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January 1997, Vol 151, No. 1 >
Article | January 1997

Relationship Between Cigarette Smoking and Health Risk and Problem Behaviors Among US Adolescents FREE

Luis G. Escobedo, MD, MPH; Murli Reddy, MS; Robert H. DuRant, PhD
Arch Pediatr Adolesc Med. 1997;151(1):66-71. doi:10.1001/archpedi.1997.02170380070011.
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Objective:  To examine whether sociodemographic factors and health risk and problem behaviors explain the prevalence of cigarette smoking among US adolescents.

Design:  Probability survey.

Participants:  A nationally representative sample of US adolescents.

Main Outcome Measures:  Weighted prevalence, adjusted odds ratio (OR), and 95% confidence intervals (CIs) for current smoking status by health risk and problem behaviors.

Results:  The prevalence of smoking was highest among adolescents who were white, older, and who had a high school education or lived in the Northeast. When we adjusted for sociodemographic factors and health risk and problem behaviors, smoking was associated with marijuana use (OR, 3.7; 95%CI, 2.7-5.1), binge drinking (OR, 2.1; 95% CI, 1.6-2.8), and fighting (OR, 1.4; 95% CI, 1.1-1.7) among white adolescent males. Similar associations between each of these 3 behaviors and cigarette smoking were found among white adolescent females and African American and Hispanic adolescent males and females. Cigarette smoking was also associated with using smokeless tobacco, having multiple sexual partners, and not using bicycle helmets among white adolescent males and females, having multiple sexual partners among Hispanic adolescent females, and carrying weapons among Hispanic adolescent males.

Conclusions:  Marijuana use, binge drinking, and fighting are correlates of cigarette smoking among US adolescents. These associations, which vary by sex and race or ethnicity, suggest clustering to form a risk behavior syndrome.Arch Pediatr Adolesc Med. 1997;151:66-71

REFERENCES

1 +
Centers for Disease Control and Prevention. Preventing Tobacco Use Among Young People: A Report of the Surgeon General . Rockville, Md: Office on Smoking and Health; 1994;. US Dept of Health and Human Services publication.
2 +
Nelson DE, Giovino GA, Shopland DR, Mowery PD, Mills SL, Eriksen MP.  Trends in cigarette smoking among US adolescents, 1974 through 1991 . Am J Public Health . 1995;;85:34-40.
3 +
Johnston LD, O'Malley PM, Bachman JG. National Survey Results on Drug Use From the Monitoring the Future Study, 1975-1993 . Rockville, Md: National Institute on Drug Abuse; 1994;. US Dept of Health and Human Services publication NIH 94-3809.
4 +
Pirie PL, Murray DM, Luepker RV.  Smoking prevalence in a cohort of adolescents including absentees, dropouts, and transfers . Am J Public Health . 1988;; 78:176-179.
5 +
Escobedo LG, Marcus S, Holtzman D, Giovino G.  Sports participation, age at smoking initiation, and the risk of smoking among US high school students . JAMA . 1993;;269:1391-1395.
6 +
Escobedo LG, Anda RF, Smith PF, Remington PL, Mast E.  Sociodemographic characteristics of cigarette smoking initiation in the United States: implications for smoking prevention policy . JAMA . 1990;;264:1550-1556.
7 +
Conrad KM, Flay BR, Hill D.  Why children start smoking cigarettes: predictors of onset . Br J Addict . 1992;;87:1711-1724.
8 +
Jessor R.  Risk behavior in adolescence: a psychosocial framework for understanding and action . J Adolesc Health . 1991;;12:597-605.
9 +
Eckert P.  Beyond the statistics of adolescent smoking . Am J Public Health . 1983;;73:439-441.
10 +
Willard JC, Schoenborn CA.  Relationship between cigarette smoking and other unhealthy behaviors among our nation's youth: United States, 1992 . Vital Health Stat . 1995;;263:1-12.
11 +
Benson V, Marano MA.  Current estimates from the National Health Interview Survey, 1992 . Vital Health Stat . 1994;;10:189.
12 +
Brener ND, Collins JL, Kann L, Warren CW, Williams BI.  Reliability of the Youth Risk Behavior Survey Questionnaire . Am J Epidemiol . 1995;;141:575-580.
13 +
Research Triangle Institute. SUDAAN: Professional Software for Survey Data Analysis. User Documentation for Release 6.10. Research Triangle Park, NC: Research Triangle Institute.
14 +
Garrison CZ, McKeown RE, Valois RF, Vincent ML.  Aggression, substance use, and suicidal behaviors in high school students . Am J Public Health . 1993;;83: 179-184.
15 +
Watts WD. Wright LS.  The relationship of alcohol, tobacco, marijuana, and other illegal drug use to delinquency among Mexican-American, black, and white adolescent males . Adolescence . 1990;;25:171-181.
16 +
Hartsough CS, Lambert NM.  Pattern and progression of drug use among hyperactives and controls . J Child Psychol Psychiatry . 1987;;28:543-553.
17 +
Resnick MD, Chambliss SA, Blum RW.  Health and risk behaviors of urban adolescent males involved in pregnancy . Fam Soc: J Contemp Hum Serv . 1993;; 74:366-374.
18 +
Loeber R.  Development and risk factors of juvenile antisocial behavior and delinquency . Clin Psychol Rev . 1990;;10:1-41.
19 +
Ensminger ME.  Adolescent sexual behavior as it relates to other transition behaviors in youth . In: Hofferth SL, Hayes CD, eds. Risking the Future . Washington, DC: National Academy Press; 1987;:36-55. National Research Council publication.
20 +
Baumrind D.  Familial antecedents of adolescent drug use: a developmental perspective . In: Jones CL, Battles RJ, eds. Etiology of Drug Abuse: Implications for Prevention . Rockville, Md: National Institute on Drug Abuse; 1987;:13-44. US Dept of Health and Human Services publication ADM 87-1335.
21 +
Landis JR, Koch GG.  The measurement of observer agreement for categorical data . Biometrics . 1977;;33:159-174.
22 +
Jason LA, Ji PY, Anes MD, Birkhead SH.  Active enforcement of cigarette control laws in the prevention of cigarette sales to minors . JAMA . 1991;;266:3159-3161.
23 +
Elster AB, Kuznets NJ. AMA Guidelines for Adolescent Preventive Services: Recommendations and Rationale . Baltimore, Md: Williams & Wilkins; 1994;.
24 +
Lynch BS, Bonnie RJ. Growing Up Tobacco Free . Washington, DC: National Academy Press; 1994;.
25 +
Report of the US Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions . Baltimore, Md: Williams & Wilkins; 1989;.
26 +
Kottke TE, Battista RN, DeFriese GH, Brekke ML.  Attributes of successful smoking cessation interventions in medical practice: a meta-analysis of 39 controlled trials . JAMA . 1988;;259:2883-2889.

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References

1 +
Centers for Disease Control and Prevention. Preventing Tobacco Use Among Young People: A Report of the Surgeon General . Rockville, Md: Office on Smoking and Health; 1994;. US Dept of Health and Human Services publication.
2 +
Nelson DE, Giovino GA, Shopland DR, Mowery PD, Mills SL, Eriksen MP.  Trends in cigarette smoking among US adolescents, 1974 through 1991 . Am J Public Health . 1995;;85:34-40.
3 +
Johnston LD, O'Malley PM, Bachman JG. National Survey Results on Drug Use From the Monitoring the Future Study, 1975-1993 . Rockville, Md: National Institute on Drug Abuse; 1994;. US Dept of Health and Human Services publication NIH 94-3809.
4 +
Pirie PL, Murray DM, Luepker RV.  Smoking prevalence in a cohort of adolescents including absentees, dropouts, and transfers . Am J Public Health . 1988;; 78:176-179.
5 +
Escobedo LG, Marcus S, Holtzman D, Giovino G.  Sports participation, age at smoking initiation, and the risk of smoking among US high school students . JAMA . 1993;;269:1391-1395.
6 +
Escobedo LG, Anda RF, Smith PF, Remington PL, Mast E.  Sociodemographic characteristics of cigarette smoking initiation in the United States: implications for smoking prevention policy . JAMA . 1990;;264:1550-1556.
7 +
Conrad KM, Flay BR, Hill D.  Why children start smoking cigarettes: predictors of onset . Br J Addict . 1992;;87:1711-1724.
8 +
Jessor R.  Risk behavior in adolescence: a psychosocial framework for understanding and action . J Adolesc Health . 1991;;12:597-605.
9 +
Eckert P.  Beyond the statistics of adolescent smoking . Am J Public Health . 1983;;73:439-441.
10 +
Willard JC, Schoenborn CA.  Relationship between cigarette smoking and other unhealthy behaviors among our nation's youth: United States, 1992 . Vital Health Stat . 1995;;263:1-12.
11 +
Benson V, Marano MA.  Current estimates from the National Health Interview Survey, 1992 . Vital Health Stat . 1994;;10:189.
12 +
Brener ND, Collins JL, Kann L, Warren CW, Williams BI.  Reliability of the Youth Risk Behavior Survey Questionnaire . Am J Epidemiol . 1995;;141:575-580.
13 +
Research Triangle Institute. SUDAAN: Professional Software for Survey Data Analysis. User Documentation for Release 6.10. Research Triangle Park, NC: Research Triangle Institute.
14 +
Garrison CZ, McKeown RE, Valois RF, Vincent ML.  Aggression, substance use, and suicidal behaviors in high school students . Am J Public Health . 1993;;83: 179-184.
15 +
Watts WD. Wright LS.  The relationship of alcohol, tobacco, marijuana, and other illegal drug use to delinquency among Mexican-American, black, and white adolescent males . Adolescence . 1990;;25:171-181.
16 +
Hartsough CS, Lambert NM.  Pattern and progression of drug use among hyperactives and controls . J Child Psychol Psychiatry . 1987;;28:543-553.
17 +
Resnick MD, Chambliss SA, Blum RW.  Health and risk behaviors of urban adolescent males involved in pregnancy . Fam Soc: J Contemp Hum Serv . 1993;; 74:366-374.
18 +
Loeber R.  Development and risk factors of juvenile antisocial behavior and delinquency . Clin Psychol Rev . 1990;;10:1-41.
19 +
Ensminger ME.  Adolescent sexual behavior as it relates to other transition behaviors in youth . In: Hofferth SL, Hayes CD, eds. Risking the Future . Washington, DC: National Academy Press; 1987;:36-55. National Research Council publication.
20 +
Baumrind D.  Familial antecedents of adolescent drug use: a developmental perspective . In: Jones CL, Battles RJ, eds. Etiology of Drug Abuse: Implications for Prevention . Rockville, Md: National Institute on Drug Abuse; 1987;:13-44. US Dept of Health and Human Services publication ADM 87-1335.
21 +
Landis JR, Koch GG.  The measurement of observer agreement for categorical data . Biometrics . 1977;;33:159-174.
22 +
Jason LA, Ji PY, Anes MD, Birkhead SH.  Active enforcement of cigarette control laws in the prevention of cigarette sales to minors . JAMA . 1991;;266:3159-3161.
23 +
Elster AB, Kuznets NJ. AMA Guidelines for Adolescent Preventive Services: Recommendations and Rationale . Baltimore, Md: Williams & Wilkins; 1994;.
24 +
Lynch BS, Bonnie RJ. Growing Up Tobacco Free . Washington, DC: National Academy Press; 1994;.
25 +
Report of the US Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions . Baltimore, Md: Williams & Wilkins; 1989;.
26 +
Kottke TE, Battista RN, DeFriese GH, Brekke ML.  Attributes of successful smoking cessation interventions in medical practice: a meta-analysis of 39 controlled trials . JAMA . 1988;;259:2883-2889.

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