M.O.M. van de Ven

Patterns of adolescent smoking and later nicotine dependence in young adults: A 10-year prospective study

OBJECTIVES There is considerable variability in progression from smoking initiation to established smoking. This paper addresses the extent to which different patterns of adolescent smoking, including periods of cessation, predict smoking status in young adults. STUDY DESIGN Ten-year, eight-wave prospective cohort study of a state-wide community sample in Victoria, Australia. METHODS Participants were 1520 students from 44 secondary schools, initially aged 14 to 15 years. Adolescent smoking and quitting patterns were assessed during Waves 1-6 with self-reported frequency of use and a 7-day retrospective diary. The Fagerstrom Test for Nicotine Dependence (ND) was used to assess ND at the age of 24 years (Wave 8). RESULTS The prevalence of ND in young adults was 16.9% for all adolescent smokers, with prevalence rates of 6.8% and 26.7% for adolescent non-daily and daily adolescent smokers, respectively. Maximum smoking levels, onset of daily smoking, duration of smoking, escalation time and duration of cessation during adolescence predicted later ND. Daily smokers who ceased smoking for at least two waves (> or = 12 months) had a level of risk similar to adolescents who had never smoked. CONCLUSIONS Quitting smoking as an adolescent substantially alters the risk for later ND. For adolescents who become daily smokers, quitting for 12 months should be the aim in tobacco control and clinical interventions.

Smoking-specific cognitions and smoking behaviour among adolescents with asthma

Several studies have shown that the prevalence of smoking among adolescents with asthma is similar or even higher than among non-asthmatic adolescents. To design effective interventions, the predictors of smoking among adolescents with asthma need to be identified. This is the first study investigating the theory of planned behaviour (TPB) among adolescents with asthma. An extended TPB model, also including risk perceptions and perceived prevalence of smoking, was tested in a national, cross-sectional sample of 713 adolescents with (self-reported) current asthma and 7140 non-asthmatic controls. No differences in the level of smoking-specific cognitions were found (except for perceived risk of lung affections). However, the effect of having pro-smoking cognitions (e.g. a positive attitude) on smoking was stronger for adolescents with asthma than for non-asthmatic adolescents. Therefore, smoking prevention programs based on the TPB, designed for changing cognitions, could be of extra importance for adolescents with asthma.

Depressive mood and smoking onset: A comparison of adolescents with and without asthma

This prospective population-based study aimed to compare associations between depressive feelings and smoking behaviour of adolescents with and without asthma. Data were collected from a two-wave 22–24 months prospective study among 5938 adolescents who completed self-report questionnaires. Logistic regression analyses showed that depressive feelings and smoking were related both cross-sectionally and longitudinally. Smoking behaviour was similar for adolescents with and without asthma, as well as its correlation with depressive feelings. However, participants with asthma were more likely to report depressive feelings than those without asthma, implying an indirect relationship between asthma and smoking behaviour. Implications for prevention are addressed.

Effects of asthma on nicotine dependence development and smoking cessation attempts in adolescence.

Objective. The aim of this study was to investigate whether asthma predicts the development of nicotine dependence and unsuccessful smoking cessation attempts in adolescent smokers. In addition, whether nicotine dependence could explain the relation between asthma and unsuccessful cessation attempts was also investigated. Methods. A longitudinal survey study was conducted among 286 adolescents (aged 12–15 at T1) who had never used tobacco at baseline and were current smokers at follow-up 22 months later. Regression analyses were applied to test the effects of four asthma indicators (current wheeze, indication of asthma, symptom severity, and current diagnosed asthma) on nicotine dependence and smoking cessation attempts. Results. Both adolescents who had an indication of asthma as well as adolescents with higher symptom severity developed higher levels of nicotine dependence over time and made a greater number of unsuccessful smoking cessation attempts in the past 12 months compared to those without asthma or less severe symptoms. Nicotine dependence partly mediated the effects of asthma symptoms on unsuccessful cessation attempts. Current wheezing and current diagnosed asthma did not predict nicotine dependence or unsuccessful quit attempts. Conclusions. Nicotine dependence develops more quickly in youth with symptoms of asthma, and this partly explains the increased number of unsuccessful cessation attempts of adolescents with asthma. Smoking prevention and smoking cessation programs are encouraged to provide additional support for youth with asthma, focusing on both the physiological and psychological aspects of dependence.

A Role for the DRD4 Exon III VNTR in Modifying the Association Between Nicotine Dependence and Neuroticism

INTRODUCTION Neurotic psychopathology has been extensively examined as a risk factor for nicotine dependence (ND). Genetic stratification may partially explain variability in risk estimates. Genetic variants that compromise dopaminergic neurotransmission may motivate exposure to dopamine-stimulating agents, including nicotine. The 7-repeat allele of a Variable Number Tandem Repeat (VNTR) polymorphism in DRD4 (and evolutionary derivatives 5, 6, and 8 repeats; 7R+) is associated with reduced dopamine receptor function. The purpose of this study was to examine association between both smoking initiation (SI) and progression to ND by young adulthood and (a) history of neuroticism during adolescence, (b) DRD4 7R+, and (c) interaction between neuroticism and DRD4 7R+. METHODS Participants were drawn from the Victorian Adolescent Health Cohort Study, a longitudinal study of the health and well-being of young Australians across 8 waves (14-24 years). Neuroticism was measured at Waves 3 and 6 (mean 15.9 and 17.4 years). SI was defined as any smoking at any wave. ND was measured at Wave 8 (mean 24.1 years). Genotype data for the DRD4 VNTR were available for 839 participants. RESULTS While adolescent neuroticism was associated with SI, evidence for association with progression to ND was weak. However, there was evidence of interaction between neuroticism and DRD4 7R+: The odds of progression to ND among those with a history of neuroticism were more than 3.5-fold higher among 7R+ carriers. CONCLUSIONS Without considering stratification by 7R+, the association between progression to ND and neuroticism would have been assumed barely significant. However, among those carrying DRD4 7R+, risk of progression was considerably intensified.

Adolescents' movement towards cessation of smoking: Role and relative value of the processes of change and nicotine dependence

The present study addresses the applicability of the Transtheoretical Models processes of change in explaining adolescents’ readiness to quit smoking. Furthermore, the association between nicotine dependence and readiness to quit was assessed both directly, as well as indirectly through the processes of change. A cross-sectional survey was conducted, identifying 1547 weekly smokers aged 14–18 years. Structural equation modelling showed that the processes of change were only marginally associated with readiness to quit. Adding nicotine dependence to the model showed a direct association between nicotine dependence and readiness to quit. Only one process of change, self-liberation (i.e. choice/commitment to change and belief in the ability to change), was found to mediate this association. Nicotine dependence appeared to be highly important in adolescents’ readiness to quit.

Moderating effect of gender on the prospective relation of physical activity with psychosocial outcomes and asthma control in adolescents: a longitudinal study.

Abstract Objective: Adolescents with asthma experience more psychosocial and physiological problems compared to their healthy peers. Physical activity (PA) might decrease these problems. This study was the first observational longitudinal study to examine whether habitual PA could predict changes in psychosocial outcomes (i.e. symptoms of anxiety and depression, quality of life [QOL] and stress) and asthma control over time in adolescents with asthma and whether gender moderated these relationships. Methods: Adolescents with asthma (N = 253; aged 10–14 years at baseline) were visited at home in the spring/summer of 2012 and 2013. They completed questionnaires assessing their habitual PA, symptoms of anxiety and depression, QOL, perceived stress and asthma control. Path analyses using Mplus were conducted to examine longitudinal relationships among habitual PA, psychosocial outcomes and asthma control (controlled for body mass index, age and gender). Using multi-group analyses, we examined whether gender moderated these relationships. Results: Path analyses in the total group showed that habitual PA did not predict changes in psychosocial outcomes or asthma control over time. Multi-group analyses showed that gender moderated the relation of habitual PA with anxiety and depression. Habitual PA only significantly predicted a decrease in anxiety and depression over time for girls but not for boys. Conclusions: Increasing habitual PA in girls with asthma might decrease their symptoms of anxiety and depression.

Maternal and paternal beliefs, support and parenting as determinants of sport participation of adolescents with asthma.

Abstract Rationale: Few studies have examined determinants of physical activity in patients with chronic illnesses, like asthma. The aim of this study was to examine whether baseline maternal and paternal beliefs, support and parenting were associated with changes in sport participation of adolescents with asthma, and investigate the moderating effect of sex. Methods: In a population-based cohort study, during home visits in 2012 and 2013, 253 adolescents completed a questionnaire assessing their sport participation. Both parents reported their sport-specific parenting (support, general and asthma-specific beliefs, self-efficacy to encourage sport participation). The collected data was described using descriptive statistics. Path and multi-group analyses were used to examine whether baseline parental factors predicted change in adolescent sport participation, multi-group analyses examined the moderating effect of sex. For all analyses probability p value less than the accepted level of significance α = 0.05 (p < 0.05) were taken as significant effects. Results: Few parental factors associated with changes in sport participation of the adolescents, sex did not moderate the associations. In the fully adjusted models, only maternal asthma-specific beliefs about sport participation were significantly positively associated with change in adolescent sport participation. Conclusion: Sport-specific parenting does not appear to be a determinant of sport participation in adolescents with asthma. Future research should consider other individual, social and environmental determinants to inform intervention development.