Steven A. Branstetter

The Influence of Representations of Attachment, Maternal–Adolescent Relationship Quality, and Maternal Monitoring on Adolescent Substance Use: A 2‐Year Longitudinal Examination

The present study examined the hypotheses that more secure representations of attachments to parents are associated with less adolescent substance use over time and that this link is mediated through relationship quality and monitoring. A sample of 200 adolescents (M = 14-16 years), their mothers, and close friends were assessed over 2 years. Higher levels of security in attachment styles, but not states of mind, were predictive of higher levels of monitoring and support and lower levels of negative interactions. Higher levels of security in attachment styles had an indirect effect on changes in substance use over time, mediated by maternal monitoring. These findings highlight the roles of representations of attachments, mother-adolescent relationship qualities, and monitoring in the development of adolescent substance use.

The influence of parents and friends on adolescent substance use: a multidimensional approach

Objective: The current study examined longitudinal associations between friends substance use, friendship quality, parent-adolescent relationship quality, and subsequent substance use among an adult population. Design: Participants were 166 adolescents, their parents, and their close same-sex friends recruited from both urban and suburban high schools surrounding a large metropolitan area. Measures of relationship characteristics in the10th grade were used to predict concurrent substance use and changes in substance use over a 1-year period. Results: The most consistent predictor of the use of different substances and changes in substance use over time was the friends substance-using behavior. Negative interpersonal interactions with a friend were related only to tobacco use, and friendship support neither contributed to nor protected against substance use. Mother-adolescent relationship support was associated with lower levels of concurrent substance use, as well as lower levels of hard drug use over time. Conclusions: Findings highlight the need to examine parents and peers simultaneously and the importance of parental relationships and peer behavior on adolescent substance use. Limitations and future directions are discussed.

Effects of Physical Activity on Teen Smoking Cessation

OBJECTIVE: To understand the influence of physical activity on teen smoking-cessation outcomes. METHODS: Teens (N = 233; 14–19 years of age) from West Virginia high schools who smoked >1 cigarette in the previous 30 days were included. High schools with >300 students were selected randomly and assigned to brief intervention (BI), Not on Tobacco (N-O-T) (a proven teen cessation program), or N-O-T plus a physical activity module (N-O-T+FIT). Quit rates were determined 3 and 6 months after baseline by using self-classified and 7-day point prevalence quit rates, and carbon monoxide validation was obtained at the 3-month follow-up evaluation. RESULTS: Trends for observed and imputed self-classified and 7-day point prevalence rates indicated that teens in the N-O-T+FIT group had significantly higher cessation rates compared with those in the N-O-T and BI groups. Effect sizes were large. Overall, girls quit more successfully with N-O-T compared with BI (relative risk [RR]: >∞) 3 months after baseline, and boys responded better to N-O-T+FIT than to BI (RR: 2–3) or to N-O-T (RR: 1–2). Youths in the N-O-T+FIT group, compared with those in the N-O-T group, had greater likelihood of cessation (RR: 1.48) at 6 months. The control group included an unusually large proportion of participants in the precontemplation stage at enrollment, but there were no significant differences in outcomes between BI and N-O-T (z = 0.94; P = .17) or N-O-T+FIT (z = 1.12; P = .13) participants in the precontemplation stage. CONCLUSIONS: Adding physical activity to N-O-T may enhance cessation success, particularly among boys.

Gender differences in cigarette smoking, social correlates and cessation among adolescents

BACKGROUND Despite well-established gender differences in adult smoking behaviors, relatively little is known about gender discrepancies in smoking behaviors among adolescents, and even less is known about the role of gender in smoking cessation among teen populations. METHOD The present study examined gender differences in a population of 755 adolescents seeking to quit smoking through the American Lung Associations Not-On-Tobacco (N-O-T) program. All participants enrolled in the N-O-T program between 1998 and 2009. All participants completed a series of questionnaires prior to and immediately following the cessation intervention. Analyses examined gender differences in a range of smoking variables, cessation success and direct and indirect effects on changes in smoking behaviors. RESULTS Females were more likely to have parents, siblings and romantic partners who smokes, perceive that those around them will support a cessation effort, smoke more prior to intervention if they have friends who smoke, and to have lower cessation motivation and confidence if they have a parent who smokes. Conversely, males were more likely to have lower cessation motivation and confidence and be less likely to quit if they have a friend who smokes. CONCLUSIONS Gender plays an important role in adolescent smoking behavior and smoking cessation. Further research is needed to understand how these differences may be incorporated into intervention design to increase cessation success rates among this vulnerable population of smokers.

Development and Validation of a Parental Monitoring Instrument: Measuring How Parents Monitor Adolescents' Activities and Risk Behaviors.

The aim of this article is to describe the development and validation of the Parental Monitoring Instrument (PMI). The PMI was administered to a sample of 518 parent—adolescent (aged 12 to 17 years) dyads. Initial findings provide evidence of instrument reliability and validity. The exploratory factor analysis results suggested a seven-factor solution that explained approximately 48% of the variance. An analysis of the questions reveals reasonable interpretations of the seven factors: direct, indirect, restrictive, school, health, computer, and phone monitoring. Administration of the PMI may further our understanding of how parental monitoring is associated with adolescent activities and risk behaviors, setting the stage for informed strategies to improve parent—adolescent relationships.

Time to first cigarette and serum cotinine levels in adolescent smokers: National Health and Nutrition Examination Survey, 2007-2010.

INTRODUCTION Nicotine dependence and uptake among adolescents remains challenging to characterize and measure. Among adults, a shorter time to the first cigarette after waking up in the morning (TTFC) has become increasingly recognized as an indicator of nicotine dependence because of its association with biological measures of nicotine exposure, smoking relapse, and failed cessation attempts. However, the relation between TTFC and these measures has not been studied among adolescents. This study explored the association between TTFC and cotinine among adolescent smokers. METHODS The study utilized 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey (NHANES) data from 220 regular adolescent smokers between the ages of 12 and 19 who provided blood samples for cotinine evaluation. Regression modeling was conducted to determine whether TTFC predicts cotinine levels, a marker of nicotine uptake. RESULTS The time to first cigarette was significantly correlated with several smoking behaviors including number of cigarettes per day, time since last cigarette, and having a family member who smokes at home. Mean cotinine levels were more than 200 ng/ml in youths who smoked within 5 min after waking, compared with less than 34 ng/ml in youths who waited for more than 1 hr. In multiple regression models, a shorter time to first cigarette predicted higher cotinine levels after controlling for number of cigarettes per day and other factors. The TTFC was a predictor of cotinine for both male and female smokers. CONCLUSION The TTFC is a strong indicator of nicotine dependence in adolescents and could be an important component in screening for high-risk smoking and the development of tailored adolescent smoking intervention programs.

Predictors of the Nicotine Dependence Behavior Time to the First Cigarette in a Multiracial Cohort

BACKGROUND The time to first cigarette of the day (TTFC) is a strong indicator of nicotine dependence behaviors such as nicotine uptake and quit success in young and older smokers. There are substantial differences in levels of nicotine dependence by race and ethnic group. METHODS Data from Wave III of the multiracial National Longitudinal Study of Adolescent Health were analyzed for young smokers between the ages of 21 and 28 (N = 1,425). Time to first cigarette data was compared between Hispanic, White, Black, Native American, and Asian smokers. RESULTS Black smokers were significantly more likely to smoke within 5min of waking than White, Hispanic, and Asian smokers. Lower personal income predicted smoking within 5min of waking for both White and Black smokers. For White smokers, increased number of cigarettes per day and increased years of smoking also predicted smoking within 5min of waking. The number of days smoked or number of cigarettes per day did not predict smoking within 5min of waking among smokers. CONCLUSIONS The higher prevalence of early TTFC among Blacks indicates increased nicotine and carcinogen exposure, and may help explain the increased lung cancer rates and failed cessation attempts among Black smokers. TTFC may be an important screening item, independent of cigarettes per day, for clinicians and interventions to identify those at highest risk for cessation failure and disease risk.

Time to First Cigarette Predicts Cessation Outcomes in Adolescent Smokers

INTRODUCTION This study examined the relationship between the time to the first cigarette (TTFC) of the morning with quit status among adolescent smokers at the completion of a school-based smoking cessation program. Among those who did not quit, the relationship of TTFC with changes in cigarettes/day (CPD) was also examined. METHODS A total of 1,167 adolescent smokers (1,024 nonquitters and 143 quitters) from 4 states participating in efficacy and effectiveness studies of the Not-On-Tobacco (N-O-T) cessation program were assessed prior to entry into the program and again 3 months later at the end of treatment. Linear and logistic regression analyses determined the influence of treatment condition, age, gender, motivation to quit, confidence in quitting ability, baseline CPD, and TTFC on quit status and end-of-treatment CPD. RESULTS Adolescents with a TTFC of >30min of waking were twice as likely to quit at end of treatment. Additionally, among those who did not quit at end of treatment (n = 700 for TTFC ≤30min and n = 324 for TTFC for >30min), those with a TTFC within 30min of waking smoked a greater number of CPD. The relationships of TTFC with both of these outcomes remained when controlling for all other predictor variables. CONCLUSIONS Identifying adolescent smokers who smoke their first cigarette of the day within the first 30min of waking prior to a quit attempt may help to classify those individuals as having a greater risk for cessation failure. Thus, TTFC may be a behavioral indicator of nicotine dependence in adolescents.

Time to First Cigarette and 4-(Methylnitrosamino)-1-(3-Pyridyl)-1-Butanol (NNAL) Levels in Adult Smokers; National Health and Nutrition Examination Survey (NHANES), 2007–2010

Background: The time to first cigarette (TTFC) is a good indicator of several dimensions of nicotine dependence. An early TTFC is also associated with increased lung and oral cancer risk. Our objective was to determine the relationship between TTFC and exposure to tobacco smoke carcinogens. Methods: We conducted a cross-sectional analysis of a nationally representative subsample of smoking adults that had urinary samples analyzed for tobacco biomarkers. The study included 1,945 participants from the 2007–2008 and 2009–2010 National Health and Nutrition and Examination Survey. The main outcome measure was creatinine-adjusted urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) levels. Results: The cigarette-per-day adjusted levels of NNAL were twice as high in participants who smoked within 5 minutes after waking than in participants who refrained from smoking for at least 1 hour (0.58 vs. 0.28 ng/mL, P < 0.001). In multivariate linear models, a shorter TTFC was significantly associated with increasing NNAL levels, after adjusting for cigarettes smoked per day (or cotinine), secondhand smoke exposure, age, sex, race/ethnicity, and other potential confounders. Conclusions: These data show that in a nationally representative sample, there is a dose-dependent relationship between earlier smoking in the day and higher biologic exposure to a tobacco smoke carcinogen. Impact: Our study provides further evidence that highlights the relationship between TTFC, nicotine dependence, and cancer risk. Cancer Epidemiol Biomarkers Prev; 22(4); 615–22. ©2013 AACR.

Teaching the Concept of the Sampling Distribution of the Mean

The authors use proven cognitive and learning principles and recent developments in the field of educational psychology to teach the concept of the sampling distribution of the mean, which is arguably one of the most central concepts in inferential statistics. The proposed pedagogical approach relies on cognitive load, contiguity, and experiential learning theories and on the integration of new knowledge within previously formed knowledge structures. Thus, the proposed approach stimulates both visual and auditory learning, engages students in the process of learning through problem solving, and presents information so that it builds on existing knowledge. Results of an experiment including introductory statistics undergraduate students indicate that students exposed to the proposed theory-based pedagogical approach enhanced their learning by approximately 60%.