Jennifer B. Unger

Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence

IMPORTANCE Exposure to nicotine in electronic cigarettes (e-cigarettes) is becoming increasingly common among adolescents who report never having smoked combustible tobacco. OBJECTIVE To evaluate whether e-cigarette use among 14-year-old adolescents who have never tried combustible tobacco is associated with risk of initiating use of 3 combustible tobacco products (ie, cigarettes, cigars, and hookah). DESIGN, SETTING, AND PARTICIPANTS Longitudinal repeated assessment of a school-based cohort at baseline (fall 2013, 9th grade, mean age = 14.1 years) and at a 6-month follow-up (spring 2014, 9th grade) and a 12-month follow-up (fall 2014, 10th grade). Ten public high schools in Los Angeles, California, were recruited through convenience sampling. Participants were students who reported never using combustible tobacco at baseline and completed follow-up assessments at 6 or 12 months (N = 2530). At each time point, students completed self-report surveys during in-classroom data collections. EXPOSURE Student self-report of whether he or she ever used e-cigarettes (yes or no) at baseline. MAIN OUTCOMES AND MEASURES Six- and 12-month follow-up reports on use of any of the following tobacco products within the prior 6 months: (1) any combustible tobacco product (yes or no); (2) combustible cigarettes (yes or no), (3) cigars (yes or no); (4) hookah (yes or no); and (5) number of combustible tobacco products (range: 0-3). RESULTS Past 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever users (n = 222) than never users (n = 2308) at the 6-month follow-up (30.7% vs 8.1%, respectively; difference between groups in prevalence rates, 22.7% [95% CI, 16.4%-28.9%]) and at the 12-month follow-up (25.2% vs 9.3%, respectively; difference between groups, 15.9% [95% CI, 10.0%-21.8%]). Baseline e-cigarette use was associated with greater likelihood of use of any combustible tobacco product averaged across the 2 follow-up periods in the unadjusted analyses (odds ratio [OR], 4.27 [95% CI, 3.19-5.71]) and in the analyses adjusted for sociodemographic, environmental, and intrapersonal risk factors for smoking (OR, 2.73 [95% CI, 2.00-3.73]). Product-specific analyses showed that baseline e-cigarette use was positively associated with combustible cigarette (OR, 2.65 [95% CI, 1.73-4.05]), cigar (OR, 4.85 [95% CI, 3.38-6.96]), and hookah (OR, 3.25 [95% CI, 2.29-4.62]) use and with the number of different combustible products used (OR, 4.26 [95% CI, 3.16-5.74]) averaged across the 2 follow-up periods. CONCLUSIONS AND RELEVANCE Among high school students in Los Angeles, those who had ever used e-cigarettes at baseline compared with nonusers were more likely to report initiation of combustible tobacco use over the next year. Further research is needed to understand whether this association may be causal.

Acculturation, physical activity, and fast-food consumption among Asian-American and Hispanic adolescents.

Previous studies have implicated acculturation to the US as a risk factor for unhealthy behaviors among Hispanic and Asian-American adolescents, including substance use, violence, and unsafe sex. This study examined the association between acculturation and obesity-related behaviors•physical activity and fast-food consumption•among 619 Asian-American and 1385 Hispanic adolescents in Southern California. Respondents completed surveys in 6th and 7th grade. The 6th grade survey assessed acculturation with the AHIMSA acculturation scale and a measure of English language usage. The 7th grade survey assessed frequency of moderate-to-intense physical activity and frequency of eating fast-food. Multiple regression analyses included acculturation and demographic covariates as predictors of physical activity and fast-food consumption. Acculturation to the US, assessed in 6th grade, was significantly associated with a lower frequency of physical activity participation and a higher frequency of fast-food consumption in 7th grade. The significant associations persisted after controlling for covariates and were consistent across gender and ethnic groups. Results suggest that acculturation to the US is a risk factor for obesity-related behaviors among Asian-American and Hispanic adolescents. Health promotion programs are needed to encourage physical activity and healthy diets among adolescents in acculturating families.

Evaluating transdisciplinary science.

The past two decades have seen a growing interest and investment in transdisciplinary research teams and centers. The Transdisciplinary Tobacco Use Research Centers (TTURCs) exemplify large-scale scientific collaborations undertaken for the explicit purpose of promoting novel conceptual and methodological integrations bridging two or more fields. Until recently, few efforts have been made to evaluate the collaborative processes, and the scientific and public policy outcomes, of such centers. This manuscript offers a conceptual framework for understanding and evaluating transdisciplinary science and describes two ongoing evaluation studies covering the initial phase of the TTURC initiative. The methods and measures used by these studies are described, and early evaluative findings from the first 4 years of the initiative are presented. These data reveal progress toward intellectual integration within and between several of the TTURCs, and cumulative changes in the collaborative behaviors and values of participants over the course of the initiative. The data also suggest that different centers may follow alternative pathways toward transdisciplinary integration and highlight certain environmental, organizational, and institutional factors that influence each centers readiness for collaboration. Methodological challenges posed by the complexities of evaluating large-scale scientific collaborations (including those that specifically aspire toward transdisciplinary integrations spanning multiple fields) are discussed. Finally, new directions for future evaluative studies of transdisciplinary scientific collaboration, both within and beyond the field of tobacco science, are described.

The AHIMSA Acculturation Scale: A New Measure of Acculturation for Adolescents in a Multicultural Society.

Acculturation has been associated with adolescent health-risk behaviors. Most acculturation scales are inappropriate for adolescent surveys because they are too long, are not applicable to differing ethnic groups, or are language-based only. A brief, multidimensional, multicultural acculturation measure for adolescents was developed. Sixthgrade students (N = 317) in Los Angeles completed that scale and other measures of acculturation. The Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) generates four subscores: United States Orientation (Assimilation), Other Country Orientation (Separation), Both Countries Orientation (Integration), and Neither Country Orientation (Marginalization). Three of the subscales were correlated with the subscales of a modified Acculturation Rating Scale for Mexican-Americans-II, with English language usage, and with generation in the United States providing evidence for the validity of the scale. Research on culturally diverse adolescent samples might benefit from the inclusion of the AHIMSA.

Posttraumatic Growth among Adolescents

This study examined posttraumatic growth (PTG), the construing of benefits from a traumatic event, in a sample of 435 mostly Hispanic adolescentswho experienced a major life event within the previous 3 years. Levels of PTG did not differ between experienced negative life events. The relationship between PTG and sociodemographics, substance use, religiosity, and depression was explored. Age and religiosity were positively associated with PTG, whereas substance use was inversely associated with PTG. Only age and substance use remained associated with PTG after adjusting for all other variables in a multiple regression analysis. These results demonstrate the existence of PTG among an adolescent population and suggest that PTG can be related to important health behaviors such as substance use.

Stress, Coping, and Social Support among Homeless Youth.

Evaluated in this study was the extent to which stress, coping strategies, and social support were associated with depressive symptoms, poor physical health, and substance use in homeless youth. Data were obtained from a stratified random sample of 432 homeless youth recruited.from service sites and street sites in Los Angeles, California. Stres,sful life events were associated positively with symptoms of depression, poor physical health, and substance use. Use of emotion-focused coping strategies increased the risk of symptoms of depression, poor health, and substance-use disorders, whereas use of problem-focused coping strategies decreased the risk of alcohol use disorder and poorhealth. Social support decreased the risk of symptoms of depression and poor health but was not related to the risk of substance use. Results indicate that effective coping skills and social support may counteract the negative efficts of stressful life events on physical and psychological health in homeless youth.

Functional decline in the elderly: Evidence for direct and stress-buffering protective effects of social interactions and physical activity

Advances in medical technology and improvements in health behavior have greatly increased the proportion of Americans who survive into old age. Consequently, identifying environmental and behavioral factors that enhance or protect the health and functional capacity of older adults is an important goal. This study investigated the extent to which social interactions and physical activity can protect older adults from the declines in functional ability that typically occur with age and the extent to which they buffer the negative effects of widowhood on physical functioning. Data were from the Longitudinal Study of Aging, a six-year follow-up of over 7,000 respondents in the 1984 National Health Interview Survey. Using individual growth curve models which examine the effects of predictor variables on change over time, this study investigated how physical activity, social interactions, and widowhood are related to the rate of change in functional health over a six-year period. Results suggested that physical activity and social interactions each exerted independent effects on functional decline. In addition, physical activity and social interactions buffered the effects of widowhood on functional decline, especially in men who died before the end of the study. Results suggest a need for health promotion programs to encourage both physical and social activities in the elderly.

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

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

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

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

A Further Look at the Intergenerational Transmission of Violence: Witnessing Interparental Violence in Emerging Adulthood:

The intergenerational transmission (IGT) of violence has been a main the oretical consideration to explain the link between interparental aggression in the family of origin and intimate partner violence (IPV) in subsequent intimate relationships. Studies have examined this theoretical link based on self reports of interparental violence witnessed during childhood and adolescence. However, no study has examined whether emerging adults who currently witness interparental violence are more likely to exhibit violence in their own intimate relationships. Data were analyzed from undergraduate students (N = 223) attending an ethnically diverse Southern California uni versity. Multivariate linear regression analyses were used to examine the impact of witnessing interparental violence on the physical and psycho logical IPV experienced in emerging adult relationships. The joint effects of witnessing both forms of interparental violence were also tested. Support for the intergenerational transmission of violence was identified for specific types of violence. Future directions of study and implications for prevention and treatment are offered.