Laurie Fisher

Sexual Orientation Disparities in Longitudinal Alcohol Use Patterns Among Adolescents: Findings From the Growing Up Today Study

OBJECTIVE To compare sexual orientation group differences in the longitudinal development of alcohol use behaviors during adolescence. DESIGN Community-based prospective cohort study. SETTING Self-reported questionnaires. PARTICIPANTS A total of 13,450 Growing Up Today Study participants (79.7% of the original cohort) aged 9 to 14 years at baseline in 1996 were followed up for more than 7 years. Main Exposure Self-reported sexual orientation classified as heterosexual, mostly heterosexual, bisexual, or gay/lesbian. MAIN OUTCOME MEASURES Age at alcohol use initiation, any past-month drinking, number of alcoholic drinks usually consumed, and number of binge drinking episodes in the past year. RESULTS Compared with heterosexual participants, youth reporting any minority sexual orientation reported having initiated alcohol use at younger ages. Greater risk of alcohol use was consistently observed for mostly heterosexual males and females and for bisexual females, whereas gay and bisexual males and lesbians reported elevated levels of alcohol use on only some indicators. Gender was an important modifier of alcohol use risk; mostly heterosexual and bisexual females exhibited the highest relative risk. Younger age at alcohol use initiation among participants with minority sexual orientations significantly contributed to their elevated risk of binge drinking. CONCLUSIONS Our findings suggest that disparities in alcohol use among youth with a minority sexual orientation emerge in early adolescence and persist into young adulthood. Health care providers should be aware that adolescents with a minority sexual orientation are at greater risk of alcohol use.

Subjective Social Status in the School and Change in Adiposity in Female Adolescents: Findings From a Prospective Cohort Study

OBJECTIVE To determine whether subjective social standing in school predicts a change in body mass index (BMI) in adolescent girls during a 2-year period. DESIGN Prospective cohort study. SETTING Self-report questionnaires from a community-based population of adolescent girls living across the United States from 1999 to 2001. PARTICIPANTS Of 5723 girls aged 12 to 18 years participating in the Growing Up Today Study (GUTS), adequate information was available for 4446 (78%), who provided the analytic sample. MAIN EXPOSURE Low subjective social status in the school. MAIN OUTCOME MEASURES Change in BMI between 1999 and 2001 and multivariable odds ratio for a 2-U increase in BMI in girls with low subjective social status in the school compared with girls with higher subjective social status in the school. RESULTS After adjusting for age, race/ethnicity, baseline BMI, diet, television viewing, depression, global and social self-esteem, menarche, height growth, mothers BMI, and pretax household income, adolescent girls who placed themselves on the low end of the school subjective social status scale had a 69% increased odds of having a 2-unit increase in BMI (odds ratio, 1.69; 95% confidence interval, 1.10-2.60) during the next 2 years compared with other girls. CONCLUSION Higher subjective social standing in school may protect against gains in adiposity in adolescent girls.

Household Smoking Restrictions and Adolescent Smoking

Purpose. To examine the association between household smoking restrictions and adolescent smoking, controlling for parental smoking, peer smoking, and tobacco marketing. Design. Cross-sectional analysis of 1999 data from the Growing Up Today Study, a longitudinal cohort of adolescents. Setting. Self-report questionnaire. Subjects. 10,593 adolescents aged 12 to 18 years. Measures. The dependent variable was established smoking (smoking ≥ 100 cigarettes). Variables of interest were household smoking restrictions, parental smoking, peer smoking, and tobacco promotional item (TPI) possession. Results. Four percent of participants reported that their households permitted smoking. Parental smoking, peer smoking, and TPI possession were significantly associated with established smoking. In logistic regression models adjusted for age, gender, peer smoking, and TPI possession, adolescent smoking was inversely related to the presence of a restrictive household policy (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.48–0.93); however, when parental smoking was added to this model, the association was attenuated (OR = 0.94, CI = 0.65–1.35). When only one parent in the household smoked, smoking restrictions were more common when this parent was the father. Conclusions. Although household smoking restrictions offer health benefits, they do not appear to be associated with adolescent smoking after accounting for other factors. Prior studies did not include parental smoking, peer smoking, and marketing influences. This analytic difference may explain apparent contradictions in the literature.

Association of Adolescent Cigar Use With Other High-Risk Behaviors

Objectives. To describe the association of cigar use with use of cigarettes, smokeless tobacco, and alcohol among adolescents; and to examine the association of self-esteem, physical activity, and use of tobacco promotional items with cigar use. Methods. A cross-sectional study of 7104 girls and 5499 boys 10 to 15 years of age in 1997. Data were collected from self-report questionnaires. Results. The prevalence of cigar use increased with age among both girls and boys. Among 11-year-olds, only 1% of girls and 3% of boys had used a cigar, whereas among 15-year-olds, 11% of girls and 25% of boys had used a cigar. Cigar users were much more likely than nonusers to have experimented with cigarettes (girls, odds ratio [OR]: 23.6; 95% confidence interval [CI]: 17.2–32.3; boys, OR: 21.3; 95% CI: 17.1–26.6), smokeless tobacco (girls, OR: 7.5; 95% CI: 4.5–12.4; boys, OR: 13.0; 95% CI: 9.8–17.4), and alcohol (girls, OR: 6.6; 95% CI: 4.8–9.1; boys, OR: 6.8; 95% CI: 5.3–8.8). There was a strong association between cigar use and binge drinking, especially among boys (girls, OR: 11.6; 95% CI: 7.9–16.9; boys, OR: 34.8; 95% CI: 19.4–62.3). Cigar users reported more hours of weekly physical activity than did nonusers. Additionally, cigar users were more likely to report high social self-esteem and to possess a tobacco promotional item. Conclusions. Adolescents who use cigars are more likely to use other tobacco products and alcohol, to report high social self-esteem, and to possess tobacco promotional items. Health care professionals and teachers should include cigar use in discussions with adolescents addressing substance use.

Update: master settlement agreement between the states and the tobacco industry (United States).

Ranking of smoking prevalence among adults [1] Smoking prevalence among adults, 1998 [1] Amount needed for a comprehensive tobacco control program [2] (in millions) Amount of year 2000 Settlement monies [3] (in millions) Amount of approved Settlement funding for tobacco control, year 2000 [4±9] (in millions) Amount of proposed Settlement funding for tobacco control, year 2000 [4, 5, 10] (in millions) Amount of state funding annually allocated to tobacco control [4, 10, 11±17]

Back to school: smoking policies in US college residence halls (fall 2002)

When college students across the US return to their campuses this fall, they may find that their cigarettes are no longer welcome, even in their dormitory rooms. With concerns over the health hazards of secondhand smoke, and cigarettes a leading cause of dormitory fires, many universities are reexamining their smoking policies [1]. Currently, only 27% of US colleges prohibit smoking in residence halls [2]. However, with smoke-free environments becoming increasingly acceptable, more and more universities are exploring the possibility of smoke-free student housing. In 2000, the American College Health Association issued a recommendation that colleges prohibit smoking in all campus housing, as well as all public areas of the campus [3]. Universities across the nation are now beginning to meet these guidelines, with the 2002–2003 academic year seeing many schools, such as Duke University, prohibiting smoking in all dormitories [4]. Some universities, such as University of New Hampshire, are going even further. Beginning this fall, UNH will prohibit smoking at all athletic events, both indoor and outdoor, and will designate a 20-foot smoke-free radius around every building on campus [5]. From a public health perspective, the institution of smoke-free dorms couldn’t come at a better time. Although younger teens and high school students generally have the highest risk of smoking initiation, many young adults are now becoming regular smokers during college [6]. This may be because the tobacco industry has been targeting its marketing campaigns toward young adults (particularly college students), while tobacco control efforts have been focused primarily on younger populations [7–10]. Total bans on smoking in residence halls may be a timely and effective way to counter the industry, since the bans protect students from secondhand smoke and also discourage them from starting to smoke. In a recent study, current smokers were more likely to reduce their levels of smoking if they lived in smoke-free dorms, and nonsmokers were less likely to take up tobacco [11]. With so many health benefits, one may wonder why colleges have not implemented total smoking bans before now. While most states have workplace indoor– air ordinances that ban smoking in university office and classroom areas, student residence halls are not covered under these regulations. The reluctance to expand these policies may be because many students and university officials feel that restrictions on students’ personal behaviors do not fall under the jurisdiction of the school administration. To their credit, most colleges do try to accommodate student smoking preferences when assigning housing (offering the options of smoke-free dormitories, smoke-free halls, or smoke-free rooms), but a total ban may represent a step they are not yet ready to take. While it can be argued that alcohol bans in student housing offer a precedent for similar bans on tobacco, the alcohol bans may be more acceptable since alcohol use is illegal for most college-aged students, while tobacco use is not. While university officials struggle to determine how much they will limit personal freedoms, some college students are taking no-smoking policies into their own hands. For example, at University of Missouri, the students themselves initiated policy changes on smoking in residence halls [12–14]. In an effort to encourage other students to do the same, the American Cancer Society established the Smoke-Free New England Campus Initiative, which provides information and materials to help students revise university policies on tobacco [15]. Smoke-Free New England’s policy goals include prohibiting smoking in all residence halls, as well as at all university-sponsored events. In addition, it promotes on-campus cessation services that are free, accessible, and well advertised. As new generations of young adults grow up in a society that accepts smoking restrictions as a public health measure, it is hopeful that more college students will mobilize to create smoke-free campuses. In addition, academic institutions are now making it a priority to protect students from the short-term and long-term health effects of tobacco use and secondhand smoke. Both university administrators and students will have to weigh their concerns over restricting personal behaviors with the health benefits of smoke-free residential life, but as more and more campuses expand their smoke-free policies, it appears that they are choosing health.