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Smoking and Post-traumatic Growth Among High Risk Youth

Institution: University of Southern California
Investigator(s): Thalida Arpawong, M.P.H.
Award Cycle: 2011 (Cycle 20) Grant #: 20DT-0041 Award: $57,392
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Dissertation Awards

Initial Award Abstract
The process resulting in the initiation of cigarette smoking is complex, particularly during adolescence, a tumultuous time period in which one is finding his/her autonomy and experiencing varying degrees of stress. Many sources of stress exist for youth including traumatic events such as community violence, natural disasters, medical trauma, and abuse. Studies have reported that 67.0% of adolescents have experienced at least one traumatic event by the age of 16. This percentage is estimated to be elevated among high-risk youth, particularly those attending alternative high schools. In dealing with stress, some adolescents resort to maladaptive behaviors such as cigarette smoking and other substance use. On the other hand, many adolescents are not only able to successfully cope with the stress from traumatic experiences but also positively adjust and develop Post-traumatic Growth (PTG). Those who undergo PTG tend to undergo a process of reevaluation and redefinition of their life’s priorities and emerge in the aftermath of a traumatic experience with a greater investment in and appreciation for life, interpersonal relationships, spirituality, and sense of personal strength. They tend to report more meaning in life and a greater sense of self-reliance in addition to a higher level of resilience from stress and trauma. Furthermore, PTG has been linked to better coping and healthier behaviors in the long run.

This study investigates the level of cigarette smoking, stress/trauma coping, and PTG among alternative high school students who are predominantly Latino/Hispanic. Alternative high school students are estimated to have significantly higher rates of 30-day cigarette smoking compared to regular students, 70.1% to 36.3%, respectively. Also, in California, Latino/Hispanic adolescents report the highest levels of having ever tried smoking of all ethnicities (42.8%) compared to whites (38.2%), African-Americans (35.8%), and Asian/Pacific Islanders (27.8%).

We hypothesize that better coping styles and higher levels of PTG will be related to lower levels of cigarette smoking. We also look at how these relationships differ in males and females, and anticipate that higher levels of PTG and lower levels of smoking will be reported among females. In addition, we examine if the effect that PTG has on the relationship between stress and smoking varies by levels of other interpersonal and intrapersonal factors such as family conflict, depression, positive affect, and social support. One unique and important aspect of this study is that we are able to collect data at multiple time-points such that we can evaluate if coping (measured at time-point 1) leads to PTG (measured at time-point 2), and in turn leads to change in smoking (measured at time-points 1, 2 and 3).

Results of this study will help to fill gaps in the current literature as well as help to refine future intervention programs. Implementing programs to aid youth in coping with the stress from trauma may be an important preventive measure in discouraging the initiation of cigarette smoking and ultimately reducing tobacco-caused morbidity and mortality among California’s diverse population of adolescents. It is particularly important to address racial and ethnic groups with higher reported levels of tobacco-related health disparities. This study includes a large sampling of Latino/Hispanic adolescents who consistently report higher current and lifetime smoking rates. Current teen tobacco prevention and cessation programs could be improved by including an effective stress and trauma coping module, especially when targeted at high-risk youth such as those in alternative high schools, are more likely to have experienced significant trauma, and who have a higher likelihood to experiment with smoking. Moreover, in the under-researched group of older adolescents emerging into adulthood, uncovering some of the mechanisms that lead to smoking or are protective against it is crucial for enhancing tobacco control efforts in the ethnically diverse population of California.