Association between Perceived Discrimination and Vaping among College Students.

BACKGROUND: Perceived discrimination has been associated with a higher prevalence of e-cigarette use among adult samples. However, little is understood about the relationship between discrimination and various vaping behaviors among college students. Methods: College students completed an online survey about e-cigarette use (N = 488; 73.2% women; 52.7% White, 30.5% Black/African American, 6.1% Asian, 5.3% other races, 3.9% Multiracial). Participants completed the Everyday Discrimination Scale and identified which of their identities discrimination was most directed toward. Regressions, controlling for significant covariates of outcomes, examined discrimination in relation to e-cigarette ever use, current use, and frequency of use. Results: A higher discrimination score predicted greater odds of ever vaping compared with never use (OR = 1.21, p=.03). Controlling for race (p=.003), greater discrimination was related to increased likelihood of established vaping (100+ times) versus lighter levels of use (AOR = 1.22, p=.04). Discrimination was not associated with likelihood of current vaping (p>.05). Among e-cigarette users, greater perceived discrimination was related to an increased time spent vaping per day (ß =1.69, SE = 0.204, p=.05). Conclusions/Importance: Greater perceived discrimination was associated with more frequent vaping among college students. Current results extend previous findings by suggesting that among college e-cigarette users, those who experience discrimination are more likely to use these products frequently rather than experimentally. Findings can inform the identification and development of resources for students experiencing discrimination to prevent the uptake of e-cigarette use.

Race, sex, and physician communication about tobacco as predictors of adolescent smoking trajectories in a primarily African American sample.

This study identified latent classes of adolescent smoking and examined race, gender, and physician communication (PC) as predictors of class membership. Data were drawn from five waves of a large (N = 3,049), diverse (82.9% African American) study. Several latent classes were identified: nonsmoker, quitter, early-onset escalating smoking, early-onset stable high smoking, late-onset smoking, and declining smoking. Males, Whites, and teens who received PC were more likely to be in classes with more smoking. Our study identified several youth smoking patterns and differences in smoking based on race, gender, and receipt of PC.

Ethnic and Gender differences in Strategies Used by Adolescents when Attempting to Quit or Reduce Smoking.

Few adolescent smoking cessation programs have been able to match the success rate found in adult programs. The current study identified smoking cessation strategies used by adolescents and whether strategies differed as a function of ethnic, gender, or individual smoking-level. Participants were 136 high school students who made an attempt to quit or reduce their smoking. Logistic regressions revealed that individuals making an actual quit attempt and African American adolescents used cessation strategies presumed to be more effective. Adolescents are more likely to use informal cessation methods and may need to be provided with more information on effective quit strategies.

Religious Beliefs Against Smoking Among Black and White Urban Youth.

This study explores the relation of religiosity to cigarette smoking in a sample of 4776 Black versus White adolescents. Findings show that Black adolescents have significantly stronger religious beliefs against smoking than do White students. Further, teens with strong or very strong religious beliefs are less likely to have smoked. The protective effect of religious beliefs against smoking was stronger for Whites than for Blacks. These findings suggest that efforts in the Black religious community to prevent cigarette smoking have been somewhat successful. Similar efforts in the White community might help stem the tide of tobacco use among White teens.

Conformational effects and stereocontrol in synthesis studies of medium-ring dolabellane carbocycles.

Stereoselective reactions are described which lead to functionalization of the dolabellane skeleton. The stereoselectivity is attributed to conformational effects imposed by the eleven-membered ring. An efficient pathway provides for the stereocontrolled synthesis of nonracemic 6(S)-hydroxy-4(E)-dolabellene-3-one 12 and related derivatives.

Risk factors for smoking among adolescent survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.

BACKGROUND: Few studies have examined risk factors for smoking among adolescent survivors of childhood cancer. The present study reports on the rate of smoking and identifies factors associated with smoking in a sample of adolescent survivors from the Childhood Cancer Survivor Study (CCSS). PROCEDURE: Participants included 307 adolescent survivors and 97 healthy siblings (ages 14-20) who completed a self-report survey of health, quality of life, and health behaviors. RESULTS: Smoking rates did not differ significantly between survivor and sibling groups (ever smokers: 28% vs. 33%, recent smokers: 10% vs. 9%, respectively). Ever smoking was significantly associated with peer smoking, smokers in the household, binging, suicidal behavior, and no history of CRT. There were significant interactions of peer smoking with gender and CRT for ever smoking and with binging for recent smoking. Recent smoking was more likely for survivors with other household smokers (RR=2.24, CI=1.21-4.16), past suicidality (RR=1.89, CI=1.00-3.56), and no CRT (RR=2.40, CI=1.12-5.17). Among survivors with few smoking friends, ever smoking was more likely for survivors with no CRT (RR=4.47, CI=1.43-13.9), and recent smoking was more likely among survivors who binged (RR=3.37, CI=1.17-9.71). CONCLUSIONS: Despite the health risks associated with survivorship, nearly one in three adolescent survivors of childhood cancer has smoked. Exposure to other smokers, in particular, appears to increase the likelihood of smoking for some survivors. Providing smoking cessation programs targeted to family members, helping survivors choose non-smoking friends, and teaching ways to resist smoking influences from peers may be important pathways for smoking prevention with adolescent survivors.

Predictors of Cessation Outcomes Among Older Adult Smokers Enrolled in a Proactive Tobacco Quitline Intervention.

OBJECTIVES: To identify predictors of older adults' likelihood of quitting following engagement in a proactive tobacco quit line. METHODS: Older (>60 years) participants (N = 186) enrolled in a four-session quit line with 8-weeks of nicotine replacement therapy reported demographics, beliefs, and information about tobacco use. Point prevalence abstinence was reported at 3 and 12-months. RESULTS: In final models, endorsement of quitting to take control of one's life and confidence in quitting were positively associated with 3-month cessation (OR = 1.74, 95% CI = 1.16, 2.62; OR = 1.75, 95% CI = 1.21, 2.52, respectively). At 12 months, stronger endorsement of quitting to take control of one's life and decreased nicotine dependence were associated with higher cessation (OR = 1.51, 95% CI = 1.05, 2.17; OR = 0.84, 95% CI = 0.71,0.99, respectively). DISCUSSION: For tobacco cessation among older adults, programs should provide additional support to those with higher nicotine dependence, promote quitting self-efficacy, and encourage quitting as means to gain control of life and health.

Attentional and executive dysfunction as predictors of smoking within the Childhood Cancer Survivor Study cohort.

INTRODUCTION: Previous research has suggested that childhood cancer survivors initiate smoking at rates approaching those of healthy individuals, even though smoking presents unique risks to survivors. The present study explores whether the attentional and executive functioning (EF) deficits associated with cancer and treatment place survivors of childhood cancer at increased risk for smoking. METHODS: Data from the Childhood Cancer Survivor Study were examined to identify concurrent and longitudinal correlates of tobacco use. We explored whether childhood attention problems and adulthood executive dysfunction were associated with smoking among adult survivors of childhood cancer. RESULTS: Childhood attention problems emerged as a striking predictor of adult smoking nearly a decade later on average. Nearly half (40.4%) of survivors who experienced attention problems in childhood reported a history of smoking, a significantly higher rate of ever smoking, than reported by those without childhood attention problems (relative risk [RR] = 1.53, 95% CI = 1.31-1.79). Furthermore, they were nearly twice as likely to be current smokers in adulthood compared with those without childhood attention problems (RR = 1.71, 95% CI = 1.38-2.11). Similar associations were found between components of adult executive dysfunction and adult smoking. DISCUSSION: Childhood cancer and treatment are associated with subsequent deficits in attention and EF. Early detection of these deficits will allow clinicians to identify patients who are at increased risk for smoking, an important step in promoting and maintaining health in this medically vulnerable population.

Physician Advice to Adolescents About Smoking: Who Gets Advised and Who Benefits Most?

PURPOSE: The Clinical Practice Guidelines instruct physicians to ask their patients about smoking and to advise against tobacco use. Physicians are urged especially to attend to racial minorities and teens because of these groups' increased susceptibility to smoking. Research on race and physician advice against smoking has produced contradictory findings. The purpose of this study is to clarify the relationships between physician communication about tobacco, race, and smoking among adolescents. METHODS: This cross-sectional retrospective study explored (1) racial differences in rates of receiving physician communication and (2) whether the relationship between physician communication and smoking among adolescents was moderated by race. Multiple measures of smoking status were used (e.g., intentions to quit, quit attempts, quits, relapse status). We used a large (N = 5,154), predominately African-American (82.9%) sample of 11th graders. RESULTS: Regular smokers were more likely to be screened about smoking. African Americans were more frequently advised against tobacco than Caucasians. Among African Americans, nonsmokers were most likely to be both screened and advised; among Caucasians, regular were most likely to be screened and advised. Overall, physician intervention was associated with greater benefits for young African Americans, including fewer intentions to smoke, greater likelihood of quitting, and less relapse. CONCLUSIONS: Physician communication about smoking may hold particular promise for African-American teens, reducing health disparities because of racial differences in smoking-related mortality and morbidity. Physicians should be encouraged to screen and advise all young people about tobacco, regardless of race or smoking status.

Physician Intervention for Improving Tobacco Control Among Parents Who Use Tobacco.

Research has demonstrated that parents who smoke are often inadvertent sources of their children's first cigarettes. Teaching parents to restrict their tobacco may give pediatricians another method for helping parents who are not ready to quit smoking. This purpose of this study was to determine the feasibility of a program training pediatricians to discuss tobacco control with smoking parents and to examine changes in parents' tobacco control after the physician intervention. One month after the intervention by pediatricians, parents reported significantly improved tobacco control. They were more likely to count their packs and cigarettes and to keep their tobacco products at work and on their person. Parents reported restricting household control of adult smoking, and children were exposed to significantly less secondhand smoke. These results showed that it is possible to integrate advice about tobacco control into a busy pediatric practice and to improve parents' restrictions of their tobacco products.

Physical activity in relation to all-site and lung cancer incidence and mortality in current and former smokers.

Increased physical activity has been associated with a reduction in the incidence and mortality from all-site cancer and some site-specific cancers in samples of primarily nonsmoking individuals; however, little is known about whether physical activity is associated with similar risk reductions among smokers and ex-smokers. This study examined physical activity in relation to all-site cancer and lung cancer incidence and mortality in a sample of current and former smokers (n = 7,045; 59% male; 95% Caucasian; mean age, 63 years) drawn from the beta-Carotene and Retinol Efficacy Trial, a lung cancer chemoprevention trial. Hazard rate ratios and 95% confidence intervals associated with a 1 SD increase in physical activity were 0.86 (0.80-0.94) for all-site cancer only among men, 0.84 (0.69-1.03) for lung cancer only for younger participants, 0.75 (0.59-0.94) for cancer mortality among younger participants and 0.68 (0.53-0.89) among women, and 0.69 (0.53-0.90) for lung cancer mortality only among women. These results suggest that incidence may be more attenuated by physical activity for men and mortality more attenuated for women. Effects may be more pronounced for younger people and may differ inconsistently by pack-years of smoking. Physical activity may play a role in reducing cancer risk and mortality among those with significant tobacco exposure. Prospective studies using more sophisticated measures of physical activity assessed at multiple time points during follow-up are needed to corroborate these associations.

What motivates adolescent smokers to make a quit attempt?

A sample of 120 adolescent smokers (80 males, 40 females), most of whom were referred by school personnel after being caught with cigarettes at school (n=113), reported motivations for making a quit attempt during a smoking cessation project. Most students (n=76) were randomly assigned to a four session cessation program that included discussion of a number of motivational topics, and the remaining students were assigned to a self-help control group that received a pamphlet recommending strategies for quitting. Reported motivations for quitting did not differ significantly across the two treatment conditions. Concern about future health (73%) was the most popular reason given for making a quit attempt, followed by concern about current health (65%). Concerns about physical appearance (59%), the cost of cigarettes (52%), and athletic performance (51%) were also listed as motivators by a majority of the participants. Future health was the most popular choice for the most important motivator to quit (35%). Females and participants with fewer best friends smoking were more likely to report that the prevalence of non-smoking teenagers, the relationship between smoking and weight, and physical appearance concerns were motivators to quit. African Americans were more likely than Whites to list current health concern as the most important motivator.

Coupling structure-based design with combinatorial chemistry: application of active site derived pharmacophores with informative library design.

Protein structural information is combined with combinatorial library design in the following protocol. Active site maps are generated from protein structures. All possible 2-, 3- and 4-point pharmacophores are enumerated from the active site map and encoded as bit strings. The pharmacophores define a design space that can be used to select compounds using an informative library design tool. The method was evaluated against a collection of compounds assayed previously against a cyclin-dependent kinase target, CDK-2, starting with 23 X-ray co-crystal structures. Performance was assessed based on the number of active scaffolds selected after four rounds of iterative informative library design. The method selects compounds from 12 out of the 15 active scaffolds from the CDK-2 library and outperforms a two-dimensional similarity search and docking calculations.

Risk factors for smoking among adolescents with asthma.

PURPOSE: To examine the prevalence of smoking among youth with asthma and explore potential risk factors for smoking among these youth, compared with youth without asthma. METHODS: In March 1997, a questionnaire assessing risk factors for smoking was administered to students attending public high school in Memphis, Tennessee. The sample (n = 3234) ranged from 15 to 18 years of age, was predominately African-American (76.7%), and 56.7% female. Based on a single self-reported item, 15.7% of youth reported having asthma. Logistic regression analyses assessed asthma status differences in current smoking and the association between risk factors and smoking. RESULTS: Nearly 20% of youth reported current smoking. Adolescents with asthma (current or past) were nearly 1.5 times more likely to smoke than peers without asthma. The association between risk factors and current cigarette smoking was equivalent for youth regardless of whether they had asthma and did not differ for those youth with current vs. past asthma. CONCLUSIONS: Results suggest that adolescents with or without asthma smoke for similar reasons. Research is needed to elucidate whether there are unique risk factors, not examined here, for smoking among adolescents with asthma. Smoking prevention and cessation programs are needed for youth with asthma.

Ethnic differences in smoking withdrawal effects among adolescents.

Smoking withdrawal effect information was collected from 75 adolescents (54 males and 21 females) making a quit attempt during a school-based smoking cessation program. A strong need to smoke was the most common withdrawal effect (60%), followed by irritability (51%), and difficulty concentrating (41%). Most (61%) participants experienced two or more withdrawal effects during the quit attempt, and withdrawal effects were evident in those smoking less than daily. Significant ethnic differences were found, with African Americans reporting significantly fewer withdrawal effects than Caucasians. After controlling for smoking frequency, African Americans were still less likely to report irritability, difficulty concentrating, and restlessness. Participants who chose to use nicotine replacement during the quit attempt were more likely to report difficulty concentrating, restlessness, and feeling miserable.

A prospective evaluation of the relationships between smoking dosage and body mass index in an adolescent, biracial cohort.

Although there is clearly an inverse relationship between smoking and body weight, recent studies suggest that weight attenuation via smoking is slow and may take decades to accrue. This investigation prospectively evaluated the relationships between smoking dosage (or lack thereof) and relative weight change in 1697 adolescents followed over 4 years. A 4 (smoking groups: 0, 1, 2, or 3 or more years of smoking exposure)x2 (ethnicity: Caucasian or African American)x2 (gender: male or female) analysis of variance (ANOVA) was performed to assess weight gain attenuation associated with increasing exposure to smoking. The overall results revealed a significant three-way interaction between smoking dosage, gender, and ethnicity. Specifically, smoking initiation was associated with an increase in body mass index (BMI) for 2 years after initiation. For those youth smoking 3 or more years, body weights were almost identical compared to never-smokers. No significant reductions in body weight were observed in any gender or ethnic group for up to 3 years after smoking initiation. It is concluded that smoking initiation is not associated with adolescent body weight change for at least a 3-year period.

Intraclass correlation among measures related to cigarette use by adolescents: estimates from an urban and largely African American cohort.

This paper presents the first estimates of school-level intraclass correlation (ICC) for smoking-related variables from an urban and largely African American population. Seventh graders (n = 6967) from 39 middle schools in Memphis, TN, were measured at baseline in 1994 and annually through 1997. Mixed model regression methods were used to estimate variance components for school and residual error. School-level ICCs were large enough, if ignored, to substantially inflate the Type I error rate in an analysis of treatment effects. We show how those correlations can be reduced using regression adjustments and used to determine sample size for future school-based smoking prevention studies.

Physician communication regarding smoking and adolescent tobacco use.

BACKGROUND: Physician advice increases quit rates 1% to 3% above unassisted quit rates among adults, an increase sufficient to be ranked as a high-priority, evidence-based preventive service. However, there is little research on the potential impact of physician advice on adolescent smoking. OBJECTIVE: The purpose of this study was to examine the association between recalled physician communication and adolescents' attitudes toward smoking, knowledge about smoking, intentions to smoke, tobacco use, and quitting behaviors. METHODS: This study was a retrospective observational study of 5154 students (82.9% black, 17.1% white) from an urban, mid-South school system. Outcome variables included adolescents' self-rated attitudes toward smoking, knowledge about smoking, intentions to smoke, tobacco use, and quitting behaviors. RESULTS: Physician advice and the combination of screening and advice were associated with healthier attitudes about smoking. Physician screening and advice were also associated with a more accurate knowledge regarding tobacco-related damage. Among current smokers, recalled physician advice was also associated with reduced intentions to smoke in 5 years. Importantly, advised teens were more likely to plan to quit smoking in 6 months. Furthermore, teens who were screened by their physician reported significantly more quit attempts than those who were neither screened nor advised (P = .007). CONCLUSIONS: Physician's tobacco-related interactions with adolescents seemed to positively impact their attitudes, knowledge, intentions to smoke, and quitting behaviors. Brief physician interventions have the potential to be a key intervention on a public health level through the prevention, cessation, and reduction of smoking and smoking-related disease.

Anti-Smoking Communication to Preadolescents with and without a Cancer Diagnosis: Parents and Healthcare Providers as Important Communicators.

A cancer diagnosis does not prevent smoking among pediatric oncology patients, and anti-smoking communications among parents and health care providers have been proposed as influencing smoking outcomes in this group. Anti-smoking communications were compared among 93 preadolescents with cancer and 402 controls. After adjusting for demographics and covariates, preadolescents with cancer were less likely than control participants to report receipt of anti-smoking messages from physicians and parents, and recalled more messages >/= 4 months post-diagnosis as compared to 1-3 months. Should anti-tobacco communications prove to influence smoking outcomes, parents and physicians may be uniquely positioned to provide smoking prevention interventions to these patients.