Introduction

Several 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.

Methods

Data 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.

Results

The 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.

Conclusions

As 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.

Implications

This 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.

Introduction

Approximately 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.

Methods

We 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.

Results

Seventy-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%).

Discussion

Dual 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.

There is almost no information available on cigarette smoking among homeless youth, whether they are currently receiving services for smoking cessation, and how to best help them quit. This paper presents data collected from a series of semi-structured telephone interviews with service providers from 23 shelters and drop-in centers serving homeless youth in Los Angeles County about their current smoking cessation programming, interest in providing smoking cessation services to their clients, potential barriers to providing this service, and ways to overcome these barriers. Results indicated that 84% of facilities did not offer smoking cessation services, although nearly all (91%) were interested in doing so. Barriers to implementing formal smoking cessation programs on site included lack of resources (e.g., money, personnel) to support the programs, staff training, and concern that smoking cessation may not be a high priority for homeless youth themselves. Overall, service providers seemed to prefer a less intensive smoking cessation program that could be delivered at their site by existing staff. Data from this formative needs assessment will be useful for developing and evaluating a smoking cessation treatment that could be integrated into the busy, complex environment that characterizes agencies that serve homeless youth.

Aims

We tested race/ethnic differences in alcohol and marijuana (AM) trajectories (comprising an intercept term, reflecting overall probability of use, and a slope term, reflecting change in probability of use) during adolescence, whether AM use trajectories predicted high school outcomes, and whether outcomes differed by race/ethnicity after controlling for trajectory of AM use.

Design

This longitudinal study involved 6509 youth from 16 middle schools in Southern California surveyed from age 11.5 (2008) to age 17 (2015) years; all surveys assessed AM use, and the final survey also examined high school outcomes.

Setting

Youth completed five surveys in middle school and two on-line surveys in high school.

Participants

The sample was 50% male and 80% non-white.

Measurements

Intercept (at 2.75 years post-baseline) and slope of AM use were examined as outcomes for race/ethnic differences. AM use trajectories were examined as predictors of academic performance and unpreparedness, social functioning, mental and physical health and delinquency.

Findings

We found differences in trajectories of use by race/ethnicity, with white youth reporting a higher overall intercept of alcohol use compared to all other groups (versus Asian P < 0.001, black P = 0.001, multi-ethnic P = 0.008). Overall, examination of trajectories of use showed that adolescents with a higher alcohol use intercept term reported greater academic unpreparedness (P < 0.001) and delinquency (P < 0.001) at wave 7 in high school. In addition, youth with a higher intercept for marijuana use reported greater academic unpreparedness (P < 0.001) and delinquency (P < 0.001), and poorer academic performance (P = 0.032) and mental health (P = 0.002) in high school. At wave 7, compared to white youth, Hispanic and multi-ethnic youth reported poorer academic performance (P < 0.001 and P = 0.034, respectively); Asian, black and Hispanic youth reported higher academic unpreparedness (P < 0.001, P = 0.019, and P = 0.001); and Asian youth and multi-ethnic youth reported poorer physical health (P = 0.012 and P = 0.018) controlling for AM use.

Conclusions

Greater AM use was associated with worse functioning in high school for all youth. After controlling for AM use, non-white youth reported worse outcomes in high school for academics and health.

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

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.

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.

Opioid misuse has emerged in recent years as a major public health concern in the United States, particularly for adolescents and emerging young adults. We examined the association of opioid misuse from ages 18 to 20 with four domains at age 21-22: risk behaviors and consequences; health; social functioning; and emerging adult roles. Participants were surveyed annually from 2008 through 2019. The sample includes N = 2880 youth from waves 8-11. The sample was approximately 18 years old at wave 8; 54% female, 46% Hispanic, 20% white, 20% Asian, 2% Black, and 11% multiracial. Opioid misuse was low in this general sample of young adults, with about 4% reporting misuse from age 18-20. We used latent growth curve modeling to examine how misuse from ages 18-20 was associated with functioning at age 21-22. Adolescents who reported opioid misuse at age 18 also reported more negative consequences from alcohol and cannabis use and greater odds of other prescription drug misuse at age 21-22 than those with no misuse. Those reporting opioid misuse at age 18 were also more likely to engage in sexual risk behaviors, report delinquent behavior, and have a higher likelihood of experiencing sexual victimization and engaging in sexual perpetration at age 21-22 than those with no misuse. Neither the intercept nor slope of opioid misuse was associated with depression, anxiety, physical health or ailments, satisfaction with friends, romantic relationship functioning, or emerging adult roles at wave 11. Findings highlight the importance of screening and brief intervention for adolescents reporting opioid misuse.

Purpose of review

There is not one answer to address whether marijuana use has increased, decreased, or stayed the same given changes in state legalization of medical and non-medical marijuana in the USA.

Recent findings

Evidence suggests some health benefits for medical marijuana; however, initiation of marijuana use is a risk factor for developing problem cannabis use. Though use rates have remained stable over recent years, about one in three 10th graders report marijuana use, most adolescents do not view the drug as harmful, and over 650,000 youth aged 12 to 17 struggle with cannabis use disorder.

Summary

Although the health benefits of medical marijuana are becoming better understood, more research is needed. Intervention and prevention programs must better address effects of marijuana, acknowledging that while there may be some benefits medically, marijuana use can affect functioning during adolescence when the brain is still developing.