Holly E. R. Morrell

Perceptions of smoking-related risks and benefits as predictors of adolescent smoking initiation.

OBJECTIVES The predictive value of perceptions of smoking-related risks and benefits with regard to adolescent smoking initiation has not been adequately established. We used prospective, longitudinal data to directly test whether smoking-related perceptions predict smoking initiation among adolescents. METHODS We administered surveys assessing perceptions of smoking-related risks and benefits to 395 high school students, beginning at the start of their ninth-grade year. We conducted follow-up assessments every 6 months until the end of 10th grade, obtaining 4 waves of data. RESULTS Adolescents who held the lowest perceptions of long-term smoking-related risks were 3.64 times more likely to start smoking than were adolescents who held the highest perceptions of risk. Adolescents who held the lowest perceptions of short-term smoking-related risks were 2.68 times more likely to initiate. Adolescents who held the highest perceptions of smoking-related benefits were 3.31 times more likely to initiate. CONCLUSIONS Findings from this study provide one of the first sets of empirical evidence to show that smoking initiation is directly related to smoking-related perceptions of risks and benefits. Thus, efforts to reduce adolescent smoking should continue to communicate the health risks of smoking and counteract perceptions of benefits associated with smoking.

Examining the interrelationships between social anxiety, smoking to cope, and cigarette craving

Smokers with symptoms of social anxiety often report smoking as a way to cope with negative affect. These individuals have lower success rates when attempting cessation compared with the general population. However, there is a paucity of research examining the role of social anxiety in nicotine dependence. The present study explored the relationships between symptoms of social anxiety, smoking to cope with these symptoms during social situations (STC), and cigarette craving. Thirty-eight participants completed measures of social anxiety and STC at baseline. Cigarette craving was subsequently assessed pre and post exposure to smoking-related images during periods of nicotine satiation and deprivation. Regression analyses revealed that greater symptoms of social anxiety predicted the frequency of STC behaviors and the number of cigarettes participants thought they would need in order to feel more comfortable in social situations. Symptoms of social anxiety and several behaviors associated with STC (e.g., avoiding social situations in which smoking is not permitted) predicted increases in craving during nicotine deprivation, but not satiation. These findings suggest that symptoms of social anxiety and STC behaviors may play a role in the maintenance of smoking behaviors. Further, targeting symptoms of social anxiety within the context of smoking cessation treatment may be particularly helpful and may improve the rates of smoking cessation among individuals with symptoms of social anxiety.

Adult and childhood weight influence body image and depression through weight stigmatization.

The goal of this study was to examine lifetime weight stigmatization as a mediator of the relationships among current body mass index, childhood overweight, depression, and body dissatisfaction. Participants were 299 female undergraduates (mean age = 20.52, standard deviation = 2.57; mean body mass index = 23.29, standard deviation = 4.51). Weight stigmatization significantly mediated the relationships between body mass index and body dissatisfaction, body mass index and depressive symptoms, and childhood overweight and depressive symptoms. The model accounted for 44.7 percent of the variance in depressive symptoms and 28.2 percent of the variance in body image dissatisfaction. Findings indicated that a decrease in weight stigmatization may predict better mental health.

Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity

Having a consistent source of medical care may facilitate diagnosis of autism spectrum disorders (ASD). This study examined predictors of age of ASD diagnosis using data from the 2011–2012 National Survey of Children’s Health. Using multiple linear regression analysis, age of diagnosis was predicted by race, ASD severity, having a consistent source of care (CSC), and the interaction between these variables after controlling for birth cohort, birth order, poverty level, parental education, and health insurance. While African American children were diagnosed earlier than Caucasians, this effect was moderated by ASD severity and CSC. Having a CSC predicted earlier diagnosis for Caucasian but not African American children. Both physician and parent behaviors may contribute to diagnostic delays in minority children.

Quality of Life and School Absenteeism in Children With Chronic Illness

Objective: Children and adolescents with a chronic illness (CI) tend to demonstrate diminished physical and social functioning, which contribute to school attendance issues. We investigated the role of social and physical functioning in reducing school absenteeism in children participating in Mastering Each New Direction (MEND), a family-based psychosocial intervention for youths with CI. Methods: Forty-eight children and adolescents with a CI (70.8% female, M age = 14.922, SD = 2.143) and their parent(s) completed a health-related quality of life (HRQOL) measure pre- and postintervention. Using multiple mediation, we examined whether parent- and child-rated physical and social HRQOL mediated the relationship between school attendance before and after MEND. Once the mediational model was not supported, we investigated whether HRQOL moderated the relationship between missed school days pre- and postintervention. Results: Neither physical nor social functioning mediated or moderated the relationship between missed school days pre- and postintervention. Instead, higher parent-rated physical functioning directly predicted decreased number of missed school days, while lower parent-rated social and child-rated physical functioning predicted increased missed school days. Conclusions: Parent-perceived HRQOL may have a direct effect on health-related behaviors such as school attendance. Future research should determine whether gains in parent-rated QOL are maintained in the long term and whether these continue to impact markers of functional well-being.

Treating Depressed and Anxious Smokers in Smoking Cessation Programs.

OBJECTIVE Cigarette smoking is the leading cause of preventable death in the United States. In addition, smoking rates among depressed and anxious smokers are higher than in the population at large. Furthermore, treating depressed and anxious smokers effectively is particularly challenging because of their significant negative affect, dysfunctional emotional regulation, severe withdrawal symptoms, and numerous institutional barriers to successful treatment. Previous reviews in this area have typically focused on depression or anxiety disorders, whereas this review focuses on both disorders. METHOD This article presents a brief review of the literature on treating depressed and anxious smokers in smoking cessation programs. We also discuss treatment issues, challenges, and guidelines regarding effective interventions for depressed and anxious smokers who wish to stop smoking. RESULTS The potential benefits for better health and improved functioning are quite large. Moreover, the merit of pursuing evidence-based interventions with these comorbid populations of depressed and anxious smokers-including practical, multidisciplinary, and cost-effective smoking cessation programs-is compelling. CONCLUSIONS A sensible time for an aggressive approach to this health promotion effort is now.

Subjective Invulnerability and Perceptions of Tobacco-Related Benefits Predict Adolescent Smoking Behavior.

Identifying factors that influence adolescents’ decisions to start smoking is necessary to improve interventions for reducing tobacco use. The current longitudinal study was designed to determine the direction of influence between feelings of invulnerability to harm and cigarette smoking, and to test whether the perceived risks and benefits of smoking mediate the relationship between invulnerability and smoking. Participants were 228 adolescents (57% female; X ¯ = 14 years) recruited from 9th grade classrooms, who completed questionnaires during class every 6 months through the end of 10th grade. Invulnerability predicted smoking behavior, but not vice versa. These effects became non-significant after controlling for friends’ smoking behavior. Perceived benefits of smoking, but not perceived risks, mediated the relationship between invulnerability and smoking behavior (ab = .03, 95% confidence interval [CI] = [.004, .078]). Adolescents who feel invulnerable to physical danger may be more likely to smoke in part because they perceive more benefits associated with smoking.

Substance Abuse Among American Indians and Alaska Natives: An Integrative Cultural Framework for Advancing Research

Research consistently highlights the high prevalence of substance-related psychopathology in the American Indian/Alaska Native (AIAN) population. Recent epidemiological literature suggests that these trends are not diminishing, despite decades of etiological work and prevention programs. The aim of this article was to examine the literature on risk and protective factors for substance-related psychopathology in the AIAN population from the perspective of Betancourt’s integrative model of culture, psychological processes, and behavior (Betancourt et al. 1993, 2010, 2011). This model specifies the structure of relations among sociostructural (e.g., income and education), cultural (e.g., values and norms), and psychological (e.g., cognition and emotion) factors influencing behavior. Articles were reviewed that identified one or more determinants of substance-related psychopathology in the AIAN population. An analysis of the reviewed articles revealed that the factors investigated in relation to substance-related psychopathology have typically been studied independently of each other. Also, most studies have examined factors that are rather distal from behavior (e.g., sociostructural). Results suggest that research on the interrelations among cultural and psychological, in addition to sociostructural, determinants may enhance our understanding of substance-related psychopathology in this population. To this end, suggestions for future research are derived from results of the studies reviewed. Such theoretically driven research may contribute to more effective interventions and the reduction of substance-related disparities among the AIAN population.

Positive comments, negative outcomes? The potential downsides of appearance-related commentary in ethnically diverse women

Although research has shown that appearance-related commentary influences body dissatisfaction and disordered eating, limited research has studied such commentary among ethnically diverse women. The current study examined ethnic group differences in the frequency and impact of appearance-related commentary and associations with body dissatisfaction and eating disorder psychopathology. Participants included 280 undergraduate women aged 18-25 (56.1% European American, 28.6% African American, and 15.3% Latina American). Results indicated no ethnic group differences in frequencies of positive weight/shape, positive general appearance, or negative weight/shape commentary while controlling for BMI. However, African American and Latina American women reported stronger negative responses to positive weight/shape commentary than European American women. Negative responses to positive weight/shape commentary were correlated with more body dissatisfaction in African American women, after controlling for frequency of commentary. Findings suggest that positive weight/shape commentary may be associated with poor outcomes in a subgroup of ethnic minority college women.

The youth alternative solutions program: evaluating a hospital-based intervention for adolescent substance use.

AbstractIssues of alcohol and drug use are more pronounced during adolescence than at any other period of the lifespan and represent a significant public health concern in the United States. As a result, there is currently a need for research on developmentally appropriate interventions for adolescent substance use (SU). Nurses and other mental health professionals working with adolescents need effective evidenced-based programs to refer clients having issues with SU. The current pilot study evaluated the effectiveness of the Youth Alternative Solutions Program, a hospital-based intervention program at a Level I trauma center in Southern California that partners with community stakeholders to accomplish its goals. A sample of 27 adolescents was recruited from August 2010 until October 2011. Twenty-seven total participants completed both pretest and posttest questionnaires; 14 of these participants also completed follow-up data collection. Results indicated a significant increase in negative alcohol outcome expectancies between the three study time points. More comprehensive studies of the Youth Alternative Solutions Program should be conducted in the future to determine the utility of hospital-based SU interventions and to provide evidence of the program’s long-term effects.