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标题：Pathways to Smoking Cessation Among African American and Puerto Rican Young Adults
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作者：Stephen E. Marcus ; Kerstin Pahl ; Yuming Ning 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：8
页码：1444-1448
DOI：10.2105/AJPH.2006.101212
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the pathways to smoking cessation between late adolescence and young adulthood. Methods. We obtained data from a sample of urban African American and Puerto Rican young adults (N=242), mean age 19 years, who reported tobacco use and determined cessation rates between late adolescence and young adulthood. We used structural equation modeling to examine the pathways of positive family relations, family smoking, maladaptive personality attributes, and substance use to smoking cessation. Results. A mediational pathway linked the absence of positive family relations with maladaptive personality attributes, both of which were related to substance use and ultimately smoking cessation. Substance use mediated the path between family smoking and smoking cessation. Conclusions. The results suggest that a positive relationship with one’s parents, less smoking in the family, conventional personality attributes, and little or no other substance use facilitate smoking cessation among young adults. Smoking is on the decline in the United States 1 ; however, tobacco use continues to inflict a great burden on society in terms of morbidity and mortality. Smoking has been linked to numerous adverse health outcomes, including heart disease, cancer, stroke, and respiratory disease. 2 It is estimated that 440000 deaths 3 are attributable to tobacco use every year. To reduce this considerable loss, it is important to reduce the number of people who start smoking and increase efforts to support those who have already initiated smoking cessation efforts. It is particularly important to target young adults who have not been smokers for long, because the chances of becoming dependent on nicotine—a severe barrier to cessation—increase with years of smoking. 4 In addition, younger smokers who quit have a greater chance of escaping the more serious health consequences of smoking such as lung cancer. 5 By young adulthood (ages 20–29), many smokers experience great difficulty when they attempt to quit smoking. 6 There is some evidence that a higher percentage of adolescent (mean age 19 years) and young adult (mean age 24 years) smokers than of older adult smokers are addicted to nicotine 4 and find it very difficult to stop smoking. To identify the factors that can facilitate smoking cessation in this younger age group, we investigated pathways to cessation among racial/ethnic populations. There is a dearth of research on the pathways to smoking cessation among young adults of color. Our study will begin to fill this gap in the research literature by exploring the pathways to smoking cessation among a sample of African Americans and Latinos of Puerto Rican descent in young adulthood. The theoretical approach was based in family interactional theory, 7 which stresses the importance of multiple domains of influence on legal and illegal substance use and cessation. One crucial domain of influence on young adult tobacco cessation, according to family interactional theory, is the smoking behavior of family members. We hypothesized that the relation between the smoking behavior of close family members (mother, siblings) and smoking cessation would be mediated by the young adult’s use of legal and illegal substances. (A mediator is a variable that stands causally between the predictor and the dependent variable on which it has an effect and accounts in part or in full for that effect.) Adolescents who are exposed to smoking in their families are likely to initiate smoking at a younger age, 8 which in turn, is related to less successful smoking cessation in adulthood. 9 ^, 10 Family influences on smoking may also make adolescents and young adults more susceptible to the use of other substances, including alcohol and marijuana. 11 ^, 12 The mechanisms underlying the relation between family smoking and substance use may be the result of genetic influences 13 or social modeling, or both. 14 ^, 15 Substance use, in turn, has been shown to be inversely related to smoking cessation. 16 In addition, we hypothesized that family smoking would exert a direct negative effect on young adult smoking cessation. Parental smoking has been shown to be associated with adolescent tobacco use 17 ^– 24 and less successful attempts to quit. 25 Furthermore, siblings’ smoking contributes to the risk of adolescents’ smoking. For example, Gritz et al. 22 found that adolescents who lived with at least 1 parent who smoked, as well as at least 1 sibling who smoked, were 4.58 times more likely to have tried smoking than those who did not live with any relatives who smoked. In addition to the effect of family smoking on young adult smoking cessation, the quality of parent–offspring relationships appear to play an important role in successful smoking cessation. According to family interactional theory, adolescents and young adults who have a closer bond and less conflict with their parents should smoke less 7 ^, 26 and should have an easier time with smoking cessation as young adults. We hypothesized that this relation would be mediated by the young adult’s maladaptive personality attributes and their substance use. A positive, conflict-free relationship with one’s parents contributes to psychological health and a less deviant personality. Mutual parent–child bonding will result in the internalization of conventional values by the adolescent. 7 Failure to develop a positive parent–offspring bond in adolescence and young adulthood may lead to psychological distress, deviance, and other maladaptive behaviors and attitudes. Maladaptive personality attributes such as unconventionality, low achievement, and intrapersonal distress have been shown to be associated with tobacco and other substance use. 22 ^, 27 ^– 30 For example, Bryant and Zimmerman 27 found that both academic achievement and truancy were related to substance use (smoking, alcohol, and marijuana) among urban adolescents. Gritz et al. 22 found that depressive symptoms were related to smoking status in a sample of adolescents. Higher levels of substance use and the initiation of smoking at a young age both make it more difficult for young adults to give up smoking. 9 ^, 10 ^, 16 In this study of pathways to smoking cessation between late adolescence and young adulthood, we hypothesized that (1) there would be a mediational path between positive family relationships and smoking cessation via the young adults’ maladaptive personality attributes and substance use; (2) family models of smoking would relate positively to substance use, which in turn would relate negatively to cessation of smoking; and (3) there would be direct negative paths from family smoking and substance use to smoking cessation. We also hypothesized that these pathways to smoking cessation would be similar in both African American and Puerto Rican young adults.