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Behavioral problems and tobacco use among adolescents in Central America and the Dominican Republic 

Results. Occurrence of tobacco use was observed to vary dramatically from country to country. Nonetheless, for the combined group of countries, the estimated odds of tobacco use in youths at the highest levels of behavioral problems was more than five times that for youths at the lowest levels, after controlling for sex, age, lack of participation in recreational activities, level of irritability, and levels of problems with school, family, and mental health. Country- specific analyses show that youths at the highest levels of behavioral problems have a consistently greater occurrence of tobacco use as compared to youths at the lowest levels of behavioral problems.

Conclusions. These findings are concordant with prior studies on tobacco use among adolescents with behavioral problems. Although the magnitude of observed associations varied according to the country of residence, the strength of these associations and their significance by conventional standards were observed in nearly all the countries sampled. This is the first study in these seven countries on potentially causal relationships such as these. More research is needed to augment our knowledge regarding the observed cross-country differences and ultimately to develop, implement, and evaluate effective tobacco preventive intervention programs.

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