Developmental changes in genetic and environmental influences on Chinese child and adolescent anxiety and depression.

BACKGROUND: Twin and family studies using Western samples have established that child and adolescent anxiety and depression are under substantial genetic, modest shared environmental, and substantial non-shared environmental influences. Generalizability of these findings to non-Western societies remains largely unknown, particularly regarding the changes of genetic and environmental influences with age. The current study examined changes in genetic and environmental influences on self-reported anxiety and depression from late childhood to mid-adolescence among a Chinese twin sample. Sex differences were also examined. METHOD: Self-reported anxiety and depression were collected from 712 10- to 12-year-old Chinese twins (mean = 10.88 years, 49% males) and again 3 years later. Quantitative genetic modeling was used to examine developmental changes in genetic and environmental influences on anxiety and depression, and sex differences. RESULTS: Heritability of anxiety and depression in late childhood (23 and 20%) decreased to negligible in mid-adolescence, while shared environmental influences increased (20 and 27% to 57 and 60%). Shared environmental factors explained most of the continuity of anxiety and depression (75 and 77%). Non-shared environmental factors were largely time-specific. No sex differences were observed. CONCLUSIONS: Shared environmental influences might be more pronounced during the transition period of adolescence in non-Western societies such as China. Future research should examine similarities and differences in the genetic and environmental etiologies of child and adolescent internalizing and other psychopathology in development between Western and non-Western societies.

An examination of trends in amount and type of cigarette advertising and sales promotions in California stores, 2002-2005.

BACKGROUND: Cigarette companies spend more of their marketing dollars in stores than in any other venue. In 2005, they spent 88% of a total of $13.1 billion to advertise and promote product sales in stores. AIM: The purposes of this study were to identify how the amount and types of cigarette advertising and sales promotions have changed in stores in California between 2002 and 2005, and to assess neighbourhood influences on cigarette marketing in stores. METHODS: Four observational assessments of cigarette advertising were conducted in approximately 600 California stores that sold cigarettes from 2002 to 2005. Trained observers collected data on the amount and type of cigarette advertising, including signs, product shelving and displays and functional items, and presence of sales promotions on these items. Longitudinal analyses were performed to estimate trends over time and identify correlates of change in the amount and type of tobacco advertising. RESULTS: The mean number of cigarette advertisements per store increased over time from 22.7 to 24.9. The percentage of stores with at least one advert for a sales promotion increased from 68% to 80%. The amount of advertising and proportion of stores with sales promotions increased more rapidly in stores situated in neighbourhoods with a higher proportion of African-Americans. CONCLUSION: The results indicate increasing use of stores to market and promote cigarette sales. Further, these increases are disproportionately accelerating in neighbourhoods with more African-Americans. Legislative strategies should be pursued to control the marketing of tobacco products and promotional strategies used to reduce prices in stores.

Definitive and palliative radiotherapy for cervix cancer in the elderly.

The elderly population is increasing in number. Aggressive therapeutic intervention in this patient group may not always be possible because of age, the presence of co-morbidity, and poor functional status. Hence, individualized management of cervix cancer (CC) in the elderly is often practiced. Because of the preceding consideration, the cases of 79 women 65 years of age and older with CC treated with radiation over the last 20 years were reviewed. The cases were classified into two groups--those who were aggressively irradiated (group 1: 43 patients) and those managed less intensively for palliation (group 2: 36 patients). Local tumor control, complications, and survival were assessed. There were fewer extremely aged (> or = 75 years of age) women (p = 0.006) with advanced stage disease (p = 0.012) in group 1 than in group 2. Also, group 1 women experienced fewer treatment failures (p < 0.0003) and more of them were alive and well at last follow-up (p < 0.005) than those from group 2. The median survival periods for groups 1 and 2 were 60 months and 11 months, respectively (p < 0.0001); the corresponding 5-year crude survival rates were 54% and 19%, respectively (p = 0.002). Two women required remedial surgery for bowel obstruction/perforation after irradiation, and one patient sustained chronic radiation cystitis.

The relation between cortisol excretion and fractures in healthy older people: results from the MacArthur studies-Mac.

BACKGROUND: In persons with depression, higher urinary cortisol is associated with lower bone mineral density. OBJECTIVE: To examine the relation between urinary free cortisol (UFC) and fractures. SETTING: Community-based samples from Durham, NC, East Boston, MA, and New Haven, CT. PARTICIPANTS: 684 men and women, aged 70 to 79 at baseline, who were part of the MacArthur Study of Successful Aging. DESIGN: Cohort study. Participants with previous history of fractures at baseline were excluded. MEASURES: The primary exposure variable was overnight (8:00 p.m. to 8:00 a.m.) UFC (microg/g creatinine) at baseline (1988). Outcomes were self-reported hip, arm, spine, wrist, or other fracture during the follow-up period (1988-1995). Covariates were baseline age, gender, race, body mass index, current physical activity, lower extremity strength, depression subscale of the Hopkins Symptom Checklist, and current use of cigarettes and alcohol. ANALYSIS: Logistic regression was used to predict the occurrence of incident fractures (1988-1995) as a function of quartiles of baseline UFC. Models were adjusted for age, gender, and race and were also multiply adjusted for the remaining covariates listed above. Gender-stratified models and models that excluded corticosteroid users were also run. RESULTS: In multiply adjusted models, higher baseline levels of UFC were significantly associated with incident fractures. Odds of fracture (95% Confidence Intervals) for increasing quartiles of baseline UFC, multiply adjusted, were: 2.28 (.91, 5.77); 3.40 (1.33, 8.69); 5.38 (1.68, 17.21). Results were not materially influenced by exclusion of persons using corticosteroids. CONCLUSIONS: Higher baseline UFC is an independent predictor of future fracture.

Stages of change of smoking cessation: relationships with other health behaviors.

Health behaviors are often intercorrelated, suggesting that these behaviors may be manifestations of underlying attitudes toward health. Changes in these attitudes may cause simultaneous changes in several health behaviors. As individuals progress among the stages of change of one health behavior, such as smoking cessation, they may make changes in other health behaviors as well. This study evaluated the hypothesis that subjects in the later stages of change of smoking cessation would practice more healthful behaviors than subjects in the early stages of change. Subjects were 929 respondents in the California Behavioral Risk Factor Surveillance Study who were current smokers or had quit smoking within the past year. Subjects in the more advanced stages of smoking cessation showed more healthful levels of alcohol use and exercise than subjects in the earlier stages. These results suggest that people may make improvements in several health behaviors concurrently. If so, lifestyle-based health promotion programs may be able to take advantage of shifts in attitudes toward health behavior to modify several health behaviors simultaneously.

Adolescent smoking in Wuhan, China: baseline data from the Wuhan Smoking Prevention Trial.

BACKGROUND: This study reports the prevalence of adolescent smoking in the urban and rural areas of Wuhan, China, the capital of Hubei Province, on the Yangtze River in central China. METHODS: Smoking behavior was examined by age, gender, and urbanicity as part of the Wuhan Smoking Prevention Trial. Subjects included 6994 seventh- to ninth-grade students attending 22 randomly selected schools in urban and rural districts. Outcome measures included lifetime smoking, past-30-day smoking, established smoking (>100 cigarettes in lifetime), and susceptibility to smoking (absence of a firm commitment not to smoke). RESULTS: Lifetime smoking prevalence was 47% among boys and 18% among girls. Past-30-day smoking prevalence was 16% among boys and 4% among girls. Established smoking prevalence was 2% among boys and 0% among girls. The prevalence of susceptibility to smoking was 31% among boys and 10% among girls. Smoking increased significantly with age (p<.0005). Susceptibility was more prevalent in rural areas than in urban areas (p<.05), but there were no urban-rural differences in lifetime, past 30-day smoking, or established smoking. Trend analyses revealed that smoking increased with age more rapidly among boys than among girls (p<.05). Smoking was more prevalent among rural boys than among urban boys, but it was more prevalent among urban girls than among rural girls (p<.05). CONCLUSIONS: Adolescent smoking is a significant public health problem in China. Boys are at particularly high risk, as are girls living in urban areas. Effective smoking prevention programs for adolescents, as well as restrictions on tobacco industry marketing and youth access to tobacco, are needed to prevent tobacco-related morbidity and mortality in China.

English language use as a risk factor for smoking initiation among Hispanic and Asian American adolescents: evidence for mediation by tobacco-related beliefs and social norms.

Acculturation increases the risk of smoking among Hispanic and Asian American adolescents, but the underlying mechanisms are not understood. This study examined associations between English language use and smoking among 4,167 Hispanic and 2,836 Asian American adolescents in California. Potential mediators were assessed, including access to cigarettes, perceived consequences, friends' smoking, cigarette offers, refusal self-efficacy, and prevalence estimates of peer smoking. English language use was associated with increased risk of lifetime smoking in both groups. This association became nonsignificant after access, perceived consequences, friends' smoking, and offers were controlled for. The acculturation process (as indicated by English language use) may be associated with smoking-related psychosocial variables, which may lead to an increased risk of experimentation with smoking.

Contraceptive use among Latina women: social, cultural, and demographic correlates.

PIP: This study examined attitudes toward contraceptives and their use among Latino women recruited from obstetrics/gynecology waiting rooms in Los Angeles, California. Interviews were conducted among 291 Latino women aged 15-50 years who were not pregnant or planning to become pregnant. Most Latino women were ranked low on acculturation. Barriers to contraceptive use (CU) were measured on the Meyers and Rhodes scale of 13 barriers. Attitudes were assessed with a modified UCLA Multidimensional Condom Attitudes Scale. The mean age was 29.5 years. 91% were born outside of the US. 50% were married. 68% reported CU during each sexual act. 74% reported intention to use during each future sexual act. 71% were very certain they would use birth control during each sexual act over the next 6 months. 89% reported at least 1 barrier to CU. 48% reported that contraceptive responsibility was a women's role. 42% reported opposition to use of birth control by their partner. 35% had the attitude that sex was more romantic without contraception. CU was highest among women aged 31-40 years, non-natives of the US, with 1 or more children, without a desire for more children, with fewer barriers to CU, with high social support for CU, with low levels of economic stress, and with low acculturation. The multivariate model with controls for confounders revealed that CU was associated with no desire for additional sons, social support, self efficacy, and low acculturation.^ieng

Perceived consequences of teenage childbearing among adolescent girls in an urban sample.

PURPOSE: The purpose of this study was to examine the perceived positive consequences of teenage childbearing among female adolescents, and to determine whether perceived consequences of teenage childbearing are associated with other attitudes and sexual risk behaviors. METHODS: The sample consisted of 584 female students attending three urban high schools in Los Angeles, California. The respondents' mean age was 15.8 years, and 72% were Hispanic/Latina. Respondents completed a paper-and-pencil survey assessing their attitudes and risk behaviors relevant to teenage pregnancy. Multiple regression and logistic regression analyses were used to examine the associations between perceived consequences of teenage childbearing and demographic variables, educational variables, parental characteristics, psychosocial variables, attitudes, and sexual behavior. RESULTS: Higher scores on a scale of perceived positive consequences of teenage childbearing were associated with increased risk of sexual intercourse and unprotected sexual intercourse. Higher scores on this scale were found among girls who were Latinas, were non-U.S. natives, had low levels of expected educational attainment, had low parental monitoring, had good communication with parents, and wished to have many children. CONCLUSION: Potential strategies for preventing adolescent pregnancy include educating girls about the difficulties of teenage childbearing, countering their positive illusions about the expected benefits, and teaching them more adaptive ways to meet their emotional needs.

Smoking patterns of Asian-American youth in California and their relationship with acculturation.

PURPOSE: To examine patterns of smoking behavior among subgroups of Asian-American youth in California and their relationship with acculturation status. METHODS: Data were from the 1990-1996 California Tobacco Survey and the California Youth Tobacco Survey, which assessed smoking-related attitudes and behaviors among California youth in grades 7-12. Among the 20,482 respondents, 1,810 were Asian-Americans. Variables assessed included lifetime smoking prevalence, 30-day smoking prevalence, and age of smoking onset. Acculturation status was assessed with measures of English usage, language spoken at home, and age at immigration to the United States. RESULTS: Of the 1,810 Asian-Americans (52% male), 19% were Chinese, 33% Filipino, 8% Japanese, 13% Korean, and 26% other Asian-Americans. Lifetime smoking prevalence was 16.1% for Asians and 26.1% for non-Asians. The 30-day smoking rate was 6.9% for Asians and 14.2% for non-Asians. Subgroup-specific analyses revealed differences in lifetime smoking prevalence (18.9% for Filipinos, 17.3% for Japanese, 16.3 % for Koreans, 11.0% for Chinese, and 13.7% for other Asian-Americans) and 30-day smoking rate (8.6% for Filipinos, 8.3% for Koreans, 7.4% for Japanese, 2.8% for Chinese, and 7.2% for other Asian-Americans). Gender differences in lifetime smoking prevalence varied by Asian subgroup; smoking prevalence was higher among males than among females for Chinese and Koreans, but smoking prevalence was higher among females than among males for Japanese and other Asians. The average age of smoking onset was 12.9 years for Asians and 12.8 years for non-Asians. Age of smoking onset differed among Asian-American subgroups but did not differ by gender. In addition, smoking behaviors of the Asian respondents were significantly associated with their acculturation status. CONCLUSIONS: Asian-American youth have relatively lower smoking rates and later age of smoking onset than non-Asian youth in California. In addition, subgroups of Asian-American youth vary widely in their smoking behavior. High levels of acculturation among Asian-American youth are associated with higher smoking prevalence rates and earlier age of smoking onset.

Exposure to, and perceived usefulness of, school-based tobacco prevention programs: associations with susceptibility to smoking among adolescents.

PURPOSE: To examine the relationships of exposure to school-based tobacco prevention programs and perceived usefulness of such programs to smoking susceptibility. METHODS: An ethnically representative sample of 6929 Grade 10 students participated in a cross-sectional survey of tobacco-related activities and behaviors. Perceived usefulness of prevention programs was investigated according to two dimensions: perceived helpfulness of information received at school with regard to making decisions about tobacco use and perceived availability of social resources that might help students cope with tobacco-related issues. RESULTS: The extent of exposure to school prevention programs and both dimensions of perceived usefulness of these programs were inversely associated with susceptibility to smoking. In addition, perceived information helpfulness mediated the effect of program exposure on susceptibility status, whereas perceived availability of social resources moderated that effect. The study also presented evidence suggesting ethnic/cultural variability in the status of susceptibility to smoking at this age. CONCLUSIONS: The study indicates a need to examine the perceptions of students receiving school prevention programs. Perceived usefulness of school prevention programs may be used to identify youth at high risk for smoking susceptibility. Future studies, however, should investigate other dimensions of perceived usefulness as well as intrapersonal, interpersonal, and environmental correlates of this construct.

Homeless youth and their exposure to and involvement in violence while living on the streets.

PURPOSE: The purpose of this research were to explore homeless youths' histories of exposure to violence, perpetration of violence, and fear of violent victimization, and to examine the extent to which these constructs are associated with demographic variables. METHODS: A sample of 432 youth (between 13 and 23 years old) who were homeless or at imminent risk for homelessness were sampled from both service and street sites. The percentage of youth who reported exposure to each type of violence was calculated. Multiple regression analyses were used to examine differences in the risk of exposure to violence across gender, ethnicity, age, and length of time homeless. RESULTS: Respondents reported a high rate of exposure to violence. Female respondents reported levels of exposure to violence that were as high as those reported by males. Females were more likely to report having been sexually assaulted and fearing victimization, and tended to be less likely to report perpetrating violence. With a few exceptions, ethnic identity was not a significant predictor of exposure to violence or fear of victimization. Age tended to be inversely associated with risk of exposure to violence. Length of time homeless was not associated with fear of victimization. CONCLUSIONS: Homeless youth are at high risk for exposure to a variety of forms violence as both witnesses and victims. The overall rates of exposure to violence and patterns of association with demographic variables are significantly higher than those reported in national samples of adolescents.

Service utilization among homeless and runaway youth in Los Angeles, California: rates and reasons.

PURPOSE: To describe the service utilization patterns of homeless and runaway youth in a "service-rich" area of Los Angeles, California; identify demographic and other correlates of utilization; and contextualize the findings with qualitative data. METHOD: During Phase 1 of this study, survey data were collected from an ethnically diverse sample of 296 youth aged 13-23 years, recruited from both service and natural "hang-out" sites using systematic sampling methods. During Phase 2, qualitative data were collected from 46 youth of varying ethnicities and lengths of time homeless. RESULTS: Drop-in centers and shelters were the most commonly used services (reported by 78% and 40%, respectively). Other services were used less frequently [e.g., medical services (28%), substance abuse treatment (10%) and mental health services (9%)]. Utilization rates differed by ethnicity, length of time in Los Angeles, and city of first homeless episode (Los Angeles versus all others). Shelter use was strongly associated with use of all other services. Despite youths' generally positive reactions to services, barriers were described including rules perceived to be restrictive, and concerns youth had about confidentiality and mandated reporting. Youth suggested improvements including more targeted services, more long-term services, revised age restrictions, and more and/or better job training and transitional services to get them off the streets. CONCLUSIONS: Because shelters and drop-in centers act as gateways to other services and offer intervention potential for these hard-to-reach youth, it is vital that we understand the perceived barriers to service utilization.

Service utilization among homeless and runaway youth in Los Angeles, California: rates and reasons.

PURPOSE: To describe the service utilization patterns of homeless and runaway youth in a "service-rich" area (Los Angeles, California); identify demographic and other correlates of utilization; and contextualize the findings with qualitative data. METHOD: During Phase 1 of this study, survey data were collected from an ethnically diverse sample of 296 youth aged 13-23 years, recruited from both service and natural "hang-out" sites using systematic sampling methods. During Phase 2, qualitative data were collected from 46 youth of varying ethnicities and lengths of time homeless. RESULTS: Drop-in centers and shelters were the most commonly used services (reported by 78% and 40%, respectively). Other services were used less frequently [e.g., medical services (28%) and substance abuse treatment (10%) and mental health services (9%)]. Utilization rates differed by ethnicity, length of time in Los Angeles, and city of first homeless episode (Los Angeles vs. all others). Shelter use was strongly associated with use of all other services. Despite youths' generally positive reactions to services, barriers were described including restrictive rules, confidentiality and reporting problems, and negative interactions with staff members. Youth suggested improvements including more targeted services, more long-term services, revised age restrictions, and more and/or better job training and transitional services to get them off the streets. CONCLUSIONS: Because shelters and drop-in centers act as gateways to other services and offer intervention potential for these hard-to-reach youth, it is vital that barriers to use of these services are eliminated.

Social relationships and physical activity in health club members.

The results of this study support the hypothesis that social variables are related to exercise behavior and satisfaction. Exercise frequency was related to having friends at the health club and socializing outside the club with people met at the club. Frequency of skipping workouts was negatively associated with having friends at the club. The results shown in Table 2 suggest that of the three social variables, socializing outside the club with people met at the club was the best predictor of exercise frequency, having friends at the club was the best predictor of frequency of skipping, and exercising with a friend was the best predictor of exercise satisfaction. The three social variables explained 11% of the variance in exercise frequency, 8% of the variance in skipping frequency, and 4% of the variance in satisfaction. These findings suggest that friendships that involve exercising together and the social contacts that result from exercising in public places such as health clubs may motivate exercise behavior. A large segment of the population may derive social, as well as physical, benefits from exercise, and these social benefits may encourage them to adhere to their exercise programs. The significant interaction of marital status and socialization with people met at the club in the prediction of exercise frequency suggests that social interaction may be a more important motivator of exercise behavior for single people than for people who are married or have significant others. Exercise programs involving social interaction may be especially effective for single, divorced, or widowed people.

The relationship between home smoking bans and exposure to state tobacco control efforts and smoking behaviors.

PURPOSE: To examine the relationship between home smoking bans and adult smokers' exposure to the statewide California Tobacco Control Program (TCP) and their cigarette smoking behavior. DESIGN: Cross-sectional survey that was part of the statewide Independent Evaluation of the California Tobacco Control, Prevention and Education Program. SETTING: Random telephone interviews within 18 California counties. SUBJECTS: A representative sample of 1315 adult smokers, aged 25 years and older. MEASURES: The telephone survey included questions about smoking behavior, quitting smoking, exposure to tobacco control program components, home smoking rules, and attitudes related to tobacco use and environmental tobacco smoke (ETS). RESULTS: Smokers with a home smoking ban were twice as likely (OR = 2.29; 95% CI 1.22, 4.29) to have heard of TCP community programs and three times more likely (OR = 3.18; 95% CI 1.34, 7.57) to have seen and talked about the ETS media spot than smokers with no home smoking policy. Multivariate regression models indicated that having a home smoking ban was related to smoking fewer cigarettes per day and greater interest in quitting smoking compared with smokers with no smoking rules in the home (p < .05). CONCLUSIONS: These findings suggest that smokers reporting exposure to the California TCP were more likely to have restrictive home smoking policies and that more restrictive home smoking policies were associated with reduced smoking behavior.

Self-efficacy beliefs and perceived declines in functional ability: MacArthur studies of successful aging.

Longitudinal data from a cohort of older men and women, aged 70-79, were used to test the hypothesis that stronger self-efficacy beliefs would protect against onset of perceived functional disabilities over a 2.5-year follow-up, independent of underlying physical ability. Standard self-report scales were used to assess perceived functional disabilities, ranging from mild performance difficulties (measured by a 5-item scale based on items by Nagi) to more severe disabilities (measured by the 7-item Katz Activities of Daily Living Scale [ADL]). Performance-based measurements of strength, balance, and gait provide more objective assessments of physical abilities. Self-efficacy beliefs were measured in terms of beliefs relating to managing interpersonal relationships and beliefs relating to managing more instrumental daily activities. Gender-specific multiple regression models revealed that weaker instrumental self-efficacy beliefs predicted declines in reported functional status as measured by the Nagi performance scale among both men and women, independent of standard sociodemographic, health status, and health behaviors. Among men, instrumental efficacy beliefs were also negatively related to reports of onset of Katz ADL. Self-efficacy beliefs were unrelated to measured changes in actual physical performance abilities for both men and women. These findings suggest that self-efficacy beliefs have significant impacts on perceptions of functional disability, independent of actual underlying physical abilities. Through such influences on perceptions of disability, self-efficacy beliefs may importantly affect lifestyles and quality of life at older ages.

Variation in the impact of social network characteristics on physical functioning in elderly persons: MacArthur Studies of Successful Aging.

OBJECTIVES: Social support and social networks have been shown to exert significant effects on health and functioning among elderly persons. Although theorists have speculated that the strength of these effects may differ as a function of sociodemographic characteristics and prior health status, few studies have directly tested the moderating effects of these variables. METHODS: Longitudinal data from the MacArthur Study of Successful Aging were used to examine the effects of structural and functional social support on changes in physical functioning over a 7-year period, measured by the Nagi scale, in a sample of initially high-functioning men and women aged 70 to 79 years. Multiple regression analyses were used to test the main effects of social support and social network variables, as well as their interactions with gender, income, and baseline physical performance. RESULTS: After controlling for potential confounding effects, respondents with more social ties showed less functional decline. The beneficial effects of social ties were stronger for respondents who were male or had lower levels of baseline physical performance. DISCUSSION: The effects of social support and social networks may vary according to the individual's gender and baseline physical capabilities. Studies of functional decline among elderly persons should not ignore this population variation in the effects of social networks.

The role of social networks and media receptivity in predicting age of smoking initiation: a proportional hazards model of risk and protective factors.

The increasing prevalence of adolescent smoking demonstrates the need to identify factors associated with early smoking initiation. Previous studies have shown that smoking by social network members and receptivity to pro-tobacco marketing are associated with smoking among adolescents. It is not clear, however, whether these variables also are associated with the age of smoking initiation. Using data from 10,030 California adolescents, this study identified significant correlates of age of smoking initiation using bivariate methods and a multivariate proportional hazards model. Age of smoking initiation was earlier among those adolescents whose friends, siblings, or parents were smokers, and among those adolescents who had a favorite tobacco advertisement, had received tobacco promotional items, or would be willing to use tobacco promotional items. Results suggest that the smoking behavior of social network members and pro-tobacco media influences are important determinants of age of smoking initiation. Because early smoking initiation is associated with higher levels of addiction in adulthood, tobacco control programs should attempt to counter these influences.

Identification of adolescents at risk for smoking initiation: validation of a measure of susceptibility.

Primary prevention of smoking in adolescents requires effective screening instruments for identifying those adolescents who are most likely to experiment with cigarettes. This study investigated the predictive value of a measure of susceptibility to smoking (the lack of a firm commitment not to smoke) for predicting smoking initiation 1 and 2 years later among 687 seventh-grade nonsmokers. Results showed that susceptible adolescents were approximately two to three times more likely to experiment with cigarettes during the ensuing 2 years than were nonsusceptible adolescents. At the lower levels of smoking, these relationships persisted even after controlling for psychosocial variables. Measures of susceptibility to smoking could be an effective tool for identifying adolescents at increased risk of experimenting with cigarettes or assessing their readiness for smoking-prevention programs.