Electronic Theses and Dissertations





Date of Award


Document Type


Degree Name

Doctor of Philosophy




Clinical Psychology

Committee Chair

Leslie Robinson

Committee Member

Kristoffer Berlin

Committee Member

James Murphy

Committee Member

Kenneth Ward


The examination of smoking trajectories bridges the study of adolescent smoking initiation, escalation, persistance, quitting, and relapse through the conceptualization of smoking as a developmental process. An advantage of this approach is that it allows for the investigation of longitudinal patterns in tobacco uptake and the association of these patterns with predictor variables. For example, physician advice has been associated with reduced smoking among adolescents, but only cross-sectional research has been conducted. The present study examined the longitudinal impact of physician communication on adolescent smoking trajectories using growth mixture modeling (GMM). This study aimed to (1) identify trajectories for smoking; (2) identify any possible unobserved (latent) classes; and (3) examine whether gender, ethnicity, or physician communication were related to adolescent smoking trajectories. Data were drawn from five ways of a large (N = 3,049), diverse (82.9% African American) sample of adolescents from the Memphis Health Project, a 10-year longitudinal study of smoking. GMM was utilized to capture individual differences in adolescent smoking trajectories and examine how physician communication related to trajectory classes. The best fitting model was a six class piecewise GMM with the following identified latent classes (from the largest to smallest classes): nonsmoker class, quitter class, early onset-escalating smoking class, early onset-stable high smoking class, late onset smoking class, and declining smoking class. Males and Caucasians were more likely to be in classes characterized by higher levels of tobacco use. Physician communication was also often associated with classes with higher levels of smoking. These results have significant clinical implications as they highlighted the need for early and consistent systematic tobacco surveillance and intervention among youth, not just those at highest risk.


Data is provided by the student.

Library Comment

dissertation or thesis originally submitted to the local University of Memphis Electronic Theses & dissertation (ETD) Repository.