useful in ongoing national cancer control surveillance efforts, and the lessons learned will enhance the development of tobacco control programs.     

Stress and tobacco use among African-American adolescents: the buffering effect of cultural factors

Tobacco is a leading contributor to morbidity and mortality and a primary reason for health disparities among African Americans. In this study we explore the role of stress in smoking and cultural factors that protect against stress among African-American adolescents. Our sample consisted of 239 youth who were recruited into the study while enrolled in 8th and 12th grade. Measures of risk factors (stress, school transition stress, and community disorganization), moderator or protective factors (religious support and intergenerational connections), and 30-day tobacco use were collected. Hierarchical multiple regression analyses were conducted. Intergenerational connections moderated the effect of stress on past 30-day tobacco use. Religious support moderated the effect of neighborhood disorganization on past 30-day tobacco use. Religious support also moderated the effect of stress on past 30-day tobacco use. The findings have implications for prevention efforts to consider religious beliefs and practices and also to link youth with supportive adults in their community.     

The irrelevance of evidence in the development of school-based drug prevention policy, 1986-1996

This article examines development in school-based drug prevention policy and programming since the Anti-Drug Abuse Act of 1986. Using data from national surveys and evaluations of school-based programs, it argues, first, that there was really no need for a massive infusion of money into school-based drug prevention in the late 1980s, and, second, that there was little or no evidence to indicate that a "new generation" of effective programs, based on the so-called social influence model, was emerging at this time. Despite the infusion of resources into school-based prevention efforts, adolescent drug use has risen in recent years. Moreover, evaluations continue to show that the effectiveness of social influence programs is very much in the eye of the beholder. Fundamental questions need to be asked of school-based drug prevention--just as they should be asked of other key components of our current drug control policy.     

A Review of Multicomponent Interventions to Prevent and Control Tobacco Use Among College Students

Abstract

Objective: Multicomponent tobacco control programs have been implemented at the state and community levels and have led to a reduction in tobacco use. The purpose was to review the public health research literature on tobacco prevention and control programs on college campuses and derive evidence-based implications for comprehensive program implementation. Methods: MEDLINE, PsycINFO, ERIC, and PubMed databases were used to search the research literature concerning tobacco prevention and control programs conducted on college campuses published between 2000 and 2009. Results: No studies were found that implemented all 5 recommended components of a comprehensive program. Tobacco control programs containing policy and prevention education were used the most and promotion of tobacco-free environments and banning sales of tobacco products were used the least. Conclusion: The review suggests that despite the recommendation of comprehensive tobacco control programs to reduce tobacco use on college campuses, few institutions have implemented and evaluated programs consisting of multiple components.     

College smoking policies and smoking cessation programs: results of a survey of college health center directors

College students' cigarette smoking rose dramatically during the 1990s. Little is known about what colleges do to address the problem. Health center directors at 393 4-year US colleges provided information (response rate: 65.1%) about college policies addressing smoking and the availability of smoking cessations programs. Of the health center directors surveyed, 85% considered students' smoking a problem; yet only 81% of colleges prohibit smoking in all public areas and only 27% ban smoking in all indoor areas, including students' rooms in dormitories and in private offices. More than 40% of the respondents reported that their schools did not offer smoking cessation programs and that the demand for existing program was low. Colleges need to do more to discourage student tobacco use. Recommended actions include campus-wide no-smoking policies that apply to student residences and identification of new ways of providing smoking prevention and cessation services.     

Trends from 1987 to 1991 in alcohol, tobacco, and other drug (ATOD) use among adolescents exposed to a school district-wide prevention intervention.

This study involved a school-based prevention program initiated to reduce alcohol, tobacco, and other drug (ATOD) use among adolescents in the Troy School District in the Detroit area. One purpose was to describe the current ATOD situation by investigating changes in reported ATOD use from 1987 to 1991. Another purpose was to explore and identify the most salient risk and protective factors present. In 1987, 1,490 students (comprising grades 8 and 11) and in 1991, 3,171 students (comprising grades 8 to 12) completed questionnaires. Significant decreases were found for use of most drugs with the exception of alcohol. Involvement in problem behaviors was identified as the most salient risk factor, while having a member of a non-using peer group was the most salient protective factor. Implications for the design of subsequent intervention programs are discussed.     

The prevalence of evidence-based substance use prevention curricula in the nation's elementary schools

Current guidelines for school-based substance use prevention suggest that prevention efforts should begin in elementary grades, before students begin using substances. Previous research suggests, however, that the use of evidence-based curricula in these grades may be low. Using a 2005 survey of public school districts in the United States that include elementary grades (n = 1563), we assessed the prevalence of elementary curricula use, particularly those designated as evidence-based. We found that although 72% of districts administer a substance use prevention curriculum to their elementary students, only about 35% are using one that is evidence-based and only about 14% are using an evidence-based curriculum more so than any other prevention curriculum. We present prevalence estimates for specific evidence-based curricula and conclude by discussing possible reasons for and implications of our findings.     

A meta-analysis of the California school-based risk reduction program

Prominent nonquantitative reviews of research evaluating school-based interventions designed to deter adolescents from the use of tobacco, alcohol and other drugs found the methodology to be flawed and thus little evidence existed that the interventions had the desired impact. Recent meta-analytic reviews indicate that information-focused interventions have more impact upon knowledge but less upon attitudes and behavior whereas alternative interventions have less impact upon knowledge but more upon attitudes and behavior. This result is replicated by the current meta-analysis performed upon eight risk-reduction programs meeting six standard methodological requirements for evaluation research.     

A large-scale initiative to disseminate an evidence-based drug abuse prevention program in Italy: Lessons learned for practitioners and researchers

Across developed countries, experimentation with alcohol, tobacco, and other drugs often begins in the early adolescent years. Several evidence-based programs have been developed to prevent adolescent substance use. Many of the most rigorously tested and empirically supported prevention programs were initially developed and tested in the United States. Increasingly, these interventions are being adopted for use in Europe and throughout the world. This paper reports on a large-scale comprehensive initiative designed to select, adapt, implement, and sustain an evidence-based drug abuse prevention program in Italy. As part of a large-scale regionally funded collaboration in the Lombardy region of Italy, we report on processes through which a team of stakeholders selected, translated and culturally adapted, planned, implemented and evaluated the Life Skills Training (LST) school-based drug abuse prevention program, an evidence-based intervention developed in the United States. We discuss several challenges and lessons learned and implications for prevention practitioners and researchers attempting to undertake similar international dissemination projects. We review several published conceptual models designed to promote the replication and widespread dissemination of effective programs, and discuss their strengths and limitations in the context of planning and implementing a complex, large-scale real-world dissemination effort.     

College Smoking Policies and Smoking Cessation Programs: Results of a Survey of College Health Center Directors

Abstract

College students' cigarette smoking rose dramatically during the 1990s. Little is known about what colleges do to address the problem. Health center directors at 393 4-year US colleges provided information (response rate: 65.1%) about college policies addressing smoking and the availability of smoking cessation programs. Of the health center directors surveyed, 85% considered students' smoking a problem; yet only 81% of colleges prohibit smoking in all public areas and only 27% ban smoking in all indoor areas, including students' rooms in dormitories and in private offices. More than 40% of the respondents reported that their schools did not offer smoking cessation programs and that the demand for existing program was low. Colleges need to do more to discourage student tobacco use. Recommended actions include campus-wide no-smoking policies that apply to student residences and identification of new ways of providing smoking prevention and cessation services.     

Exposure to school and community based prevention programs and reductions in cigarette smoking among adolescents in the United States, 2000-08

Smoking remains prevalent among US youth despite decades of antismoking efforts. Effects from exposure to prevention programs at national level may provide informative and compelling data supporting better planning and strategy for tobacco control.A national representative sample of youth 12-17 years of age from the National Survey on Drug Use and Health was analyzed. A 3-stage model was devised to estimate smoking behavior transitions using cross-sectional data and the Probabilistic Discrete Event System method. Cigarette smoking measures (prevalence rates and odds ratios) were compared between exposed and non-exposed youth.More than 95% of the sample was exposed to prevention programs. Exposure was negatively associated with lifetime smoking and past 30-day smoking with a dose-response relation. Reduction in smoking was related to increased quitting in 2000-02, to increased quitting and declined initiation in 2003-05, and to initiation, quitting and relapse in 2005-08.Findings of this analysis suggest that intervention programs in the United States can reduce cigarette smoking among youth. Quitting smoking was most responsive to program exposure and relapse was most sensitive to funding cuts since 2003. Health policy and decision makers should consider these factors in planning and revising tobacco control strategies.     

Smoking risk factors and gender differences among Spanish high school students

The objectives of the present study were to analyze the pattern of tobacco use among Spanish adolescents, as well as to determine gender differences in specific risk factors of cigarette use. The study sample was made up of 1,483 boys and 1,358 girls, aged 12-16 (M = 14). Participants were asked to answer an ad-hoc instrument to evaluate the pattern of use, perceived availability, risk of harm, family- and peer-use, engagement in leisure activities, drive for thinness, and self-esteem. Results showed no gender differences in the pattern of use. With regard to risk and protector factors, a predictive analysis showed that peer-related variables were the most determinant for tobacco use both for boys and girls. Some gender differences were also detected: Playing sports was protective for boys only, and listening to music for girls only. Drive for thinness and self-esteem were not related to tobacco use for either boys or girls. These findings help increase our understanding of smoking risk factors in adolescence and to pay special attention to the group of friends when planning prevention programs to reduce risk factors.     

Determinants of tobacco use among Korean female adolescents: Longitudinal test of the theory of triadic influence

This study aimed to examine the influences of social, attitudinal, and intrapersonal factors at three levels on tobacco use among female adolescents in South Korea using longitudinal national data. The study analyzed data from the Korean Youth Panel Study, with a study population consisting of middle-school second-graders (N = 1594). Using time dependent Cox regression, our analyses yielded the following main findings: the theory of triadic influence was verified to provide a theoretical framework for smoking among Korean female adolescents. All of the social factors at the three levels, including parental supervision, attachment to friends, and peer smoking prevalence, were found to influence tobacco use among Korean female adolescents. Stigma on the distal level and attitude towards smoking on the proximal level were significant attitudinal factors. Among intrapersonal factors, self-control on the distal level and stress on the proximal level were found to be significant. The study findings suggest that including parental education and promoting attachment to non-smoking friends, as well as enhancing sound relationships with them, would provide an effective strategy for the prevention and cessation of smoking. Prevention and cession should include strategies that alleviate stigma and stress, and improve negative attitude toward smoking and the level of self-control.     

Tobacco use and quit behaviors among delinquent youth: a pilot study

With rates of adolescent tobacco use steadily increasing over the past 20 years, assisting youth to quit, particularly those youth most susceptible to tobacco use, has become a national focus. The purpose of this pilot study was to examine and profile the smoking patterns of a small sample (n = 37) of juvenile offenders in Texas. In contrast to anecdotal reports, the sample group from this study did not differ clinically from the general population of adolescent tobacco users. Importantly, the study participants indicated previous attempts to stop smoking. The authors conclude that delinquent youth may be responsive to cognitive behavioral smoking cessation programs that also address the management of peer networks.