Objective and perceived measures of tobacco marketing are uniquely associated with cigar use.

BACKGROUND: Few studies have examined associations between perceived and objective exposure to tobacco marketing and cigar use, which is the second most commonly used tobacco product by youth. METHODS: We used Geographic Ecological Momentary Assessment data over 14 days from youth aged 16-20 years (n=83 participants, n=948 observations; 34% past month users of any tobacco product) in eight city areas in California. Tobacco outlets in study cities were visited by trained observers to record outlet Global Positioning System (GPS) point locations and outdoor tobacco marketing. We assessed daily perceived exposure to tobacco marketing within participants' activity spaces; daily objective exposure to tobacco outlets with outdoor marketing within 50 m of activity space polylines (number of outlets and time spent near outlets) and daily cigar use excluding and including blunts. RESULTS: Controlling for demographics and baseline tobacco use, results from mixed logistic regression models showed that greater perceived exposure to tobacco marketing was positively associated with higher odds of cigar use each day, excluding blunts (adjusted odds ratios (aOR): 2.00; 95% CI 1.03 to 3.87) and including blunts (aOR: 1.87; 95% CI 1.26 to 2.77). Also, exposure to a greater number of tobacco outlets with outdoor marketing was associated with higher odds of cigar use each day, excluding blunts (aOR: 1.34; 95% CI 1.01 to 1.78), but not including blunts. CONCLUSIONS: Tobacco control efforts should consider both perceived and objective exposure to tobacco marketing and unique associations with blunt use to prevent cigar use.

Understanding academic readiness for kindergarten: The interactive role of emotion knowledge and teacher-child closeness.

One goal of this study was to test the role of emotion knowledge and teacher-child closeness and conflict in predicting academic readiness for kindergarten over and above demographic factors and executive functioning skills (especially inhibitory control) known to predict readiness. Another goal was to test teacher-child closeness as a moderator of the association between emotion knowledge or executive functioning and academic readiness. A total of 141 4- and 5-year-old children completed emotion knowledge, academic readiness, and inhibitory control measures. Preschool teachers reported their perceived relationship closeness and conflict with individual students. Accounting for child age in months, family income, and inhibitory control, emotion knowledge and teacher-child closeness were positively associated with academic readiness. Teacher-child closeness moderated the relationship between emotion knowledge and academic readiness, suggesting that teacher-child closeness may be especially important in promoting academic readiness for preschool students with low emotion knowledge.

Longitudinal and bidirectional associations between family conflict and adolescents' e-cigarette use.

INTRODUCTION: This study examined potential longitudinal and bidirectional relationships between family conflict and adolescent e-cigarette use, and whether gender moderated these associations. METHODS: Adolescents (NT1 = 1334; Mage = 13.11, SD = 0.82; 52% female; 50% White) from the United States completed surveys in the spring of 2016 and again in the fall of 2017. RESULTS: Logistic regression analyses indicated that after controlling for previous e-cigarette use, family conflict was positively associated with a greater likelihood of e-cigarette use 6 months later. Results from multiple regression analyses indicated that after controlling for previous family conflict, e-cigarette use was associated with increases in later family conflict, particularly for girls. CONCLUSIONS: Study findings highlight reducing family conflict and supporting family functioning as a possible intervention target for adolescent e-cigarette use, a major public health problem.

Time Perspective and Substance Use: An Examination Across Three Adolescent Samples.

Time perspective is conceptualized as a multidimensional construct that assesses individuals' feelings and thoughts about the past, present, and future. The current study examined relationships between feelings (time attitudes) and thoughts (time orientation) about time and substance use behaviors across three adolescent samples. Participants included a high-risk sample of adjudicated youth (N=124; M age =15.54, SD=1.69; 51.61% female) and two general population school samples (N=777; M age =15.82, SD=1.23; 53.41% female; N=1873; M age =15.87, SD=1.28; 52.22% female). Cross-sectional survey data were collected from samples in schools during 2010, 2016, and 2011, respectively. Poisson and negative binomial regression analyses indicated that overall, more positive feelings about time were associated with fewer substances used and, conversely, more negative feelings about time were associated with more substances used. These findings were particularly salient for participants with stronger positive and negative feelings toward the past and present time periods. Further, across the three samples, adolescents with a balanced time orientation (i.e., equal emphasis on all three time periods) generally reported less substance use than individuals who emphasized only one or two time periods. Findings highlight relationships between time perspective dimensions and substance use across diverse samples and illustrate opportunities for adapting time perspective-based substance use interventions for adolescents.

Siblings as ethnic-racial socialization agents: A call for research.

Research illustrating the adverse impact of discrimination and the increasing ethnic and racial diversity in the United States has resulted in a substantial body of work examining risk and protective factors for marginalized and ethnic and racial minority individuals. One factor that has received considerable attention over the past several decades is ethnic-racial socialization (ERS). Extant empirical research on ERS has heavily focused on parents, especially mothers, as socialization agents. What is noticeably missing from this literature is the potentially important roles of siblings as salient ERS agents. After briefly illustrating the focus of past research on parents as ERS agents, we review the theoretical justification for studying siblings in the ERS process and the very limited research on siblings' role in ERS-related processes. We close with a discussion of the important considerations for future researchers investigating sibling ERS.

Changes in Drinking Contexts over the Night Course: Concurrent and Lagged Associations with Adolescents' Nightly Alcohol Use.

BACKGROUND: Examining underage drinking contexts can advance the field of adolescent substance use prevention by supporting and informing interventions that can target adolescents in specific contexts. The current study examines how concurrent and lagged situational (i.e., alcohol availability and adult supervision), social (i.e., the number of people and presence of friends), and location (i.e., home vs other location) context characteristics change risks for alcohol use over the night course. METHODS: Text messages with links to online surveys were used to collect ecological momentary assessment (EMA) data over 2 weekends from adolescents in California. Data were collected using adolescents' personal cell phones early and late in the evening and the following morning. Analyses were limited to adolescents with at least 1 drinking occasion during EMA (N = 58; Mage = 16.64, SD = 0.74; 48% female; 83% White). RESULTS: Drinking earlier in the evening was positively associated with continued drinking over the night course. Context characteristics were found to play important concurrent and lagged roles in increasing the likelihood of alcohol use over evening hours. CONCLUSIONS: Findings indicated substantive concurrent and lagged social, situational, and location-based contextual effects on adolescent alcohol use over the course of an evening. Importantly, context characteristics were differentially associated with alcohol use over the course of the evening. The fact that these contextual factors are modifiable suggests that the use of prevention strategies delivered to adolescents throughout the evening may reduce adolescents' drinking and related problems over the evening hours.

Sexual Orientation-Based Depression and Suicidality Health Disparities: The Protective Role of School-Based Health Centers.

This study's purpose was to examine whether school-based health centers (SBHCs) support mental health indicators among sexual minority youth (SMY). Data came from the 2015 Oregon Healthy Teens Survey with 13,608 11th graders in 137 public high schools in Oregon. Regression results revealed significant SBHC by SMY status interactions indicating relative reductions in likelihood of depressive episodes (30%), suicidal ideation (34%), and suicide attempts (43%) among SMY in schools with SBHCs. SMY students in SBHC schools reported lower likelihood of a past-year depressive episode, suicidal ideation, and suicide attempt versus those attending non-SBHC schools. Conversely, no differences in these outcomes were observed for non-SMY by SBHC status. SBHCs may help reduce mental health disparities among SMY, a marginalized, underserved population.

The Influence of Parental Support and Community Belonging on Socioeconomic Status and Adolescent Substance Use over Time.

Background. Despite a growing trend in community-based research, studies investigating the influence of multi-level community factors on individual-level outcomes remain relatively sparse. Objective. The current study aimed to extend this literature by investigating the association between community disadvantage measured at the community level, and adolescents' substance use over time. Additionally, this study also investigated the influence of parental support and community belonging on this association. Methods. Data were drawn from Waves I and III of the National Longitudinal Study of Adolescent to Adult Health data set. Using a multi-level modeling approach, we tested the association between community disadvantage and substance use during adolescence. Second, to determine if this association held longitudinally, we examined the influence of community disadvantage on substance use over time, into young adulthood. Lastly, we tested the moderating effects of parental support and community belonging on the association between community disadvantage and substance use during adolescence and young adulthood. Results. Findings suggested that individuals experiencing the greatest disadvantage were less likely to engage in substance use in comparison to those experiencing the greatest advantage. Conclusions/Importance. Differential effects of parental support and community belonging on community disadvantage and substance use were also found. Implications of these findings are discussed.

Sexual Orientation-Based Alcohol, Tobacco, and Other Drug Use Disparities: The Protective Role of School-Based Health Centers.

This study investigated whether the presence of school-based health centers (SBHCs) was associated with six substance use behaviors among sexual minority youth (SMY) and their heterosexual peers. Data from the 2015 Oregon Healthy Teens Survey, including 13,608 11th graders in 137 schools (26 with SBHCs) were used in the current study. Multilevel logistic regression analyses were performed. Results revealed significant SBHC by SMY status interactions indicating a relatively lower likelihood of past 30-day alcohol use (23%), binge drinking (43%), use of e-cigarettes (22%), marijuana (44%), and unprescribed prescription drugs (28%) among SMY in SBHC schools compared with non-SMY at SBHC schools. Furthermore, SMY in SBHC schools reported lower likelihood of aforementioned substance use behaviors than SMY attending non-SBHC schools. Conversely, no differences in these outcomes were observed for non-SMY in SBHC and non-SBHC schools. Findings from this study suggest SBHCs may help to mitigate substance use disparities among marginalized populations, such as SMY.

School-based health services and educational attainment: Findings from a national longitudinal study.

This study examined whether availability and use of different types of school-based health services (SBHS) during adolescence were associated with educational attainment in adulthood. Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed in 2018 to assess relationships between different types of SBHS provided by schools and use of SBHS among adolescents in 1995, and educational attainment in young adulthood (2001-02) and later adulthood (2008). Multi-level linear regression models included SBHS such as providing immunizations, physical exams and emotional counseling at the school level, and receiving a school-based physical exam, emotional counseling or family planning counseling at the individual level, with other school and individual characteristics included as covariates. At the school level, providing immunizations in 1995 was associated with higher educational attainment in 2001-02 and 2008. Providing physical exams and physical fitness/recreation centers also were marginally associated with higher educational attainment in 2001-02 and 2008, respectively. At the individual level, receiving a physical exam at school in 1995 was associated with higher educational attainment in 2001-02, while receiving emotional counseling at school was inversely associated with educational attainment in 2008. None of the other types of SBHS at the school or individual level were associated with later educational attainment. This study suggests that preventive SBHS such as immunizations, physical exams and physical fitness/recreation centers may contribute to academic achievement and higher educational attainment during young and later adulthood.

Tobacco outlet density and adolescents' cigarette smoking: a meta-analysis.

OBJECTIVE: We conducted meta-analyses of studies that investigated the associations between tobacco outlet density around homes and schools and adolescents' past-month cigarette smoking. DATA SOURCES: Systematic literature searches of eight databases were carried out in February 2017. Searches were not limited by date, language, country or peer-reviewed status. STUDY SELECTION: After screening for quality, studies that examined the relationship between tobacco outlet density and adolescents' past-month smoking were selected for inclusion. DATA EXTRACTION: Two investigators screened study abstracts and full texts and independently extracted data. Consensus was reached at each stage. DATA SYNTHESIS: Random-effects meta-analyses were conducted on 11 studies that provided 13 effect sizes. Results showed that there was a significant association between tobacco outlet density around homes and adolescents' past-month smoking behaviour, with an overall effect size of OR=1.08 (95% CI 1.04 to 1.13; P<0.001; I2=0%). For density around schools, the association was not statistically significant (OR=1.01, 95% CI 0.98 to 1.03; P=0.53; I2=39%). CONCLUSIONS: These findings suggest that exposure to tobacco outlets near home environments may be important for understanding adolescents' past-month smoking. Restricting access to tobacco outlets and controlling the number of outlets in residential areas may be an effective preventive strategy to help reduce adolescents' smoking.

Prevention of Underage Drinking on California Indian Reservations Using Individual- and Community-Level Approaches.

OBJECTIVES: To evaluate combined individual- and community-level interventions to reduce underage drinking by American Indian/Alaska Native (AI/AN) youths on rural California Indian reservations. METHODS: Individual-level interventions included brief motivational interviewing and psychoeducation for Tribal youths. Community-level interventions included community mobilization and awareness activities, as well as restricting alcohol sales to minors. To test effects, we compared 7 waves of California Healthy Kids Survey data (2002-2015) for 9th- and 11th-grade AI/AN and non-AI/AN students in intervention area schools with California AI/AN students outside the intervention area (n = 617, n = 33 469, and n = 976, respectively). RESULTS: Pre- to postintervention mean past 30-day drinking frequency declined among current drinkers in the intervention group (8.4-6.3 days) relative to comparison groups. Similarly, heavy episodic drinking frequency among current drinkers declined in the intervention group (7.0-4.8 days) versus the comparison groups. CONCLUSIONS: This study documented significant, sustained past 30-day drinking or heavy episodic drinking frequency reductions among AI/AN 9th- and 11th-grade current drinkers in rural California Indian reservation communities exposed to multilevel interventions. Public Health Implications. Multilevel community-partnered interventions can effectively reduce underage alcohol use in this population.

Cognitive precursors to adolescents' reproductive health: Exploring the role of school-based health services.

The goal of this study was to examine associations between the number of school-based health services (SBHS) provided and the cognitive precursors to adolescents' reproductive health, including birth control self-efficacy, motivation to use birth control, attitudes toward birth control, and contraception knowledge. Further, this study examined whether these associations varied by adolescents' age, gender, socioeconomic status (SES), and race/ethnicity. Data were drawn from two waves of Add Health, a longitudinal survey of a nationally representative sample of U.S. adolescents (1994-96). Results from hierarchical linear regression models indicated that the number of SBHS interacted with adolescents' age to predict birth control self-efficacy, such that a greater number of SBHS were associated with greater birth control self-efficacy among 15-year-old adolescents. Findings also indicated that a greater number of SBHS were associated with lower reported birth control motivation. Although access to a greater number of health services in school settings had some effect, study findings suggest that simply increasing the number or range of health services provided may not be the most effective method for supporting diverse adolescents' reproductive health. This information is important for schools as it highlights the need for SBHS to be health outcome specific and can be used to inform initiatives related to adolescents' reproductive health.

Reproductive Health Services: Barriers to Use Among College Students.

The objective of the current study was to explore demographic, financial, and psychosocial barriers associated with the use/non-use of reproductive health (RH) services. The sample included 212 college students (60 % female) aged 18-19 from a Northern California public university. In October, 2014, students took an on-line survey with questions on knowledge, access, barriers, and use of different RH services and settings. Findings indicated that college students were more likely to visit a primary care setting and/or school-based setting for their RH care. Sexual intercourse was the strongest correlate of having received RH care in the past year, followed by gender, social disapproval, and knowledge of available services. Analyses stratified by gender found a similar pattern among females. However, the only significant predictor among males was knowledge of available services. These finding highlight universities as uniquely positioned to reduce perceived barriers to accessing RH services by making use of technology, promoting health and wellness centers, and providing/adding sexual and reproductive information to general education classes.

Parental problem drinking and adolescent externalizing behaviors: The mediating role of family functioning.

This study explored relationships among parental problem drinking, family functioning, and adolescent externalizing behaviors. The unique effects of maternal and paternal drinking were examined separately for girls and boys. The sample included 14-19 year old U.S. adolescents (Mage = 16.15; SD = .75; 52.5% female) and their parents. Participants completed surveys in the spring of 2007 and 2008. Structural equation modeling was used to conduct path analysis models. Results showed the distinctive and adverse effects of parental problem drinking on adolescent alcohol use, drug use, rule breaking, and aggressive behavior over time. Findings also highlighted the indirect and mediating roles of family functioning. For both girls and boys, family cohesion mediated the relationship between parental problem drinking and adolescent externalizing behaviors. For girls, adolescent-father communication predicted increased externalizing behaviors over time. These findings draw attention to the importance of exploring adolescent and parent gender when examining parental problem drinking, family functioning, and externalizing behaviors.

A Long-Term Longitudinal Examination of the Effect of Early Onset of Alcohol and Drug Use on Later Alcohol Abuse.

BACKGROUND: Early onset of alcohol use has been linked to later alcohol problems in adulthood. Currently, it is not clear whether early onset of marijuana and tobacco use similarly predicts alcohol problems. Moreover, most studies examining the effect of early substance use onset on later problems only have followed youth into their early 20s. Therefore, the primary goal of this study was to examine whether early onset of alcohol, marijuana, and tobacco use predicts alcohol problems beyond the transition to adulthood. METHODS: The sample included 225 15-19-year-old youth (60% girls; 62% Caucasian) who were surveyed in three time periods: 1993-1998 (Time 1), 1998-2003 (Time 2), and 2003-2007 (Time 3). Participants reported their age of onset for regular drinking, tobacco use, and marijuana use. At each time of measurement, they also completed surveys relating to their alcohol use and abuse. RESULTS: Participants with an earlier age of onset of drinking regularly scored higher on the Michigan Alcoholism Screening Test (MAST) and drank more frequently to get high and drunk throughout their 20s. Tobacco use onset and marijuana use onset were not associated with later alcohol use or abuse. CONCLUSIONS: Results from this study suggest that the relationship between the onset of substance use and later substance abuse may be substance specific. Of note, early onset of regular drinking was associated with alcohol problems during adulthood, underscoring the importance of delaying the onset of regular alcohol use among youth.

Narcissism and alcohol use: The mediating role of drinking motives among college students.

Objective: The current study examined associations between grandiose and vulnerable subclinical narcissistic traits and alcohol use among college students and whether drinking motives mediated these associations.Methods and Participants: Young adult college students who reported past month alcohol use were invited to complete self-report online surveys (N = 406; 81% female; Mage = 20.13, SD = 1.69; 10% Hispanic; 85% White).Results: Results from path analysis using structural equation modeling indicated that there were no direct associations between grandiose or vulnerable subclinical narcissistic traits and alcohol use. However, several drinking motives mediated these associations. Specifically, the association between grandiose traits and alcohol use was mediated by enhancement and social motives. Similarly, the association between vulnerable traits and alcohol use was mediated by enhancement, social and coping motives.Conclusions: Findings highlight a potential mechanism by which personality traits may contribute to a health risk behavior among young people.

Introducing an instrument to assess time orientation and time relation in adolescents.

We report on two studies that examine new instruments that assess time orientation and time relation in adolescents. These concepts refer to how individuals think about the past, the present, and the future, with time orientation defined as the emphasis one gives toward each time period and time relation defined as the degree one perceives that the time periods are related to one another. Study 1 showed that time orientation predicted academic achievement and self-esteem and time relation predicted academic achievement and hope. Study 2, which included revised versions of the instruments, replicated most findings and demonstrated that both time orientation and time relation were related to engaging in risky behaviors. As hypothesized, in both studies, there were no gender differences in time orientation or time relation. These instruments provide a new way to assess how adolescents' perceive time and how this relates to their development and behavior.

Youth tobacco and cannabis use and co-use: Associations with daily exposure to tobacco marketing within activity spaces and by travel patterns.

BACKGROUND: We investigated youth daily activity spaces, travel patterns, exposure to tobacco retail marketing, and tobacco and cannabis use and co-use. METHODS: Data included 1,060 daily assessments from 100 participants (16-20 years old) in 8 California cities. Using GPS-enabled smartphones with a survey application, youth completed brief daily surveys, and location coordinates were obtained at one-minute intervals. Tobacco outlets in study cities were visited by observers to record outlet GPS point locations and data concerning tobacco marketing. Tobacco outlet addresses and GPS location coordinates were geocoded. Activity spaces were constructed by joining sequential location points. Measures included the number of outlets with outdoor tobacco marketing within 50 m of activity space polylines and the amount of time participants were within 50 m of these outlets each day. Participants also reported tobacco and cannabis use and whether they saw tobacco ads by their neighborhood, school, workplace, and anywhere else each day. Additionally each day they reported how much time they traveled by different modes of transportation, with parents/guardians, and with friends. RESULTS: In mixed effects multinomial regression models, perceived exposure to tobacco marketing was associated with co-use of tobacco and cannabis on a given day (RRR = 1.66, p < 0.05). Although perceived exposure to tobacco marketing was not associated with tobacco use only, moderation analysis indicated that the likelihood of tobacco use was greater among youth who walked/biked/skated more (RRR = 5.22, p < 0.05). CONCLUSION: Perceived exposure to tobacco marketing contributes to youth tobacco and cannabis use or co-use, especially for those who travel by walking/biking/skating.

Alcohol Marketing and Adolescent and Young Adult Alcohol Use Behaviors: A Systematic Review of Cross-Sectional Studies.

OBJECTIVE: This article provides a systematic review of cross-sectional research examining associations between exposure to alcohol marketing and alcohol use behaviors among adolescents and young adults. METHOD: Literature searches of eight electronic databases were carried out in February 2017. Searches were not limited by date, language, country, or peer-review status. After abstract and full-text screening for eligibility and study quality, 38 studies that examined the relationship between alcohol marketing and alcohol use behaviors were selected for inclusion. RESULTS: Across alcohol use outcomes, various types of marketing exposure, and different media sources, our findings suggest that cross-sectional evidence indicating a positive relationship between alcohol marketing exposure and alcohol use behaviors among adolescents and young adults was greater than negative or null evidence. In other words, cross-sectional evidence supported that alcohol marketing exposure was associated with young peoples' alcohol use behaviors. In general, relationships for alcohol promotion (e.g., alcohol-sponsored events) and owning alcohol-related merchandise exposures were more consistently positive than for other advertising exposures. These positive associations were observed across the past four decades, in countries across continents, and with small and large samples. CONCLUSIONS: Despite issues of measurement and construct clarity within this body of literature, this review suggests that exposure to alcohol industry marketing may be important for understanding and reducing young peoples' alcohol use behavior. Future policies aimed at regulating alcohol marketing to a greater extent may have important short- and long-term public health implications for reducing underage or problematic alcohol use among youth.