A Multilevel Analysis of the

1

• A Multilevel Analysis of the
• Effects of Youth Access Laws
• on Adolescents
• Hyoshin Kim, Ph.D.
• Pamela I. Clark, Ph.D.
• Mary Kay Dugan, M.A.
• Battelle Centers for
• Public Health Research
• Evaluation

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Adolescent Smoking

• Sharp increase in adolescent smoking prevalence
  from early 1990s
• But prevalence declining since 1997
• 90 of adult smokers started smoking before age
  18
• Smokers exhibit differential susceptibility or
  resiliency

3
Issues

• Tobacco control policy analysis
• Multilevel approach
• Longitudinal approach
• Subgroup analysis
• Analysis of contextual influences

4
Question

• What tobacco control factors-
• - state
• - school
• - individual
• -predict current smoking stage among adolescents?

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Data

• National Longitudinal Study of Adolescent Health
  (Add Health)
• Nationally representative school-based survey
• Sample from Wave 1 in 1994-1995 (7th-12th grade)
• N 16,060 students from 128 schools, in 33 states

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Smoking Stage Subgroups

• Never Smokers
• Experimental Smokers
• Intermittent Smokers
• Regular Smokers
• Ex-Smokers

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Ever puffed? N 16,066
Stages of Smoking in Adolescents (Lloyd-Richardson
et al., 2002)
Yes
days smoked/ past 30 days N 7,951
0
No
Ever smoked regularly? N 6,196
Never Smokers N 8,115 (50.5)
30
1-29
Yes
Regular/ Established N 1,868 (10.6)
Intermittent N 3,158 (19.7)
No
Experimental N 2,541 (15.8)
Quit smoking? N 552
Year
DK/Refu
Ex-smokers N 481 (3.0)
Undefined N 71
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Analysis of Comparing Smoking Stage Subgroups

• Never vs.
• Experimental / Intermittent / Regular
• Never / Experimental vs.
• Intermittent / Regular
• Never / Experimental / Intermittent vs. Regular

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Measures

• State level
• Youth access law score
• State excise tax
• School level
• School smoking prevalence
• Individual level
• Availability of cigarettes at home
• Number of friends smoking

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Measures (contd)

• State Tobacco Control Policies
• Youth access law score (NCI Alciati et al. 1998)
• 9 items (e.g., Enforcement, Packaging, Random
  Inspections, Free Distribution, etc.)
• 0 (none) to 5 (outstanding) points for each
  item total score ranges from 0 to 36 points
• State excise tax in 1995

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State Tobacco Control Policy Scores
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Analysis

• Multilevel modeling for nested data structure
• Individual-, school- state-level predictors
  during adolescence
• Outcomes
• Odds of being a smoker in more advanced stage
• Intensity of daily smoking among smokers

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Odds Ratios by Subgroups
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Odds Ratios by Subgroups
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Odds Ratios by Subgroups
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Policy Effects on Daily Smoking Intensity of
Past 30-Day Smokers
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Effects of Multilevel Predictors
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Conclusions

• Stronger tobacco control policies
• associated with
• lower odds of being a smoker in more advanced
  stage of smoking
• lower intensity of daily smoking among smokers
• Individual-level predictorspowerful!
• School-level predictorschool smoking prevalence

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Discussion

• What policies might work?
• Enforcement issue?
• Social sources of cigarettes
• Experimental, Intermittent smokers