title: Evaluating depressive symptom interactions on adolescent smoking prevention program mediators: a mediated moderation analysis.
abstract: BACKGROUND
  Smoking prevention interventions have been shown to be effective in reducing smoking prevalence in the United States. Further work is needed to address smoking in China, where over one third of the world's current smokers reside. China, with more than 60% of the male population being smokers, also presents a unique opportunity to test cognitive processes involved in depression, social influences, and smoking. Adolescents at-risk for developing depression may process social information differently from low-risk counterparts.
  
  
  METHODS
  The Wuhan Smoking Prevention Trial was a school-based longitudinal randomized controlled trial aimed at preventing initiation and escalation of adolescent smoking behaviors. Thousand three hundred and ninety-one male seventh-grade students were assessed with a 200-item paper-and-pencil baseline survey, and it was readministered 1 year later following program implementation.
  
  
  RESULTS
  Friend prevalence estimates were significantly higher among 30-day smokers and among those at highest risk for depression symptoms. The program appeared to be successful in changing the perception of friend smoking prevalence only among adolescents with a comorbidity of high scores of depression symptoms and who have experimented previously with smoking. This Program x Comorbidity interaction on perceived friend smoking prevalence was significant in predicting 30-day smoking 1 year after program implementation.
  
  
  CONCLUSIONS
  This study provides evidence that those adolescents with high levels of depressive symptoms may be more sensitive to social influences associated with smoking prevalence. Individual Disposition x Social Environmental Influences may be important when developing future effective prevention programming.
authors.affiliation: Prevention Research Center, Pennsylvania State University, 402 Marion Place, University Park, PA 16802, USA. ksakuma@psu.edu
authors.forename: Kari-Lyn Kobayakawa
authors.initials: KL
authors.lastname: Sakuma
authors.forename: Ping
authors.initials: P
authors.lastname: Sun
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Unger
authors.forename: C Anderson
authors.initials: CA
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002681:China / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D033062:Friends; D015438:Health Behavior; D006266:Health Education / Q000379:methods*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007398:Interpersonal Relations; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D010379:Peer Group; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires