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Association between latchkey status and smoking behavior in middle school children
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Association between latchkey status and smoking behavior in middle school children
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ASSOCIATION BETWEEN LATCHKEY STATUS AND SMOKING BEHAVIOR IN MIDDLE SCHOOL CHILDREN by I-Pei Liu A Thesis Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirement for the Degree MASTER OF SCIENCE (APPLIED BIOSTATISTICS AND EPIDEMIOLOGY) August 2003 Copyright 2003 I-Pei Liu Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UMI Number: 1420381 INFORMATION TO USERS The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleed-through, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. ® UMI UMI Microform 1420381 Copyright 2004 by ProQuest Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, Ml 48106-1346 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UNIVERSITY OF SOUTHERN CALIFORNIA THEGRADUATE SCHOOL UNIVERSITY PARK LOS ANGELES, CALIFORNIA 90089-1695 This thesis, written by T f > -■ I - irl g i MlA under the direction of h B-t" thesis committee, and approved by all its members, has been presented to and accepted by the Director o f Graduate and Professional Programs, in partial fulfillment o f the requirements fo r the degree of Director AppklL anl Date D ecem ber 1 7 , 2003 Thesis Committee Chair Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ACKNOWLEGEMENTS I would like to express my greatest thanks to my thesis committee chair, Dr. Stanley P. Azen, for his guidance, support, and commitment of time. I would also like to thank my thesis committee members, Dr. Paula Palmer and Dr. Jennifer Unger for their expert advice. A special thanks to my project supervisor, Steven Cen, MS, for his help and support. Thanks to my colleagues lie Wu Weiss PhD., Sohaila Shakid PhD., and Michelle Mouttapa MA from the Institute of Preventive Research (IPR) at USC, for their brilliant ideas to this paper. Last but not least, thanks to the teammates of Pacific Rim Integrated Research Project (PRIRP), it has been a pleasure to work with this outstanding group. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. iii TABLE OF CONTENTS ACKNOWLEDGEMENTS ii LIST OF TABLES AND FIGURES Iv ABSTRACT v INTRODUCTION 1 METHODS Subjects 2 School Selection 3 Student Recruitment 3 Procedure 5 Measures 5 Statistical Analysis 6 RESULTS Demographic Characteristics and Unsupervised Hours 7 Latchkey Status and Smoking Behavior 8 Unsupervised Hours and Smoking Behavior 9 Stratified Analysis 10 DISCUSSION Overall Conclusion 13 Gender Differences 14 Limitation 14 Intervention/Future Recommendation 15 BIBLIOGRAPHY 17 REFERENCES 18 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. iv LIST OF TABLES AND FIGURES Table 1: Demographic Characteristics in Relation to the Unsupervised Hours 7 Table 2a: Latchkey Status and Smoking (Yes/No) 9 Table 2b: Unsupervised Hours and Smoking Status (Yes/No) 9 Figure 1: Unsupervised Hours in Girls and Boys 10 Table 3a: Unsupervised Hours and Smoking Status (Yes/No) in Girls 11 Table 3b: Unsupervised Hours and Smoking Status (Yes/No) in Boys 11 Figure 2: Odd Ratios of Smoking Behavior in Girls and Boys 12 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. V ABSTRACT This study examined the relationship between latchkey status and smoking behavior among 6th grade children, while controlling for age, gender, and race/ethnicity. Latchkey status was also categorized and analyzed in different amount of unsupervised hours: 1) <2bi, 2) 3-4 hrs, and 3) >5hrs. Latchkey status and smoking behavior was also examined independently in boys and girls. Data represented a cross-sectional from a cohort study of Pacific Rim Integrated Research Project (PRIRP). A significant relationship was found between latchkey status and smoking behavior (p<0.0001). A significant association was also found between latchkey status and age, latchkey status and ethnicity, and latchkey status and gender (p=0.013, 0.0005, <0.0001, respectively). In stratified analyses, a significant association was found between latchkey status and smoking behavior in both boys and girls (p=0.0014, <0.0001). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Introduction The increase in the number of dual-career and single-parent families accompanied by the decrease in traditional, extended family arrangement for child care has resulted in increasing number of children caring for themselves during after school hours (1). These individuals, commonly referred to as “latchkey children”, are regularly without adult supervision for part of the day, particularly after school. It is estimated that in 1991, approximately 7.6% of the 21.2 million children in the U.S. were in self-care at least part of the time during the day. This included 3.7% of 5-11 years olds and 16.8% of all 12-14 year olds (2). The unsupervised time that latchkey children spend after school has become a concern since there is some evidence of a direct relationship between the number of hours spent in after-school self-care and the risk of using alcohol, tobacco, and other drugs (1). Unfortunately, there is limited research focusing on the effects of latchkey status on substance use or on other risk behaviors. In previous research, results have shown that being latchkey children during after school hours may be a significant risk factor for cigarette smoking. One study found a significant, positive association between latchkey status and cigarette, alcohol, marijuana, and inhalant use among middle-school children (1). Another study from Richardson et al. found that eighth grade students who took care of themselves ten or more hours a week after school were twice as likely as those who spent less than one hour per week in self-care to engage in cigarette smoking and other substance use behavior (3). Subsequent research by Richardson et al. also Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 2 revealed that the place/setting of after-school self-care may also play an important environmental role in the smoking behaviors of latchkey children (4). In addition, the study by Mott el al. indicated that the intensity of the self-care experience, defined as how many days and how many hours per week, was significantly associated with adolescent smoking behavior (5). The objectives of this study are to: a) Examine the relationship between latchkey status and smoking behavior, b) Examine the relationship between latchkey status and demographic characteristics including age, gender, family structure, and ethnicity, c) Examine the relationship between the amount of unsupervised hours by adults and smoking behavior, and d) Establish a statistical model to explain the association between smoking behavior and latchkey status. Methods Subjects Data were obtained from the Pacific Rim Integrated Research Project (PRIRP), a longitudinal school-based experimental trial of smoking prevention strategies in a multicultural, urban population of adolescents in California. The respondents in this study were 6th -grade students attending the middle schools participating in the study. The purpose of the baseline survey was to assess tobacco use and related psychosocial and cultural variables before the implementation of culturally relevant smoking prevention programs. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 3 School Selection Because the study focused on the two largest immigrant ethnic groups to the U.S. (Hispanics and Asians), the sample selection procedure was designed to select schools with large proportions of Hispanic and Asian students. Data from the California Board of Education and the Roman Catholic Archdiocese of Los Angeles and Orange Counties identified and classified schools as Asian, Latino, or ethnically diverse. Schools were predominantly Asian or Latino if: (1) at least 50% of the students were the ethnicity of interest, or (2) at least 35% of the students were the ethnicity of interest, and less than 25% of the students were the other ethnicity. For example, one school qualified as predominantly Asian because the population was 48% Asian and 21% Latino. Schools were classified as multicultural if they did not meet the above criteria (e.g., one school was 38% Asian and 44% Latino, and another was 25% Asian and 29% Latino). To facilitate longitudinal follow-up of students, the sample was limited to middle schools that included grades 6, 7, and 8 (i.e., school systems were excluded if their students matriculate from elementary school to junior high school between grades 6 and 7). Student Recruitment All 6th -grade students in the participating schools were invited to participate in the study. The study included two components with different informed consent requirements according to California law and the University’s Institutional Review Board. The curriculum evaluation portion of the study required only implied parental consent and active student assent (i.e., students could choose to participate if Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 4 their parents did not provide a written refusal). The more extensive survey of cultural and psychosocial variables, which contained more personal questions that were not directly related to the content of the curriculum, required active written parental consent (i.e., students could choose to participate only if their parents provided active written informed consent). Because part of the study required active written consent and part required only implied consent, a two-stage process was used to obtain parental consent and student assent to participate. Consent forms were sent home to the parents/guardians of all 6th -grade students in the school. If a parent actively refused the child’s participation (i.e., checked “no” on the form and returned it to the school), the child was not eligible to participate in any part of the survey. If a parent provided active written consent for the complete survey (i.e., checked “yes” on the form and returned it to the school), the child was invited to participate in the complete study. If a parent did not return the consent form at all, the child was invited to participate only in the portion of the study that did not require active written parental consent (e.g., non-sensitive survey questions that were part of the usual curriculum evaluation, which in California requires only implied parental consent). Students were then invited to provide written assent to participate. If the parent and student provided active written consent/assent, the student participated in the foil survey. If the parent provided only implied consent (i.e., did not return the survey) and the student provided assent, the student participated in the curriculum evaluation only. If the parent and/or student provided a written refusal, the student Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 5 did not participate in any phase of the study. Of the 4427 students invited to participate, 3326 (75.1%) provided active parental consent, and 681 (15.4%) provided implied parental consent. Of the students with both active parental consent and student assent, 271 students did not complete the survey or were absent from school on the day of data collection. The data reported here are from the 3109 students who provided active parental consent and student assent and completed the baseline survey. Procedure Students completed a 160-item paper-and-pencil survey in their classrooms during a single class period (45-50 minutes). Trained data collectors, who were not previously acquainted with the students, distributed the surveys. The surveys were identified only by a code number, not with the students’ names or any other identifying information. Because the students all were attending English-language schools in which their classes were conducted only in English, a basic level of English-language proficiency was assumed and the surveys were provided only in English. However, students were encouraged to ask the data collectors to clarify the meanings of any unfamiliar words. Measures Outcome variable: To assess the smoking experience, we categorized students based on item response to the question: “ Have you ever tried cigarette smoking, even a few puffs?” Smoking status was then dichotomized as either 1) Yes, or 2) No. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Independent variables: Latchkey status was assessed by using one of the two questions in the survey, namely how many hours is the subject at home without an adult there. The hours per day was categorized into 4 levels: (1)2 hours or less; (2) 3 or 4 hours; (3) 5 hours or more; and (4) I’m never home without an adult. Statistical Analysis All analyses were conducted at the significance level of 0.05. Logistic regression and multiple logistic regression analyses were performed to determine the significance of each independent variable. Logistic regression analyses were performed to obtain the odds ratios and test for the association. To control for confounding effects, the demographic variables including sex, ethnicity, age, and family structure were analyzed as covariates. One-way interaction test between the main effect and covariates was performed using multiple logistic regression. If significant interaction was observed, stratified analysis was also performed. Results The study cohort consisted of 1515 (52.8%) girls and 1353 (47.2%) boys, with mean age 11.3 years old (SD=0.52). Among those students, 1271 (44.2%) were supervised after school all the time, and 1606 (55.8%) were unsupervised some time after school hours. Students were from a wide range of racial and ethnic backgrounds: Caucasian (11.3%), African American (2.2%), Asian (22.0%), Latino (45.9%), and Multi-ethnic (18.7%). At the time of survey, 55.1% of the students were living with both biological parents, 28.9% living with extended family, 10.1% with a single parent, and 5.9% with two parents, only one biological. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 7 Demographic Characteristics and Unsupervised Hours Hie percent of different levels of latchkey children was computed for each demographic characteristic (Table 1). The results were as follows: Table 1 -Demographic Characteristics in Relation to the Unsupervised Hours Characteristics Total N 0 hr <2 hr 3-4hr >5hr OR p-value* Age 2886 1274 (44.1) 1097 (38.0) 307 (10.6) 208 (7.2) 0.013 <=11 yo 1991 (69.0) 912(45.8) 754 (37.9) 187 (9.4)) 138 (6.9) 1.00 12 yo 862 (29.9) 356(41.3) 325 (37.7) 115(13.3) 66 (7.7) 1.11 0.07 >=13 yo 33 (1.1) 6(18.2) 18 (54.6) 5(15.2) 4(12.1) 2.38 0.02 Gender 2868 1267 (44.2) 1090 (38.0) 304 (10.6) 207 (7.2) <0.0001 Girls 1515 (52.8) 740 (48.8) 529 (34.9) 161 (10.6) 85 (5.6) 1.00 Boys 1353 (47.2) 527 (39.0) 561 (41.5) 143 (10.6) 122 (9.0) 1.39 <0.0001 Ethnicity 2689 1189(44.2) 1028 (38.2) 286 (10.6) 186(6.9) 0.0005 Caucasian 305(11.3) 103 (33.8) 151 (49.5) 29(9.5) 22 (7.2) 1.00 African 58 (2.2) 30(51.7) 22 (37.9) 3 (5.2) 3 (5.2) 0.53 0.30 Asian 591 (22.0) 248 (42.0) 205 (34.7) 94(15.9) 44 (7.5) 0.63 0.72 Latino 1233 (45.9) 578 (46.9) 466 (37.8) 117(9.5) 72 (5.8) 0.60 0.23 Multi 502(18.7) 230 (45.8) 184(36.7) 43 (8.6) 45 (9.0) 0.59 0.26 Family Structure Both Parents (both bio) 2871 1582(55.1) 1264 (44.0) 674 (42.6) 1096 (38.2) 632 (40.0) 304 (10.6) 169(10.7) 207 (7.2) 107 (6.8) 1.00 0.16 Extended 829 (28.9) 388 (46.8) 297 (35.8) 77 (9.3) 67(8.1) 0.83 0.19 Single Parents 291 (10.1) 128 (44.0) 106 (9.7) 32(11.0) 25 (8.6) 0.90 0.89 Both Parents (at least 1 non -bio) 169 (5.9) 74(43.8) 61 (36.1) 26 (15.4) 8 (4.7) 0.92 0.93 * Describe the 2 types of p values: b.f=overall, regulai-specific Age groups: The results demonstrated a significant association between unsupervised hours and different age groups (p=0.013). As the age increased above 11 years of age (reference group), the greater the chance was that the children were unsupervised (O R = l.ll to 2.38 for 12 and 3 years old, respectively). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Gender: Results indicated a significant association between unsupervised hours and gender (p<G.0001). In comparison to girls, boys were more likely to be latchkey children than girls (OR=l .39). Ethnicity: A significant association between unsupervised hours and ethnicity was existed (p=0.0005). It also revealed that African American, Asian, Latino, and multiethnic groups were less likely to become latchkey children than Caucasian (OR=0.53 to 0.63 for all other ethnic groups). Family Structure: The result showed there was no significant association between unsupervised hours and family structure (p=0.16). When compared with children living with both biological parents, those children living with extended family members demonstrated the lowest likelihood of being latchkey children (OR=0.83). Latchkey Status and Smoking Behavior Table 2a indicated a significant association between latchkey status and smoking behavior (p<0.0001). Latchkey children were 2.06 times more likely to smoke compared to non-latchkey children, without controlling for the covariates. After adjusting for the covariates, there was a significant association between latchkey and smoking behavior (p<0.0001), and risk of behavior was 1.88 times more likely in latchkey children, compare with non-latchkey children. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 9 Table 2a - Latchkey Status and Smoking Behavior (Yes/No) _____ __ ____ Hours Total N Smoke Smoke OR p-value Adjusted Adjusted (Yes) (No) OR* p-value* ________ _ N (%) N (%) _ _____ _____ ______________ ~ ~ o — • — • - j 8? — - — 5 — ^o jo o d ir" Non-Latchkey 1271 (44.2) 74 (5.8) 1197(94.2) 1.00 1.00 Latchkey 1606 (55.8) 181 (11.3) 1425 (88.7) 2.06 <0.0001 1.88 <0.0001 * Adjusted for sex, age, and ethnicity Unsupervised Hours and Smoking Behavior Table 2b demonstrated a significant association between unsupervised hours and smoking behavior (p<0.0001). As the unsupervised hours increased, the chance Table 2b - Unsupervised Hours and Smoking Behavior (Yes/No) Hours Total N Smoke (Yes) N (%) Smoke (No) N (%) OR p-value Adjusted OR* Adjusted p-value* Total 2877 255 (8.9) 2622 (91.1) <0.0001 <0.0001 0 hr 1271 (44.2) 74 (5.8) 1197 (94.2) 1.00 1.00 <2 hr 1095 (38.1) 115 (10.5) 980 (89.5) 1.90 0.71 1.84 0.62 3-4 hr 305 (10.6) 38 (12.5) 267 (87.5) 2.30 0.11 2.39 0.04 >5 hr 206 (7.2) 28 (13.6) 178 (86.4) 2.54 0.04 2.01 0.32 * Adjusted for sex, age, and ethnicity of smoking increased when compared to subjects who were always supervised (unsupervised hours: <2hr:OR=1.9G, S-A hrO R^JO ; >5hr:OR=2:.54). In addition, after adjusting for covariates (sex, age groups, and ethnicity), there was still a positive association between unsupervised hours and smoking behavior. However, the increasing trend did not include the >5hour group. Surprisingly, children were unsupervised for more than 5 hours actually were less likely to smoke than children who were unsupervised for 3-4 hours, all compared with children who were always supervised (unsupervised hours: ^ h rO R ^ l.S d ; 3-4hr:OR=2.39; >5hr:OR=2.01). Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 10 Stratified Analysis An interaction test was performed between, unsupervised hours and covariates (ie. age, gender, ethnicity), and revealed a significance difference between unsupervised hours and smoking behavior in boys and girls (p=0.04). Therefore, gender was treated as an effect modifier and a stratified analysis was conducted. Both girls and boys had the similar trends as the unsupervised hours increased, however, the distribution in the amount of hours was different in girls and boys (Figure 1). Figure 1 -Unsupervised Hours in Girls and Boys Sex vs Latchkey Hours 60 50 fem ale male 0 0 hour < 2 hour 3-4 hour >5 hour h o u rs without ad u lt su p erv isio n Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Girls: Results showed a significant association between unsupervised 1 1 hours and smoking behavior in girls, after adjusting for age and ethnicity (p<0.0001). As the unsupervised hours increased, the chance of smoking behavior increased as well, compared with girls who were supervised all the time (unsupervised hours: <2hr:OR=1.97; 3-4hnOR=3.96; >5hr:OR=3.61)(Table 3a). However, the odds ratios did not indicate a consistent increase in smoking behavior when the unsupervised hours increased. Unsupervised Hours Total N Smoke (Yes) N (%) Smoke (No) N (%) OR* P-value Total 1515 98 (6.5) 1407 (93.5) <0.0001 0 hr 740 (48.8) 29 (4.0) 705 (96.0) 1.00 <2 hr 529 (34.9) 37 (7.0) 489 (93.0) 1.97 0.38 3-4 hr 161 (10.6) 22(13.8) 138 (86.3) 3.96 0.011 >5 hr 85 (5.6) 10(11.8) 75 (88.2) 3.61 0.11 * Adjusted for age and ethnicity. Boys: Results indicated a significant association between unsupervised hours and smoking behavior in boys, after adjusting for age and ethnicity (p=0.0014). As the unsupervised hours increased, the likelihood of smoking behavior increased as well, when compared with boys who were supervised all the time (unsupervised hours: <2hr:OR=1.74; 3-4hr:OR=1.36; >5hr:OR=1.44)(Table 3b). Unsupervised Hours Total N Smoke (Yes) N (%) Smoke (No) N (%) OR* P-value Total 1353 155 (11.5) 1188 (88.5) 0.0014 0 hr 527 (39.0) 45 (8.6) 479 (91.4) 1.00 <2 hr 561 (41.5) 76(13.6) 481 (86.4) 1.74 0.1 3-4 hr 143 (10.6) 16(11.3) 126(88.7) 1.36 0.98 >5 hr 122 (9.0) 18(15.0) 102 (85.0) 1.44 0.82 1 Adjusted for age and ethnicity. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Similar to girls, the smoking behavior in boys did not increase 1 2 consistently as the unsupervised hours increased. Results revealed that girls were at higher risk of smoking behavior for al! 3 levels of unsupervised hours. Specifically for the unsupervised levels at 3-4hr and >5hr, girls were at least 2.5 times more likely to smoke than boys (Figure 2). Figure 2 -Odds Ratios of Smoking Behavior in Girls and Boys OR of Smoking Behavior in Girls and Boys A J ------------------------------------------------------------------------ ! I — ! 3.5 3 ■ 2 f 2.5 £3 <•£ 1 .5 ------ 1 i--- <2h 3-4h >5h unsupervised hours 0.5 - Oh □ Girls □ Boys Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 13 Discussion Overall Conclusion This paper enhanced our understanding of the relationship between latchkey status and smoking behavior in a sample of culturally diverse youth. The data presented revealed that being unsupervised during after school hours is an important risk factor for smoking behavior in 6th grade students. As the unsupervised hours increased, the risk of smoking behavior increased as well, when compared to the children who were supervised all the time. A negative trend was observed between age groups of children who were supervised all the time. Older children were more likely to have less supervision than younger children. This is probably because parents tend to allow the older children to be independent and to take care themselves. Ethnicity/race showed that Caucasian children were between 1.58 and 1.89 times more likely to be unsupervised after school hours, compared to other ethnic groups. This may be due to the working status of parents, family structure, or a less authoritative parental style. There was no significant association between family structure and unsupervised hours. However, children living with both parents were 1.09 to 1.20 times more likely to be unsupervised during after school hours, compared with children from single and extended families, or two-parents reconstituted families. Surprisingly, children living with one parent did not comprise the highest unsupervised group in this study. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 14 Gender Differences Adolescence is a period when independence and separation from the family begins to increase, with different expectations for males and females. In our study, more girls were supervised all the time (48.8%), compare to boys (39.0%). This finding is consistent with previous studies demonstrated girls tend to get more attention and more protection from their families than boys. Boys are more likely to be unsupervised because they are socialized to be independent and active. Girls tend to spend equal amounts of time with parents and peers whereas boys spend significantly more time with peers (6). Girls also receive closer monitoring of their activities and are allowed less independence than boys. Additionally, girls are typically taught to be more dependent and oriented toward family issues, potentially rendering them more vulnerable to the risk behaviors (7). Previous research also found that among 6th graders, greater unsupervised time from adults was associated with a higher number of problem behaviors in girls during winter and summer breaks (8). Limitation Previous studies used the product of days and hours to calculate the total unsupervised hours. However, not one of the articles presented the relationship between these two variables and why they used the product as the main predicting latchkey variable. For example, a total of five hours of unsupervised time could have two scenarios: 1) adults are not home for five hours in one day per week, or 2) Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 15 adults are not home for one hour in all five days per week. Therefore, unsupervised days and unsupervised hours should be analyzed independently. For this study, we hypothesized that children who were left without supervision on a daily basis, but for short duration, would have fewer opportunities to take part in risk behaviors. On the other hand, children who were left not frequently during the week, but with long duration of hours, might have more opportunities to engage in risk behaviors. In our study, there were 710 subjects who checked “never” for unsupervised days per week, but represented a non-zero value for hours, or vice versa. After discussion with several social and behavioral scientist, we concluded that subjects might mean they are not alone as often as one day a week, but on the rare occasions when they are, this is how many hours it lasts. Therefore, we believed that the question regarding “hours per day” without adult supervision is more concise and valid, and was used for the analysis in this paper. Future clarification for the questions on the survey is needed and more analyses could be done to verify our hypothesis for unsupervised hours and unsupervised days. Intervention/Recommendations Parents of latchkey children might consider sources of alternative care with adult supervision during after school hours. Schools and communities agencies often provide supervised after school care for children. Health care providers can help families and communities face these issues to make the latchkey experience a positive one. For instance, an intergenerational telephone reassurance line for Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 16 latchkey children can be provided to help them cope with being home alone by talking with elderly in senior housing. Previous studies have demonstrated that how children spend their unsupervised time and the setting in which they spend this time may be important in determining the likelihood of their engaging in smoking and other unhealthfol behaviors. Future studies may include the questions that elucidate these issues so that further analyzes can be conducted to compare the risk of smoking behavior in different settings. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 17 BIBLIOGRAPHY Casper LM, Hawkins M, O’Connell M. Who’s minding the kids. Child care arrangements: Fall, 1991. Current Reports. Household Economic Studies, Bureau of the Census, Washington, DC, 1994;70-86. Galambos NL, Maggs JL. Out-of-school care of young adolescents and self -reported behavior. Develop Psych 1991;27:611-655. Kavanagh K, Hops H. Good girls? Bad boys? Gender and development as contexts for diagnosis and treatment. Advances in Clinical Childe Psychology, 16th ed, New York: Plenum Press 1994:45-79. Montemayor R. Parents and adolescents in conflict: All families some of the time and some families most of the time. Early Adolesc 1983; 3:83-103. Mott JA, Crowe PA, Richarson JL, et al. After-school supervision and adolescent cigarette smoking: Contributions of the setting and Intensity of after-school self -care. J Behav Med 1999;22:35-59. Mulhall PF, Stome D. Home alone: Is it a risk factor for middle school youth and drug use? J Drug Educ 1996;26:39-48. 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. Richardson JL, Radziszewska B, Dent CW, et al. Relationship between after -school care of adolescents and substance use, risk taking, depressed mood, and academic achievement. Pediatrics 1993;92:32-38. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 18 REFERENCES 1. Mulhall PF, Stome D. Home alone: Is it a risk factor for middle school youth and drug use? J Drag Educ 1996;26:39-48. 2. Casper LM, Hawkins M, O’Connell M. Who’s minding the kids. Child care arrangements: Fall, 1991. Current Reports. Household Economic Studies, Bureau of the Census, Washington, DC, 1994;70-86. 3. 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. 4. Richardson JL, Radziszewska B, Dent CW, et al. Relationship between after school care of adolescents and substance use, risk taking, depressed mood, and academic achievement. Pediatrics 1993;92:32-38. 5. Mott JA, Crowe PA, Richarson JL, et al. After-school supervision and adolescent cigarette smoking: Contributions of the setting and Intensity of after school self-care. J Behav Med 1999;22:35-59. 6. Montemayor R. Parents and adolescents in conflict: All families some of the time and some families most of the time. Early Adolesc 1983; 3:83-103. 7. Kavanagh K, Hops H. Good girls? Bad boys? Gender and development as contexts for diagnosis and treatment. Advances in Clinical Childe Psychology, 16th ed, New York: Plenum Press 1994:45-79. 8. Galambos NL, Maggs JL. Out-of-school care of young adolescents and self- reported behavior. Develop Psych 1991;27:611-655. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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Asset Metadata
Creator
Liu, I-Pei
(author)
Core Title
Association between latchkey status and smoking behavior in middle school children
School
Graduate School
Degree
Master of Science
Degree Program
Applied Biostatistics and Epidemiology
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
health sciences, public health,OAI-PMH Harvest,psychology, social
Language
English
Contributor
Digitized by ProQuest
(provenance)
Advisor
Azen, Stanley (
committee chair
), Palmer, Paula (
committee member
), Unger, Jennifer (
committee member
)
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-c16-311704
Unique identifier
UC11328851
Identifier
1420381.pdf (filename),usctheses-c16-311704 (legacy record id)
Legacy Identifier
1420381.pdf
Dmrecord
311704
Document Type
Thesis
Rights
Liu, I-Pei
Type
texts
Source
University of Southern California
(contributing entity),
University of Southern California Dissertations and Theses
(collection)
Access Conditions
The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...
Repository Name
University of Southern California Digital Library
Repository Location
USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA
Tags
health sciences, public health
psychology, social