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Patterns of tobacco use from adolescence to young adulthood

Institution: RAND Corporation
Investigator(s): Phyllis Ellickson, Ph.D.
Award Cycle: 1997 (Cycle 6) Grant #: 6RT-0245 Award: $565,277
Subject Area: Epidemiology
Award Type: Research Project Awards
Abstracts

Initial Award Abstract
Why do young people of different racial/ethnic groups start and stop smoking? Researchers at RAND's Health Program will try to answer that question by analyzing the smoking habits of an ethnically diverse group of young Californians. The findings of the study will help improve programs aimed at reducing tobacco use by the state's adolescents and young adults - and will shed light on how to make such programs more sensitive to different racial/ethnic attitudes about smoking.

The study will be based on information gathered from 1985 to 1996 about a group of participants whose history of tobacco use was traced from early adolescence (ages 12-13) to young adulthood (ages 23-24). The participants were originally enrolled in 19 middle- and junior high school in five school districts from Northern and Southern California.

RAND's analysis of the information collected about these participants will provide an overall picture of tobacco use by both male and female Californians in the years leading up to adulthood. An important part of that picture will reveal similarities and differences in the smoking habits across four racial/ethnic groups: African American, Hispanic, Asian and non-Hispanic white.

By examining data collected over a long term, the study will uncover differences in reasons why members of these groups start to smoke, why some of them quit, and why many of them keep smoking. The findings can help smoking prevention and treatment programs better meet the needs of young people in all four racial/ethnic groups.

Final Report
This study uses data from a ten-year panel of over 3,000 California and Oregon youth to examine variation in rates of initiation, current smoking, and cessation across groups and over time. Prospective profiles of smoking status across five and ten year periods show substantial movement in and out of smoking with high quit rates and low uptake rates for African Americans and Asians compared with whites and Latinos. Heavy smoking was low in grade seven but increased dramatically by grade twelve, with white youth reporting the highest rates of smoking at age 18 followed by Hispanic, Asian and African American youth.

Doing poorly in middle/high school and prior smoking behavior are robust predictors of both initiation and cessation across the two developmental periods (between grade 7 and grade 12 and between grade 12 and age 23). Being young for one's cohort and intending to smoke in the next 6 months-predicted initiation at ages 18 and 23 and cessation at age 18. Grade 7 risk factors unique to high school smoking initiation include being female, being white, and early deviant behavior. Protective factors include being African American, Hispanic or Asian.

Adolescent females who quit smoking by grade 12 had friends who smoked less frequently, perceived less parental approval of their smoking, reported weaker intentions to continue smoking and had weaker bonds with family and school. Females who quit smoking as young adults also had fewer smoking friends, less parental approval of smoking and weaker intentions to smoke (plus better grades in high school), while males who quit as young adults had fewer offers, weaker intentions, stronger familial bonds, and good grades. Lower rates of current smoking among Asian and African American young adults were explained by social influences during high school, particularly lower exposure to friends and siblings who smoked and to parental approval of smoking. Lower rates of smoking by African American adolescents compared to whites were explained by greater exposure to parental disapproval of smoking, greater vulnerability to such disapproval, and less exposure to peers who smoke.

These results suggest that smoking prevention should start early and continue through high school, that improving school performance might curb smoking and that prevention and cessation efforts should be sensitive to the greater risk of smoking initiation among whites and adolescent females. Prevention efforts should continue to focus on decreasing vulnerability to pro-smoking influences and curbing motivations to smoke, while also helping parents effectively communicate their disapproval of smoking throughout the adolescent years. Programs aimed at smoking cessation among adolescent females need to take a multidimensional approach, addressing parental attitudes toward smoking, peer smoking, and school and social bonds and use of other substances.
Publications

Explaining racial/ethnic differences in smoking during the transition to adulthood.
Periodical: Addictive Behaviors Index Medicus:
Authors: Ellickson P, Perlman M, Klein D ART
Yr: 2003 Vol: 28 Nbr: Abs: Pg: 915-931

Smoking cessation during the transition from adolescence to young adulthood.
Periodical: Nicotine and Tobacco Research Index Medicus:
Authors: Tucker J, Ellickson P, Klein D ART
Yr: 2002 Vol: 4 Nbr: 3 Abs: Pg: 321-332

Sex differences in predictors of adolescent smoking cessation.
Periodical: Health Psychology Index Medicus:
Authors: Ellickson P, Tucker J, Klein D ART
Yr: 2001 Vol: 20 Nbr: 3 Abs: Pg: 186-195

Predictors of late-onset smoking and cessation over ten years.
Periodical: Journal of Adolescent Health Index Medicus:
Authors: Ellickson P, McGuigan K, Klein D ART
Yr: 2001 Vol: 29 Nbr: 2 Abs: Pg: 101-108