This study examined whether the distribution of tobacco use and related psychosocial risk factors among youth in urban India vary by socioeconomic status (SES). Data were derived from a cross-sectional survey of students enrolled in the 6th and 8th grades in 32 schools in Delhi and Chennai (N = 11,642). The survey was conducted in 2004, before the implementation of a program designed to prevent and reduce tobacco use (MYTRI). Mixed-effect regression models were used (a) to determine the prevalence of tobacco use among private (higher SES) and government (lower SES) school students, (b) to investigate whether certain psychosocial factors were associated with increased tobacco use, and (c) to determine how these factors varied by school type. Ever-use of multiple forms of tobacco (e.g., gutkha, bidis, and cigarettes) was more prevalent among government school students than private school students. After adjusting for city, gender, grade, and age, we found the prevalence rate for ever-use of any tobacco product to be 18.9% for government school students, compared with 12.2% for private school students (p<.01). Students in government schools scored lower than private school students on most psychosocial risk factors for tobacco use studied here, indicating higher risk. Government school students scored the lowest for refusal skills, self-efficacy, and reasons not to use tobacco. Social susceptibility to chewing tobacco and social susceptibility to smoking were strong correlates of current tobacco use among government school students. Exposure to tobacco advertising was also a strong correlate of current tobacco use for government school students but not private school students. In two large cities of India, students attending government schools are using many forms of tobacco at higher rates than private school students. The psychosocial risk profile of government school students suggests they are more vulnerable to initiation and use and to outside influences that encourage use.

Objectives-We examined the prospective effects of parental education (as a proxy for individual socioeconomic status [SES]) and neighborhood SES on adolescent smoking trajectories and whether the prospective effects of individual SES varied across neighborhood SES.Methods-The study included 3635 randomly recruited adolescents from 5 age cohorts (12-16 years) assessed semiannually for 3 years in the Minnesota Adolescent Community Cohort study. We employed a cohort-sequential latent growth model to examine smoking from age 12 to 18 years with predictors.Results-Lower individual SES predicted increased levels of smoking over time. Whereas neighborhood SES had no direct effect, the interaction between individual and neighborhood SES was significant. Among higher and lower neighborhood SES, lower individual SES predicted increased levels of smoking; however, the magnitude of association between lower individual SES and higher smoking levels was significantly greater for higher neighborhood SES.Conclusions-We found evidence for differential effects of individual SES on adolescent smoking for higher and lower neighborhood SES. The group differences underscore social conditions as fundamental causes of disease and development of interventions and policies to address inequality in the resources.Correspondence should be sent to Charu Mathur, Division of Epidemiology and Community Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN 55454 (math0304@umn.edu). Contributors C. Mathur and D. J. Erickson contributed to study conceptualization and design, interpretation of data, and article writing. J. L. Forster contributed to data acquisition and provided final approval of the article. J. R. Finnegan Jr contributed to drafting the article. M. H. Stigler critically revised the article for important intellectual content and provided final approval of the article.We presented this article as part of a spotlight session titled "Innovative Epidemiologic Methodology for Analyzing Repeated Measures" at the Third North American Congress of Epidemiology, June 23, 2011, Montreal, Canada. Human Participant ProtectionThe University of Minnesota institutional review board approved this study. There is increasing evidence that the neighborhoods in which people live influence health through such mechanisms as the availability and accessibility of health services and other infrastructure, the prevalence of attitudes toward health and health-related behaviors, stress levels, and social capital. 1 In addition, research suggests that there are persistent and definite patterns of youth smoking across communities defined by geographical areas and groups defined by gender, race, education level, occupation income, and marital status. 2 These findings substantiate the prospect of environmental influences at the neighborhood level on youth smoking, including both as a direct effect as well as the moderating or conditioning effects of such contexts. To better understand individual behaviors and outcomes, it may...

The purpose of this article is to present the intermediate results for Project MYTRI, a school-based, multiple component intervention designed to prevent and reduce many forms of tobacco use (chewing tobacco, cigarettes, and bidis) among youth in India. The intervention is based on effective models in the United States ''translated'' for use in this context. The intervention targets two cohorts of students who were in the 6th and 8th grade when the study started. Thirtytwo schools in Delhi (north India) and Chennai (south India) were randomized to receive the intervention (n = 16) or serve as a delayed intervention control (n = 16). Students in these schools were surveyed before the intervention began and at an intermediate point, 1 year into this 2-year intervention (n = 8,369). A test of the changes in risk factors for tobacco use between the baseline and intermediate surveys revealed that, compared with the control, students in the intervention condition (a) had better knowledge about the health effects of tobacco (P < 0.01); (b) believed that there were more negative social consequences to using tobacco (P = 0.04); (c) had fewer reasons to use tobacco (P < 0.01); (d) had more reasons not to use tobacco (P = 0.03); (e) were less socially susceptible to chewing (P = 0.04) and smoking (P = 0.03) tobacco; (f) perceived fewer peers and adults around them smoked (P < 0.01) or chewed (P < 0.01) tobacco; (g) felt that tobacco use was not acceptable, especially among their peers (P < 0.01); (h) were more confident in their ability to advocate for tobacco control (P = 0.03); (i) were more knowledgeable about tobacco control policies (P < 0.01); and (j) supported these policies, too (P = 0.04). Fewer students in the intervention condition reported having intentions to smoke tobacco in the next year (P = 0.02) or chew tobacco when they reached college (P < 0.01). No changes in actual tobacco use were observed at this stage of the study. (Cancer Epidemiol Biomarkers Prev 2007;16(6):1050 -6)

Objectives We studied the effect of home smoking bans on transitions in smoking behavior during emerging adulthood. Methods We used latent transition analysis to examine movement between stages of smoking from late adolescence (ages 16–18 years) to young adulthood (ages 18–20 years) and the effect of a home smoking ban on these transitions. We used data from the Minnesota Adolescent Community Cohort study collected in 2004 to 2006. Results Overall, we identified 4 stages of smoking: (1) never smokers, (2) experimental smokers, (3) light smokers, and (4) daily smokers. Transition probabilities varied by stage. Young adults with a home ban during late adolescence were less likely to be smokers and less likely to progress to higher use later. Furthermore, the protective effect of a home smoking ban on the prevalence of smoking behavior was evident even in the presence of parental smoking. However, this effect was less clear on transitions over time. Conclusions In addition to protecting family members from exposure to secondhand smoke, home smoking bans appear to have the additional benefit of reducing initiation and escalation of smoking behavior among young adults.

Introduction Although the relationship between risk perceptions and quit intentions has been established, few studies explore the potential impact of smoking level on these associations, and none have done so among diversely-aged samples of multiple ethnicities. Methods Participants, ranging in age from 25 to 81, were 1133 nondaily smokers (smoked ≥1 cigarette on 4 to 24 days in the past 30 days), 556 light daily smokers (≤10 cigarettes per day), and 585 moderate to heavy daily smokers (>10 cigarettes per day). Each smoking level comprised approximately equal numbers of African Americans, Latinos, and Whites. A logistic regression analysis, adjusted for sociodemographics, self-rated health, time to the first cigarette of the day and smoking level, was used to examine the association between risk perception (perceived risk of acquiring lung cancer, lung disease, and heart disease) and intention to quit (≤6 months versus >6 months/never). A second adjusted model tested moderation by smoking level with an interaction term. Results Greater risk perception was associated with a higher odds of planning to quit within 6 months (AOR=1.34, CI.95=1.24, 1.45). Smoking level did not moderate this association (p=.85). Conclusions Results suggest that educating all smokers, irrespective of their smoking level, about increased risk of developing smoking-related diseases might be a helpful strategy to enhance their intention to make a smoking quit attempt.