Refusal skills help minority youths combat smoking, study finds

Youths identified as American Indian or Alaska Native (AI/AN) have the greatest lifetime smoking rate of all racial groups, according to the Department of Health and Human Services. Nearly half of the 1.2 million AI/AN youths in the U.S. smoke cigarettes. A University of Missouri study found that public health strategies to combat smoking should teach refusal skills to help youths combat smoking influences, including family members and peers.

"Smoking and quitting behaviors are heavily influenced by factors in the immediate environment, including family, peers and school," said ManSoo Yu, assistant professor in the MU School of Social Work in the College of Human Environmental Sciences. "Particularly, AI/AN youths have more opportunities for smoking than non-AI/AN youths because tobacco use is common at traditional ceremonies and events related to their cultures. It is difficult for these youths to refuse tobacco products from family members and friends who smoke or view refusal as disrespect."

"Tobacco control strategies should include group-based programs that provide skills and training for responding to family members' and friends' smoking," Yu said. "The ability to refuse smoking is related to non-smoking in youths."

In the study, Yu examined self-reported responses from the National Youth Tobacco Survey. He found that family members' smoking and age predicted tobacco use. School truancy, family members' smoking and heightened receptivity to tobacco marketing predicted the use of multiple tobacco products. Refusal to smoke negatively predicted the use of single or multiple tobacco products.

AI/AN adolescents between the ages 12-17 have the greatest rate of lifetime cigarette smoking (42 percent), followed by white (25 percent), Hispanic (23 percent), black (19 percent) and Asian (11 percent), according to the National Survey on Drug Use and Health. In the study, AI/AN adolescents were most likely to use cigarettes (54 percent), followed by cigars (24 percent), smokeless tobacco (16 percent), pipes (13 percent) and menthol cigarettes (12 percent). Approximately one in three AI/AN youths used two or more forms of tobacco. High school students were significantly more likely to use tobacco products than middle-school students.