Recently Completed Projects: GATOR Study
Georgetown Adolescence Tobacco Research study, (GATOR study)
Project Leader: Janet Audrain, Ph.D.
PROJECT DESCRIPTION : Data show that cigarette smoking among high school students in the United States has increased from 27.5% in 1991 to 36.4% in 1997 (CDC, 1998). Previous research has focused primarily on either social factors or psychological factors in youth smoking adoption, yet these data fail to explain fully why some youth can experiment with smoking yet not become established smokers, while others transition rapidly to a pattern of established smoking. Research on the genetic basis of smoking may shed some light on this question. We propose a novel study of the genetic and nongenetic determinants of smoking adoption in high school students. This prospective cohort study will collect data on genetic and psychosocial factors in 1,200 9th graders and follow them over a four-year period (eight assessments) to assess initial smoking experiences and smoking patterns over time. The primary aim of the proposed study is to evaluate prospectively the contributions of specific genetic factors (i.e., genotypes for genes important in dopamine regulation) to the adoption of smoking. We will also evaluate whether these genetic effects are mediated by the rewarding effects of the initial smoking experience and/or by novelty-seeking personality. As a secondary aim, we will explore the main and interacting effects of other psychosocial factors (e.g., peer/family smoking, tobacco advertising, depression, alternate reinforcers) in the adoption of smoking. The data from this study can inform the development of programs to reduce the likelihood of adoption of an established pattern of smoking among adolescents and programs for smoking cessation treatment.
LATEST FINDINGS:
Psychosocial Correlates of Alternate Tobacco Product Use During Early Adolescence
Background . The objective was to assess psychosocial correlates of alternate tobacco product (chew/snuff, cigar, pipe, bidi, kretek) use. Methods . Measures of alternate tobacco product use, cigarette smoking, environmental smoking exposure, and depression were included in a school-based self-report survey completed by 1,107 ninth graders. Results . The current (past 30 days) use rate for one or more alternate tobacco products was 8.3% and the current use rate for cigarettes was 11%; 45% of current cigarette smokers also used alternate tobacco products. After controlling for demographic factors and current cigarette smoking, adolescents exposed to peers who smoke and those with greater depressive symptoms were two to three times more likely to currently use an alternate tobacco product than adolescents without exposure to peer smoking and those with lesser depressive symptoms. Conclusions . Social and psychological associations with alternate tobacco product use should be further evaluated as this information could be helpful in developing anti-tobacco messages targeted to high-risk youth.
Tercyak KP, Audrain J. Psychosocial correlates of alternative tobacco product use in early adolescence. Preventive Medicine . 2002; 35: 193-8 .
Interacting Effects of Depression and Tobacco Advertising Receptivity on Adolescent Smoking
Objective: To evaluate the independent effects of exposure to others who smoke and receptivity to tobacco advertising on adolescent smoking practices and the moderating influence of depression on these relationships. Methods : Participants were 1,123 high school freshmen who completed a self-report survey as part of a longitudinal investigation of the biobehavioral predictors of adolescent smoking adoption. Sixty percent of freshmen reported that they were never smokers (i.e., never tried or experimented with smoking, even a few puffs), and 40% reported being ever smokers (i.e., ever smoked at least a partial or whole cigarette). Results : In logistic regression models, the adjusted likelihood of ever smoking was greater for students reporting exposure to peer smoking. Further, a significant interaction was detected between receptivity to tobacco advertising and depression; specifically, adolescents with a high receptivity to tobacco advertising and clinically significant depressive symptoms were more likely to smoke than adolescents without these symptoms. Conclusions : Our data support the hypothesis that adolescents with both high advertising receptivity and depressed moods are most vulnerable to experiment with smoking. Tailoring prevention and intervention efforts to encompass tobacco advertising's effects and the role of depression could lead to a reduction in youth smoking.
Tercyak KP, Goldman P, Smith A, Audrain J. Interacting effects of depression and tobacco advertising receptivity on adolescent smoking . Journal of Pediatric Psychology . 2002; 27(2):145-54.
Recruiting Adolescents into Genetic Studies of Smoking Behavior
The goal of this study is to describe the process of establishing a longitudinal cohort to study genetic, psychological, and social predictors of adolescent smoking. Parents of eligible adolescents were approached for their consent via mail. Seventy-two percent of parents (n = 1533 of 2120) provided a response regarding their teens' participation. Among those who provided a response, 75% (1151) agreed to allow their teen to participate in the research yielding an overall parental consent rate of 54%. Compared with parents who consented to their teens' participation, parents who declined were less educated (89% had greater than a high school education compared with 69% of those who did not provide consent), less likely to be Caucasian (68 versus 48%), and less likely to report having ever even experimented with smoking (71 versus 60%). The most frequently reported reasons parents gave for declining consent included lack of interest and confidentiality concerns. A logistic regression model predicting consent to participate revealed a significant race by education interaction, indicating that among Caucasian parents, those with an education beyond high school were over two times more likely to provide consent compared with Caucasian parents with a high school education or less (odds ratio = 2.43; confidence interval = 1.37-4.32, P = 0.003).
Audrain J, Tercyak KP, Goldman P, Bush A. Recruiting adolescents into genetic studies of smoking behavior. Cancer Epidemiology Biomarkers & Prevention. 2002; 11(3):249-52.
Association of Attention-deficit/hyperactivity Disorder Symptoms with Levels of Cigarette Smoking in a Community Sample of Adolescents
Objective: Research on the association of attention-deficit/hyperactivity disorder (ADHD) with cigarette smoking has primarily occurred within samples of clinically referred youths. This paper reports the association of ADHD symptoms with smoking practices in a community sample of adolescents. Method : Confidential self-report surveys were completed by 1,066 tenth-grade students enrolled in five public high schools who were taking part in a longitudinal study of biobehavioral predictors of adolescent smoking adoption. A well-standardized measure of ADHD inattention and hyperactivity-impulsivity symptoms, as well as demographic and social risk factors, were examined in relation to three levels of cigarette smoking: (.1) never having smoked, (2) ever having smoked, and (3) current smoking (having smoked a cigarette within the past 30 days). Results : Regarding lifetime cigarette use, approximately 43% of students had ever smoked. Among those who had ever smoked, approximately 31% of students were current smokers. Ever having smoked was associated with family (odds ratio [OR] = 2.49, confidence interval [CI] = 1.85,3.36) and peer smoking (OR = 4.05, CI = 3.07,5.33), and clinically significant ADHD inattention symptoms (OR = 3.39, CI = 1.53, 7.54). Current smoking was also associated with peer smoking (OR = 2.99, CI = 1.72,5.20) and clinically significant ADHD inattention symptoms (OR = 2.80, CI = 1.20, 6.56). Conclusion : Clinically significant ADHD symptoms should be taken into account when identifying adolescents at risk to smoke, since those with problematic inattention may be more likely to experiment with smoking and to become regular tobacco users.
Tercyak KP, Lerman C, Audrain J. Association of attention-deficit/hyperactivity disorder symptoms with levels of cigarette smoking in a community sample of adolescents. Journal of the American Academy of Child & Adolescent Psychiatry . 2002; 41(7):799-805.
Which Adolescents are Most Receptive to Tobacco Industry Marketing? Implications for Counter-Advertising Campaigns
This study sought to identify adolescents most receptive to tobacco advertising based on individual differences in novelty-seeking personality and other key variables. Confidential self-report surveys were completed by 1,071 high school freshmen at 5 public high schools. The survey included validated measures of novelty-seeking personality, smoking habits, peer and family smoking, and tobacco advertising receptivity. Multiple logistic regression analysis was used to evaluate the independent associations of these variables and demographics with receptivity to tobacco advertising. Of the ninth graders, 44% had moderate to high levels of advertising receptivity and 56% had minimal to low levels of receptivity. Higher levels of receptivity were associated with ever smoking (OR = 2.59, CI = 1.99-3.39) and novelty-seeking personality (OR = 2.14, CI = 1.57-2.93). The association of novelty-seeking personality and tobacco advertising receptivity was most pronounced among adolescents who had never had a puff of a cigarette. Counter-advertising messages should consider individual differences in novelty-seeking, since novelty-seekers may be most receptive to tobacco industry promotional campaigns.
Audrain J, Tercyak, KP, Shields A, Bush A, Espinel F, Lerman C. Which adolescents are most receptive to tobacco industry marketing? Implications for counter-advertising campaigns. Health Communication . 15(4):499-513.
Personality Differences Associated with Smoking Experimentation among Adolescents with and without Comorbid Symptoms of ADHD
This study evaluated differences in adolescent personality (novelty-seeking, harm avoidance, and reward dependence), lifetime cigarette smoking, and symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) among 1,051 youths enrolled in several public high schools in middle Atlantic towns in the United States in 2000 and 2001. Psychological and behavioral data were obtained via self-report on the Temperament and Character Inventory (personality), standard epidemiological survey items (smoking), and the Current Symptoms Scale (ADHD). The results indicated that adolescent ever smokers with high-normal symptoms of ADHD had the highest novelty seeking scores compared to all other study groups. These data highlight the greater vulnerability to smoking that is associated with novelty seeking and symptoms of inattention and hyperactivity. To the extent that novelty seeking and ADHD share cognitive and/or behavioral elements that may negatively impact upon youths' ability to attend to tobacco control communications, additional research on ways to adjust the delivery and content of smoking prevention and intervention program messages to meet the needs of these adolescents is warranted.
Tercyak KP, Audrain-McGovern J. Personality differences associated with smoking experimentation among adolescents with and without comorbid symptoms of ADHD. Substance Use and Misuse . 2003; 38(14):1953-1970.
Smoking Progression and Physical Activity
This study examined the relationship between changes in physical activity and changes in smoking among adolescents. We prospectively examined smoking progression, physical activity, demographic factors, and covariates in 978 high school students participating in a longitudinal cohort study of the predictors of smoking adoption. We employed latent growth modeling with the parallel processes smoking progression and physical activity as our method, with smoking progression measured as an ordered categorical variable. Results indicated that higher levels of physical activity reduced the odds of progressing to smoking or a higher level of smoking by nearly one and a half (1.44; p < .05). No race differences were found. However, being male increased the odds of smoking progression by 1.32 (p < .05). Higher levels of physical activity may reduce the risk of smoking during adolescence. Youth smoking prevention initiatives should incorporate strategies to promote physical activity to prevent smoking experimentation and escalation.
Audrain-McGovern J, Rodriguez D, Moss HB. Smoking progression and physical activity. Cancer, Epidemiology, Biomarkers & Prevention . 2003: 12(11):1121-1129.
Team Sport Participation and Smoking: A Growth Mixture Model
Objective : To assess the likelihood of smoking among adolescents with different patterns of team sport participation, grades 9 - 11. Methods: Adolescents ( N = 1098) participating in a longitudinal study of the biobehavioral predictors of smoking adoption completed items assessing various health-related behaviors including team sport participation and smoking practices. General growth mixture modeling (GGMM) was used to analyze the data. Results: Four patterns of team sport participation were found. Adolescents with decreasing or erratic participation were nearly three times more likely than adolescents with high participation to be current smokers in 11 th grade. Non-Caucasians were at particular risk for these two patterns of team sport participation, and later smoking. Females were at high risk for low team participation. Conclusion: Results suggest that multiple patterns of team sport participation can be identified with GGMM, and that these patterns may be useful in characterizing individuals at particular risk of future smoking.
Rodriguez D, Audrain-McGovern J. Team sport participation and smoking: A growth mixture model. Journal of Pediatric Psychology . In Press.
Construct Validity Analysis of the Early Smoking Experience Questionnaire for Adolescents
Analysis was undertaken to assess the construct validity of a measure of early smoking experience with a sample of adolescent smokers who had ever tried smoking. The results of this study support a two-factor structure of early smoking experience as well as the assertion that initial smoking experience can be characterized by both unpleasant and pleasant sensations. A cross-structure analysis with related and unrelated constructs support the convergent and discriminant validity of the measure for an adolescent population .
Rodriguez D, Audrain-McGovern J. Construct validity analysis of the Early Smoking Experience Questionnaire for adolescents. Addictive Behaviors . In press.
Applying a Behavioral Framework to Understanding Adolescent Smoking
Adolescents' choice to smoke may depend on substitute reinforcers for smoking, complementary activities to smoking, and individual differences in reinforcer value. The influence of these variables on smoking was determined among 983 adolescents. Substitutes were school involvement, academic performance, physical activity, and sports team participation; complements were peer smoking and substance use; delay discounting assessed individual differences in reinforcer value. Latent Growth Modeling indicated that substitute reinforcers reduced the odds of smoking progression almost two-fold, complementary reinforcers increased the odds by 1.14, and delay discounting indirectly influenced the odds of smoking progression through complementary reinforcers. Adolescents who smoke may have fewer reinforcers that protect against smoking and more reinforcers that promote smoking. Discounting of future rewards affects smoking through reinforcer type .
Audrain-McGovern J, Rodriguez D, Tercyak KP, Epstein L, Goldman P, Wileyto EP. Applying a behavioral framework to understanding adolescent smoking . Psychology of Addictive Behaviors. In press.