Adolescent Participation in Tobacco Promotions: The Role of Psychosocial Factors
* Social and Behavioral Sciences Department, Boston University School of Public Health, Boston, Massachusetts
Center for Survey Research, University of Massachusetts at Boston, Boston, Massachusetts
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODSRESULTSDISCUSSION AND CONCLUSIONREFERENCES |
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Objectives. To identify psychosocial factors that place adolescents at risk for participation in tobacco promotions, and to further investigate the hypothesis that psychosocial vulnerabilities have an indirect effect on smoking initiation among youth by way of involvement with tobacco promotions.
Methods. Data were from a follow-up telephone survey of youth in Massachusetts. A subset of adolescents who were not established smokers, had not smoked cigarettes in the past 30 days, and did not own a promotional item at baseline in 1993 was used for the analyses (n = 468). Bivariate analyses were used to evaluate the association between psychosocial vulnerabilities and subsequent acquisition of cigarette promotional items. Logistic regression was conducted to identify the set of factors that best predict attainment of tobacco promotional items, and to examine the mediating influence of item acquisition on the relation of between psychosocial vulnerabilities and smoking initiation.
Results. Adolescents who were academically disengaged at baseline were more likely to acquire a tobacco promotional item at follow-up. Academic disengagement was significantly associated with item acquisition, above and beyond the other psychosocial vulnerabilities. The direct effect of academic disengagement changed from marginally significant to nonsignificant when item acquisition was introduced.
Conclusions. This study provides evidence that receptivity to tobacco promotional items is greatest among youth who are disengaged from school.
Key Words: psychosocial factors • tobacco promotions • cigarette smoking • adolescents
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSION AND CONCLUSIONREFERENCES |
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Receptivity to tobacco promotions is recognized as being associated with movement along the smoking uptake continuum among adolescents. Earlier studies conducted by Australian researchers found higher rates of smoking initiation among youth who had indicated approval or attractiveness of cigarette advertising 1 to 2 years earlier.1,2 Later, a Scottish follow-up study showed that adolescents whose intentions to smoke when older became more positive between the 2 interviews had been more aware of cigarette advertising at the time of the first interview relative to those whose intentions to smoke were negative at both interviews.3 More recently, American researchers have renewed an interest in this relationship. For example, Pierce and colleagues4 reported that one third of all experimentation in California between 1993 and 1996 can be attributed to tobacco promotional activities. Biener and Siegel5 also found that adolescent nonsmokers and early experimenters who owned a tobacco promotional item and named a brand whose advertisements attracted their attention at baseline were more than twice as likely to have become established smokers 4 years later as compared with those not involved with tobacco promotions. Hence, longitudinal studies indicate that tobacco promotions are causally implicated in adolescents’ decisions to begin smoking and in their progression to higher levels of smoking.
With the exception of 1 cross-sectional study,6 very little is known about predictors of adolescent involvement in tobacco promotions. The lack of research in this area is conspicuous given that a sizable number of studies have shown that tobacco promotions are associated with smoking behaviors. A key issue concerns the role receptivity and involvement with tobacco promotions plays in the association between psychosocial factors and smoking initiation. In this study, we hypothesize that adolescent nonsmokers exhibiting psychosocial vulnerabilities such as academic disengagement, depression, body dissatisfaction, and rebelliousness are more likely to become involved with tobacco promotions. We also predict that psychosocial vulnerabilities have an indirect effect on smoking initiation by way of involvement with tobacco promotions that serve to increase the social value of smoking to youth.
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METHODS |
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Data and Sample
Data were from the 1993 Massachusetts Tobacco Survey of youth and adults, conducted by the Center for Survey Research, University of Massachusetts Boston. This was a random-digit-dialing telephone survey of housing units in the state of Massachusetts. Initial interviews were conducted with an adult informant in 11 463 households who provided information about the age and sex of all household members; the smoking status, educational level, and ethnicity of all adult household members; and the annual income of the household. Parents were informed of the purpose of the youth study and permission was sought to interview the youth. All youth in the household between the ages of 12 and 17 were eligible for interview. Before interviewing the youths, their informed assent was requested. Between October 1993 and March 1994, extended interviews were completed with 75% of the eligible youths, yielding a final baseline sample of 1606 adolescents, 1069 of whom were between the ages of 12 and 15. The youth survey contained questions about general attitudes and activities; smoking behavior; tobacco use by family and friends; exposure to tobacco smoke; media exposure; school activities; attitudes about smoking and health; as well as demographic information. Details of the sampling design and procedures have been published elsewhere.7
Between November 1997 and February 1998, a follow-up survey was conducted with the Massachusetts Tobacco Survey youth respondents who were 12 to 15 years old at baseline. Of the 1069 respondents, 328 (30.7%) of the respondents were unable to be traced. Interviews were completed with 83.4% (N = 618) of the remaining 741 youths for an overall follow-up response rate of 57.8%. For the purposes of this article, we used a subset of the sample: 468 adolescents who at baseline were not established smokers, had not smoked cigarettes in the past 30 days, and did not own a promotional item. The University of Massachusetts Institutional Review Board reviewed and approved the protocols for both the baseline and follow-up surveys.
Measures
Outcome Variable
The outcome measure was a dichotomous indicator of whether the adolescent had become an established smoker by smoking 100 or more cigarettes by follow-up. The theoretical rationale and validation of this measure of adolescent smoking have been established previously.8–10
Explanatory Variables
Depression
We used a 6-item scale to assess depressive symptoms. This scale covers several major components of depressive symptomology, including depressed mood and psychomotor retardation. It is a modified, short-form of the Center for Epidemiologic Studies Depression Scale,11 and has been used in related work.12 Specifically, the items included: too tired to do things; trouble going to sleep; unhappy, sad, or depressed; hopeless about the future; nervous or tense; and worried too much about things. Answers to each item were coded as 0 if the respondent experienced the feeling "never in the past 12 months," coded 1 for "rarely," 2 for "sometimes," and 3 for "often." Summing across the 6 items yielded a scale that ranged from 0 to 18 (Chronbach’s 
= .71), with higher scores indicating greater psychological distress.
Rebelliousness
This construct was measured with four items that represent problem behavior in adolescence, including: attraction to risk and danger ("I get a kick out of doing things that are a little risky or dangerous;" "If anyone upsets me I usually try to get revenge"),13 and solidarity with deviant peers ("I don’t mind getting into trouble or telling lies if it helps my friends;" "I don’t mind lying to keep my friends out of trouble").14 These items have good face validity and moderate internal consistency (Chronbach’s = .57). Each of the 4 items was dichotomous and coded as 0 for disagree and as 1 for agree. The scale was further dichotomized to represent low and high rebelliousness. A similar scale of rebelliousness was used in related work.24
Body Dissatisfaction
We used a single item to capture dissatisfaction with body development. Each adolescent was asked, "How satisfied are you with the way your body is developing?" Responses ranged from 1 to 4 and were collapsed to represent 0 = very satisfied, 1 = generally satisfied, or 2 = somewhat/very dissatisfied.
Academic Disengagement
The scale of school disengagement is constructed from 2 variables. Adolescents were asked, "How much do you like school?" (a lot, some, very little, not at all) and "How do you do in school?" (much better than average, better than average, average or below average). Responses to both questions ranged from 1 to 4 (Chronbach’s = .46). The variables were summed, with higher numbers indicating more disengagement from school, and trichotomized as 0 = low, 1 = mid-level, or 2 = high disengagement.
Mediating Variable
To test the hypothesis that involvement in tobacco promotions plays a role in the relation between psychosocial vulnerabilities and smoking initiation, we use a measure of acquisition of cigarette promotional items at follow-up. The dichotomous variable is from the question; "Some companies make clothing, hats or other things with their brand on it. Do you have a piece of clothing, or other thing that has a tobacco brand name on it?" Response categories included "yes" (coded 1) and "no" (coded 0).
Sociodemographic Variables
In addition to the mediating variable, several time-invariant control variables are used in the analyses. These variables include parental education, age, gender, and race/ethnicity from the baseline survey.
Household Smoking
A potential confounding variable is the smoking status of parents. Children who live with a parent that smokes have easier access to cigarette promotional items, as well as cigarettes, than children who live with nonsmoking parents. To prevent biased parameters resulting from an association between acquisition of promotional items and parental smoking, we include a dichotomous variable indicating whether at least 1 adult informant smoked at baseline.
Statistical Analysis
Before developing multivariate models, we examined the association between cigarette promotional item acquisition by follow-up and baseline psychosocial vulnerabilities among the sample. To determine statistical significance for categorical variables, we used 
2 analysis and for comparison of means we used the F ratio from 1-way analysis of variance models. We then performed logistic regression analyses to examine the effects of psychosocial factors on acquisition of tobacco promotional items by follow-up. Last, we use logistic regression to examine the mediating influence of promotional item acquisition on the relation between psychosocial vulnerabilities and becoming an established smoker by follow-up. The mediational model would be supported if the addition of acquisition of promotional items to the logistic regression model reduces the effects of the psychosocial factors.15 Because our sample is small, we report findings that are significant at the .10 level.
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RESULTS |
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Attrition
To evaluate potential bias in the cohort, we compared the characteristics of youth who would have been in the cohort, but were lost to follow-up with those were retained in the sample. The youths who were lost to follow-up were significantly more likely to be high in rebelliousness (P < .10). Yet, there were no significant differences between the 2 groups across the psychosocial factors of depression, body dissatisfaction, and academic disengagement. These results suggest that youths at higher risk for progression to established smoking were slightly underrepresented in the cohort, but that their inclusion would not have had much of an impact on the results.
Characteristics of the Cohort
Table 1 presents the baseline characteristics of adolescents who did and did not acquire a tobacco promotional item by follow-up. Overall, 15.2% of the adolescent sample acquired a promotional item by follow-up (n = 71). The mean age of the total sample was 13.5 years at baseline with a standard deviation of 1.10, while the age range was between 12 and 15. Of the total sample, 49.2% were male and 19.8% were nonwhite. In addition, 35.3% of the respondents lived with at least 1 adult smoker in the household and 57.5% lived with at least 1 adult with more than a high school education. In terms of academic disengagement, 28.4% of the total sample was characterized as low, 63.3% as middle, and 8.3% as high. Of the other psychosocial variables, 34.1% of the total sample was high in rebelliousness; 13.9% was somewhat or very dissatisfied with his/her body; while the mean depression score was 8.3 with a standard deviation of 3.63.
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Sociodemographic and psychosocial variables by acquisition of a tobacco promotional item by follow-up are also examined in Table 1. For example, of those who acquired a promotional item, 12.7% were characterized as highly disengaged compared with only 7.6% of those who did not acquire an item (P < .001). The same was true for rebelliousness, of those who obtained a promotional item by follow-up, 45.1% were considered high on this scale relative to 32.2% of those who did not acquire an item (P < .05). Results not shown here further indicate that of adolescents who were highly disengaged 23.1% acquired a promotional item compared with 18.1% and 6.0% of moderate and low disengaged adolescents respectively. Contrary to our hypothesis, there were no statistically significant differences between the 2 groups across body dissatisfaction and depression. In addition, adolescents who lived with at least 1 smoker in the household at baseline or lived with a parent who had a high school degree or less were more likely to acquire a promotional item by follow-up.
Odds ratios and confidence intervals obtained from the logistic regression analysis for acquisition of a promotional item are shown in Table 2. Academic disengagement was significantly associated with acquisition, above and beyond the other psychosocial vulnerabilities. For each unit increase on the 3-point disengagement scale from low to high, adolescents were more than twice as likely to acquire a promotional item at follow-up. Adolescents who lived with smokers in their household were >3 times as likely to become involved with tobacco promotions as those who lived with parents who do not smoke. In addition, results not shown here also indicate that among those who acquired a promotional item by follow-up, 45.1% became an established smoker by follow-up, compared with 14.7% of those who did not own an item (P < .001).
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Table 3 displays the logistic regression analyses that show the direct and indirect effects of psychosocial vulnerabilities on becoming an established smoker by follow-up. The table illustrates that, in the reduced model, academic disengagement at baseline was significant at the .10 level (P < .10) in predicting established smoking at the follow-up. Consistent with previous research, rebelliousness at baseline had a significant and direct effect on becoming an established smoker by follow-up in the reduced and full models (P < .001). Once the mediating variable of promotional item acquisition was introduced, the effect of academic disengagement became nonsignificant, while acquisition mediated
12% of the initial effect of disengagement from the reduced model. Promotional item acquisition mediated a very small portion 4% of the effect of rebelliousness on established smoking at follow-up. As expected, promotional acquisition itself had a direct effect on smoking behavior at follow-up. That is, those who acquired a promotional item by follow-up were >4 times as likely to have become an established smoker as those who did not own an item. In addition, age and race were associated with smoking initiation at follow-up in both the reduced and full models.
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DISCUSSION AND CONCLUSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSION AND CONCLUSIONREFERENCES |
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One of the mechanisms hypothesized to account for the impact of tobacco advertising on youth smoking is the fact that the messages conveyed by advertising images are precisely those that would appeal to young people; ie, images suggesting that smokers are attractive to the opposite sex, adventurous, popular, risk-taking, and independent.16 Indeed, additional cross-sectional analyses of the Massachusetts youth data revealed that the more knowledge teenagers have about cigarette advertising slogans, the more likely they are to report that young people who smoke are more attractive, more mature and independent, and more popular than nonsmokers.17 A recent qualitative study of English adolescents found smoking to have "symbolic significances," including the images of being grown up, tough, in control, and looking cool.18 Yet, exposure to tobacco advertising does not inevitably lead to smoking initiation. Tobacco advertising has been unavoidable in the environment of adolescents, and most teenagers do not become smokers. Tobacco marketing may be particularly powerful for adolescents who exhibit psychosocial vulnerabilities and seek the kind of identity that the smoking images are carefully designed to offer them.
Another line of research has identified psychosocial factors that influence initiation and maintenance of smoking among adolescents. Many of these risk factors are considered broad indicators of psychological distress,19 including depressed mood,20 low self-esteem,21 body dissatisfaction,22 and high levels of rebelliousness.23 The general relationship between smoking status and school performance has also been well-established in earlier studies.10,24–26 Students who perform poorly in school, have low academic aspirations and are uncommitted to school are more likely to smoke than those who are academically engaged. One study has shown that school disconnectedness, as measured by 5 items related to feeling a part of the school environment, increased the likelihood of cigarette usage.27
In this study, we set out to answer 2 questions. First, is there a relationship between psychosocial vulnerabilities and the likelihood that an adolescent will become involved in tobacco promotions? Second, if there is a relationship, do such psychosocial factors affect smoking indirectly through their impact on receptivity to tobacco promotions? In terms of the first question, our results show that only academic disengagement emerged as a significant contributor to acquisition of tobacco promotional items. Contrary to our hypothesis, body dissatisfaction, depression, and rebelliousness were not predictive of ownership at follow-up. The relationship between disengagement from school and acquisition of tobacco promotions persisted even after controlling for several confounding variables.
Although the results shed some light on the second question, we found relatively weak support for a mediating model. The direct effect of academic disengagement on smoking initiation was significant only at the .10 level before accounting for the effect of promotional item acquisition. A stronger effect may have been detected with a larger sample size and a more sensitive measure of disengagement. Yet, these results are suggestive that school disengagement may affect smoking behavior indirectly through its impact on receptivity to tobacco promotions. Future research will profit from investigating the role tobacco promotions play in smoking initiation as part of identity development during adolescence. It remains that those young people who feel alienated from school may seek to take on the attractive images portrayed by cigarette brand advertising.
In recent years considerable interest has focused on the relationship between receptivity to tobacco marketing and smoking susceptibility among children and adolescents. Our analysis extends the work of Sargent and colleagues6 who demonstrated a relation between poor school performance and exposure to cigarette promotions. Through the identification of pathways to smoking initiation, appropriate interventions can be designed to target adolescents at risk during stages of identity development. These findings also underline the importance of public policy that would limit the use of image advertising by tobacco companies. It is the most vulnerable of teenagers who are at risk for adopting those images and subsequently the deadly products they promote.
Important limitations to this study should be acknowledged. First, our measure of academic disengagement is not well-established, and is limited to only 2 items. A more sensitive and comprehensive measure of school disengagement may produce a stronger effect of academic disengagement on smoking initiation, which has been previously shown to be a risk factor for smoking.24–26 Second, we cannot account for the time sequence between ownership of promotional items and smoking initiation. That is, the possibility that some youth in the sample started to smoke before obtaining a promotional item cannot be ruled out. Estimates from longitudinal studies have reported that those with a high level of receptivity to promotional items were roughly three times more likely to progress toward smoking.4,5 This suggests that our although our estimate of the relation between promotional item acquisition and smoking initiation may be biased upward to some degree, there is clear evidence in the literature demonstrating the major predictive effect on smoking initiation of promotional item ownership. Most importantly, what this study adds is the evidence that receptivity is greatest among those youth who are disengaged from school.
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ACKNOWLEDGMENTS |
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This work was supported by grants from the Robert Wood Johnson Foundation, Substance Abuse Policy Research Program, and the Massachusetts Department of Public Health, Massachusetts Tobacco Control Program (Health Protection Fund).
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FOOTNOTES |
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Received for publication May 15, 2002; Accepted Sep 27, 2002.
Reprint requests to (A.B.A.) Social and Behavioral Sciences Department, Boston University School of Public Health, 715 Albany St, T2W, Boston, MA 02118. E-mail: aalbers{at}bu.edu
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REFERENCES |
|---|
|
TOPABSTRACTINTRODUCTIONMETHODSRESULTSDISCUSSION AND CONCLUSIONREFERENCES |
|---|
- Alexander HM, Callcott R, Dobson AJ, et al. Cigarette smoking and drug use in school children, IV factors associated with changes in smoking behaviour.
Int J Epidemiol.1983; 12
:59
–66
[Abstract/Free Full Text] - Armstrong BK, deKlerk NH, Shean RE, Dunn DA, Dolin PJ. Influence of education and advertising on the uptake of smoking by children. Med J Aust.1990; 152 :117 –124[Web of Science][Medline]
- Aitken PP, Eadie DR, Hastings GB, Haywood AJ. Predisposing effects of cigarette advertising on children’s intentions to smoke when older. Br J Addict.1991; 86 :383 –390[CrossRef][Web of Science][Medline]
- Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Berry CC. Tobacco industry promotion of cigarettes and adolescent smoking.
JAMA.1998; 279
:511
–515
[Abstract/Free Full Text] - Biener L, Siegel M. Tobacco marketing and adolescent smoking: more support for a causal inference.
Am J Public Health.2000; 90
:407
–411
[Abstract/Free Full Text] - Sargent JD, Dalton M, Beach M. Exposure to cigarette promotions and smoking uptake in adolescents: evidence of a dose-response relation.
Tob Control.2000; 9
:163
–168
[Abstract/Free Full Text] - Biener L, Fowler FJ Jr, Roman AM. Technical Report: 1993 Massachusetts Tobacco Survey. Boston, MA: Center for Survey Research, University of Massachusetts; 1994
- Pierce JP, Farkas AJ, Evans N, Gilpin EA. An improved surveillance measure for adolescent smoking? Tob Control.1995; 4(suppl 1) :S47 –S56
- Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Merritt RR. Validation of susceptibility as a predictor of which adolescents take up smoking in the United States. Health Psychol.1996; 15 :355 –361[CrossRef][Web of Science][Medline]
- Choi WS, Pierce JP, Gilpin EA, Farkas AJ, Berry CC. Which adolescent experimenters progress to established smoking in the United States? Am J Prev Med.1997; 13 :385 –391[Web of Science][Medline]
- Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas.1977; 1 :385 –401[CrossRef]
- Albers AB, Biener L. The role of smoking and rebelliousness in the development of depressive symptoms among a cohort of Massachusetts adolescents. Prev Med.2002; 34 :625 –631[CrossRef][Web of Science][Medline]
- Sussman S, Dent CW, Galaif ER. The correlates of substance abuse and dependence among adolescents at high risk for drug abuse. J Subst Abuse.1997; 9 :241 –255[CrossRef][Web of Science][Medline]
- Richardson JL, Dwyer K, McGuigan K, et al. Substance use among eighth-grade students who take care of themselves after school.
Pediatrics.1989; 84
:556
–566
[Abstract/Free Full Text] - Wheaton B. Models for the stress-buffering functions of coping resources. J Health Soc Behav.1985; 26 :352 –364[CrossRef][Web of Science][Medline]
- Altman DG, Slater MD, Albright CL, Maccoby N. How an unhealthy product is sold: cigarette advertising in magazines, 1960–1985. J Commun.1987; 37 :95 –106[CrossRef][Web of Science]
- Biener L, Siegel M. The role of tobacco advertising and promotion in smoking initiation. In: Institute NC, ed. Changing Adolescent Smoking Prevalence. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2001. NIH Publ. No. 02-5086
- Denscombe M. Uncertain identities and health-risking behaviour: the case of young people and smoking in late modernity. Br J Soc.2001; 52 :157 –177
- Kirby JB. The influence of parental separation on smoking initiation in adolescents. J Health Soc Behav.2002; 43 :56 –71[CrossRef][Web of Science][Medline]
- Kandel DB, Davies M. Epidemiology of depressive mood in adolescents: an empirical study.
Arch Gen Psychiatry.1982; 39
:1205
–1212
[Abstract/Free Full Text] - Ahlgren AR, Ardyth A, Hochhauser M, Garvin J. Antecedents of smoking among pre-adolescents. J Drug Edu.1982; 12 :325 –340[Web of Science]
- King TK, Matacin M, Marcus BH, Bock BC, Tripolone J. Body image evaluations in women smokers. Addict Behav.2000; 25 :613 –618[CrossRef][Web of Science][Medline]
- Bauman KE, Fisher LA, Bryan ES, Chenoweth RL. Antededents, subjective expected utility, and behavior: a panel study of adolescent cigarette smoking. Addict Behav.1984; 9 :121 –136[CrossRef][Web of Science][Medline]
- Kaufman NJ, Castrucci BC, Mowery PD, Gerlach KK, Emont S, Orleans CT. Predictors of change on the smoking uptake continuum among adolescents.
Arch Pediatr Adolesc Med.2002; 156
:581
–587
[Abstract/Free Full Text] - Stanton WR, Oei TP, Silva PA. Sociodemographic characteristics of adolescent smokers. Int J Addict.1994; 29 :913 –925[Web of Science][Medline]
- Spear SF, Akers RL. Social learning variables and the risk of habitual smoking among adolescents: the Muscatine study. Am J Prev Med.1988; 4 :336 –342[Web of Science][Medline]
- Bonny AE, Britto MT, Klostermann BK, Hornung RW, Slap GB. School disconnectedness: identifying adolescents at risk.
Pediatrics.2000; 106
:1017
–1021
[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics
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