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Introduction In response to high rates of youth tobacco use, many states and localities are considering regulations on flavored tobacco products. The purpose of this study was to assess whether flavored tobacco restrictions (FTRs) in Massachusetts curb youth tobacco use over time and whether a dose–response effect of length of policy implementation on tobacco-related outcomes exists. Aims and Methods Using a quasiexperimental design, two municipalities with a FTR (adopting municipalities) were matched to a comparison municipality without a FTR. Surveys were administered before (December 2015) and after (January and February 2018) policy implementation to high school students in these municipalities (more than 2000 surveys completed at both timepoints). At follow-up, adopting municipalities had a policy in place for 1 and 2 years, respectively. In 2019, focus groups were conducted with high school students in each municipality. Results Increases seen in current tobacco use from baseline to follow-up were significantly smaller in adopting municipalities compared to the comparison (−9.4% [−14.2%, −4.6%] and −6.3% [−10.8%, −1.8%], respectively). However, policy impact was greater in one adopting municipality despite shorter length of implementation. Focus groups indicated reasons for differential impact, including proximity to localities without FTRs. Conclusions Restrictions implemented in adopting municipalities had positive impacts on youth tobacco awareness and use 1–2 years postimplementation. Policy impact varies depending on remaining points of access to flavored tobacco, as such policy effectiveness may increase as more localities restrict these products. Implications In response to high rates of youth flavored tobacco use (including flavored vape products), federal, state, and localities have passed FTRs that reduce availability of flavored tobacco in youth-accessible stores. Previous research has found that FTRs may curb youth tobacco use in the short-term; however, the long-term effectiveness remains unknown. This is the first study to show FTRs can curb youth tobacco use and reduce youth awareness of tobacco prices and brands even 2 years after policy passage. Municipality-specific factors, including proximity to localities without FTRs, may attenuate policy impact, highlighting the importance of widespread policy adoption.

Lesbian, gay, bisexual, and questioning (LGBQ) youth are overrepresented among youth experiencing homelessness (YEH), and health disparities among LGBQ youth are well-documented. LGBQ youth are typically aggregated as a single sexual minority group; however, research suggests that bisexual youth may have greater mental health, substance use, and physical health risks relative to their gay and lesbian peers. In a probability sample of LGBQ YEH in Los Angeles County (n = 183), we examined subgroup differences in homelessness severity, depression, physical health, and substance use, focusing on differences between bisexual and gay/lesbian youth due to the small subsample of questioning youth. Indicators of homelessness severity were standalone outcomes, and also were integrated as control variables with gender, age, race/ethnicity, and education in multivariable models. Bisexual youth were more likely to have become unaccompanied homeless persons as minors (OR = 4.35, 95% CI 1.85–10.23), and to have not recently utilized emergency shelters or transitional housing at least once in the past month (OR = 6.41; 95% CI 2.41–17.03). Bisexual youth were more likely to have probable depression (OR = 4.06, 95% CI 1.41–11.68). Among sexual minority YEH, bisexual youth may be at elevated risk for depression, in addition to more severe homelessness.

To counter the high prevalence of flavored tobacco use among youth, many U.S. localities have passed policies that restrict youth access to these products. This study aims to evaluate the short-term impact of a flavored tobacco restriction policy on youth access to, and use of, flavored tobacco products in a Massachusetts community.A community with the policy (Lowell) was matched to a community without the policy (Malden) with similar demographics, retailer characteristics, and point-of-sale tobacco policies. Product inventories were assessed in tobacco retailers in the 2 communities, and surveys were administered to high school-aged youth in those communities. Inventories and surveys were conducted around the time the policy took effect in October 2016 (baseline) and approximately 6 months later (follow-up); all data were analyzed in 2017. Chi-squared tests and difference-in-difference models were used to estimate the impact of the policy on flavored tobacco availability and youth perceptions and behaviors related to flavored tobacco use.Flavored tobacco availability decreased significantly in Lowell from baseline to follow-up periods by 70 percentage points (p0.001), whereas no significant changes in flavored tobacco availability were seen in Malden. In addition, current use of both flavored and non-flavored tobacco decreased in Lowell, but increased in Malden from baseline to follow-up; these changes were significantly different between communities (flavored tobacco: -5.7%, p=0.03; non-flavored tobacco: -6.2%, p=0.01).Policies that restrict the sale of flavored tobacco have the potential to curb youth tobacco use in as few as 6 months.

We develop an effect persistence model for intensive longitudinal data under a general assumption of an exponential loss of association between exposure and outcome over time. The working model proposed may be useful for understanding the complexity of phenomena where subjects can be repeatedly exposed to an intervention or a naturally occurring event while at the same time, the effect of any one exposure is expected to diminish over time. Under the main assumption, we specify a semi-linear model with extensions to generalized linear models. These methods are motivated by, and applied to, data from a study of adolescent exposure to pro-smoking advertisement where the impact of pro-smoking media exposure on young adults’ susceptibility to smoking is assessed along with the decay of the effect over time. We investigate the performance of the proposed method when the model assumptions are correctly specified or not. Supplementary materials for this article are available online.

OBJECTIVES: Use of alternative tobacco products, as well as regular cigarettes, is widespread among unaccompanied youth experiencing homelessness. However, little is known about their level of motivation for quitting use of these products, factors associated with motivation to quit, or how these might vary by type of tobacco product. METHODS: Unaccompanied homeless youth were sampled from 25 street and service sites in Los Angeles County (N=469). All participants were past month tobacco users who completed a survey on their tobacco-related behaviors and cognitions, including motivation to quit, as well as background characteristics. RESULTS: Among self-reported users of each product, motivation to quit in the next 30 days was highest for regular cigarettes (33%), followed by e-cigarettes/vaporizers (30%), little cigars/cigarillos (25%), cigars (20%), and natural cigarettes (20%). Between 33-49% of youth, depending on product, were not thinking about quitting at all. Correlates of lower motivation to quit differed somewhat by product type, with the most consistent being race, more frequent use, lower perceived riskiness of the product, and using the product because of its good taste or smell. CONCLUSIONS: Results from this study identify a set of psychosocial and behavioral factors, some that are common across tobacco products and others that are product-specific, that may be particularly important to address in efforts to reduce tobacco use among youth experiencing homelessness. Future regulations on the sale of flavored tobacco products may also serve to increase motivation to quit in this population.

PURPOSE: Adolescents who report having mental health problems, including depression and anxiety, are at greater risk of alcohol use. We examined the longitudinal association between mental health and alcohol use six months later in a diverse adolescent sample attending a primary care appointment. The primary care setting provides a unique opportunity to reach this younger age group and address risk factors, including mental health problems and substance use. METHODS: Adolescents aged 12–18 (n = 668) recruited from waiting rooms at four primary care clinics in Los Angeles, California and Pittsburgh, Pennsylvania completed a baseline web-based survey (April 2013 to November 2015) and another survey six months later. Bivariate analysis and multi-variable regression assessed associations between baseline mental health and 6-month alcohol use outcomes (any use, heavy use, and maximum quantity). RESULTS: Adolescents were stratified by mental health scores using the Mental Health Inventory-5 (MHI-5) cut off at baseline. In unadjusted analyses of alcohol outcomes at six months, adolescents with more mental health problems reported higher alcohol use across all three measures (p < .01 for heavy use; p < .05 for any use and maximum quantity used). Adolescents’ reports of better mental health at baseline were associated with fewer heavy drinking episodes (p < .05) and lower maximum number of drinks (p < .05) at six months, after adjusting for baseline alcohol use, intervention group, site, and demographic characteristics. CONCLUSIONS: Addressing mental health in primary care may be important for decreasing alcohol problems in adolescents. Strategies for facilitating screening and intervention with adolescents at-risk of alcohol use are warranted.

Introduction Cigarette smoking and associated high-risk behaviors are prevalent among youth experiencing homelessness (YEH), making appropriately tailored interventions targeting smoking behavior important for this group. We pilot tested a brief text-messaging intervention (TMI) as an adjunct to standard care for YEH who smoke and found promising preliminary effects of the intervention on smoking cessation. The purpose of the present study was to test the TMI’s effect on the secondary outcomes of other substance use (including use of other tobacco/nicotine devices) and mental health symptoms. Methods A total of 77 participants completed the pilot randomized controlled trial, with 40 receiving the TMI (174 automated text messages plus a group smoking counseling session and provision of nicotine patches). They completed an assessment at baseline and another three months later that evaluated use of other tobacco/nicotine devices, alcohol, marijuana, and anxiety and depression symptoms. Results We found that the TMI helped to reduce secondary substance use behaviors and mental health symptoms among the participants; mainly there were medium effects of the intervention on changes in other tobacco/nicotine use, drinking, and anxiety and depression symptoms. The intervention did not have an effect on number of marijuana use days in the past month; however, past 30-day marijuana users who received the intervention benefited by reducing the number of times they used marijuana per day. Conclusions In addition to helping reduce cigarette smoking, we found that a TMI for YEH was helpful in improving secondary outcomes, suggesting the promise of the TMI on benefiting YEH even beyond targeted smoking behavior. Implications This pilot study demonstrates that by targeting cigarette smoking using a text message-based intervention among youth experiencing homelessness, effects may be seen in other areas of functioning such as other substance use and mental health. Trial registration ClinicalTrials.gov Identifier NCT03874585. Registered March 14, 2019, https://clinicaltrials.gov/ct2/show/record/NCT03874585.

Introduction Smoking rates are alarmingly high among young people experiencing homelessness (YEH), yet there are no evidence-based cessation programs for this population. This paper presents results from a pilot evaluation of a text messaging-based smoking cessation treatment, as an adjunct to brief group cessation counseling, to improve abstinence rates among 18–25-year-old smokers experiencing homelessness. The goal of this study was to estimate effect sizes for a larger trial and it was not powered to detect group differences. Aims and Methods YEH smokers who had a working cell phone with them at recruitment were randomized to receive a group counseling session, nicotine patches, and written material on quitting (n = 37) or a similar program that also included a 6-week automated text messaging intervention (TMI) to provide ongoing support for quitting (n = 40). Smoking outcomes were evaluated through a 90-day follow-up. Results Seven-day point prevalence abstinence at 90-day follow-up was higher in the TMI condition than standard condition (17.50% vs. 8.11%, respectively; Cohen’s h = .37); however, the 90-day continuous abstinence rate was not statistically different from zero in either condition. Reductions in the number of days smoked in the past 30 days from baseline to follow-up were greater in the TMI condition than the standard condition (−14.24 vs. −8.62, respectively; Cohen’s d = .49). Conclusions Adding a 6-week TMI support to a brief group counseling and pharmacotherapy protocol holds promise for smoking reduction and abstinence among YEH smokers. Results indicate that further development and evaluation of the TMI in this population is warranted. Trial Registration ClinicalTrials.gov Identifier NCT03874585. Registered March 14, 2019, https://clinicaltrials.gov/ct2/show/record/NCT03874585. Implications This is the first study to evaluate the feasibility of using a text messaging-based intervention (TMI) for behavior change with 18–25 year olds experiencing homelessness, and more specifically, the first to test a TMI to provide ongoing support for smoking cessation. Small to medium effect sizes for the TMI are promising in terms of implementing a TMI using participants’ own cell phones, as well as the efficacy of this approach as an adjunct to standard care (brief group counseling and pharmacotherapy) for smoking cessation among YEH.

Background Smoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. Objective This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. Methods Homeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. Results Participants had widespread (smart)phone ownership—16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention. Conclusions The TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions. Trial Registration ClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585 International Registered Report Identifier (IRRID) RR2-10.1186/s13722-020-00187-6

OBJECTIVE The primary care (PC) setting provides a unique opportunity to address adolescent alcohol and other drug (AOD) use. METHOD We conducted a randomized controlled trial in 4 PC clinics from April 2013 to November 2015 to determine whether a 15-min brief motivational interviewing (MI) AOD intervention, delivered in PC, reduced alcohol and marijuana use and consequences. Adolescents ages 12-18 who came for an appointment during the 2.5-year study period were asked to be in the study and screened using the National Institute of Alcohol Abuse and Alcoholism Screening Guide. Those identified as at risk were randomized to the CHAT intervention or usual care (UC). Adolescents completed 4 web-based surveys at baseline and 3, 6, and 12 months postbaseline. RESULTS The sample (n = 294) was 58% female and 66% Hispanic, 17% Black, 12% White, 5% multiethnic or other, with an average age of 16 years. Compared to UC adolescents, CHAT adolescents reported significantly less perceived peer use of alcohol and marijuana at 3 months (alcohol: p < .0001; marijuana p = .01) and 6 months (alcohol: p = .04; marijuana p = .04). CHAT adolescents also reported marginally fewer negative alcohol consequences experienced at 6 months (p = .08). At 12 months, compared to UC, CHAT adolescents reported less perceived peer alcohol (p = .04) and marijuana (p < .01) use and fewer negative consequences from alcohol (p = .03) and marijuana (p = .04) use. CONCLUSIONS A brief MI intervention delivered in PC reduced negative consequences from alcohol and marijuana use 1 year later. Findings emphasize that adolescents can benefit from PC interventions that briefly and effectively address both alcohol and marijuana use. (PsycINFO Database Record

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) screening guide (SG) uses a 2-question screening process to identify adolescents at risk for alcohol use. The aim of this study was to identify the optimal screening rule in terms of identifying adolescents with alcohol use disorder (AUD) using the NIAAA questions by examining whether the cutpoint should vary by gender, race/ethnicity, grade, and/or age. Youth aged 12 through 18 years (N = 1,573; 27% Black, 51% Hispanic) were screened using the NIAAA SG, and then completed a survey. We used receiver operating characteristic curve analyses to identify the optimal cutpoint for the NIAAA screener question on self-use with AUD as the outcome. We compared the resulting screening rule with the NIAAA SG rule. We found that the optimal cutpoint depended on age and grade of adolescents. The resulting screening rule was the same as the NIAAA SG, and thus independently validated the NIAAA SG, with the exception of screening for adolescents 18 years of age, for which a lower cutpoint was indicated. The performance of both screening rules was highly similar when applied to the study sample, with a sensitivity of 0.89 for the optimal screening rule and a sensitivity of 0.87 for the NIAAA SG. In settings in which the cost of a false positive is relatively low (depending on available resources and cost of the intervention), lower cutpoints for older adolescents should be considered, as this may increase sensitivity of identifying these individuals at risk for AUD. (PsycINFO Database Record

Objectives This experiment tested whether introducing graphic antitobacco posters at point-of-sale (POS) had any effect on adolescents' susceptibility to future cigarette smoking and whether these effects were moderated by adolescents' baseline risk of cigarette smoking. Methods The study was conducted in the RAND StoreLab, a life-sized replica of a convenience store that was developed to experimentally evaluate how changing aspects of tobacco advertising displays in retail POS environments influence tobacco use risk and behavior during simulated shopping experiences. In this study, 441 adolescents were randomized to one of the four conditions in a 2 (graphic antismoking poster placed near the tobacco power wall: no, yes) × 2 (graphic antismoking poster placed near the cash register: no, yes) experimental design. The outcome of interest was susceptibility to future cigarette smoking. Results The addition of antismoking posters at POS led to a significant increase in future smoking susceptibility among those adolescents who already were at high risk for smoking in the future (p < .045). The introduction of graphic antismoking posters had no impact on committed never smokers, regardless of poster location; never smokers' susceptibility to future smoking was uniformly low across experimental conditions. Conclusions Introducing graphic antismoking posters at POS may have the unintended effect of further increasing cigarette smoking susceptibility among adolescents already at risk.

Self-efficacy has been associated with smoking cessation outcomes in many correlational research studies, but strong causal inferences are lacking. This study tested whether self-efficacy affects initial smoking cessation in a laboratory experiment, which will allow for stronger causal inferences in this domain of inquiry. Participants (n = 103 motivated adult smokers) were provided with brief cessation treatment over three days in preparation for quitting on a target quit day (TQD). In addition, participants were randomized to one of two standard self-efficacy manipulations in the form of bogus feedback about their chances of quitting smoking. Participants in the Average Chances of Quitting (ACQ) condition took a computerized test and were told (falsely) that the test showed that they had the same chances of quitting as everyone else in the study. Participants in the High Chances of Quitting (HCQ) condition took the same computerized test and were told (falsely) that the test showed that they had a greater chance of quitting compared to everyone else in the study. The main outcome was whether participants were able to quit for 24 hours on the TQD. Results revealed that HCQ participants had a significantly greater chance of quitting smoking compared to ACQ participants. However, these effects were not attributable to changes in self-efficacy brought about by the manipulation. An exploration of other potential mediators showed that the manipulation actually influenced smoking outcome expectancies, and changes in these outcome expectancies influenced initial smoking cessation. The results highlight the conceptual and empirical challenges with manipulating self-efficacy in the smoking literature.

Little is known about the extent and nature of youth exposure to online alcohol advertising, or factors that may be associated with exposure. The current study recruited middle school students who completed a paper survey and then logged each alcohol advertisement that they encountered over a 2-week period using cell phones as part of an ecological momentary assessment design. We examined the percentage of youth who reported exposure to online alcohol advertising in the past 2 weeks, average weekly rate of exposure, types of online alcohol advertisements youth reported seeing, and factors that increased youths' risk of exposure to online alcohol advertising. Analyses are based on 485 participants (47% female; 25% Hispanic, 25% White, 27% Black; 6% Asian, 16% other). Youth logged exposures to a total of 3,966 (16,018 weighted for underreporting) alcohol advertisements across the monitoring period; 154 (568 weighted) or 3.6% were online ads. Seventeen percent of youth reported seeing any online alcohol ad; the majority of online ads seen were video commercials (44.8%) and banner/side ads (26.6%). Factors associated with greater ad exposure were being older, rebellious, and Black race; greater parental monitoring and more hours spent on social media were associated with less exposure. Findings provide important information about adolescents' exposure to online alcohol advertising and what might contribute to a greater likelihood of exposure. Given that online ad exposure is linked to drinking behavior, prevention programming for younger adolescents should continue to address this issue to help youth make healthy choices regarding alcohol use. (PsycINFO Database Record

INTRODUCTION. Tobacco and marijuana co-use among young people in the U.S. is a public health concern that deserves greater attention. This study addresses a significant gap in the literature by examining the prevalence and correlates of tobacco and marijuana co-use among young people experiencing homelessness. METHODS. The analytic sample consisted of 449 unaccompanied homeless youth (mean age=22; 72% male) who had used any type of tobacco product in the past 30 days. Participants were recruited from 12 service sites and 13 street sites in Los Angeles County. RESULTS. Over 90% of young homeless tobacco users reported past month marijuana and tobacco co-use: 65% reported any co-administration (mixing both substances in a cigarette, joint, blunt, bong, hookah, pipe or bowl) and 27% reported only using them separately. Analysis of covariance tests found that co-administrators reported greater quantity and frequency of tobacco cigarette use, more frequent marijuana use, and, in some cases, poorer functioning and more severe homelessness compared to other tobacco users (p

Purpose:Virtually nothing is known about the potential effects of tobacco advertising on tobacco use among youth experiencing homelessness, a vulnerable population with high tobacco use rates. This study examines associations between the appeal of advertising for 5 classes of tobacco product (electronic cigarettes, hookah, cigars, cigarillos, and smokeless tobacco) and future intentions to use those products again among homeless youth who had indicated any level of lifetime use.Design:A cross-sectional design was used.Setting:Settings were 25 service and street sites in Los Angeles County.Participants:A probability sample of 469 young tobacco users experiencing homelessness (mean age = 22; 71% male; 29% non-Hispanic White) was recruited.Measures:Assessments included product-specific tobacco advertising appeal and future intentions to use the product again, as well as a range of covariate controls (eg, demographics, homelessness severity, current tobacco use, general advertising exposure).Analysis:Linear regression tested for associations between the appeal of advertising for a specific tobacco product and intentions to use that product again in the future, controlling for myriad covariates.Results:Advertising appeal was positively associated with future intentions to use again for electronic cigarettes ( P = .006) and hookah ( P = .001), but not cigars ( P = .486), cigarillos ( P = .126), or smokeless tobacco ( P = .109).Conclusion:Results suggest that advertising appeal may increase use of certain tobacco products among youth experiencing homelessness. However, differences in themes emphasized by advertising for specific tobacco products could differentially influence use in this population.

BACKGROUND AND OBJECTIVES: The primary care (PC) setting provides an opportunity to address adolescent alcohol and marijuana use. We examined moderators of effectiveness for a PC brief motivational intervention on adolescents’ alcohol and marijuana use and consequences 1 year later. METHODS: We conducted a randomized controlled trial in 4 PC clinics from April 2013 to November 2015 and followed adolescents using Web-based surveys. We examined whether demographic factors and severity of use moderated 12-month outcomes. Adolescents aged 12 through 18 were screened by using the National Institute on Alcohol Abuse and Alcoholism Screening Guide. Those identified as at risk were randomly assigned to the intervention (CHAT) or to usual care (UC). RESULTS: The sample (n = 294) was 58% female, 66% Hispanic, 17% African American, 12% white, and 5% multiethnic or of other race with an average age of 16 years. After controlling for baseline values of outcomes, teens in CHAT who reported more negative consequences from drinking or had an alcohol use disorder at baseline reported less alcohol use, heavy drinking, and consequences 1 year later compared with teens in UC. Similarly, teens in CHAT with more negative consequences from marijuana use at baseline reported less marijuana use 1 year later compared with teens in UC; however, teens in CHAT who reported fewer marijuana consequences at baseline reported greater marijuana use 1 year later compared with teens in UC. CONCLUSIONS: A brief intervention can be efficacious over the long-term for adolescents who report problems from alcohol and marijuana use. Findings emphasize the importance of both screening and intervention in at-risk adolescents in PC.

BackgroundFlavoured tobacco products are widely available in youth-accessible retailers and are associated with increased youth initiation and use. The city of Boston, Massachusetts restricted the sale of flavoured tobacco products, including cigars, smokeless tobacco and e-cigarettes, to adult-only retailers. This paper describes the impact of the restriction on product availability, advertisement and consumer demand.MethodsBetween January and December 2016, data were collected in 488 retailers in Boston at baseline and 469 retailers at 8-month follow-up, measuring the type, brand and flavour of tobacco products being sold. Process measures detailing the educational enforcement process, and retailer experience were also captured. McNemar tests and t-tests were used to assess the impact of the restriction on product availability.ResultsAfter policy implementation, only 14.4% of youth-accessible retailers sold flavoured products compared with 100% of retailers at baseline (pConclusionTobacco retailers across Boston were largely in compliance with the regulation. Availability of flavoured tobacco products in youth-accessible retailers declined city-wide after policy implementation. Strong educational and enforcement infrastructure may greatly enhance retailer compliance.

Author(s): Golinelli, Daniela; Tucker, Joan S; Shadel, William G | Abstract: IntroductionSeveral studies have reported pronounced racial/ethnic differences in smoking behavior among homeless youth. Better understanding the factors underlying racial/ethnic differences in daily smoking among homeless youth may help inform programs to reduce smoking in this population.MethodsData come from a probability sample of homeless youth in Los Angeles County collected between 2008 and 2009. The sample includes 116 African American, 99 Hispanic, and 119 White youth with ages ranging from 13 to 24 years. Chi-square tests were used to test the differences in daily smoking among African American, Hispanic, and White youth. Propensity score and doubly robust methods were used to produce a less biased estimate of the association between daily smoking and race/ethnicity after having removed the effect of potential confounders.ResultsThe daily smoking rate for White youth was 70.1%, more than 31 percentage points than the rates for either African American or Hispanic youth. Propensity score analysis revealed that the majority of the racial/ethnic differences in smoking rates could be explained by differences in homelessness severity, although background characteristics and comorbidity were relevant as well.ConclusionsAs programs are developed to reduce smoking among homeless youth, results suggest that additional outreach may be needed to engage White youth in services. Also, smoking prevention programs may benefit from incorporating a social network-based approach that assists youth in fostering relationships with lower-risk peers, as well as addressing other forms of substance use. Incorporating these elements may help reduce the large racial/ethnic disparities in daily smoking among homeless youth.ImplicationsThis report extends the small existing literature on racial/ethnic differences in smoking among homeless youth in two important respects. First, it confirms differences in daily smoking, an important indicator of dependence, across racial/ethnic groups. Second, it seeks to understand the extent to which differences in smoking can be explained by demographic characteristics (other than race/ethnicity), background factors, homelessness severity, and comorbidity characteristics known to be associated with substance use among homeless youth.

Objective China issued a nationwide "Tobacco-Free Campus" Policy (TFCP) in January 2014, but it is unclear how well it was implemented across China's 2138 college campuses. We conducted an Internet survey of Beijing college students to evaluate the implementation of the TFCP in Beijing. Methods An Internet survey of 711 students from 37 colleges in Beijing was conducted in May 2015. Respondents reported on secondhand smoking (SHS) exposure on campus, knowledge on and actions taken against SHS, and tobacco marketing exposure on campus. Results Almost 90% of respondents were exposed to SHS on campus at least once in the past month. Approximately 37% of nonsmokers and 61% of smokers reported seeing a teacher smoking, and the majority of both smokers and nonsmokers reported seeing a classmate smoking in campus buildings. The likelihood and location of SHS exposure depend on the participant's demographics and own smoking behavior. Nonsmokers were more likely to be aware of the health risk of SHS than smokers. Although most participants were aware of the harms, only 13% and 9% tried to stop their last SHS exposure indoors and outdoors, respectively. Forty-seven students from 14 colleges noticed tobacco marketing activities on campus. Conclusions The TFCP on Chinese college campuses was only partially enforced, particularly with regard to SHS. Implications On January 29, 2014, the Chinese Ministry of Education issued the TFCP. A major barrier to effective tobacco control in China is the difficulty in implementing policies issued by the central government. At this point, it is unclear whether the TFCP was successfully implemented on China's college campuses. Major tobacco use monitoring efforts do not include college students. The present research describes the current tobacco control environment on Beijing's college campuses 15 months after the TFCP took effect. To our knowledge, this is the first paper in the English literature on tobacco environment and exposure (rather than a prevalence survey) of college students in China.

Purpose To evaluate the momentary association between exposure to alcohol advertising and middle-school students' beliefs about alcohol in real-world settings and to explore racial/ethnic differences in this association. Methods Middle-school students (N = 588) carried handheld data collection devices for 14 days, recording their exposures to all forms of alcohol advertising during the assessment period. Students also responded to three investigator-initiated control prompts (programmed to occur randomly) on each day of the assessment period. After each exposure to advertising and at each control prompt, students reported their beliefs about alcohol. Mixed-effects regression models compared students' beliefs about alcohol between moments of exposure to alcohol advertising and control prompts. Results Students perceived the typical person their age who drinks alcohol (prototype perceptions) more favorably and perceived alcohol use as more normative at times of exposure to alcohol advertising than at times of nonexposure (i.e., at control prompts). Exposure to alcohol advertising was not associated with shifts in the perceived norms of black and Hispanic students, however, and the association between exposure and prototype perceptions was stronger among non-Hispanic students than among Hispanic students. Conclusions Exposure to alcohol advertising is associated with acute shifts in adolescents' perceptions of the typical person that drinks alcohol and the normativeness of drinking. These associations are both statistically and substantively meaningful.

Introduction Most young people experiencing homelessness smoke cigarettes, but little is known about use of alternative tobacco products (ATPs) such as e-cigarettes or other electronic nicotine delivery systems (ENDS) and little cigars/cigarillos (LCCs). This study examines past month use and correlates of cigarettes and ATP among young tobacco users experiencing homelessness. Methods We surveyed a probability sample of N = 469 unaccompanied homeless 13–25 year olds (mean age = 22; 71% male), who reported past month use of any type of tobacco product, from 25 service and street sites in Los Angeles County. Results Nearly all (90%) participants reported smoking regular cigarettes, and 78% reported using at least one tobacco product other than regular cigarettes. The most commonly used of these other products was natural cigarettes (55%), followed by LCCs (43%), ENDS (34%), cigars (31%), hookah (14%), chewing tobacco (7%), and snus (5%). Multivariable models indicated that correlates of past month use differed by product, but included sociodemographic characteristics, homelessness severity, depression, exposure to other people who used the product, and product perceptions (e.g., relative access, cost, and harm compared to cigarettes). Conclusion Use of cigarettes and ATPs are both widespread among young homeless tobacco users, suggesting that efforts to reduce tobacco use in this population should have a broad focus that includes a variety of products. The effectiveness of these efforts may be enhanced by addressing their considerable exposure to other tobacco users, as well as their perceptions of certain products as being less harmful or more cost-effective options than regular cigarettes.

Introduction Identifying distinct patterns of tobacco product use can inform efforts to reduce poly-tobacco use among young people, but little is known regarding patterns of use among youth experiencing homelessness. This study identified patterns of using tobacco/nicotine products among youth experiencing homelessness, and assessed whether certain subgroups of youth were more likely than others to engage in specific patterns of use. Methods Data were collected from a probability sample of 469 homeless youth who used tobacco in the past month, recruited from 25 service and street sites in Los Angeles County. Participants reported on lifetime and past month use of natural cigarettes, cigars, little cigars/cigarillos, electronic nicotine delivery systems, hookah, and chewing tobacco. Latent class analysis was used to identify patterns of tobacco product use. Results We identified four main classes of use: traditional cigarettes smokers (34.7% of the sample), poly-tobacco experimenters (24.9%), current users of combustible products (natural cigarettes, cigars, little cigars/cigarillos; 27.1%), and current poly-tobacco users (13.1%). Youth who were male, slept outdoors, and screened positive for substance abuse disorder were more than twice as likely as their counterparts to be current poly-tobacco users relative to traditional cigarettes smokers. Conclusions Rates of poly-tobacco experimentation and current use among youth experiencing homelessness are high. This suggests that efforts to reduce the use of tobacco products in this population should focus on the combined use of these products, and further, that users with the greatest poly-use may have competing unmet needs such as substance use disorders and more severe homelessness.

Introduction Roll-your-own (RYO) cigarette smoking is uncommon among young smokers in the U.S. but may be more widespread among those experiencing homelessness as it is a less expensive source of cigarettes. This study examines the prevalence and correlates of RYO use among young cigarette smokers experiencing homelessness. Methods The analytic sample consisted of 433 unaccompanied homeless youth who reported past month use of factory-manufactured cigarettes. Participants were sampled from 25 street and service sites in Los Angeles County, and completed a survey on their tobacco-related behaviors and cognitions. Results RYO use was reported by 43% of cigarette smokers. Among those who filled RYOs with tobacco, 87% rolled them with used tobacco (typically mixed with new tobacco). Most RYO smokers reported engaging in high-risk smoking practices, such as smoking discarded cigarettes. Although RYO smokers were more likely than other smokers to perceive RYOs as less risky in general, these groups did not differ in the perceived relative harm, expense, and ease of access of RYOs compared to regular cigarettes. Multivariable analyses indicated that RYO use was associated with older age, less perceived riskiness of RYOs, greater exposure to RYO smokers, and stronger future intentions to smoke. Conclusion RYOs may encourage continued tobacco use among youth experiencing homelessness and pose additional health risks despite users’ beliefs to the contrary. Future research is needed to obtain more detailed information on RYO practices and motivations for use, as well as how to address RYOs in efforts to reduce tobacco use in this population.

The purpose of this correlational study was to evaluate the association between attention paid by adolescents to the tobacco power wall and their susceptibility to future smoking. The study was conducted in the RAND Store Lab (RSL), a life-sized replica of a convenience store designed to investigate how tobacco advertising displays in retail point-of-sale environments relate to tobacco use risk and behaviors. In this study, middle and high school students (N = 80) shopped in the RSL while their attention to the tobacco power wall was measured covertly. Before and after shopping in the RSL, participants completed a measure of susceptibility to smoking in the future. Controlling for baseline cigarette smoking susceptibility and other potential confounders, attention toward the tobacco power wall was found to be significantly associated with future smoking susceptibility, p = .046. This finding suggests that policies aimed at decreasing the prominence of power walls in retail outlets should be given careful consideration as ways to reduce the impact of point-of-sale tobacco advertising and promotion on youth smoking susceptibility.

OBJECTIVE: The purpose of this study was to quantify the persistence of immediate changes in adolescents’ alcohol-related beliefs associated with exposure to alcohol advertising. METHOD: Middle school students (N = 606) carried handheld devices for 14 days and logged all of their exposures to alcohol advertisements as they naturally occurred. Perceptions of the typical person one’s age who drinks (“prototype perceptions”) and perceived norms regarding alcohol use were assessed after each exposure to advertising and at random prompts issued daily throughout the assessment period. Generalized additive modeling was used to determine how long pro-drinking shifts in beliefs persisted after exposure to advertising. RESULTS: Following exposure to advertisements, positivity of youth’s prototype perceptions immediately increased (β = .07, 95% CI [.06, .09]) and then decreased (β = -.05, 95% CI [-.07, -.03]) over the subsequent 1.5 days, whereas perceived normativeness of alcohol use immediately increased (β = .04, 95% CI [.01, .06]) and then decreased (β = -.03, 95% CI [-.05, -.01]) over the subsequent 2 days. Changes in beliefs occurring after 1.5 days for prototype perceptions and after 2 days for perceived norms were not statistically significant, suggesting that these beliefs were no longer affected by the advertising exposure. CONCLUSIONS: Findings are consistent with theories of alcohol advertising effects that presume that repeated exposure results in cumulative, enduring effects on beliefs. Given the rate of decay of alcohol advertising effects, it may be important to limit youth exposures to one every 2 days to avoid cumulative, lasting pro-drinking shifts in beliefs or to devise ways to interrupt cumulative effects with counter-messaging through media, parents, or other influential others at similar intervals.

Background Although the association between alcohol use and sexual risk behaviour has been well-documented, there is little understanding of whether marijuana use alone or combining marijuana with alcohol use contributes to sexual risk behaviour among adolescents. Methods: A diverse sample of sexually active adolescents (n = 616) aged 12–18 years (50.32% Hispanic; 31.17% Black) completed a survey on alcohol use, marijuana use and sexual risk behaviour during a visit to a primary care clinic. Results: Adolescents were more likely to report having had two or more sexual partners in the past 3 months if they reported using both alcohol and marijuana (OR = 3.90, P

Introduction Adolescents’ e-cigarette use is now more prevalent than their combustible cigarette use. Youth are exposed to e-cigarette advertising at retail point-of-sale (POS) locations via the tobacco power wall (TPW), but no studies have assessed whether exposure to the TPW influences susceptibility to future e-cigarette use. Methods The study was conducted in the RAND Store Lab (RSL), a life-sized replica of a convenience store developed to experimentally evaluate how POS advertising influences tobacco use risk under simulated shopping conditions. In a between-subjects experiment, 160 adolescents (M age = 13.82; 53% female, 56% white) were randomized to shop in the RSL under one of two conditions: (1) TPW located behind the cashier (n = 80); or (2) TPW hidden behind an opaque wall (n = 80). Youths rated willingness to use e-cigarettes (“If one of your best friends were to offer you an e-cigarette, would you try it?”; 1 = definitely not, 10 = definitely yes) before and after exposure. Linear regression assessed differences in pre-post changes in willingness to use across conditions. Results Ever-use of e-cigarettes was 5%; use of cigarettes was 8%; use of both e-cigarettes and cigarettes was 4%. There were no differences between TPW conditions on these or other baseline variables (eg, age, gender). Compared to the hidden condition, TPW exposure was associated with greater increases in willingness to use e-cigarettes in the future (B = 1.15, standard error [SE] = 0.50, p = .02). Conclusions Efforts to regulate visibility of the TPW at POS may help to reduce youths’ susceptibility to initiating e-cigarettes as well as conventional tobacco products like cigarettes. Implications Past work suggests that exposure to the TPW in common retail settings, like convenience stores, may increase adolescents’ susceptibility to smoking cigarettes. This experimental study builds upon prior research to show that exposure to the TPW at retail POS similarly increases adolescents’ willingness to use e-cigarettes in the future. Efforts to regulate the visibility of the TPW in retail settings may help to reduce youths’ susceptibility to initiating nicotine and tobacco products, including e-cigarettes.

Background To describe patterns of alcohol and other drug (AOD) use risk and adolescent reported primary care (PC) screening and intervention, and examine associations of AOD risk and mental health with reported care received. Methods We analyzed data from cross-sectional surveys collected from April 3, 2013 to November 24, 2015 from 1279 diverse adolescents ages 12–18 who reported visiting a doctor at least once in the past year. Key measures were AOD risk using the Personal Experience Screening Questionnaire; mental health using the 5-item Mental Health Inventory; binary measures of adolescent-reported screening and intervention. Results Half (49.2%) of the adolescents reported past year AOD use. Of the 769 (60.1%) of adolescents that reported being asked by a medical provider in PC about AOD use, only 37.2% reported receiving screening/intervention. The odds of reported screening/intervention were significantly higher for adolescents with higher AOD risk and lower mental health scores. Conclusions Adolescents at risk for AOD use and poor mental health are most likely to benefit from brief intervention. These findings suggest that strategies are needed to facilitate medical providers identification of need for counseling of both AOD and mental health care for at risk youth. Trials registration clinicaltrials.gov , Identifier: NCT01797835, March 2013.

Ecological momentary assessment was used to examine immediate changes in 87 college students' smoking-related attitudes, beliefs, and intentions as a joint function of their exposure to antismoking media and smoking status. Students (37 never smokers, 41 experimental smokers, and 9 current intermittent smokers) carried handheld data-collection devices for 3 weeks to record naturally occurring exposures to antismoking media and respond to investigator-initiated control prompts. At each reported exposure to antismoking media and each control prompt, participants reported their smoking-related attitudes, perceptions of the prevalence of smoking among their peers, resistance self-efficacy, and intentions to smoke. Mixed-effects regression was used to compare responses between encounters with antismoking media and control prompts. Experimental smokers reported weaker intentions to smoke and greater resistance self-efficacy at moments of exposure to antismoking media than at control prompts. Regardless of smoking experience, participants reported higher perceived prevalence of smoking at times of exposure to antismoking media than at control prompts. These findings generally support the value of antismoking media messages for shifting the beliefs and intentions of experimental smokers, who are at high risk for becoming committed regular smokers. (PsycINFO Database Record

Objectives Tobacco power walls display hundreds of tobacco products and are known to be a key part of the impact of point-of-sale tobacco advertising on risk for smoking in adolescents. The current study examined factors that are hypothesized to mediate the effect of tobacco power wall exposure on adolescents' susceptibility for smoking in the future. Method Participants (N = 148) aged 11-17 years were invited to shop in the RAND StoreLab, a life-sized replica of a convenience store. They were randomized to 1 of 2 conditions: one in which the power wall was located in its typical position behind the cashier and the other in which it was hidden behind an opaque wall. Participants shopped in the RAND StoreLab and then completed measures of susceptibility for smoking in the future, perceived smoking norms, and perceived accessibility of cigarettes. Participants' movements in the store were electronically tracked. Results Having the tobacco power wall behind the cashier increased adolescents' susceptibility for smoking in the future by 14.3% (total effect) compared with when the power wall was hidden (p = .01), and 14% of this effect was mediated by participants' perceived smoking norms. Time spent in front of the cashier and perceived accessibility of cigarettes did not play a role in the association between study condition and susceptibility for smoking in the future. Conclusions The tobacco power wall increases adolescents' smoking risk, and this effect is partly explained by the effect of the power wall on adolescents' perceptions of how normative smoking is. (PsycINFO Database Record

OBJECTIVE: Recent research revealed momentary associations between exposure to alcohol advertising and positive beliefs about alcohol among adolescents (Martino et al., 2016). We reanalyzed those data to determine whether associations depend on adolescents' appraisal of ads. METHOD: Over a 10-month period in 2013, 589 youth, ages 11-14, in the Los Angeles, CA, area, participated in a 14-day ecological momentary assessment, logging all exposures to alcohol advertisements as they occurred and completing brief assessments of their skepticism toward, liking of, and identification with any people in each ad, as well as their alcohol-related beliefs at the moment. Participants also completed measures of their alcohol- related beliefs at random moments of nonexposure throughout each day. Mixed-effects regression models compared beliefs about alcohol at moments of exposure to alcohol advertising that was appraised in a particular way (e.g., with liking, without liking) to beliefs at random moments. RESULTS: When youth encountered ads they appraised positively, their beliefs about alcohol were significantly more positive than when they were queried at random moments. Beliefs in the presence of ads that were not positively appraised were generally similar to beliefs at random moments. CONCLUSION: Youth are active participants in the advertising process. How they respond to and process alcohol advertising strongly moderates the association between exposure and alcohol-related beliefs. More effort is needed to identify attributes of alcohol advertisements, and of youth, that determine how youth process alcohol ads. This information can be used to either limit exposure to problematic ads or make youth more resilient to such exposure. (PsycINFO Database Record(c) 2017 APA, all rights reserved). Language: en

Smoking is a coping strategy for many smokers who then have difficulty finding new ways to cope with negative affect when they quit. This paper describes analyses conducted to develop and evaluate item banks for assessing the coping expectancies of smoking for daily and nondaily smokers.Using data from a large sample of daily (N = 4,201) and nondaily (N = 1,183) smokers, we conducted a series of item factor analyses, item response theory analyses, and differential item functioning (DIF) analyses (according to gender, age, and ethnicity) to arrive at a unidimensional set of items for daily and nondaily smokers. We also evaluated performance of short forms (SFs) and computer adaptive tests (CATs) for assessing coping expectancies of smoking.For both daily and nondaily smokers, the unidimensional Coping Expectancies item banks (21 items) are relatively DIF free and are highly reliable (0.96 and 0.97, respectively). A common 4-item SF for daily and nondaily smokers also showed good reliability (0.85). Adaptive tests required an average of 4.3 and 3.7 items for simulated daily and nondaily respondents, respectively, and achieved reliabilities of 0.91 for both when the maximum test length was 10 items.This research provides a new set of items that can be used to reliably assess coping expectancies of smoking, through a SF, CAT, or a tailored set selected for a specific research purpose.

INTRODUCTION The Patient-Reported Outcomes Measurement Information System (PROMIS) Smoking Initiative has developed 6 item banks for assessing smoking behaviors and biopsychosocial correlates of smoking among daily and nondaily adult cigarette smokers. This paper presents descriptive information and preliminary validity evidence for the item banks (Nicotine Dependence, Coping Expectancies, Emotional and Sensory Expectancies, Health Expectancies, Psychosocial Expectancies, and Social Motivations). METHODS Using data from a large sample of daily (N = 4,201) and nondaily (N = 1,183) smokers, we generated mean daily and nondaily smoking bank scores according to select demographic groups. We also examined correlations among the 6 banks and examined the associations of bank scores with smoking behavior items (e.g., quantity of smoking, interest in quitting) and select health-related quality of life measures (i.e., physical functioning, anxiety, alcohol consumption). RESULTS Correlations among the 6 banks are moderate (daily mean r = .48, range = .04-.80; nondaily mean r = .47, range = .12-.75). The pattern of associations between bank scores and other measures provides validity evidence for the bank domains (e.g., nicotine dependence is most strongly associated with smoking quantity and time to first cigarette of the day; health and psychosocial expectancies are most related to quitting recency and interest; coping expectancies are strongly associated with anxiety). CONCLUSIONS These analyses provide useful descriptive information about the 6 smoking item banks as well as preliminary evidence for their validity. Independent sample data are currently being collected to replicate these findings, to establish test-retest reliability, and to develop crosswalks to existing smoking measures (e.g., nicotine dependence to Fagerstrom Test for Nicotine Dependence). Future research will also evaluate the bank scores' sensitivity to change.

Introduction Nicotine dependence is a core construct important for understanding cigarette smoking and smoking cessation behavior. This article describes analyses conducted to develop and evaluate item banks for assessing nicotine dependence among daily and nondaily smokers. Methods Using data from a sample of daily (N = 4,201) and nondaily (N =1,183) smokers, we conducted a series of item factor analyses, item response theory analyses, and differential item functioning analyses (according to gender, age, and race/ethnicity) to arrive at a unidimensional set of nicotine dependence items for daily and nondaily smokers. We also evaluated performance of short forms (SFs) and computer adaptive tests (CATs) to efficiently assess dependence. Results A total of 32 items were included in the Nicotine Dependence item banks; 22 items are common across daily and nondaily smokers, 5 are unique to daily smokers, and 5 are unique to nondaily smokers. For both daily and nondaily smokers, the Nicotine Dependence item banks are strongly unidimensional, highly reliable (reliability = 0.97 and 0.97, respectively), and perform similarly across gender, age, and race/ethnicity groups. SFs common to daily and nondaily smokers consist of 8 and 4 items (reliability = 0.91 and 0.81, respectively). Results from simulated CATs showed that dependence can be assessed with very good precision for most respondents using fewer than 6 items adaptively selected from the item banks. Conclusions Nicotine dependence on cigarettes can be assessed on the basis of these item banks via one of the SFs, by using CATs, or through a tailored set of items selected for a specific research purpose.

INTRODUCTION The positive emotional and sensory expectancies of cigarette smoking include improved cognitive abilities, positive affective states, and pleasurable sensorimotor sensations. This paper describes development of Positive Emotional and Sensory Expectancies of Smoking item banks that will serve to standardize the assessment of this construct among daily and nondaily cigarette smokers. METHODS Data came from daily (N = 4,201) and nondaily (N =1,183) smokers who completed an online survey. To identify a unidimensional set of items, we conducted item factor analyses, item response theory analyses, and differential item functioning analyses. Additionally, we evaluated the performance of fixed-item short forms (SFs) and computer adaptive tests (CATs) to efficiently assess the construct. RESULTS Eighteen items were included in the item banks (15 common across daily and nondaily smokers, 1 unique to daily, 2 unique to nondaily). The item banks are strongly unidimensional, highly reliable (reliability = 0.95 for both), and perform similarly across gender, age, and race/ethnicity groups. A SF common to daily and nondaily smokers consists of 6 items (reliability = 0.86). Results from simulated CATs indicated that, on average, less than 8 items are needed to assess the construct with adequate precision using the item banks. CONCLUSIONS These analyses identified a new set of items that can assess the positive emotional and sensory expectancies of smoking in a reliable and standardized manner. Considerable efficiency in assessing this construct can be achieved by using the item bank SF, employing computer adaptive tests, or selecting subsets of items tailored to specific research or clinical purposes.

Introduction Negative psychosocial expectancies of smoking include aspects of social disapproval and disappointment in oneself. This paper describes analyses conducted to develop and evaluate item banks for assessing psychosocial expectancies among daily and nondaily smokers. Methods Using data from a sample of daily (N = 4,201) and nondaily (N =1,183) smokers, we conducted a series of item factor analyses, item response theory analyses, and differential item functioning analyses (according to gender, age, and race/ethnicity) to arrive at a unidimensional set of psychosocial expectancies items for daily and nondaily smokers. We also evaluated performance of short forms (SFs) and computer adaptive tests (CATs) to efficiently assess psychosocial expectancies. Results A total of 21 items were included in the Psychosocial Expectancies item banks: 14 items are common across daily and nondaily smokers, 6 are unique to daily, and 1 is unique to nondaily. For both daily and nondaily smokers, the Psychosocial Expectancies item banks are strongly unidimensional, highly reliable (reliability = 0.95 and 0.93, respectively), and perform similarly across gender, age, and race/ethnicity groups. A SF common to daily and nondaily smokers consists of 6 items (reliability = 0.85). Results from simulated CATs showed that, on average, fewer than 8 items are needed to assess psychosocial expectancies with adequate precision when using the item banks. Conclusions Psychosocial expectancies of smoking can be assessed on the basis of these item banks via the SF, by using CAT, or through a tailored set of items selected for a specific research purpose.

Introduction Smokers' health-related outcome expectancies are associated with a number of important constructs in smoking research, yet there are no measures currently available that focus exclusively on this domain. This paper describes the development and evaluation of item banks for assessing the health expectancies of smoking. Methods Using data from a sample of daily (N = 4,201) and nondaily (N = 1,183) smokers, we conducted a series of item factor analyses, item response theory analyses, and differential item functioning analyses (according to gender, age, and race/ethnicity) to arrive at a unidimensional set of health expectancies items for daily and nondaily smokers. We also evaluated the performance of short forms (SFs) and computer adaptive tests (CATs) to efficiently assess health expectancies. Results A total of 24 items were included in the Health Expectancies item banks; 13 items are common across daily and nondaily smokers, 6 are unique to daily, and 5 are unique to nondaily. For both daily and nondaily smokers, the Health Expectancies item banks are unidimensional, reliable (reliability = 0.95 and 0.96, respectively), and perform similarly across gender, age, and race/ethnicity groups. A SF common to daily and nondaily smokers consists of 6 items (reliability = 0.87). Results from simulated CATs showed that health expectancies can be assessed with good precision with an average of 5-6 items adaptively selected from the item banks. Conclusions Health expectancies of smoking can be assessed on the basis of these item banks via SFs, CATs, or through a tailored set of items selected for a specific research purpose.

BACKGROUND: It is important to improve primary care providers’ capability to identify youth at risk for alcohol and other drug use. To our knowledge, this is the first study to use Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria to compare screeners for youth for both alcohol and marijuana, given that these are the most frequently used substances by this age group. METHODS: We compared the psychometric performance of 4 screeners: the National Institute on Alcohol Abuse and Alcoholism Screening Guide (NIAAA SG), the Alcohol Use Disorders Identification Test, the Car–Relax–Alone–Forget–Family and Friends–Trouble (CRAFFT) screener, and the Personal Experience Screening Questionnaire Problem Severity Scale (PESQ-PS) in identifying alcohol and marijuana use outcomes. Youth age 12 through 18 (N = 1573; 27% black, 51% Hispanic) were screened with the NIAAA SG, followed by a Web survey that included the other screeners and outcomes. RESULTS: Sensitivity for alcohol outcomes indicated that the NIAAA SG (0.87) did not perform as well as the CRAFFT (0.97) or PESQ-PS (0.97) screeners but performed better than the Alcohol Use Disorders Identification Test (0.70). The pattern for sensitivity across screeners for marijuana outcomes was similar. CONCLUSIONS: An important tradeoff in primary care settings is precision versus practicality. Because of brevity and focus on frequency of drinking, the NIAAA SG offers ease of administration and is good at identifying youth with probably problematic drinking levels. The PESQ-PS and the CRAFFT correctly identify more at-risk youth for alcohol and marijuana than the NIAAA SG. Future work is needed to elucidate how to efficiently and accurately identify at-risk youth in the primary care setting, including determining the best cutoff points to use to increase sensitivity.

The purpose of this study was to quantify middle school youth's exposure to alcohol advertisements across media and venues, determine venues of greatest exposure, and identify characteristics of youth who are most exposed.Over a 10-month period in 2013, 589 Los Angeles-area youth ages 11-14 from diverse racial/ethnic backgrounds completed a short paper-and-pencil survey assessing background characteristics and then participated in a 14-day ecological momentary assessment, logging all exposures to alcohol advertisements on handheld computers as they occurred.African American and Hispanic youth were exposed to an average of 4.1 and 3.4 advertisements per day, respectively, nearly two times as many as non-Hispanic White youth, who were exposed to 2.0 advertisements per day. Girls were exposed to 30% more advertisements than boys. Most exposures were to outdoor advertisements, with television advertisements a close second.Exposure to alcohol advertising is frequent among middle school-age youth and may put them at risk for earlier or more frequent underage drinking. Greater restrictions on alcohol advertising outdoors and on television should be considered by regulators and by the alcohol industry and should focus particularly on reducing exposure among minority youth.

This study examined whether an adolescent’s self-identified race moderates the perceived effectiveness of anti-smoking messages. A sample of 94 never smoking adolescents (59% African-American; 41% European-American) participated in this two-part study. First, they rated the persuasive strength of a series of five decontextualized anti-smoking messages (i.e., messages delivered in text format). Second, they were exposed to five sets of anti-smoking public service announcements (PSAs; viewed as TV advertisements) that had embedded in them the five anti-smoking messages used in the first part of the study and rated their smoking refusal self-efficacy after each one. Although race moderated participants’ ratings of the decontextualized messages, there were no significant moderating effects of race when those messages were embedded in PSAs. The results of this study support the notion that anti-smoking PSAs should not be targeted to adolescent racial background, but suggests that decontextualized anti-smoking messages may be more effective if targeted to adolescent race.

Exposure to smoking in movies is strongly associated with smoking uptake and maintenance among adolescents. However, little is known about what features of movies (e.g., the context for smoking or motives for a character smoking) moderate the association between exposure to movie smoking and adolescent smoking. This laboratory study examined whether exposure to movie smoking that is portrayed as having a clear motive is associated with the desire to smoke differently than smoking that is portrayed as having no clear motive.A sample of 77 middle school students (mean age of 12.8 years, 62% male, 60% Caucasian) viewed movie clips that portrayed smoking as helping to facilitate social interaction, to relax, to appear rebellious, or as having no clear motive. After exposure to each clip, participants rated their desire to smoke.Exposure to clips where smoking was portrayed as helping characters to relax was associated with a significantly stronger desire to smoke compared with clips where the motive for smoking was unclear. Desire to smoke was similar for clips where no motive was clear, social smoking clips, and rebellious smoking clips.These results suggest that the way that smoking is portrayed in movies is important in determining its effect on adolescent smoking.

Aims Little is known about smoking during the transition to college. The current study examined trajectories of smoking among college freshmen, how trajectories predicted later smoking and the social context of smoking. Design Weekly assessments of daily smoking were collected via the web during the first year of college for a large cohort with a previous history of smoking. Participants and setting A total of 193 college freshmen from a large public university with a previous history of smoking who smoked frequently enough to be included in trajectory analysis.Measurements Measuresincludedweeklyreportsof dailysmoking,familysmoking,perceivedpeerattitudes and smoking, social norms and social smoking environment. Findings Seven trajectories were identified: one of low-level sporadic smoking, one of low-level smoking with a small increase during the year, two classes with a substantial decrease during the year, two classes with relatively small decreases and one class with a substantial increase in smoking. Trajectories of smoking in the freshman year predicted levels of sophomore year smoking, and some social context variables tended to change as smoking increased or decreased for a given trajectory class. Conclusions The transition into college is marked by changes in smoking, with smoking escalating for some students andcontinuingintothesophomoreyear.Shiftsinsocialcontextthatsupportsmokingwereassociatedwithtrajectories of smoking. Despite the focus of developmental models on smoking in early adolescence, the transition into college warrants further investigation as a dynamic period for smoking.

Increased exposure to cigarette advertising and marketing is associated with increased levels of adolescent smoking (see narrative reviews by DiFranza et al., 2006; Wakefield, Flay, Nichter, & Giovino, 2003, see meta-analysis by Wellman, Sugarman, DiFranza, & Winkoff, 2006). The Master Settlement Agreement (MSA), reached in 1998, essentially banned youth-focused tobacco advertising and significantly restricted how the tobacco industry can advertise and market cigarettes. As a seeming consequence of the MSA, the relative proportion of advertising and marketing dollars has moved away from youth-focused outlets (e.g., magazine and billboard advertisements to point of sale promotions; Federal Trade Comission, [FTC], 2007). However, tobacco industry advertising budgets have nearly doubled since 1998 (FTC, 2007) and a substantial majority of adolescents continue to be exposed to cigarette advertising and marketing (King & Siegel, 2001; Lancaster & Lancaster, 2003; Lee, Taylor, & McGetrick, 2004; Pollack & Jacobson, 2003). For example, the ∼$32 million decrease in tobacco industry advertising in newspapers and magazines from 2002 to 2004 (FTC, 2007) corresponded only to an 11% drop in the percentage of adolescents who report being exposed [see the 2002 and 2004 National Youth Tobacco Survey (http://www.cdc.gov/tobacco/data_statistics/surveys/NYTS/index.htm)]. Cigarette advertising may be particularly influential for adolescents who have never smoked or who have minimal levels of experience with smoking. The development of dependent smoking among youth has been characterized as stage-based (Leventhal & Cleary, 1980; Mayhew, Flay, & Mott, 2000). Adolescents are theorized to move from (a) never smoking or having no desire or intention to smoke; to (b) preparing to smoke; to (c) engaging in initial smoking trials (i.e., the first puffs of a cigarette on one or in a few very circumscribed occasions); to (d) experimenting with smoking (i.e., more frequent, but still irregular smoking in particular contexts); to (e) engaging in regular smoking (i.e., smoking on a regular basis in specific contexts); and then finally to (f) engaging in dependent smoking (i.e., smoking that occurs regularly and is driven by processes that define the nicotine dependence syndrome, e.g., craving, withdrawal, see Shadel, Shiffman, Niaura, Nichter, & Abrams, 2000). In general, transitions to smoking among the earlier stages (e.g., never smoking to preparing to smoke to engaging in initial trials) are theorized to be governed more by factors such as tobacco-related media, improving the self-image, peer norms, and mood, whereas later transitions (e.g., experimental to regular to dependent use) are theorized to be governed more by physiological cues and reactions to smoking, and to processes relating to nicotine dependence (e.g., craving, withdrawal) (Flay & Petraitis, 1994; Leventhal & Cleary, 1980; USDHHS, 1994). Consistent with this theoretical position, data from a recently published meta-analysis indicate that exposure to cigarette advertisements increases the odds of moving from never smoking to initiation by 79–91%; exposure increases the odds of progressing from experimental smoking to more regular smoking around 12%. The effects of exposure on initiation were significantly larger than the effects of exposure on progression to regular smoking (Wellman et al., 2006). Clearly, then, exposure to cigarette advertising still appears to represent a potentially significant influence on adolescent smoking, particularly in never smoking adolescents. However, the field still struggles to understand who is most vulnerable to the effects of cigarette advertising. A better understanding of moderators of cigarette advertising efficacy could lead to improved smoking prevention and media literacy programs that target particularly vulnerable individuals with more aggressive interventions (Kazdin & Nock, 2003). The research reported in this article builds on recent work (Shadel, Niaura, & Abrams, 2001, 2004b) that has examined how individual differences in the developmental maturity of the self-concept may be associated with adolescents’ responses to cigarette advertising. This work has capitalized on findings suggesting that the images in cigarette advertisements are critical to understanding their persuasive efficacy among adolescents (Covell, 1992; Covell, Dion, & Dion, 1994; Romer & Jamieson, 2001; Shadel, Niaura, & Abrams, 2002; Slovic, 2001). It also builds on less formal speculation that the adolescents’ developing self-concept is a psychological mechanism through which cigarette advertising may exert an effect on adolescent smoking (Chapman & Fitzgerald, 1982; Krugman, Quinn, Sung, & Morrison, 2005; Pierce, DiStafan, Jackson, & White, 2002; Pollay et al., 1996; USDHHS, 1994). Individuals’ self-concept undergoes significant change during adolescence (Arnett, 1999; Erikson, 1968; Harter, 1999a, b; Marcia, 1999). Social-cognitive perspectives on self-concept development operationalize these changes in self-concept as conflicts among the various descriptive self-attributes that an individual adolescent uses to define him or her self (i.e., “How can I be both independent and dependent?”). In general, these conflicts are relatively fewer in number during early adolescence (e.g., ages 11–13), increase during middle adolescence (ages 14–17) and decline in late adolescence (ages 18–22) and beyond (Harter, 1999a, b; Harter & Monsour, 1992). Conflicts among self-attributes arise due to adolescents’ increasing awareness that new and different self-attributes can be used to describe them, and a lack of the cognitive facilities necessary to resolve the contradictions that may arise between opposing self-attributes. The cognitive capacity to resolve self-conflicts develops during middle and late adolescence. Adolescents who possess a high number of self-conflicts and are not capable of resolving those conflicts (i.e., young adolescents due to their relative lack of cognitive maturity) look to external contexts to help them decide, which attributes are most important and which one(s) they should adopt as part of their self-concept (Harter, 1999a). Shadel and colleagues (2001) proposed that the powerful images displayed by cigarette advertisements represent one such external context that adolescents who have higher levels of unresolvable self-conflict may look to for help in defining themselves. In a sample of never smokers, a previous study (Shadel et al., 2004b) found that young adolescents with a greater number of self-conflicts reported that cigarette advertising imagery was more relevant to them compared to young adolescents with lower numbers of self-conflicts and middle adolescents (regardless of self-conflict). Self-relevance of the advertisements was a key outcome in this study, given that communications that are more relevant to the self are generally more persuasive than those for which that is not the case (Petty & Wegener, 1999). Significant questions about the role of self-conflict in moderating adolescents’ reactions to cigarette advertising remain, however. Most critically, it is unclear as to whether self-conflict has any bearing on adolescents’ smoking cognitions and smoking behavior after they have been exposed to cigarette advertising. The purpose of the current study was to expand upon the findings of Shadel et al. (2004b) by evaluating how the number of self-conflicts interacts with age and self-relevance of cigarette advertising to predict adolescent never smokers’ intentions to smoke following exposure to cigarette advertising. Intentions are a key predictor of progression to regular smoking in adolescence (Choi, Gilpin, Farkas, & Pierce, 2001; Wakefield et al., 2004) and as such, are a logical outcome for laboratory-based work with adolescent never smokers. Based upon theory (Shadel et al., 2001) and prior work (Shadel et al., 2004b), it was hypothesized that young adolescents who have higher numbers of self-conflicts and who evaluate cigarette advertisements as more self-relevant would have the strongest intentions to smoke following exposure to cigarette advertising compared to young adolescents with lower numbers of self-conflicts. Self-conflict was not expected to play as strong a role with middle adolescents.

Studies have shown that increased exposure to cigarette advertising increases adolescents' risk of smoking and moreover, that gender may play an important role in moderating how cigarette advertisements are viewed and processed. However, information about the particular features of cigarette advertising that interact with gender to promote smoking among adolescents is scarce. The purpose of this study was to examine if gender moderates the degree to which the relaxation valence (i.e., degree to which relaxing themes are emphasized) of cigarette advertisements is related to smoking intentions in a sample of never smoking adolescents. Regardless of brand type (of the seven brands studied), cigarette advertisements that displayed highly relaxing images were associated with increased intentions to smoke among female adolescents only. These results have implications for understanding what features of cigarette advertisements have the most influence among different groups of adolescents.

Background This study of homeless youth uses quantitative data to estimate the prevalence of high-risk smoking practices (obtaining or using cigarettes in a way that increase exposure to toxins and/or susceptibility to infectious diseases) and identify characteristics associated in particular with sniping (smoking discarded cigarettes), and qualitative data to describe why and how homeless youth engage in sniping. Methods A probability sample of 292 homeless youth smokers in Los Angeles County completed a self-administered survey, and a separate convenience sample of 27 homeless youth who were lifetime smokers participated in focus groups. Survey participants reported on background characteristics, smoking cognitions, and high-risk smoking practices. Focus group participants described how they obtained cigarettes and responses relevant to sniping were coded. Results Survey results indicated that nearly all youth engaged in at least one high-risk smoking practice, with three-quarters having sniped cigarettes in the past 30 days. Sniping was more frequent among youth with less negative smoking attitudes ( b = −0.29, 95% CI = −0.55 to −0.04, p = 0.02), greater nicotine dependence ( b = 0.11, 95% CI = 0.00 to 0.23, p = 0.046), lower income ( b = −0.05, 95% CI = −0.09 to −0.01, p = 0.02), and more severe drug abuse ( b = 0.15, 95% CI = 0.04, 0.26, p = 0.01). Focus groups data indicated that youth snipe because it provides cheap and easy access to tobacco, and use specific strategies to mitigate the perceived health risks of sniping. Conclusions Sniping and other high-risk smoking practices deserve further attention among homeless youth, particularly those already facing greater health threats due to factors such as nicotine dependence, lower income, and drug abuse.

Author(s): Tucker, Joan S; Shadel, William G; Golinelli, Daniela; Ewing, Brett; Mullins, Leslie | Abstract: IntroductionApproximately 70% of unaccompanied homeless youth are current smokers. Although a few studies have described smoking behavior among homeless youth, none have focused on how to help homeless youth quit smoking. As such, there are significant gaps in understanding their interest in quitting and what strategies might best fit their specific needs.MethodsUnaccompanied homeless youth were randomly sampled from street sites in Los Angeles County (N = 292). All were current smokers who completed a survey on their smoking-related behaviors and cognitions.Results65.7% of youth had quit for at least 24hr during the past year, and 43.4% were motivated to quit. Previous quit attempts tended to be unassisted, but 58.6% reported that they would be interested in formal cessation treatment. Multivariate analyses indicated that motivation to quit was higher among youth who were older, Black or Hispanic (vs. White), and who asked about smoking by a service provider, but it was lower among those who were more nicotine dependent. Being interested in cessation treatment was more likely among youth who were asked about smoking by a service provider, anticipated more barriers to quitting, and were motivated to quit; it was less likely among youth who had slept outdoors during the past 30 days.DiscussionSmoking cessation is often considered a low priority for homeless youth. However, many are motivated to quit and are interested in smoking cessation products and services. Implications for developing and engaging homeless youth in cessation treatment are discussed.

Cigarette advertising may be partly responsible for adolescent smoking initiation, but few studies have investigated the advertising and individual difference factors that may be responsible. This study evaluated whether individual differences in the number of self-conflicts (i.e., conflicts between personality attributes experienced as part of self-concept development) interacts with stage of development (early versus middle adolescence) to predict responses to cigarette advertising imagery. One hundred and one never smoking adolescents judged the self-relevance of various cigarette advertisements. As predicted, self-conflict was related to judgments of self-relevance for early adolescents only; early adolescents who are having the most difficulty defining themselves are more likely to look to the powerful images displayed by cigarette advertisements for help. These results have implications for understanding the impact of cigarette advertising on smoking initiation for some adolescents.

Author(s): Tucker, Joan S; Shadel, William G; Golinelli, Daniela; Ewing, Brett | Abstract: IntroductionApproximately 70% of homeless youth smoke cigarettes, but their use of alternative tobacco products (ATPs) is unknown. This paper reports on ATP use among past-month smokers in Los Angeles County, including whether it differs by demographic characteristics, homelessness severity, past-year quit attempts, and readiness to quit smoking. Given the growing popularity of e-cigarettes, we also report on perceptions of harm and reasons for using this product.MethodsWe surveyed 292 unaccompanied homeless youth who were randomly sampled from street sites. Participants had smoked at least 100 cigarettes during their lifetime and 1 cigarette during the past month.ResultsSeventy-two percent of youth reported past-month ATP use (e-cigarettes = 51%; little cigars/cigarillos = 46%; hookah = 31%; other smokeless tobacco product = 24%; chewing tobacco/moist snuff = 19%). Current ATP use was unrelated to most demographic characteristics or having a past-year quit attempt. However, youth who planned to quit smoking in the next 30 days were significantly less likely to report current use of hookahs, other smokeless tobacco products, or e-cigarettes. Among lifetime e-cigarette users, the most common reasons for use included not having to go outside to smoke (38%) and being able to deal with situations or places where they cannot smoke (36%); it was less common to report using e-cigarettes to quit smoking (17%-18%).DiscussionDual use of ATPs among homeless youth smokers is common and is more likely among those who have no immediate plans to quit smoking. Effective and easily disseminable strategies for reducing all forms of tobacco use among homeless youth are urgently needed.