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Abstract: Background: Underage heavy episodic drinking is a major contributor to alcohol-related morbidity/mortality. Reports indicate underage binge drinking among college students is widespread and has remained stable over the past decade. This study describes individual characteristics and calendar-specific events associated with binge drinking episodes over the course of freshman college academic year (2002–2003). Methods: Students (N =827, age 18 years), with a prior history of tobacco use, attending a large Midwest university completed weekly web-based surveys on the number of drinks consumed for each of the past 7 days over the duration of 35 consecutive weeks (avg. number of weeks reported 16.0±10.5). Results: Average prevalence of binge episodes across the academic year was 17.2±14.4%, 23.6±8.3%, and 66.3±11.2% for weekdays, Thursdays, and weekend days, respectively. Two-level random effects logit survival models for repeated events indicated the prevalence of weekday and Thursday binge drinking was associated with specific university/community events (Local festival odds ratio [OR] 6.03, 95% confidence interval [CI] 4.34–8.36), holidays (New Year''s Eve OR 18.48, CI 12.83–26.63), and academic breaks (Spring Break OR 6.45, CI 4.57–9.08). Expected associations of younger age of first heavy drinking, past 12-month drinking, and experiencing negative consequences from heavy drinking were observed. Conclusions: Although individual characteristics were related to engaging in a binge episode, binge episodes were strongly associated with time-specific calendar events. Effective interventions to prevent immediate and long-term health consequences associated with binge drinking should consider environmental and institutional policy-level controls to reduce high levels of binge drinking on college campuses connected with holidays and university/community events. [Copyright &y& Elsevier]

Aims Little is known about smoking during the transition to college. The current study examined trajectories of smoking among college freshmen, how trajectories predicted later smoking and the social context of smoking. Design Weekly assessments of daily smoking were collected via the web during the first year of college for a large cohort with a previous history of smoking. Participants and setting A total of 193 college freshmen from a large public university with a previous history of smoking who smoked frequently enough to be included in trajectory analysis. Measurements Measures included weekly reports of daily smoking, family smoking, perceived peer attitudes and smoking, social norms and social smoking environment. Findings Seven trajectories were identified: one of low-level sporadic smoking, one of low-level smoking with a small increase during the year, two classes with a substantial decrease during the year, two classes with relatively small decreases and one class with a substantial increase in smoking. Trajectories of smoking in the freshman year predicted levels of sophomore year smoking, and some social context variables tended to change as smoking increased or decreased for a given trajectory class. Conclusions The transition into college is marked by changes in smoking, with smoking escalating for some students and continuing into the sophomore year. Shifts in social context that support smoking were associated with trajectories of smoking. Despite the focus of developmental models on smoking in early adolescence, the transition into college warrants further investigation as a dynamic period for smoking. [ABSTRACT FROM AUTHOR]

Recruitment of adolescents into tobacco use research is often challenging. This study reports on the predictors of recruitment and retention in a longitudinal study of adolescent smoking behavior. In 2000, 8th and 10th grade students at 18 schools ( N = 5,298) in the Chicago metropolitan area completed brief screening surveys; 1457 students (ranging from susceptible nonsmokers to regular smokers) were invited to participate in a longitudinal study, and 48.9% agreed. Chi-square analyses revealed that female and white students were more likely to participate than male and nonwhite students. Recruitment rates did not vary by parental smoking status, students' experience with smoking, or student grade. Multivariate analyses revealed that overall, gender and race were significant predictors of participation. Chi-square and multivariate analyses revealed no significant differences in retention on the demographic, smoking experience, or psychosocial variables measured. Implications of the results and study limitations are discussed. [ABSTRACT FROM AUTHOR]

Outcome expectancies have been related to smoking behavior among adults, but less attention has been given to expectancies about smoking among adolescents at differing levels of smoking experience. The present study reports the psychometric properties and predictive validity of a brief expectancy scale across two samples of adolescents. Sample 1 (N = 349) consisted of high school students (54% female) who were regular smokers enrolled in a cessation program. Sample 2 (N = 273) consisted of 8th- and 10th-grade early experimenters (54% female) involved in a natural history study of smoking trajectories. In both samples, a principal component analysis of a 13-item expectancy scale yielded four factors (taste, weight control, boredom relief, and negative affect management), each with high internal consistency (coefficient alphas >.77) and accounting for 73% and 80% of the total variance for each sample, respectively. Expectancies were significantly higher among current smokers than among early initiators. In Sample 1, boredom relief and weight management expectancies predicted smoking status 6 months later. In Sample 2, students whose smoking increased over 18 months had higher overall expectancies at baseline compared with those who tried smoking and did not escalate. These findings support the predictive validity of expectancies in predicting escalation and cessation. Implications for the importance of expectancies in understanding adolescent smoking behavior are considered. [ABSTRACT FROM AUTHOR]

Very few studies have defined trajectories of smoking. In the present study, we modeled growth in adolescent smoking and empirically identified prototypical trajectories. We conceptualized escalation of smoking as a growth process and modeled rates of change and heterogeneity of these patterns using latent growth mixture modeling. The analysis identified six trajectories with low ambiguity about group membership (early rapid escalators, late rapid escalators, late moderate escalators, late slow escalators-smokers, stable puffers, and late slow escalators-puffers). A trajectory of quitters was not identified. We also examined predictors of the smoking trajectories. The predictors were assessed across the adolescent years and included variables related to smoking and other substance use, as well as a range of variables related to sociodemographic factors and mental health. Observed change in the pattern of predictors across age has implications for the mechanism of effect of these variables in relation to smoking trajectories, including predictors that differentiated among daily smokers, variables that may determine the trajectory (e.g., friends smoking), and variables that may result from the trajectory (e.g., marijuana use, less attachment to friends). [ABSTRACT FROM AUTHOR]

To demonstrate that intentions predict long-term future levels of smoking, irrespective of level of past smoking experience. A growing body of research suggests that intentions about future smoking might play an important role in addition to the influence of past smoking experience on the likelihood of smoking in future. Using logistic regression analyses, we assessed the relationship between baseline smoking experience and a firm intention ‘not to be smoking cigarettes 5 years from now’ with four outcome measures of smoking at follow-up: 30-day smoking at a 3/4- and 5/6-year follow-up and current established smoking (self-described regular smokers or former smokers who had smoked in the past 30 days) at a 3/4- and 5/6-year follow-up. US nationally representative samples of 12th graders who responded to the Monitoring the Future (MTF) survey from the years 1976 to 1993, inclusive. For these panels, we linked stage of smoking and intentions at 12th grade to follow-up measures of smoking collected at 3/4 years after baseline and 5/6 years after baseline. Analysis of 3/4-year follow-up data (weighted n = 4544) and 5/6-year follow-up data (weighted n = 3885) for both definitions of smoking outcome indicated that there was a dose–response relationship between levels of baseline smoking experience and the likelihood of future smoking. In addition, independent of baseline smoking experience, there was a statistically significant protective effect for a firm intention not to smoke in five year's time on future smoking behavior. The findings suggest that evaluative studies of tobacco control policies and programs might usefully employ smoking uptake categories that incorporate smoking intentions as early indicators of outcome. [ABSTRACT FROM AUTHOR]

The Theory of Triadic Influence provides a unified and parsimonious integration of (a) the many empirical findings regarding correlates of, or influences on, youth tobacco use, (b) the many sociological and psychological theoretical explanations of youth tobacco use, and (c) the various tested approaches to addressing the supply-side and demand-side factors that influence youth initiation of tobacco use. Findings reported in this section by Drs Chaloupka, Emery, Choi, Pierce, and Rigotti support the important role of socio-cultural factors, particularly price, advertising/promotion and access policies, in influencing youth tobacco use. The TTI reminds us that these factors are fairly distal, so that their mechanisms of action may be multiple, and other approaches to prevention might multiply the effects of changes in any one of these factors. For example, a counteradvertising message might increase the overall effects of pricing by emphasizing the social unacceptability of smoking that might be implied by higher prices (and associated lower levels of use by adults). Findings reviewed by Dr Pentz, together with those reported in other sessions (particularly those by Drs Mermelstein, McMahon, and Shiffman) support the role of all of the other social and intrapersonal factors suggested in the TTI. Much further research is needed, however, on causal processes, that is, on understanding how the various factors have their effects. Factors may have their influences through various mechanisms (e.g., mediation, moderation, feedback), and knowledge of these mechanisms may lead to improved approaches to prevention. Prevention programs designed for whole populations of students (that is, universal programs) may need to be supplemented by special programs tailored for students at higher risk than most (e.g., children with conduct disorder) (that is, selective intervention). Students who become heavy experimenters may require special prevention programs (i.e., indicated interventions)—such programs are yet to be designed and evaluated. Finally, youth who use enough tobacco, or use on enough occasions, to become dependent or addicted will need cessation programs to help them quit—these will be reviewed in Section VI. [ABSTRACT FROM AUTHOR]

Knowledge of risk and protective factors for adolescent tobacco use will lead to the development of improved intervention strategies to reduce/prevent tobacco use. Theory and empirical findings demonstrate the multivariate complexity of the etiology of tobacco use. Sociocultural, social/interpersonal, and intrapersonal factors act through mediated chains of ultimate, distal, and proximal influences. Some influences moderate the effects of others. Once tobacco is used, feedback mechanisms modify prior causes that in turn alter subsequent tobacco use behavior. Most theories and cross-sectional, prospective, and causal process studies have contained major limitations: (a) most addressed only small portions of the total picture; (b) most mediational studies did not test for interactions and most moderation studies are based on limited theory (if any); and (c) most theories do not discuss how the causal processes might be different for males and females or for different ethnic groups (special cases of moderation). Furthermore, few studies focused on more distal or ultimate influences or examined multi-stream patterns, and few theories or causal process studies have specified or tested feedback loops. Determining psychosocial risk factors and how they influence tobacco use faces several major challenges, including discovering complex mediating processes, moderating variables, and overcoming limitations of surveys and theory. We offer six recommendations to advance transdisciplinary tobacco-prevention research: (a) base future studies on strong theory and aim to test one or more theories or theoretically derived hypotheses; (b) collect four or more waves of data and adopt dynamic strategies of prediction and analysis, including interactions, indirect effects, feedback loops, and transitions from one level of tobacco use to another; (c) provide evidence of generalizability to sub-populations within the study sample, such as by gender, ethnic group, and socioeconomic status; (d) use high-quality measures and multiple methodologies, including non-panel longitudinal studies, intensive interview, ethnography, experimental intervention, and small exploratory studies as well as further prospective studies; (e) include variables from multiple streams of influence to investigate interrelationships among cultural, social, and intrapersonal factors; and (f) collect data from multiple nested units (e.g., children within families, within schools, within neighborhoods) and employ multi-level analysis methods to investigate interrelationships among ultimate, distal, and proximal variables. [ABSTRACT FROM AUTHOR]

Abstract: This paper reports six-year follow-up data from the first large-scale randomized trial of the social influences approach to smoking prevention. In 1979, 22 schools were randomly assigned to program or control conditions. Students in program schools received a social influences curriculum in six core and two maintenance sessions in grade 6, two booster sessions in grade 7, and one booster session in grade 8. All students were assessed at pretest (T1), immediate posttest (T2), end of grade 6 (T3), beginning and end of grade 7 (T4 and T5), end of grade 8 (T6), and grades 11 and 12 (T7 and T8). Ninety percent of study students were relocated and data obtained from over 80 percent of them at T8. Program effects on experimental smoking observed in grades 7 and 8 had completely decayed by T8, six years after the beginning of the program. Grade 6 smoking experience and social risk were each strong predictors of T8 smoking behavior. Subjects who had left school were smoking at more than twice the rate of subjects still in high school (grade 12) at T8. We discuss implications of the results. [ABSTRACT FROM AUTHOR]

Objectives. We present 1-year follow-up data from a school-based tobacco use prevention project designed to test the effectiveness of three main components of social influence programs. The components teach refusal skills, awareness of social misperceptions about tobacco use, and misconceptions about physical consequences. Methods. Four different curricula were developed and tested in a randomized experiment involving 48 junior high schools. The outcome variables examined were changes in initial and weekly cigarette and smokeless tobacco use 1 year after the intervention. Results. Analysis indicated that each of the component programs were effective in decreasing both the initial and the weekly use of cigarettes except for the curriculum in which refusal skills were taught. Also, each curriculum was effective in decreasing the initial use of smokeless tobacco except for the one aimed at correcting social misperceptions. Only the combined curriculum showed an effect on the weekly use of smokeless tobacco. Conclusions. The combined intervention was the most effective overall in reducing the initial and weekly use of cigarettes and smokeless tobacco. This suggests that different reasons for use exist and need to be counteracted simultaneously. However, since single programs were also effective in reducing all but weekly smokeless tobacco use, any of these components may be worth-while prevention tools. [ABSTRACT FROM AUTHOR]

The present study tested three assumptions often made by smoking prevention researchers and practitioners regarding the nature and causes of smoking prevalence estimates. Specifically, it is often assumed that (a) adolescent prevalence estimates of all levels of smoking are inflated, (b) youths at different stages of smoking onset all overestimate smoking prevalence, and (c) the predictors of these estimates are the same for youths at different stages of smoking onset. Measures of smoking behavior based on self-reports using a bogus pipeline procedure, estimates of cigarette smoking prevalence (trying behavior and weekly use), and reports of smoking in significant others were obtained by the same youths when they were in eighth and ninth grades. Results indicated that, taken over all youths, estimates of trying cigarettes were accurate, whereas estimates of weekly use were inflated. When responders were defined by their stage of smoking onset, either as a nonsmoker, trier, or regular smoker, analyses revealed that triers were accurate regarding prevalence estimates of trying, whereas non-smokers made gross underestimations and regular smokers made overestimations of trying. All groups of youths overestimated prevalence of weekly smoking. Analyses of variance revealed that both youths' smoking status and interpersonal smoking environment additively predicted prevalence estimates, and estimates of smoking prevalence were relatively higher in youths who began to smoke, or increased their levels of smoking, within the next year. Thus, previous assumptions were partially confirmed. Future research and prevention programming should focus more on regular smoking as the focus of normative smoking distortion effects and correction efforts. [ABSTRACT FROM AUTHOR]

The article presents information on the curricula contents, and presents data to evaluate the implementation, process and immediate post-test knowledge of Project Towards No Tobacco Use. It highlights the development of four different school-based tobacco use prevention curricula. The main project objective is to attempt to determine which, from among the three most common components of current comprehensive social influences programming, is the most effective in preventing use of tobacco-containing products. Cigarette smoking prevention programs that focus on teaching strategies to counteract social influences have been successful in reducing the onset of adolescent smoking by as much as 50% 3 years post-program.

Abstract: Background: The present study compared the predictive and incremental validity of four commonly used dependence measures (Diagnostic and Statistical Manual-IV [DSM-IV] nicotine dependence criteria, Fagerstrom Test for Nicotine Dependence [FTND], Hooked On Nicotine Checklist [HONC], Nicotine Dependence Syndrome Scale [NDSS]) in a first year college sample reporting light smoking patterns. Methods: Nicotine dependence measures were administered at the end of the first semester and follow-up smoking behavior (i.e. continued smoking, quantity, frequency, and length of abstinence) was assessed at the end of the first and second academic years. Results: Higher levels of dependence as measured by the HONC and DSM-IV predicted smoking behavior at both follow-up assessments. While higher scores on some of the NDSS factors predicted heavier smoking behavior during follow-up assessments, higher scores on other NDSS factors predicted lighter smoking behavior. The DSM-IV, NDSS-priority, and HONC measures provided some evidence for incremental validity. Higher dependence scores on all four measures were related to shorter lengths of smoking abstinence. Conclusions: The four dependence measures were differentially related to smoking behavior outcomes in a light smoking sample. These findings suggest that nicotine dependence can predict a variety of smoking behaviors in light smokers. [Copyright &y& Elsevier]