Marketing and Explanatory Processes in Tobacco Progression Among Vulnerable Youth

说明(由申请人提供)：先前已发现接触烟草营销与青少年烟草使用之间的重要联系。然而，以前关于烟草营销影响的纵向研究并没有把重点放在特别脆弱的人群或青春期后期过渡期间的青年身上，因为烟草使用试验往往会升级并形成终身习惯。以前的纵向研究也没有调查营销暴露对烟草使用轨迹产生影响的可能的解释过程(干预认知过程/中介)。本项目侧重于弱势、社会经济地位较低、多族裔(主要是西班牙裔和非西班牙裔白人)的青年人口，在吸烟习惯发生重大变化的年龄段(16至20岁)，他们的吸烟率大大高于全国正常水平。一定有什么原因可以解释这一人群中烟草使用升级率大幅上升的原因，而在较低SES社区的零售店进行烟草营销是一个很大的可能性。这个项目还评估了关键的可信的解释过程，这些过程以几个学科的基础研究为基础。一些可以解释营销效应的最可信的过程，以前没有在这个领域进行过研究，已经得到了神经、认知和行为分析层面的多条独立证据的一致支持--而不仅仅是调查或心理测量证据。对超过关键年龄的弱势人群的营销影响进行研究，再加上对一些最可信的解释过程的研究，将为FDA提供明确的监管指导，说明是否需要对烟草销售终点站(POS)制定新的法规。强有力的证据表明，POS在SES较低的社区和弱势群体中具有特别强大的、可解释的影响，这将强烈建议进行监管改革。为了调查这些影响和可信的过程，该项目在南加州多种族人口中的1000名弱势青年中实施了一项队列序贯设计。该提案中的三个设计特征尤其重要，可以为POS烟草广告和烟草使用之间的任何联系提供强有力的推断，这是支持FDA政策决策所必需的。首先，该设计允许对变量之间的时间关系进行迄今为止最严格的测试，这是因果关系的关键标准之一。其次，对干预变量的测试将为看似合理的因果机制提供支持，这些机制也得到了广泛的基础研究的支持。最后，对潜在的混杂因素和协变量进行了全面的评估和彻底的评估。该项目提供了迄今为止关于烟草营销对年长青年的影响的最严格、可能最有信息量的研究。结果可能会揭示为什么一些年龄较大的青少年吸烟率大幅上升(是全国平均水平的两倍多)，从而在未来导致严重的健康风险。因此，该项目很有可能对保护青少年的公共健康产生重大的监管影响。1

DESCRIPTION (provided by applicant): Important links between exposure to tobacco marketing and tobacco use in youth have previously been uncovered. However, previous longitudinal research on tobacco marketing effects has not focused on particularly vulnerable populations or on youth during transitions in later adolescence when tobacco use experimentation often escalates and consolidates into life-long habits. Previous longitudinal research also has not investigated likely explanatory processes (intervening cognitive processes/mediators) through which marketing exposure has effects on tobacco use trajectories. The present project focuses on a vulnerable, lower SES, multi-ethnic (primarily Hispanic and non-Hispanic White) population of youth with substantially higher rates of smoking than the national norm, during ages in which dramatic changes in tobacco habits occur (16 to 20). Something must explain the substantially higher rates of tobacco use escalation in this population, and tobacco marketing at retail outlets in lower SES neighborhoods is one strong possibility. This project also evaluates key credible explanatory processes, well grounded in basic research across several disciplines. Some of the most credible processes that can explain marketing effects, not previously studied in this domain, have received consistent support from multiple lines of independent evidence across neural, cognitive, and behavioral levels of analysis --not merely survey or psychometric evidence. The study of marketing effects in a vulnerable population over critical ages, coupled with research on some of the most credible explanatory processes, will provide clear regulatory guidance to the FDA about any needs for new regulations on point-of- sale tobacco marketing (POS). Regulatory changes would be strongly suggested by firm evidence that POS has especially strong, explainable effects in lower SES neighborhoods and vulnerable populations. To investigate these effects and credible processes this project implements a cohort-sequential design in 1000 vulnerable youth from a multi-ethnic population in southern California. Three design features in this proposal are especially important to provide strong inference for any link between POS tobacco advertising and tobacco use, which is needed to support FDA policy decisions. First, the design allows the most rigorous testing of the temporal relationship among the variables, to date, one of the key criteria for causality. Second, testing for the intervening variables will provide support for plausible causal mechanisms also buttressed by extensive basic research. Finally, potential confounders and covariates are comprehensively assessed and thoroughly evaluated. The project provides the most rigorous, potentially most informative study to date about tobacco marketing effects in older youth. Results are likely to reveal why some older adolescents have substantially higher smoking rates (more than double the national average), leading to critical health risks in the future. Thus, the project has a strong potential for major regulatory implications for protecting the public health in adolescents. 1