Frequency of daily tooth brushing: predictors of change in 9- to 11-year old US children.

OBJECTIVE: To investigate whether an increase in daily tooth brushing frequency in children was predicted by either a) having a strong intention to brush twice a day or b) their parents receiving information about their new caries experience. BASIC RESEARCH DESIGN: Secondary data analyses were conducted on two waves of data from the Aban Aya Youth Project and the Iowa Fluoride Study. PARTICIPANTS: The Aban Aya study included 576 10- and 11-year olds from Chicago, Illinois. The Iowa Fluoride Study included a convenience sample of 709 babies born in Iowa. The present study includes those children at age 9. MAIN OUTCOME MEASURES: In both studies, reported daily tooth brushing frequency was assessed twice six months apart. RESULTS: In the Aban Aya data, compared with children with a weak intention at wave 1 to brush twice a day, children with a strong intention to brush twice a day were more likely to increase their brushing frequency by wave 2, OR 7.0, 95%CI 1.5,32.9. In the Iowa Fluoride Study, compared with children who did not have new caries at wave 1, children who had new caries experience were less likely to increase their brushing frequency by wave 2, OR 0.4, 95%CI 0.2,0.9. CONCLUSIONS: Strengthening intention to brush twice a day might increase children's brushing frequency. However, simply providing parents with information about new caries probably will not. Future studies should assess tooth brushing frequency, habit strength, intention, and situational cues at closely-spaced waves.

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.

Relation between newspaper coverage of tobacco issues and smoking attitudes and behaviour among American teens.

OBJECTIVE: Geographic variation in youth smoking prevalence suggests that community-level factors influence risk of tobacco use. We examine the extent to which newspaper coverage of tobacco issues is related to youth smoking attitudes and behaviours. DESIGN: We conducted a content analysis of 8390 newspaper articles on tobacco issues from 386 daily newspapers circulating at 5% or more in 2001-3 Monitoring the Future (MTF) survey communities. This resulted in the creation of community level measures of news volume, content and valence. Associations between news and youth outcomes were assessed using logistic regression analyses adjusting for individual, geographic and tobacco policy factors linked to youth smoking and attitudes. SUBJECTS: 98,747 youth participating in the nationally representative school-based MTF annual surveys between 2001 and 2003. MAIN OUTCOME MEASURES: Perceived harm of smoking, perceived peer smoking, disapproval of smoking, smoking within the past 30 days, daily cigarette consumption. RESULTS: In the five months preceding survey administration, newspapers in MTF communities published an average of 11.9 tobacco related articles (range 0-55.7). Each 10-article increase in newspaper volume over the five-month period was associated with increased odds of perceiving great harm from smoking (OR = 1.04, p<0.01) and disapproving of smoking (OR = 1.04, p<0.05) and decreased odds of perceiving most or all friends smoke (0.94, p<0.01) and smoking in the past 30 days (OR = 0.93, p<0.001). No consistent association was found between the content or valence of coverage and youth smoking outcomes. CONCLUSIONS: Gaining and keeping tobacco on the media agenda is an important tool for tackling youth smoking. As volume appears to be the driving factor, media advocacy may be best targeted towards generating events and highlighting issues likely to increase and sustain news attention.

Obesity prevention in low socioeconomic status urban African-american adolescents: study design and preliminary findings of the HEALTH-KIDS Study.

OBJECTIVES: Obesity prevention among children and adolescents is a public health priority; however, limited school-based intervention trials targeting obesity have been conducted. This article provides an overview of the study design and baseline preliminary findings of our ongoing school-based intervention study. DESIGN: Randomized intervention trial to test a school-based, environmental obesity prevention program in urban low socioeconomic status (SES) African-American adolescents. The intervention program was developed based on several behavioral theories and was guided by preliminary findings based on focus group discussion and baseline data. SETTING: Four Chicago public schools in the US. SUBJECTS: Over 450 5-7th graders and their families and schools were involved. RESULTS: Our baseline data indicate a high prevalence of overweight (43% in boys and 41% in girls) and a number of problems in these children's physical activity and eating patterns. Only 26% reported spending > or = 20 min engaged in vigorous-moderate exercise in > or = 5 days over the past 7 days; 29% reported spending > or = 5 h each day watching TV, playing video games, or using computer. They also consumed too many fried foods and soft drinks. On average, 55% consumed fried foods > or = 2 times/day over the past 7 days; regarding soft drinks, 70% reported consuming > or = 2 times/day. CONCLUSION: School-based obesity prevention programs are urgently needed in the target US urban, low SES, minority communities. These data can be used to inform intervention activities.

Covariates of tooth-brushing frequency in low-income African Americans from grades 5 to 8.

PURPOSE: The purpose of this study was to examine tooth-brushing frequency in 575 urban and nearby suburban African American children as part of a comprehensive risk-reduction study for students at high risk for violence, drugs, school delinquency, and unsafe sexual behaviors to determine which covariates predicted tooth-brushing frequency. METHODS: Students were surveyed 5 times, from the beginning of grade 5 and the end of each year through grade 8, and parents were surveyed at the beginning of grade 5. Peer influence, importance of being liked, self-esteem, attitudes towards tooth-brushing, oral health knowledge, self-efficacy, parental attitudes, and other covariates were examined for the ability to predict self-reporting of tooth-brushing frequency. RESULTS: In the fifth grade, peer influence, the importance of being liked, and physical self-esteem were the significant predictors, and peer influence continued to predict tooth-brushing in the eighth grade. Oral health knowledge and parental influence were not significant. CONCLUSION: Peer influence is an important factor in tooth-brushing behavior in metropolitan African American preadolescent children.

Reviewing theories of adolescent substance use: organizing pieces in the puzzle.

This article reviews 14 multivariate theories of experimental substance use (e.g., alcohol and marijuana use) among adolescents, including those theories that emphasize (a) substance-specific cognitions, (b) social learning processes, (c) commitment to conventional values and attachment to families, and (d) intrapersonal processes. Important similarities and differences among these theories are addressed, as are the conceptual boundaries of each theory. In an attempt to integrate existing theories, a framework is proposed that organizes their central constructs into 3 distinct types of influence (viz., social, attitudinal, and intrapersonal) and 3 distinct levels of influence (viz., proximal, distal, and ultimate). Implications for future theory development are discussed.

Relationship between after-school care of adolescents and substance use, risk taking, depressed mood, and academic achievement.

OBJECTIVE: To examine the relationship between parental monitoring and six negative behaviors: cigarette, alcohol, and marijuana use; depressed mood; risk taking; and lower academic grades. DESIGN: Survey of 3993 ninth-grade students in six school districts in southern California. SUBJECTS: The sample consisted of 1930 boys and 2063 girls, self-classified as non-Hispanic white (32%), African-American (13%), Hispanic (46%), or Asian (9%). RESULTS: A relationship was found between unsupervised care after school and susceptibility to cigarette, alcohol, and marijuana use; depressed mood; risk taking; and lower academic grades. Adolescents who were unsupervised at home were slightly more likely to engage in problem behavior than those who were supervised at home. Adolescents at a neighbor's house, at school, or at a job and especially those who "hang out" were most likely to engage in problem behavior. Risk was higher if the parent had an unengaged parenting style. Although girls were less likely than boys to engage in problem behavior when supervised, as supervision decreased they were significantly more likely to have each of these problems. Family structure had little impact on risk. CONCLUSIONS: Self-care, especially when it occurs outside of the home, is associated with substance use, risk taking, depressed mood, and lower academic grades.

Substance use among eighth-grade students who take care of themselves after school.

This investigation focused on substance use among children who regularly care for themselves after school (latchkey children). The data, collected from 4932 eighth-grade students, indicated that self-care is an important risk factor for alcohol, tobacco, and marijuana use. Data collected from 2185 parents validated these findings. Eighth-grade students, who took care of themselves for 11 or more hours a week, were at twice the risk of substance use as those who did not take care of themselves at all. This relationship held at all levels of sociodemographic status, extracurricular activities, sources of social influence, and stress. Of the 186 stratified tests of the relationship, 90% were significant; even those not found to be significant were in the direction expected. Path analyses suggest that risk-taking, having friends who smoke, and being offered cigarettes may partially explain the relationship between self-care and substance use. Those eighth-grade students who select friends who smoke and place themselves in situations in which they are offered cigarettes may be manifesting a desire to display their sense of maturity and independence. The fact that the increase in substance use occurred among almost all strata tested and the fact that mediation was not complete suggest that more than one mechanism may account for the associated increase in substance use. It is also possible that more time in self-care results in more unnoticed solitary trials of substances, as well as trials motivated by peer offers or peer pressure to use substances.

Characteristics of eighth-grade students who initiate self-care in elementary and junior high school.

The purpose of this paper is to examine whether children who care for themselves for longer periods of time are at increased risk of poor grades, truancy, anger, family conflict, stress, risk-taking, and peer influences (in addition to the increased risk of substance use previously reported). Demographic characteristics of eighth-grade students who initiate self-care in junior high school are compared with those initiating self-care in elementary school. Further, increased risks for those initiating self-care in elementary school are examined. Over two thirds of the respondents (67.8%) cared for themselves after school without adult supervision at some time during the week; 23.5% for 1 to 4 hours per week, 15.7% for 5 to 10 hours per week, and 28.6% for 11 or more hours per week. Of those in self-care, 48.5% initiated self-care during elementary school and 51.5% during junior high school. Students who were in the highest category of self-care (greater than or equal to 11 hours per week) vs those in self-care zero hours per week were 1.5 to 2 times as likely to score high on risk-taking, anger, family conflict, and stress, to be more likely to see their friends as their major source of influence, and to attend more parties. The self-reports of academic grades did not differ. The grade of initiation of self-care (elementary vs junior high school) conferred additional risk for drinking alcohol (odds ratio = 1.4), risk-taking tendencies (odds ratio = 1.5), and attending parties (odds ratio = 1.6).

The patterns and predictors of smokeless tobacco onset among urban public school teenagers.

This study describes the patterns and predictors of smokeless tobacco (ST) use in a large sample of urban public school students in Los Angeles and San Diego. The use of ST is more common among men than women and among Caucasians than African Americans, Hispanics, and others. Approximately 20% of the male respondents and 5% of the female respondents reported use of ST at least once, and 10.1% of male students and 3.1% of female students who had never tried ST by seventh grade started to use it by eighth grade. Among Caucasians, about 30% of boys reported trying ST at least once and 13.7% of those who had never used ST by seventh grade initiated experimentation by eighth grade. These data are used to examine the family, peer, and intrapersonal predictors of ST onset. The family risk factors for ST onset include living with a single parent, parent-child conflicts, and parental alcohol use. The peer risk factors for ST use include peer drug use and activities with friends, such as parties and participation in sports. The intrapersonal risk factors include poor grades in school, risk taking, and stress. The study also shows that those who use cigarettes, alcohol, or marijuana are at higher risk of using ST and vice versa. This study supports a problem-prone behavior perspective of ST use and cigarette smoking. We suggest that both products be targeted because the same programs are likely to apply to both products to counteract problem-prone type variables. Medical Subject Headings (MeSH): tobacco, smokeless chewing tobacco, adolescent behavior.

Psychosocial approaches to smoking prevention: a review of findings.

Twenty-seven school-based studies of psychosocial approaches to smoking prevention are reviewed. Two major approaches are represented: the "social influences" approach and the broader "life/social skills" approaches. The research studies are considered in four "generations": the seminal work by Richard Evans and colleagues at the University of Houston; seven "pilot" studies of improved programs at Stanford, Minnesota, New York, and Washington, with one school or classroom per experimental condition; twelve improved "prototype" studies by these four groups and others, with two or three units randomly assigned to conditions; and six studies in which maximizing internal validity was of prime concern. Reported results were fairly consistent, with each tested program seeming to reduce smoking onset by about 50%. However, none of the pilot or prototype studies considered alone provided easily interpreted results. The major contributions were improved programs and methods. The findings from the fourth generation of studies were more easily interpreted, though only two of them were interpreted with high confidence. It seems that psychosocial approaches to smoking prevention, particularly the social influences approach--fourth generation tests of the broader life/social skills approaches have yet to be reported--are effective, but at this time we know very little about why, for whom, or under what conditions. Suggestions are provided for improved future research.

Attitudes and health behavior in diverse populations: drunk driving. Alcohol use, binge eating, marijuana use, and cigarette use.

Five different health behaviors (cigarette use, alcohol use, binge eating, illicit drug use, and drunk driving) were studied prospectively in 5 different groups of subjects. Associations between attitudes toward these behaviors and the behaviors themselves were investigated over at least 2 waves of measurement. Findings revealed that attitudes predicted behavior nonspuriously in 2 instances: alcohol use and marijuana use. Attitudes did not predict drunk driving, binge eating, or smoking behaviors. Past behavior predicted attitude in the domains of binge eating and smoking, but not in the domains of alcohol use, drunk driving, or marijuana use. The results are discussed in terms of several alternative approaches that have implications for interventions that attempt to influence health behavior through attitude change.

Mediating mechanisms in a school-based drug prevention program: first-year effects of the Midwestern Prevention Project.

Describes (a) the effects of a social-influences-based drug prevention program (the Midwestern Prevention Project) on the mediating variables it was designed to change and (b) the process by which the effects on mediating variables changed use of drugs (tobacco, alcohol, and marijuana). Students in 42 middle schools and junior high schools in Kansas City, Missouri, and Kansas City, Kansas, were measured in the fall of 1984 (N = 5,065) and again 1 year later (N = 5,008) after 24 of the schools had been through the program. Compared to students in control schools, students in program schools became less likely to express belief in the positive consequences of drug use, less likely to indicate that they would use such drugs in the future, more likely to report that their friends were less tolerant of drug use, and more likely to believe that they were better able to communicate with their friends about drug or school problems. Change in perceptions of friends' tolerance of drug use was the most substantial mediator of program effects on drug use. There was evidence that intentions to use and beliefs about the positive consequences of use may also mediate program effects on drug use.

Identifying trajectories of adolescent smoking: an application of latent growth mixture modeling.

The goal of the current study was to identify discrete longitudinal patterns of change in adolescent smoking using latent growth mixture modeling. Five distinct longitudinal patterns were identified. A group of early rapid escalators was characterized by early escalation (at age 13) that rapidly increased to heavy smoking. A pattern characterized by occasional puffing up until age 15, at which time smoking escalated to moderate levels was also identified (late moderate escalators). Another group included adolescents who, after age 15, began to escalate slowly in their smoking to light (0.5 cigarettes per month) levels (late slow escalators). Finally, a group of stable light smokers (those who smoked 1-2 cigarettes per month) and a group of stable puffers (those who smoked only a few puffs per month) were also identified. The stable puffer group was the largest group and represented 25% of smokers.

Random-effects regression models for clustered data with an example from smoking prevention research.

A random-effects regression model is proposed for analysis of clustered data. Unlike ordinary regression analysis of clustered data, random-effects regression models do not assume that each observation is independent but do assume that data within clusters are dependent to some degree. The degree of this dependency is estimated along with estimates of the usual model parameters, thus adjusting these effects for the dependency resulting from the clustering of the data. A maximum marginal likelihood solution is described, and available statistical software for the model is discussed. An analysis of a dataset in which students are clustered within classrooms and schools is used to illustrate features of random-effects regression analysis, relative to both individual-level analysis that ignores the clustering of the data, and classroom-level analysis that aggregates the individual data.

Estimating individual influences of behavioral intentions: an application of random-effects modeling to the theory of reasoned action.

Methods are proposed and described for estimating the degree to which relations among variables vary at the individual level. As an example of the methods, M. Fishbein and I. Ajzen's (1975; I. Ajzen & M. Fishbein, 1980) theory of reasoned action is examined, which posits first that an individual's behavioral intentions are a function of 2 components: the individual's attitudes toward the behavior and the subjective norms as perceived by the individual. A second component of their theory is that individuals may weight these 2 components differently in assessing their behavioral intentions. This article illustrates the use of empirical Bayes methods based on a random-effects regression model to estimate these individual influences, estimating an individual's weighting of both of these components (attitudes toward the behavior and subjective norms) in relation to their behavioral intentions. This method can be used when an individual's behavioral intentions, subjective norms, and attitudes toward the behavior are all repeatedly measured. In this case, the empirical Bayes estimates are derived as a function of the data from the individual, strengthened by the overall sample data.

Two-year behavior outcomes of project towards no tobacco use.

The article presents 2-year follow-up data from a school-based tobacco use prevention project designed to test the effectiveness of 3 primary components in social influence programs. The components either teach refusal skills, awareness of social value misperceptions, or physical consequences. Curricula were tested with a randomized experiment involving 48 junior high schools. These data suggested that (a) a physical-consequences curriculum is successful at attenuating increases in adolescent smokeless tobacco use, (b) cigarette experimentation may be attenuated by various approaches, and (c) a comprehensive program with all 3 components was necessary to attenuate increases in weekly use of both forms of tobacco. These results also indicate that school-based tobacco use interventions can be effective at least 2 years postprogram, after students make their transition to high school.

Relative effectiveness of comprehensive community programming for drug abuse prevention with high-risk and low-risk adolescents.

This article reviews major risk factors for cigarette smoking, alcohol, and other drug abuse and promising community-based approaches to primary prevention. In a longitudinal experimental study, 8 representative Kansas City communities were assigned randomly to program (school, parent, mass media, and community organization) and control (mass media and community organization only) conditions. Programs were delivered at either 6th or 7th grade, and panels were followed through Grade 9 or 10. The primary findings were (a) significant reductions at 3 years in tobacco and marijuana use and (b) equivalent reductions for youth at different levels of risk. This study provides evidence that a comprehensive community program-based approach can prevent the onset of substance abuse and that the benefits are experienced equally by youth at high and low risk.

Group self-identification and adolescent cigarette smoking: a 1-year prospective study.

As an extension of previous work, we analyzed the longitudinal relations between group self-identification and adolescent cigarette smoking. The predictive precedence of cigarette smoking and identification with 6 different types of peer groups was examined. Results indicated that 7th-grade group self-identification predicted 8th-grade cigarette smoking, whereas 7th-grade cigarette smoking did not predict 8th-grade group self-identification. Group self-identification also was compared with 7 other psychosocial variables as predictors of smoking 1 year later. The pattern of results suggests that group self-identification is about as good a predictor of smoking as other psychosocial variables, and that group self-identification is more than a mere proxy of other psychosocial variables.

Stages in the development of adolescent smoking.

Many researchers have conceptualized smoking uptake behavior in adolescence as progressing through a sequence of developmental stages. Multiple social, psychological, and biological factors influence this process, and may play different functions at different points in the progression, and play different roles for different people. The major objective of this paper is to review empirical studies of predictors of transitions in stages of smoking progression, and identify similarities and differences related to predictors of stages and transitions across studies. While a number of factors related to stage of progression replicated across studies, few variables uniquely predicted a particular stage or transition in smoking behavior. Subsequently, theoretical considerations related to stage conceptualization and measurement, inter-individual differences in intra-individual change, and the staged or continuous nature of smoking progression are discussed.