Parental smoking and adolescent smoking initiation: an intergenerational perspective on tobacco control.

OBJECTIVE: Adolescence is an important period of risk for the development of lifelong smoking behaviors. Compelling, although inconsistent, evidence suggests a relationship between parental smoking and the risk of smoking initiation during adolescence. This study investigates unresolved issues concerning the strength and nature of the association between parent smoking and offspring smoking initiation. METHODS: We enrolled 564 adolescents aged 12 to 17, along with 1 of their parents, into the New England Family Study between 2001 and 2004. Lifetime smoking histories were obtained from parents and their adolescent offspring. Discrete-time survival analysis was used to investigate the influence of parental smoking histories on the risk of adolescent smoking initiation. RESULTS: Parental smoking was associated with a significantly higher risk of smoking initiation in adolescent offspring. In addition, the likelihood of offspring smoking initiation increased with the number of smoking parents and the duration of exposure to parental smoking, suggesting a dose-response relationship between parental smoking and offspring smoking. Offspring of parents who had quit smoking were no more likely to smoke than offspring of parents who had never smoked. The effects of parental smoking on offspring initiation differed by sex (with a stronger effect of fathers' smoking on boys than girls), developmental period (with a stronger effect of parental smoking before the adolescent was age 13 than afterward), and residence of parents (with effects of fathers' smoking being dependent on living in the same household as the adolescent). Parental smoking was also associated with stronger negative reactions to adolescents' first cigarette, a potential marker of the risk of progression to higher levels of use. CONCLUSIONS: Parental smoking is an important source of vulnerability to smoking initiation among adolescents, and parental smoking cessation might attenuate this vulnerability.

How do Mothers, Fathers, and Friends Influence Stages of Adolescent Smoking?

Parent and friend influences may differentially promote or deter adolescent smoking at discrete stages. Drawing from national (Add Health) data, a partial proportional odds ordinal regression model was utilized to examine the multivariate influence of parent and friend variables and their interactions on transitions across smoking stages (Never Smokers, Experimenters, Intermittent, Regular/Established) separately for mother-child pairs (N = 15,983) and father-child pairs (N = 1,142). Friend smoking status was by far the strongest predictor across smoking stages. Gender differences indicated males with one or more daily smoking friends are at higher risk for regular smoking relative to females. Fathers' smoking status had a direct effect on teen smoking across all stages, whereas mothers' smoking was significant in influencing which stage of smoking teens exhibited. Moreover, maternal smoking status had an indirect effect by moderating the association between teen smoking and the closeness of the mother-teen relationship. Mothers who smoke were found to have a stronger impact on the transition to regular smoking compared to mothers who do not smoke regardless of the number of smoking friends the teen reports. Results have implications for stage-matched and family-based prevention and intervention programs.

Cancer prevention in primary care: predictors of patient counseling across four risk behaviors over 24 months.

OBJECTIVE: Rates of preventive counseling remain below national guidelines. We explored physician and patient predictors of preventive counseling across multiple cancer risk behaviors in at-risk primary care patients. METHODS: We surveyed 3557 patients, with at least one of four cancer risk behaviors: smoking, diet, sun exposure, and/or mammography screening, at baseline and 24 months. Patients reported receipt of 4A's (Ask, Advise, Assist, Arrange follow-up); responses were weighted and combined to reflect more thorough counseling (Ask=1, Advise=2, Assist=3, Arrange=4, score range 0-10) for each target behavior. A series of linear-regression models, controlling for office clustering, examined patient, physician and other situational predictors at 24 months. RESULTS: Risk behavior topics were brought up more often for mammography (90%) and smoking (79%) than diet (56%) and sun protection (30%). Assisting and Arranging follow-up were reported at low frequencies across all behaviors. More thorough counseling for all behaviors was associated with multiple visits and higher satisfaction with care. Prior counseling predicted further counseling on all behaviors except smoking, which was already at high levels. Other predictors varied by risk behavior. CONCLUSIONS: More thorough risk behavior counseling can be delivered opportunistically across multiple visits; doing so is associated with more satisfaction with care.

Assessment of parents' smoking behaviors at a pediatric emergency department.

The pediatric emergency department is an important source of treatment for children with complaints related to environmental tobacco smoke (ETS) and may provide a teachable moment to address parent smoking. Parents who smoke were recruited from a pediatric emergency department waiting room and completed an interview assessment used to develop intervention messages. Of the 715 parents in the final sample, 77% were women, 60% White, and 60% low income (

Family and peer influences on tobacco use among adolescents with psychiatric disorders.

The purpose of this study was to examine family and peer influences on smoking behaviors among 239 (191 smokers; 48 nonsmokers) psychiatrically hospitalized adolescents. Participants were queried using scales to measure parental supervision and monitoring, parenting style, adolescent-parent communication, family conflict and relations with parents, and the importance placed on life goals. The results of this study are consistent with previous findings from general population studies. Psychiatrically hospitalized adolescents' smoking status were also correlated with their siblings', peers', and girlfriends'/boyfriends' smoking status. In addition, we found that parental monitoring, closeness to parents, and ambitious life goals were protective factors against smoking. As a result, peer and family influences strongly impact the initiation and maintenance of adolescent smoking and should be considered when designing smoking cessation interventions for adolescents with psychiatric disorders.

HIV-RISK BEHAVIORS AMONG PSYCHIATRICALLY HOSPITALIZED ADOLESCENTS WITH AND WITHOUT COMORBID SUD.

OBJECTIVE: The purpose of this study was to examine HIV-risk behaviors among a sample of psychiatric inpatient adolescents with and without comorbid SUD. METHOD: 239 adolescents (60.7% female; mean age=15.3) were interviewed while hospitalized in a psychiatric inpatient treatment facility. Adolescents with and without substance use disorder (SUD) were compared on a number of HIV-risk behaviors and the association between HIV-risk behaviors and other types of mental health problems were examined. RESULTS: Compared to those without SUD, adolescents with SUD, after controlling for age, gender, and other psychiatric disorders, were at an increased risk for being currently sexually active (AOR=2.01, CI=1.00-4.04, p<.05) and for having used alcohol or drugs prior to last sexual intercourse (AOR=5.48, CI=1.91-15.72, p<.01). HIV-risk behaviors were more evident among adolescents with externalizing disorders and those with higher levels of self-reported distress. CONCULSION: Adolescents in psychiatric settings, especially those with substance use disorders and/or externalizing problems, are an important population for whom prevention efforts are needed to reduce the risk of HIV infection.

Adolescents and genetic testing: what do they think about it?

PURPOSE: To examine adolescents' attitudes toward screening for hereditary disorders. METHODS: A survey was distributed among 672 students in grades 10 to 12 attending a public suburban high school. The first part of the survey consisted of information about three diseases: familial breast cancer, Tay-Sachs disease, and hypercholesterolemia. The second part was a questionnaire developed by the authors, which explored students' attitudes toward testing for these diseases. Comparisons between and within groups were performed using X2 analysis. RESULTS: Out of the 672 surveys distributed, 361 were returned (54% response rate). Mean age of participants was 17 +/- 1 years. Most girls (67%) wanted to be tested for familial breast cancer. Girls were significantly more willing than boys to be tested for Tay-Sachs disease (23% vs. 13%, p <.002) and for hypercholesterolemia (54% vs. 39%, p <.001). Girls who had a relative with breast cancer were significantly more willing to be tested than other girls (p <.05). Individuals in the ethnic risk groups for Tay-Sachs disease were significantly more willing to be tested than those not in the ethnic risk groups (p <.001). However, only 33% of those in the ethnic risk groups for Tay-Sachs disease stated that they would either "definitely" or "probably" wish to be tested. Students who had a family history of high cholesterol were significantly more willing to be tested than those without a family history (70% vs. 34%, p <.0001). About 81% of the students with a family history of high cholesterol had never been referred for cholesterol testing. Only about 25% of participants stated that their attitude toward genetic testing was affected by concerns that genetic information might be misused by insurance companies/employers. CONCLUSIONS: The main motivator for genetic testing is having someone in the family affected by the disease in question. Adolescent girls are more willing to be tested for genetic diseases than are boys.

An academic detailing intervention to disseminate physician-delivered smoking cessation counseling: smoking cessation outcomes of the Physicians Counseling Smokers Project.

BACKGROUND: Little is known about the effectiveness of interventions to disseminate smoking cessation interventions among a population of primary care physicians. This study's objective was to determine the effect of a community-based academic detailing intervention on the quit rates of a population-based sample of smokers. METHODS: This community-based, quasi-experimental study involved representative samples of 259 primary care physicians and 4295 adult smokers. An academic detailing intervention was delivered to physicians in intervention areas over a period of 15 months. Analyses were performed on the data from the 2346 subjects who reported at least one physician visit over 24 months. Multivariate regression analyses were conducted to determine the impact of the intervention on self-reported smoking quit rates, reported by adjusted odds ratios. RESULTS: Among smokers reporting a physician visit during the study period, there was a borderline significant effect for those residing in intervention areas versus control areas (OR = 1.35; 95% CI.99-1.83; P = 0.057). Among a subgroup of 819 smokers who reported a visit with an enrolled physician, we observed a significant effect for those residing in intervention areas (OR = 1.80; 95% CI 1.16-2.75; P = 0.008). CONCLUSION: An academic detailing intervention to enhance physician delivered smoking cessation counseling is an effective strategy for disseminating smoking cessation interventions among community-based practices.

Differentiating stages of smoking intensity among adolescents: stage-specific psychological and social influences.

Researchers' understanding of the impact of sociocultural and psychological factors on the various stages of adolescent smoking uptake is limited. Using national data, the authors examined transitions across smoking stages among adolescents (N = 20,747) as a function of interpersonal, familial, and peer domains. Peer smoking was particularly influential on differentiating regular smoking, whereas alcohol use was most influential on earlier smoking. Although significant, depression and delinquency were attenuated in the context of other variables. Higher school grade was more likely to differentiate regular smoking from earlier smoking stages, whereas African American ethnicity and connectedness to school and family were protective of smoking initiation. Results lend support for an interactional approach to adolescent smoking, with implications for stage-matched prevention and intervention applications.