Psychosocial risk and protective factors for adolescent tobacco use

Abstract

Knowledge of risk and protective factors for adolescent tobacco use will lead to the development of improved intervention strategies to reduce/prevent tobacco use. Theory and empirical findings demonstrate the multivariate complexity of the etiology of tobacco use. Sociocultural, social/interpersonal, and intrapersonal factors act through mediated chains of ultimate, distal, and proximal influences. Some influences moderate the effects of others. Once tobacco is used, feedback mechanisms modify prior causes that in turn alter subsequent tobacco use behavior. Most theories and cross-sectional, prospective, and causal process studies have contained major limitations: (a) most addressed only small portions of the total picture; (b) most mediational studies did not test for interactions and most moderation studies are based on limited theory (if any); and (c) most theories do not discuss how the causal processes might be different for males and females or for different ethnic groups (special cases of moderation). Furthermore, few studies focused on more distal or ultimate influences or examined multi-stream patterns, and few theories or causal process studies have specified or tested feedback loops. Determining psychosocial risk factors and how they influence tobacco use faces several major challenges, including discovering complex mediating processes, moderating variables, and overcoming limitations of surveys and theory. We offer six recommendations to advance transdisciplinary tobacco-prevention research: (a) base future studies on strong theory and aim to test one or more theories or theoretically derived hypotheses; (b) collect four or more waves of data and adopt dynamic strategies of prediction and analysis, including interactions, indirect effects, feedback loops, and transitions from one level of tobacco use to another; (c) provide evidence of generalizability to sub-populations within the study sample, such as by gender, ethnic group, and socioeconomic status; (d) use high-quality measures and multiple methodologies, including non-panel longitudinal studies, intensive interview, ethnography, experimental intervention, and small exploratory studies as well as further prospective studies; (e) include variables from multiple streams of influence to investigate interrelationships among cultural, social, and intrapersonal factors; and (f) collect data from multiple nested units (e.g., children within families, within schools, within neighborhoods) and employ multi-level analysis methods to investigate interrelationships among ultimate, distal, and proximal variables.

Correlates of Susceptibility to Smoking among Secondary School Students in Kota Tinggi District, Johor, Malaysia

“…The finding is in line with the empirical work by Leatherdale et al (2005) who reported that the odds of a non-smoker being more likely to be susceptible to smoking is high if he or she attends a school with smokers around, while breaking a school rule (including prohibition of smoking) was less likely to lead to increased susceptibility to smoking; this is also in line with Chen et al (2013) who reported that school environment can cause a school to be a high risk place for smoking initiation. The finding also supports the theory by Flay et al (1999) which posits that environment is one of the factors that influences human behavior. The increase in time spent by adolescents in secondary schools in our schooling system would increase the influence of the school environment on individuals, but with strict enforcement of school rules and the law which prohibits individuals below 18 years old from possessing or using tobacco products may help decrease the number of students who smoke in the school compound.…”

“…Previous studies (Biener et al, 1997;Albers et al, 2008) showed that consistent application of a rule or message is crucial if it is to be effective with adolescents. Some studies (Flay et al, 1999;Martinez-Donate, 2009) showed that partial smoking ban has not been effective in influencing children not to initiate smoking. Varying sample size, age groups and sampling methods used in the studies may be other factors which contribute to the contradictory results of this study and those mentioned above (Albers et al, 2008).…”

A Cross-Country Comparison of Knowledge, Attitudes and Practices about Tobacco Use: Findings from the Global Adult Tobacco Survey

“…However, a high level of knowledge about the ill effects of tobacco consumption is not necessarily a predictor of low tobacco consumption prevalence (Flay et al, 1999;Rosendahl et al, 2005). GATS survey in multiple countries has shown that awareness about harmful effects of tobacco smoking is very high.…”

Cigarette smoking and the lifetime alcohol involvement continuum

“…These protective factors likely operate during adolescence and young adulthood when initiation of use of both alcohol and tobacco is most common. Certain environmental influences during adolescence such as peers, parents, and religious beliefs, may limit both exposure to alcohol and exposure to tobacco during this time in life (Cohen et al, 1994;Flay et al, 1994;Flay et al, 1999). However, longitudinal studies also have shown that there is a bidirectional influence between smoking and alcohol initiation in adolescence that appears to be independent of common potential third factors (Jackson et al, 2002;Wetzels et al, 2003).…”