Lindsey Turner

Individual and contextual influences on adolescent smoking.

Abstract: Cigarette smoking among adolescents remains one of the most important public health challenges. Despite much attention to research on the etiology of smoking, notably the examination of factors that differentiate adolescent smokers from never smokers, much less is known about factors that predict the development of dependence once an adolescent tries smoking. This paper reviews individual and contextual influences on the progression of smoking among adolescents. Highlights include a consideration of multiple levels of influence, from intra‐individual factors, such as genetics, demographics, temperament and comorbidities, to social influences, such as families and peers, to the more macro, societal/cultural levels of influence, including advertising and tobacco‐related policies. More recent work examining microcontextual influences through the use of Ecological Momentary Assessments is also discussed. Finally, the need to consider both developmental and transdisciplinary approaches to understanding the development of nicotine dependence in adolescents is emphasized.

The Impact of State Laws and District Policies on Physical Education and Recess Practices in a Nationally Representative Sample of US Public Elementary Schools

OBJECTIVE To examine the impact of state- and school district-level policies on the prevalence of physical education (PE) and recess in a nationally representative sample of US public elementary schools. DESIGN Analyses from annual, nationally representative, cross-sectional surveys of school administrators in the United States. SETTING Data were collected through surveys conducted between February and June during the 2006-2007 through 2008-2009 school years. State laws and district policies were compiled annually by researchers at the University of Illinois at Chicago using established legal research techniques. PARTICIPANTS The sample size was 47 states, 690 districts, and 1761 schools. MAIN EXPOSURES State- and school district-level PE and recess-related laws. MAIN OUTCOME MEASURES Twenty minutes of daily recess and 150 min/wk of PE. RESULTS The odds of schools having 150 min/wk of PE increased if they were located in states (odds ratio [OR], 2.8; 95% CI, 1.3-5.7) or school districts (OR, 2.4; 95% CI, 1.3-4.3) having a law or policy requiring 150 min/wk of PE. Schools located in states with laws encouraging daily recess were significantly more likely to have 20 minutes of recess daily (OR, 1.8; 95% CI, 1.2-2.8). District policies were not significantly associated with school-level recess practices. Adequate PE time was inversely associated with recess and vice versa, suggesting that schools are substituting one form of physical activity for another rather than providing the recommended amount of both recess and PE. CONCLUSION By mandating PE or recess, policy makers can effectively increase school-based physical activity opportunities for youth.

Adolescents' smoking expectancies: Psychometric properties and prediction of behavior change

Outcome expectancies have been related to smoking behavior among adults, but less attention has been given to expectancies about smoking among adolescents at differing levels of smoking experience. The present study reports the psychometric properties and predictive validity of a brief expectancy scale across two samples of adolescents. Sample 1 (N = 349) consisted of high school students (54% female) who were regular smokers enrolled in a cessation program. Sample 2 (N = 273) consisted of 8th- and 10th-grade early experimenters (54% female) involved in a natural history study of smoking trajectories. In both samples, a principal component analysis of a 13-item expectancy scale yielded four factors (taste, weight control, boredom relief, and negative affect management), each with high internal consistency (coefficient alphas >.77) and accounting for 73% and 80% of the total variance for each sample, respectively. Expectancies were significantly higher among current smokers than among early initiators. In Sample 1, boredom relief and weight management expectancies predicted smoking status 6 months later. In Sample 2, students whose smoking increased over 18 months had higher overall expectancies at baseline compared with those who tried smoking and did not escalate. These findings support the predictive validity of expectancies in predicting escalation and cessation. Implications for the importance of expectancies in understanding adolescent smoking behavior are considered.

Fresh Fruit and Vegetable Program Participation in Elementary Schools in the United States and Availability of Fruits and Vegetables in School Lunch Meals

Dietary intake among children in the United States falls short of national recommendations. Schools can play an important role in improving childrens preferences and food consumption patterns. The US Department of Agricultures Fresh Fruit and Vegetable Program (FFVP) aims to improve childrens nutrient intake patterns by offering fresh fruits and vegetables as snacks outside the reimbursable meals programs in elementary schools that serve large numbers of low-income children. Using a nationally representative sample of public elementary schools, this cross-sectional study investigated FFVP participation patterns among schools by demographic and school characteristics. Further, the study investigated the association between FFVP participation and availability of fresh fruits, salads, and vegetables at lunch as reported by school administrators and foodservice staff. Data collected via a mail-back survey from 620 public elementary schools participating in the National School Lunch Program during 2009-2010 were analyzed. Almost 70% of the FFVP-participating schools had a majority of students (>50%) eligible for free and reduced-cost meals. Participating in US Department of Agriculture Team Nutrition Program and having a registered dietitian or a nutritionist on staff were significantly associated with FFVP participation. Based on the results from logistic regression analyses schools participating in the FFVP were significantly more likely (odds ratio 2.07; 95% CI 1.12 to 3.53) to serve fresh fruit during lunch meals. Slightly >25% of public elementary schools across the United States participated in the FFVP, and participation was associated with healthier food availability in school lunches.

Slow Progress in Changing the School Food Environment: Nationally Representative Results from Public and Private Elementary Schools

BACKGROUND Children spend much of their day in school, and authorities have called for improvements in the school food environment. However, it is not known whether changes have occurred since the federal wellness policy mandate took effect in 2006-2007. OBJECTIVE We examined whether the school food environment in public and private elementary schools changed over time and examined variations by school type and geographic division. DESIGN AND PARTICIPANTS Survey data were gathered from respondents at nationally representative samples of elementary schools during the 2006-2007 and 2009-2010 school years (respectively, 578 and 680 public schools, and 259 and 313 private schools). MAIN OUTCOME MEASURES Topics assessed included competitive foods, school meals, and other food-related practices (eg, school gardens and nutrition education). A 16-item food environment summary score was computed, with possible scores ranging from 0 (least healthy) to 100 (healthiest). ANALYSES Multivariate regression models were used to examine changes over time in the total school food environment score and component items, and variations by US census division. RESULTS Many practices improved, such as participation in school gardens or farm-to-school programs, and availability of whole grains and only lower-fat milks in lunches. Although the school food environment score increased significantly, the magnitude of change was small; as of 2009-2010 the average score was 53.5 for public schools (vs 50.1 in 2006-2007) and 42.2 for private schools (vs 37.2 in 2006-2007). Scores were higher in public schools than in private schools (P<0.001), but did not differ by race/ethnicity or school size. For public schools, scores were higher in the Pacific and West South Central divisions compared with the national average. CONCLUSIONS Changes in the school food environment have been minimal, with much room remaining for improvement. Additional policy changes may be needed to speed the pace of improvement.

Examining the psychometric properties and predictive validity of a youth-specific version of the Nicotine Dependence Syndrome Scale (NDSS) among teens with varying levels of smoking ☆

Current conceptualizations of nicotine dependence suggest assessing its multidimensional structure, especially for understanding how dependence develops in teen smokers. It is unknown if a multidimensional structure holds for teens with varying levels of smoking. The psychometric properties and predictive validity of the youth-specific, multidimensional Nicotine Dependence Syndrome Scale (NDSS) was assessed among 526 teens (55.5% female; 74.3% Caucasian) who reported smoking in the past 30 days. NDSS and smoking measures were obtained at baseline and six months. Confirmatory factor analysis supported the NDSS-Total (NDSS-T, α = 0.94) and five factors for the sample: Drive (α = 0.92), Tolerance (α = 0.85), Priority (α = 0.83), Stereotypy (α = 0.73), and Continuity (α = 0.64). NDSS-T, Drive, Tolerance, and Priority were predictors of subsequent amount smoked (p < 0.01). Drive, Tolerance, and Continuity predicted subsequent cessation (p < 0.05). Though the youth-specific NDSS has good psychometric properties, tests of predictive validity for subsequent smoking and cessation behavior suggest only certain dimensions of dependence, particularly Drive and Tolerance, appear to be salient in this sample. Further studies should assess the multidimensional nature of nicotine dependence among teens with varying levels of smoking.

Web-based support as an adjunct to group-based smoking cessation for adolescents

Although group-based programs remain the most common treatment approach for adolescent smoking cessation, success rates for these programs have been relatively modest, and their reach may be limited. Web-based adjuncts may be one way to boost the efficacy and reach of group-based approaches. The purpose of this study was to evaluate the effectiveness of enhancing the American Lung Associations Not on Tobacco program (NOT) with a Web-based adjunct (NOT Plus). Twenty-nine high schools were randomly assigned to either the NOT program alone or to the NOT Plus condition, which included access to a specially designed Web site for teens, along with proactive phone calls from the group facilitator to the participant. Self-reported smoking behavior was obtained at end-of-program and at a 3-month follow-up. Using hierarchical linear modeling, accounting for the clustering of students in schools, and controlling for student gender, grade, race, and baseline smoking rate, there was a marginally significant (p=.06) condition effect at end-of-treatment and a significant effect at 3-month follow-up (p<.05) favoring the NOT Plus condition. Approximately 57% of adolescents reported visiting the Web site, and among the NOT Plus condition, use of the Web site was associated with cessation significantly at end-of-program (p<.05), but not at 3 months. Adolescents in urban schools were more likely to access the Web site than those in rural schools. Participants who visited the Web site rated it positively on several dimensions. Reasons for not using the Web site will be discussed, as well as its value as an adjunct.

Psychosocial Characteristics Associated with Sun Protection Practices Among Parents of Young Children

Despite the importance of sun protection during childhood, many parents fail to adequately protect their children from the sun. The current study assessed sun-related knowledge, stage of change, and psychosocial characteristics of parents of young children. We examined how knowledge and psychosocial characteristics differed by stage of change, and tested a model of the relationship among demographics, knowledge, psychosocial variables, and child sun protection. Surveys were completed by 391 parents of preschool-aged children. Parent knowledge about skin cancer was relatively high and did not vary by stage of change. Parents in earlier stages of change perceived more barriers to child sun protection, had more positive beliefs about children’s sun exposure, perceived their child to be less susceptible to sun damage, and had lower self-efficacy for child sun protection than did parents in later stages of change. In a path model, the strongest predictors of child sun protection were parents’ own sun protection habits, perceived barriers, and self-efficacy. Results highlight the importance of parent psychosocial characteristics in predicting child sun protection.

The impact of state safe routes to school-related laws on active travel to school policies and practices in U.S. elementary schools

This study examined the relationship between state laws requiring minimum bussing distances, hazardous route exemptions, sidewalks, crossing guards, speed zones, and traffic control measures around schools and active travel to school (ATS) policies/practices in nationally representative samples of U.S. public elementary schools between 2007-2009. The state laws and school data were compiled through primary legal research and annual mail-back surveys of principals, respectively. Multivariate logistic and zero-inflated poisson regression indicated that all state law categories (except for sidewalks) relate to ATS. These laws should be considered in addition to formal safe routes to school programs as possible influences on ATS.

Changes in self-efficacy and readiness for smoking cessation among women with high school or less education.

The most common theory of smoking cessation postulates that readiness to quit begins with changes in attitudes that move the smoker toward behavioral change and eventual cessation. However, trends in smoking indicate that many who currently smoke are not ready to quit. Hence, strategies that both enhance readiness and focus on quitting are likely to be most effective. We hypothesize that an intervention addressed to motivating behavior change will enhance readiness to change, which will in turn increase the smokers self-efficacy regarding further change. A smoking cessation intervention that combined a self-help booklet and televised segments was developed to address these issues in a population of women smokers with high school or less education. Readiness to quit was measured prior to the intervention, immediately following the intervention, and again at six and 12 months after intervention. The results indicate that the intervention had its effects on readiness to quit, which in turn affected self-efficacy, which further enhanced readiness to quit. These findings indicate that interventions aimed at this group of smokers may need to provide achievable objectives that focus on preparing the smoker to quit as well as promote cessation.