Outcome of a tobacco use cessation randomized trial with high-school students.

This study analyzed quantitative data on tobacco use and dependency for 3,589 high-school students, qualitative data for 448 students, and outcome data for a randomized trial comparing the efficacy of two cessation interventions and a control condition for 337 students. Data were collected from 1988 through 1992 in California and Illinois as part of a larger longitudinal study. Smokeless tobacco users, but not smokers, were more likely than controls to maintain cessation for 4 months: biochemically validated cessation at 4 months was 6.5% versus 3.2% for smokers and 14.3% versus 0.0% for smokeless tobacco users. Implications and limitations are discussed.

Implicit cognition and dissocative experiences as predictors of adolescent substance use.

The present study evaluated the mediating role of implicit cognitive processes in the prediction of alcohol and marijuana use and examined the relationships between dissociative experiences, implicit processes, and sensation seeking in models of drug use and problem experiences. Participants were 467 diverse at-risk adolescents in California. Results from latent variable models revealed that implicit cognition independently predicted alcohol and marijuana use and mediated the predictive effects of sensation seeking on drug use. Dissociative experiences did not predict implicit cognition or drug use in this sample, though this factor was a significant predictor of problem experiences and was positively correlated with sensation seeking. This research provides further evidence suggesting that implicit, associative memory processes are influential in drug-use motivation.

Effects of sixty six adolescent tobacco use cessation trials and seventeen prospective studies of self-initiated quitting.

This paper provides a review of the last two and a half decades of research in adolescent and young-adult tobacco use cessation. A total of 66 tobacco cessation intervention studies - targeted or population - are reviewed. In addition, an exhaustive review is completed of adolescent self-initiated tobacco use cessation, involving 17 prospective survey studies.Average reach and retention across the intervention studies was 61% and 78%, respectively, and was higher when whole natural units were treated (e.g., classrooms), than when units created specifically for the program were treated (e.g., school-based clinics). The mean quit-rate at a three to 12-month average follow-up among the program conditions was 12%, compared to approximately 7% across control groups. A comparison of intervention theories revealed that motivation enhancement (19%) and contingency-based reinforcement (16%) programs showed higher quit-rates than the overall intervention cessation mean. Regarding modalities (channels) of change, classroom-based programs showed the highest quit rates (17%). Computer-based (expert system) programs also showed promise (13% quit-rate), as did school-based clinics (12%).There was a fair amount of missing data and wide variation on how data points were measured in the programs' evaluations. Also, there were relatively few direct comparisons of program and control groups. Thus, it would be difficult to conduct a formal meta-analysis on the cessation programs. Still, these data suggest that use of adolescent tobacco use cessation interventions double quit rates on the average.In the 17 self-initiated quitting survey studies, key predictors of quitting were living in a social milieu that is composed of fewer smokers, less pharmacological or psychological dependence on smoking, anti-tobacco beliefs (e.g., that society should step in to place controls on smoking) and feeling relatively hopeful about life. Key variables relevant to the quitting process may include structuring the context of programming for youth, motivating quit attempts and reducing ambivalence about quitting, and making programming enjoyable as possible. There also is a need to help youth to sustain a quit-attempt. In this regard, one could provide ongoing support during the acute withdrawal period and teach youth social/life skills. Since there is little information currently available on use of nicotine replacement in young people, continued research in this arena might also be a useful focus for future work.

Cost-effectiveness of a school-based tobacco-use prevention program.

OBJECTIVE: To determine the cost-effectiveness of a school-based tobacco-use prevention program. DESIGN: Using data from the previously reported 2-year efficacy study of the Project Toward No Tobacco Use (TNT), we conducted a decision analysis to determine the cost-effectiveness of TNT. The benefits measured were life years (LYs) saved, quality-adjusted life years (QALYs) saved, and medical care costs saved, discounted at 3%. The costs measured were program costs. We quantified TNT's cost-effectiveness as cost per LY saved and cost per QALY saved. INTERVENTION: A 10-lesson curriculum designed to counteract social influences and misconceptions that lead to tobacco use was delivered by trained health educators to a cohort of 1234 seventh-grade students in 8 junior high schools. A 2-lesson booster session was delivered to the eighth-grade students in the second year. The efficacy evaluation was based on 770 ninth-grade students who participated in the program in the seventh and eighth grades and in both the baseline and the 2-year follow-up survey. RESULTS: Under base case assumptions, at an intervention cost of $16 403, TNT prevented an estimated 34.9 students from becoming established smokers. As a result, we could expect a saving of $13 316 per LY saved and a saving of $8482 per QALY saved. Results showed TNT to be cost saving over a reasonable range of model parameter estimates. CONCLUSIONS: The TNT is highly cost-effective compared with other widely accepted prevention interventions. School-based prevention programs of this type warrant careful consideration by policy makers and program planners.

Project EX: outcomes of a teen smoking cessation program.

Project EX is an eight-session teen school-based clinic tobacco use cessation program that involves the inclusion of enjoyable, motivating activities ("games," "talk show," and alternative medicine-type) to try to enhance quit rates among youth. This clinic program was tested in a three-group experimental design: clinic-only, clinic plus a school-as-community (SAC) component, and standard care control. Eighteen schools were assigned to the three conditions using a randomized block design. A total of 335 smokers participated in the study, making this the largest controlled teen smoking cessation field trial conducted to date. Seventeen percent of the smokers enrolled in the clinics had reports of having quit smoking for at least the last 30 days at 3-month follow-up (5 months after the program quit day), compared to only 8% of the control condition smokers over than same time period. The Project EX clinic component appears to be an effective means of tobacco use cessation among teens.

Project Towards No Drug Abuse: generalizability to a general high school sample.

OBJECTIVE: We examined the generalizability of a successful classroom-based prevention program developed for youth at alternative high schools (high risk) to youth at general high schools. METHOD: A replication of a previously tested prevention program in a general high school population was conducted with 1-year follow-up data. Classrooms within each of three schools were randomly assigned to two conditions, classroom education or standard care control. RESULTS: Statistically significant effects on alcohol and illicit drug use were achieved in this population through a 1-year period following the program, although effects were not achieved on cigarette smoking and marijuana use. CONCLUSIONS: These results suggest that this program (Project Towards No Drug Abuse) has applicability to a wide range of older teens.

Self-reported high-risk locations of drug use among drug offenders.

The present study provides a detailed, multiple-choice, self-report analysis of home, work, and other public locations where drug offenders report using drugs. In addition, these settings were examined as a function of gender, ethnicity, type of drug used, and drug abuse/dependence status. The participants for the present study were 462 individuals attending drug diversion programs in southern California. The single most frequently reported location of use was the subjects' living room with a small group of friends. However, heavier users used different drugs across a greater variety of locations. Not surprisingly, drugs were used least at work (though a surprising 47% had used at work). Popular situations of drug use among drug offenders are similar to that of high-risk youth.

School-based tobacco use prevention and cessation: where are we going?

OBJECTIVE: To discuss the past, present, and future directions of school-based tobacco use prevention and cessation research. METHODS: Discuss the origins of tobacco use prevention research; how prevention research advanced with empirical etiologic work; the genesis of comprehensive social influences programming and its contents; multiple modalities of programming beyond the school setting; and the rebirth of teen cessation programming and the issue of dissemination. RESULTS: There are many avenues of teen tobacco use prevention and cessation research and practice that need continued exploration, particularly regarding effects mediation and teen cessation. CONCLUSIONS: This discussion provides a background to assist health behavior researchers and practitioners to move forward in this arena.

Predicting regular cigarette use among continuation high school students.

OBJECTIVE: To provide a 1-year prospective examination of social, behavioral, intrapersonal and demographic factors that predict transition from experimental to regular cigarette use among continuation high school students. METHODS: A cohort of 252 students completed baseline and 1-year follow-up questionnaires on health behaviors. RESULTS: Relatively low smoking prevalence estimates, intention to smoke in the next year, violence perpetration, perceived stress, sensation seeking, and male gender predicted the transition to regular use 1 year later. CONCLUSION: Intrapersonal variables may be relatively important in predicting the progression from experimental to regular smoking.

Concurrent prediction of drug use among high-risk youth.

Correlates of drug use were examined in a continuation high school sample (n = 1.315), using canonical correlation analysis. Fourteen demographic, attitudes/belief, and psychosocial pressure/ anxiety-type variables were included as concurrent predictors. Eight drug-use-related measures were also placed into the analysis as outcome variables. Two factors were revealed. White ethnicity, not being Latino, all attitude/belief measures, and family conflict and depression showed relatively high loadings on the first predictor factor, and were associated with all drug-use measures. Latino ethnicity and being relatively unacculturated (i.e., tending to speak Spanish), most of the attitude/belief measures (but not sensation seeking or spirituality), and perceived peer approval to use drugs, trait anxiety, and depression showed relatively high loadings on the second predictor factor, and were associated with the hard-drug-use measures. These results suggest that there is a subgroup of unacculturated Latino youth who are anxious, who perceive they will achieve peer approval by using drugs, and who tend to use hard drugs. Indicated drug abuse prevention strategies may need to be tailored to this subgroup when developing and implementing programming.

Group self-identification as a prospective predictor of drug use and violence in high-risk youth.

This study provides a 1-year prospective analysis of group self-identification as a predictor of adolescent drug use and violence. Youth identified with discrete groups. In most comparisons, 1 year later, a high-risk group reported greater levels of drug use and violence-related exposure than other groups, and the statistical relation between group self-identification and drug use or violence remained after baseline assessment of the drug use or violence measure was controlled for. This is the 1st study to demonstrate that group self-identification is a significant prospective predictor of drug use and other problem behaviors.

One-year prospective prediction of drug use from stress-related variables.

Six stress-related variables, gender, age, and ethnicity were investigated as concurrent and prospective predictors of three types of drug use (cigarettes, alcohol, and illicit drug use) among 875 "high risk" adolescents. The stress-related variables were socioeconomic status, "missing" one's parent(s), family conflict, victimization, perceived stress, and stress-drug beliefs. In general, concurrent regression models indicated that those who were lower in socioeconomic status, held stress-drug beliefs favorable toward drug use, and who had been victimized in the last year were more likely to be cigarette, alcohol, or illicit drug users. Prospective regression models indicated that those who had used drugs at baseline and had been victimized in the last year were relatively likely to use drugs the next year. Significant predictors in the multivariable models accounted for between 56 and 85% of those subjects who were above the median on later drug use. Victimization is apparently a relatively important source of stress in the prediction of future drug use. Drug-use intervention implications of these results include the need to provide supportive services to those who have been victims of violent attacks on their person or property.

Perceived invulnerability and cigarette smoking among adolescents.

Adolescent perceptions of invulnerability toward smoking and nonsmoking-related health risks were examined among 442 continuation high school students. Smokers were less likely than nonsmokers to report feeling invulnerable to both smoking and nonsmoking-related health risks. Among the smokers, those who reported feeling invulnerable to smoking-related health risks, compared to those who reported feeling vulnerable, smoked fewer cigarettes, were less addicted, were less likely to intend to smoke more in the future, attempted to quit fewer times in the past, valued their health more, and reported higher public body awareness. In a multiple logistic regression model, only high public body awareness, fewer previous attempts to quit, and being in the action stage of change (compared to being in the precontemplation stage of change) remained significant independent concurrent predictors of being in the invulnerable group. These results suggest, contrary to some previous work, that perceived invulnerability may be predictive of quitting tobacco use and may reflect relative invulnerability; that is, lighter use of tobacco.

The one-year prospective prediction of substance abuse and dependence among high-risk adolescents.

The present study examined 1-year prospective predictors of self-reported substance abuse and dependence among a sample of 702 youths at high risk for drug abuse from 21 southern California continuation high schools. Triadic influence theory was used as a theoretical guide. Predictors were selected as measures of triadic influence theory. Among 13 predictors, a drug use and intention index, and concern that one is or will become an addict or alcoholic, were consistently predictive of self-reported substance abuse or substance dependence 1 year later, controlling for baseline abuse or dependence status. In addition, baseline substance abuse, White ethnicity, and relatively poor prosocial coping predicted later substance dependence. Apparently, adolescents can predict their future use, and abuse or dependence status. Also, instruction in prosocial coping (e.g., seeking social support) may help inhibit the transition from substance abuse to substance dependence.

Comparative analyses of the studies of magnetic fields and cancer in electric utility workers: studies from France, Canada, and the United States.

OBJECTIVES: To summarise and to facilitate comparison of three major studies of electric utility workers that examined the relation between quantitative measurements of occupational exposure to magnetic fields and risk of brain cancer and leukaemia. These studies have been interpreted as providing conflicting evidence. METHODS: A common analytical approach was applied to data from the five cohorts included in the three studies based on original data from four of the cohorts, and published data from one additional cohort. A nested case-control design with conditional logistic regression was used to estimate the relative risk/10 microtesla-years (microT-years) for each of the contributing cohorts and for the combined data. The homogeneity of these estimates among the studies was also evaluated. RESULTS: Apparent inconsistencies in the findings of these studies can be explained by statistical variation. Overall, the studies suggest a small increase in risk of both brain cancer and leukaemia. Different methodological choices had little impact on the results. Based on a combined analysis of data from all five studies, the relative risk/10 microT-years was 1.12 (95% confidence interval (95% CI) 0.98 to 1.28) for brain cancer, and 1.09 (95% CI 0.98 to 1.21) for leukaemia. CONCLUSIONS: The combined estimates seem to provide the best summary measures of the data from all studies. However, fluctuations in risks among studies may reflect real differences, and the exposure measurements in different studies may not be entirely comparable.

Effects of thirty-four adolescent tobacco use cessation and prevention trials on regular users of tobacco products.

Since 1991, adolescent tobacco use rates have increased while adult use has steadily decreased. The failure of adolescent tobacco use cessation and prevention programs to reduce this overall smoking rate indicates that research must be advanced in this area. As a start, the current status of cessation and prevention research that targets adolescent regular tobacco users should be stated. This paper contributes to that goal by reviewing the last two and a half decades of research in this area. A total of 34 programs, equally divided between cessation and prevention (targeting regular tobacco users), are presented and relevant data are provided for each. Among the cessation studies, an emphasis of programming on immediate consequences of use, and instruction in coping strategies, may have led to relatively successful programs. Prevention studies arguably may have achieved lower success rates but were applied to a larger sample with a longer follow-up period. Despite showing some success, it is apparent that the scientific status of cessation research is less refined than prevention research. More research is needed to define the most successful approaches for cessation of adolescent tobacco use.