Examining Social Influences on Young Adult Smoking and Cessation Trajectories

青少年（18-24岁）是一个关键的发育过渡期，为改变吸烟行为的轨迹提供了巨大的机会，从而对公共卫生产生重大影响。特别是年轻的成年吸烟者，既逃避了青年预防，也逃避了成年戒烟干预。据报道，最近年轻人开始吸烟的比率和向经常吸烟过渡的比率增加，同时沿着该年龄组中“社交吸烟”现象的高流行率（51%-62%）。社交吸烟年轻人（SSYAs）的长期烟草使用行为尚不清楚，但很可能约有一半人在年轻时会升级为重度吸烟，或者他们的社交吸烟模式在整个成年期保持稳定。SSYA对戒烟来说既是一个重要的挑战，也是一个机会，但这需要更好地了解导致风险的潜在可改变因素。目前的项目使用初级社会化理论（PST）来解决社会发展和年轻成年人吸烟行为的交叉点，识别社交吸烟的特征和风险途径，这是年轻人中非常普遍的吸烟模式。PST认为，个体主要从少量的社会影响中学习规范和偏差行为，这些影响随着寿命的变化而动态变化。青年期的主要社会化影响是环境（工作、学校）、同伴群体、大家庭和在这一发展时期创造的新家庭环境。本研究的目的是深入研究SSYA的特征，其潜在的吸烟风险轨迹以及戒烟干预的可能途径。该提案利用了来自两个大型当代美国年轻人（18-24岁）群体的信息，这些群体拥有关于吸烟行为轨迹、吸烟的社会影响以及年轻人中“当下”吸烟行为的社会和背景影响的丰富数据。这两个队列是：1）18-24岁年轻人的全国抽样（基线时n = 864）在3年内进行半年一次评估的传统年轻成人队列研究和2）在年轻成人期随访的青少年风险组（5年随访时n = 1，027; NCI计划项目2 P01 CA 098262）使用三个年度评估和两个为期一周的每日生态瞬时评估（EMA）的组合。研究的第一阶段将使用潜在类别分析来定义两个队列中的SSYA（目标1），第二阶段将把这一定义应用于两个队列的轨迹分析，探索SSYA与其他年轻成年吸烟者相比的烟草使用模式（目标2和3）。该研究的第三阶段采用细粒度的方法来探索社会影响对吸烟和戒烟行为的近端效应，以及社交吸烟作为这种效应调节剂的潜力（目标4）。这项研究通过阐明维持或阻碍这一重要群体吸烟行为的社会因素，为SSYA制定更有效的一级和二级癌症预防干预措施奠定了基础。

DESCRIPTION (provided by applicant): Young adulthood (ages 18-24) is a critical developmental transition and provides an enormous opportunity to alter trajectories of smoking behavior for a large public health impact. Young adult smokers, in particular, have eluded both youth prevention and adult cessation intervention efforts. Recent increases in the rate of young adult smoking initiation and rate of transition to regular smoking have been reported along with the high prevalence of the phenomenon of "social smoking" in this age group (51%-62%). The long-term tobacco use behaviors of social smoking young adults (SSYAs) are unknown, but it is likely that approximately half will escalate to heavier cigarette use during young adulthood or that their pattern of social smoking will remain stable throughout adulthood. SSYAs present both a vital challenge and an opportunity for smoking cessation, but this requires a better understanding of potentially modifiable factors that contribute to risk. The current project uses primary socialization theory (PST) to address the intersection of social development and smoking behavior in young adulthood, identifying characteristics of and risk pathways leading from social smoking, a highly prevalent pattern of smoking among young adults. PST posits that individuals learn normative and deviant behavior mainly from a small number of social influences that change dynamically with lifespan transitions. The primary socialization influences in young adulthood are environmental (work, school), peer clusters, extended family, and the new family contexts created in this developmental period. The goal of the current study is to examine, in-depth, the characteristics of SSYAs, their potential smoking risk trajectories, and possible avenues for smoking cessation intervention. The proposal leverages information from two large contemporary cohorts of U.S. young adults (aged 18-24) with rich data on trajectories of cigarette smoking behavior, social influences on smoking, and social and contextual influences on "in the moment" smoking behavior among young adults. The two cohorts are: 1) a national sample of young adults aged 18-24 (n = 864 at baseline) Legacy Young Adult Cohort Study with semi- annual assessments over three years and 2) an at-risk group of adolescents followed during young adulthood (n = 1,027 at 5-year follow-up; NCI Program Project 2P01CA098262) using a combination of three annual assessments and two week-long sessions of daily ecological momentary assessment (EMA). Phase I of the study will use latent class analysis to define SSYAs in both cohorts (Aim 1) and Phase II will apply this definition to trajectory analyses in both cohorts, exploring tobacco use patterns among SSYAs compared to other young adult smokers (Aims 2 and 3). Phase III of the study takes a fine-grained approach to explore the proximal effect of social influences on smoking and cessation behavior and the potential of social smoking to serve as a moderator of this effect (Aim 4). This research lays the groundwork for developing more effective primary and secondary cancer prevention interventions for SSYAs by elucidating the social factors that maintain or impede smoking behavior in this important group.