Social and Psychological Risk Factors for Initiation and Maintenance of Tobacco Use 153Next, we present an overview of several of the psycholog-
ical and social and environmental factors known or suspected
to enhance the likelihood of initiation and/or maintenance of
regular tobacco use in humans.
SOCIALAND PSYCHOLOGICAL RISK FACTORS
FOR INITIATION AND MAINTENANCE
OF TOBACCO USE
Gender and Ethnic Differences
It has been estimated that every day approximately 5,500
youth experiment with cigarettes for the “rst time and nearly
3,000 young people transition to daily smoking (Gilpin,
Choi, Berry, & Pierce, 1999). The factors involved in the
initiation of smoking are numerous, and indeed, there are
several important studies involving careful longitudinal as-
sessment of environmental, social, and contextual smoking
initiation among adolescents (Chassin, Presson, Pitts, &
Sherman, 2000; Colder et al., 2001; Duncan, Tildesley, Duncan,
& Hops, 1995). Giovino (1999) provides a thorough review of
the current state of knowledge of the epidemiology of tobacco
use and concludes that male and female adolescents are equally
as likely to smoke cigarettes with approximately 20% of per-
sons aged 12 to 17 years in the United States having smoked
within the past 30 days. The prevalence of smoking varies as a
function of ethnicity. Among male high school seniors, 41% of
American Indian/Alaska Natives, 33% of Whites, 29% of
Hispanics, 21% for Asian Americans/Paci“c Islanders, and
12% of African Americans are current smokers. Among female
high school seniors, corresponding prevalence estimates of cur-
rent smoking for each of the ethnic groups mentioned earlier are
39%, 33%, 19%, 14%, and 9%, respectively. The ethnic differ-
ences that exist in smoking prevalence have attracted recent at-
tention. Great interest exists, for example, in understanding the
apparent susceptibility among White adolescents to social in-
”uences to smoke, while African American youth appear to be
comparatively resistant to these in”uences to smoke. Mermel-
stein (1999), in a review of the literature, concludes that the
source of these ethnic differences in smoking may generate
from the differential role that parental and family factors or
youth ability to cope with negative affect play across the vari-
ous ethnicities.
Cognitive Effects of Smoking
Individual differences in cognitive assets and liabilities may
also play a role in susceptibility to tobacco dependence.
There is substantial evidence to suggest that nicotine plays
a role in attention, learning, and memory. In humans, a
wide variety of studies have reported the positive effects of
nicotine on cognitive function (Heishman, 1999; Levin &
Rezvani, 2000). However, in most of these studies, certain
methodological issues cloud the conclusions that can be
drawn. For example, the majority of the earlier studies ex-
amined cognitive effects in cigarette smokers. Nicotine
administration can produce a marked improvement in vigi-
lance, rapid information processing, and short-term verbal
recall and reduces time to name a color on the Stroop test
(Hatsukami, Fletcher, Morgan, Keenan, & Amble, 1989;
Warburton, 1992; Warburton & Wesnes, 1984). Some stud-
ies have not found this positive effect on memory. In a
nicotine-dependent population, it is dif“cult to determine
whether enhancement in cognitive function is due to relief
of attentional de“cits mediated by nicotine withdrawal. If
smokers are deprived of nicotine, cognition is impaired and
these de“cits can be reversed once the individual is re-
exposed to nicotine (Hatsukami et al., 1989; Parrott &
Roberts, 1991; Snyder & Henning“eld, 1989). To try to rule
out the effects of nicotine on withdrawal versus cognitive
performance, experiments have examined the effects of
nicotine on attention in normal nonsmoking adults. For ex-
ample, in a computerized test of attention, nicotine can sig-
ni“cantly reduce errors in normal nonsmoking adults (Levin
et al., 1998). However, even though examination of the ef-
fects of nicotine in nonsmoking adults provides a reasonable
baseline, it is still dif“cult to compare these “ndings directly
to those seen in smokers since smokers may differ from
nonsmokers on a variety of different factors including ge-
netic, environmental, and psychological factors (Gilbert,
1995).Psychiatric Comorbidity and Tobacco DependenceAttention-de“cit hyperactivity disorder (ADHD) is charac-
terized by an increase in inactivity, an inability to retain
attention for any length in time, and increased impulsivity.
Previous research has indicated that a possible cause could be
due to impairment in the functioning of the dopamine system
(Barkley, 1990). In children, the prevalence of ADHD ranges
from 2% to 8% and is seen more frequently in boys relative
to girls (Barkley, 1990). In the adult population with ADHD,
40% are smokers compared to 26% in the general population
(Pomerleau, Downey, Stelson, & Pomerleau, 1995). Since
smoking and nicotine administration has been shown to
increase attention (see earlier discussion), it is possible
that adults with ADHD are nicotine users because it helps
alleviate some of the symptoms associated with their psychi-
atric condition. In fact, Levin et al. (1996) have shown that