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Global determinants of tobacco use onset in diverse youth

Institution: Education Training and Research Associates, Inc.
Investigator(s): Scott Carvajal, Ph.D., MPH
Award Cycle: 1998 (Cycle 7) Grant #: 7KT-0151H Award: $280,749
Subject Area: Epidemiology
Award Type: New Investigator Awards

Initial Award Abstract
The goal of this study is to identify smoking-related factors (e.g., attitudes and peer influences) as well as other more general factors (e.g., sense of future, parenting styles) related to tobacco use onset and continued use of tobacco in middle school aged youth, and to determine how these factors may differ across important sub-groups.

To accomplish these goals, a model of potential factors related to smoking will be tested to examine which factors predict tobacco use onset and continued use of tobacco in middle school youth. The model will also provide data regarding which factors are most important in understanding why students begin and continue to use tobacco at this age. The model will include smoking-related factors, such as students' perceived ability to resist tobacco use (self efficacy), students' attitudes regarding smoking, social norms (e.g., friends' and families' views regarding smoking), and environmental barriers related to cigarette smoking (e.g., access, resources, availability of places to smoke). Additionally, the model will include other potentially important general factors that have not been routinely tested in the past. These include: sense of future, depression, coping ability and connectedness to parents and others. These more general factors are currently believed to be important predictors of adolescent risk behavior, but more research is needed to understand their relationships to smoking behavior, particularly among young adolescents.

One of the important aspects of this study will involve examining how these factors differ across important sub-groups, such as males and females, members of different ethnic/racial groups, students who have differing levels of acculturation, students who are at different levels of tobacco use onset (e.g., experimenters vs. daily users) and students who report other health risk behaviors. This type of information is essential to help improve and tailor prevention programs for specific populations.

The study will involve collecting survey data three times over a two-year period from a group of 3,000 middle school students (in grades 6 and ave parental permission to participate in the project. The students will be drawn from urban schools in northern California. The study will also involve collecting data on one occasion from 1,500 8th grade students.

Currently, there is little research showing the relationships between important smoking-related factors and more general factors in adolescent tobacco use. The results of this study could be invaluable to practitioners and researchers developing comprehensive tobacco use prevention programs by providing guidance on which factors appear to be most likely to lead to sustained reductions in tobacco use among young adolescents.

Final Report
While there have been many studies of the determinants (factors) leading to youths’ cigarette smoking or risk for smoking, very few studies have tested integrated models, especially in diverse populations. The goal of this study is to identify smoking-related determinants (e.g., attitudes and beliefs particular to cigarettes) as well as other more general determinants (e.g., sense of future, optimism, parenting styles) related to tobacco use onset in middle school aged youth, and to determine how the relevant determinants differ across important sub-groups. This investigation will advance our understanding of tobacco initiation and escalation by testing one of the most comprehensive models of tobacco-specific and general determinants, and by examining the appropriateness of the model among different sub-groups.

The major programmatic objectives were achieved by our project. We developed a survey to assess a broader array of smoking behaviors and smoking determinants than typically employed in related research, and had a survey component of special relevance to Latino youth. Spanish and English versions of our survey were also developed. Another important element to our study was our recruiting sufficiently large and diverse schools to address our aims; we achieved this as we collected data with our survey on more than 2000 middle school students (1622 in cohort), and the largest group in the study was Latinos (over 40% of the sample). We also set key sampling and follow-up goals for our project—vital for making sound scientific inferences about the relationships of smoking and smoking determinants to California youth beyond our study participants. Through using incentives and frequent staff contact with teachers in our randomly selected classrooms, we were able to achieve our participation goals; for instance we had over 60% of our entire targeted sample participate, and 65% of our potential cohort students participated. Equally important, as a result of our careful cohort tracking procedures and regular staff contact with participants who moved to different schools after initial participation, we met our goals for cohort attrition. Our baseline to first follow up rate was above 85%, our baseline to second follow up rate was above 80%, and our first follow-up to second follow-up rate was above 90%.

Studies from our project data have revealed novel findings on the determinants of youth smoking. For instance, we have identified and tested a more complete model predicting current smoking than previous research. This work has shown that a combination of factors from the Theory of Planned Behavior and Social Cognitive Theory provide a good framework to predict current smoking levels in teens. Additionally, we have identified novel predictors of risk for future smoking in younger teens, otherwise described as smoking susceptibility. Parental relatedness in White teens and optimism in low SES teens appear to be critical predictors of risk for smoking, and should be considered as targets for smoking prevention programs that begin earlier than the traditional programs focused on middle school-aged students. We also have found that Latinos who are attached to and functional with their own culture as well as with other cultures (e.g., bicultural) appear to have lower levels of risk factors for future smoking. This research has already been, and will continue to be, disseminated at major national conferences and in professional journals that reach a high number of tobacco prevention professionals. Included in the forthcoming research will be findings on predictors of escalation of tobacco use over time, providing further new directions for youth tobacco preventive interventions.