Impacts of Early Exposure to Work on Smoking Initiation Among Adolescents and Older Adults: the ADD Health Survey David J. Lee, PhD University of Miami Miller School of Medicine Department of Public Health Sciences
Background Trends in smoking behaviors among adolescents and young adults have not paralleled the steady decline in smoking trends among US adult smokers. Currently smoking rates are: 1.2% in the 12 13 year olds 13.6% in 16 17 year olds 31.8% in young adults (18 25 years of age) USDHHS, The Health Consequences of Smoking 50 Years of Progress: A Report of the Surgeon General, in Chapter 13. Patterns of Tobacco Use Among U.S. Youth, Young Adults, and Adults 2014; Flay, B.R., Youth tobacco use: risks, patterns, and control. Nicotine addiction: Principles and management, 1993: p. 365 384; Addictive Behaviors, 1987. 12(4): p. 319 329.
Background There are SES, environmental and psychosocial factors which increase the risk of experimentation and progression to smoking: Lower socioeconomic status indicators Peer exposure Cigarette accessibility Rebelliousness and antisocial behavior Emotional distress/low self esteem Use of other substances Poor school achievement family and school dis connectedness J Subst Abuse, 1992. 4(3): p. 219 34; Am J Prev Med, 1997. 13(3): p. 167 74; Addict Behav, 2002. 27(2): p. 227 40; Drug Alcohol Depend, 2002. 66(3): p. 303 14; Am J Public Health, 1998. 88(10): p. 1518 22; Addiction, 2002. 97(5): p. 517 31; J Subst Abuse, 1997. 9: p. 241 55; Addict Behav, 1995. 20(4): p. 517 24; Br J Addict, 1992. 87(12): p. 1711 24; JAMA, 1997. 278(10): p. 823 32
Background The role that early employment exposures play in the risk of experimentation and progression to regular smoking in adolescence and young adulthood has produced mixed results for: Employment status Type of employment Work intensity Developmental Psychology, 1991. 27(2): p. 304 313; 1993. 29(2): p. 171 180; JOEM, 2011. 53(2): p. 196;Tob Control, 2005. 14(3): p. 181 5; Nicotine & Tobacco Research, 2007. 9(6): p. 687 697; Child Development, 1996. 67(3): p. 1243 1261.
Objective Taking a life course perspective we examine the effects of work characteristics on smoking behaviors among adolescents and young adults http://www.loc.gov/pictures/item/oem2002002747/pp/ http://www.loc.gov/pictures/item/oem2002004311/pp/ http://www.loc.gov/pictures/item/oem2002004187/pp/
http://www.cpc.unc.edu/projects/addhealth/design/slideshow
http://www.cpc.unc.edu/projects/addhealth/design/slideshow
Definition of Outcomes Time to first cigarette Have you ever tried cigarette smoking, even just 1 or 2 puffs? Yes= Smoking Experimentation Current Smoker During the past 30 days, on how many days did you smoke cigarettes? 1 or more days= current
Control Variables Male sex Age in years Hispanic ethnicity Race (black, Asian, other, white (reference)) Number of best friends who smoke at Wave I & II Parent smoked at Wave I* Parent income at Wave I* (100s of $) Parent high school education at Wave I* * parent report
Work and Occupation Variables Work status Number of hours worked (units in 10 hours) Number of hours worked squared (units in 10 hours) First job in food service, sales related, other (reference) Age at first job Age at first full time job
Analysis All analyses were performed using MPLUS Version 6 Cox hazard models Logistic regression using individual by time observations ML for item missing data, assuming MAR Weighted estimators (correcting for unequal selection) Sandwich variance estimators (correcting for clustering and stratification)
Hazard Ratios (HR) for smoking experimentation among adolescent and young adults (n=18,924)* Work Variables HR 95% CI Work status in adolescence 1.10 1.02-1.19 Hours of work in adolescence (in 10s) 1.00 1.00-1.00 First job in food service 1.12 1.05-1.20 First job in sales related 1.03 0.96-1.10 First job in other (reference) 1.00 Age at first job 0.96 0.95-0.98 Additional controls: age, gender, race, ethnicity, # of best friends who smoke, parental smoking status, educational attainment, and income
Odds Ratios of Current Smoking among Adolescents Age 11 17 (n = 25,843)* Work Variables OR 95% CI Current work status 1.05 0.95-1.17 Hours of work (in 10s) 1.09 1.04-1.14 First job in food service 1.19 1.04-1.36 First job in sales related 1.12 0.97-1.29 First job in other (reference) 1.00 Age at first job 0.94 0.91-0.99 Additional controls: age, gender, race, ethnicity, # of best friends who smoke, parental smoking status, educational attainment, and income
Odds Ratios of Current Smoking among Young Adults Age 18 34 (n = 16,830)* OR 95% CI Work Variables Current work status 0.46 0.28-0.75 Hours of work (in 10s) 1.33 1.08-1.64 Hours of work squared (in 10s) 0.98 0.96-1.00 First job in food service 1.20 1.06-1.36 First job in sales related 1.05 0.91-1.21 First job in other (reference) 1.00 Age at first job 0.91 0.88-0.95 Age at first full-time job 0.98 0.95-1.00 Work status in adolescence 1.20 1.05-1.37 Hours of work in adolescence (in 10s) 0.99 0.99-1.00 *Additional controls: age, gender, race, ethnicity, # of best friends who smoke, parental smoking status, educational attainment, and income
Conclusions/Summary Starting work at a younger age increases the likelihood of smoking in young adulthood. The type of first job in adolescence (e.g., food service) may have lasting impacts on smoking behavior. Increased weekly hours worked is the most ubiquitous work characteristic impacting smoking behavior in adolescents and young adults. The effect of hours worked is essentially linear.
Acknowledgements We wish to thank Symposium Chair Dr. Sara E. Luckhaupt, Medical Officer, National Institute for Occupational Safety and Health Supported by the National Institute for Occupational Safety and Health (NIOSH R01 OH003915; R03 OH010124) and the National Institute of Child Health and Human Development (NICHD F32 HD059318) AND David Lee: dlee@med.miami.edu Sara Luckhaupt: pks8@cdc.gov Manuel Cifuentes: manuel_cifuentes@uml.edu Alberto Caban: acaban@med.miami.edu www.umiamiorg.com