Correlates of smoking among youth: the role of parents, friends, attitudes/beliefs, and demographics.

BACKGROUND: Family engagement has been shown to play a crucial role in youth cigarette use prevention and uptake. We examine cross-sectional and longitudinal data to determine whether changes in parental monitoring factors influence changes in smoking susceptibility. METHODS: Two cross-sectional surveys of Florida youth (12-17 years) were conducted in 2009, with a follow-up survey in 2010. Multivariable analyses examined demographics, parent characteristics, family engagement, and parental monitoring on youth susceptibility to smoke. RESULTS: Cross-sectional data show eating together 6+ times/week and doing something for fun 5+ times/week were related to an increased likelihood of Very Low and decreased likelihood of High susceptibility, respectively. Parental monitoring factors and parents tell on a friend who smokes was significantly related to having Very Low susceptibility in both surveys. Mother's education, parent smokes, family engagement factors, and parental monitoring were significant in both survey rounds. Longitudinal analyses showed change in eating together did not significantly affect the odds of change in smoking susceptibility; however, change in the frequency of doing things for fun with a parent showed decreased odds of susceptibility (OR = .63 [.49-.82]), opposite of the hypothesized direction. Lastly, as youth aged, they were more likely to experience a greater odds of decreased susceptibility (OR14-15y = 1.47 [1.08-1.99] and OR≥16y = 1.40 [1.05-1.84], respectively) and less likely to experience an increased odds of susceptibility (OR14-15y = .65 [.49-.86] and OR≥16y = .72 [.56-.93], respectively). CONCLUSIONS: We found mixed results for family engagement and parental monitoring on changes in youth smoking susceptibility. Cross-sectional data showed general associations in the expected direction; however, longitudinal analyses showed family engagement variables had significance, but in the opposite hypothesized direction.

Identifying misclassification in youth self-reported smoking status: testing different consent processes of biological sample collection to capture misclassification.

INTRODUCTION: In Florida, since 1998, identical survey items have been used to measure youth smoking status for the CDC sponsored state school-based survey and the tobacco control program evaluation telephone survey. The two surveys should parallel one another to track tobacco use. Tobacco items collected in the two surveys closely paralleled one another until recently. Since 2008, data show dramatically divergent youth smoking estimates (e.g., relative differences as high as 50%), which cannot be explained by differences in survey and sampling design. As a first step in detecting misclassification of smoking status, we examined the feasibility of asking youth to self-report their smoking behavior and collect a biological sample, with the expectation that some youth will misreport their smoking status. METHODS: Using a cross-sectional population level telephone survey, youth were randomly assigned to one of three groups to test mode effects of collecting biological data with self-reported survey data (n = 303). RESULTS: It showed two groups of youth (those who are not asked for a biological and those asked for a biological with an indirect explanation of its use) had similar response rates and self-reported smoking status, while the third group (biological request with a direct explanation of its use) had a substantially lower response rate and self-reported smoking status. CONCLUSIONS: The data show youth who are given an indirect explanation of how biological data are to be used were as likely to self-report their smoking status as youth who were not asked to provide a biological sample.

Young adult former ever smokers: the role of type of smoker, quit attempts, quit aids, attitudes/beliefs, and demographics.

OBJECTIVE: Young adults who smoke are often nondaily users who either quit or transition into dependent smokers. Further, this age group often has been considered an extension of the adult population. This study aims to examine young adult former ever smokers to understand factors associated with their stopping smoking. METHOD: Telephone interviews were conducted in 2010 with 4401 young adults in Florida. We examined the association between former ever smokers and sociodemographics, smoking behavior, quit attempts, quit aids, and attitudes/beliefs about smoking. RESULTS: Thirty-seven percent of young adults were former smokers, 20% were current smokers, and 43% were never smokers. Former smokers were more likely to be female, situational smokers (compared to occasional or established), more likely to have stopped smoking without acknowledging making a quit attempt, less likely to have used a quit aid, and less likely to display pro-tobacco attitudes/beliefs. CONCLUSION: Young adult former and current smokers have unique patterns of smoking and stopping smoking. Young adults may require novel intervention techniques to promote prevention and cessation based on these unique smoking patterns. Future research is needed to understand motivations to quit smoking among young adults.

Correlates of smoking among young adults: the role of lifestyle, attitudes/beliefs, demographics, and exposure to anti-tobacco media messaging.

BACKGROUND: Young adults (18-24 years) have the highest smoking rate of any age group. Unlike youth/adult populations where there is one primary message targeting behavior, anti-tobacco campaigns targeting young adults should contain messages of prevention and cessation. The objective was to identify factors influencing young adult cigarette use, employing the Centers for Disease Control and Prevention logic model, with an emphasis on the role of lifestyle, tobacco use tolerance, and attitudes/beliefs. METHODS: Cross-sectional data were collected from 4401 young adults using telephone interviews in 2010 as part of the evaluation for the Tobacco Free Florida Campaign. Multivariate logistic regression was used to examine the relationship between current smoking status and lifestyles, tolerance of tobacco use, and attitude/belief variables. RESULTS: The young adult cigarette prevalence rate is 20.3%, with males more likely to be smokers (25.1%) than females (15.6%) and non-Hispanic Whites more likely to be smokers than other racial/ethnic groups (23.8%). Significant associations were found between lifestyle variables (frequent bar/club, drinks per month, and number of friends who smoke), tolerance of tobacco use (allow smoke in house/car and moderate tobacco use), and four attitude/belief indices and current smoking behavior. CONCLUSIONS: Results suggest lifestyles and attitudes/beliefs should be key behavioral targets of prevention programs aimed at young adults. Data strongly suggest that as young adults reject negative labels attached to smokers, they are more likely to smoke. Prevention (and cessation) programs may need to reduce barriers that result in segregating nonsmokers/smokers so smokers can have an increased chance of adopting attitudes/beliefs of nonsmokers.

Changes in youth cigarette use following the dismantling of an antitobacco media campaign in Florida.

We examined the association of the termination of a successful youth-targeted antitobacco media campaign ("truth") and changes in smoking rates among youths aged 12-17 years in Florida. Six telephone-based surveys were completed during the active media campaign (1998-2001), and 2 postcampaign surveys were completed in 2004 and 2006 (each n approximately 1,800). Prevalence of current smoking among youth observed during the campaign continued to decrease in the first postcampaign survey; however, by the second follow-up survey, youth smoking rates had increased significantly for youth aged 16 years or older. Our findings support the need for consistent antitobacco messaging to reduce the prevalence of youth smoking.

Using classification trees to profile adolescent smoking behaviors.

The purpose of this study was to explore the interactive nature of various predictor variables in profiling adolescent smoking behaviors characterized by intention to smoke, current, situational, and established smoking using classification trees. The data (n = 3610) were obtained from cross-sectional telephone surveys of the Florida Anti-Tobacco Media Evaluation Program. Three classification trees were constructed, namely, intention versus no intention to smoke among non-smokers, current smokers versus non-smokers, and established versus situational smokers. The tree model for the intention model revealed that social and health risks are important in the context of peer smoking. Certain variables such as peer smoking and alcohol consumption retained their relative importance across the tree classifiers demonstrating that smoking intention may be predictable using some of the same variables as in current or more dependent smoking.

The outcome consequences of defunding the Minnesota youth tobacco-use prevention program.

OBJECTIVE: To assess the immediate and intermediate outcome consequences of defunding a successful tobacco use prevention program. METHODS: A four-survey repeated cross-sectional design is employed. Two surveys were completed while the program was fully operational, one after program dismantling was initiated and another about 6 months after the campaign was completely dismantled. Survey to survey trends for five immediate and six intermediate outcomes are analyzed. Changes in measures are tested employing chi-square estimated using SAS 8. RESULTS: Each immediate outcome measure declined significantly from the third to the fourth survey except one, and this measure declined from the second to the third survey when it was eliminated. All intermediate outcomes showed significant change from the third or second to the fourth survey. These include two measures of openness to smoking, three attitude/belief scales and one measure of intention to smoke. CONCLUSIONS: Defunding a successful tobacco-use prevention campaign results in rapid erosion of program messages, parallel increases in susceptibility, a rapid and sharp re-emergence of pro-tobacco attitudes/beliefs and a marked rise in intentions to smoke.

Assessing the reliability and validity of anti-tobacco attitudes/beliefs in the context of a campaign strategy.

OBJECTIVES: To identify multi-item attitude/belief scales associated with the theoretical foundations of an anti-tobacco counter-marketing campaign and assess their reliability and validity. METHODS: The data analyzed are from two state-wide, random, cross-sectional telephone surveys [n(S1)=1,079, n(S2)=1,150]. Items forming attitude/belief scales are identified using factor analysis. Reliability is assessed with Chronbach's alpha. Relationships among scales are explored using Pearson correlation. Validity is assessed by testing associations derived from the Centers for Disease Control and Prevention's (CDC) logic model for tobacco control program development and evaluation linking media exposure to attitudes/beliefs, and attitudes/beliefs to smoking-related behaviors. Adjusted odds ratios are employed for these analyses. RESULTS: Three factors emerged: traditional attitudes/beliefs about tobacco and tobacco use, tobacco industry manipulation and anti-tobacco empowerment. Reliability coefficients are in the range of 0.70 and vary little between age groups. The factors are correlated with one-another as hypothesized. Associations between media exposure and the attitude/belief scales and between these scales and behaviors are consistent with the CDC logic model. CONCLUSIONS: Using reliable, valid multi-item scales is theoretically and methodologically more sound than employing single-item measures of attitudes/beliefs. Methodological, theoretical and practical implications are discussed.

Evidence of the dose effects of an antitobacco counteradvertising campaign.

OBJECTIVE: The objectives were to assess the cumulative effects of exposure to multiple antitobacco advertisements shown over a 22-month period on smoking uptake, and determine if there is evidence of a dose effect and how this effect operates through response to the campaign's major message theme and antitobacco attitudes. METHODS: A follow-up telephone survey of persons ages 12-20 years was conducted after 22 months of the Florida "truth" antitobacco media campaign. Logistic regression analyses were used to estimate adjusted odds ratios for the likelihood that time-one nonsmokers would remain nonsmokers at time two by levels of confirmed advertisement awareness, self-reported influence of the campaign's message theme, and anti-tobacco industry manipulation attitudes. Separate cohorts are analyzed and controls include gender and time-one susceptibility. RESULTS: The likelihood of nonsmokers remaining nonsmokers increases as the number of ads confirmed, the self-reported influence of the campaign's major message theme, and the level of antitobacco attitudes increases. The pattern to these relationships holds within cohorts of young and older youth and for a cohort that has aged into the early young adult years. Considering all variables simultaneously suggests that ad confirmation operates through its effects on the influence of the message theme and antitobacco industry manipulation attitudes. CONCLUSIONS: There is evidence of a dose effect; however, considering only ad confirmation underestimates this. Antitobacco campaigns that target youth can have effects at least through the early young adult ages. The uniqueness of the Florida campaign may limit the generalization of reported results.