Reducing early smokers' risk for future smoking and other problem behavior: insights from a five-year longitudinal study.

PURPOSE: To identify risk and protective factors during early and later adolescence that predict future regular smoking and multiple problem behavior among at-risk youth, defined as those who tried smoking by grade 7. METHODS: At grades 7, 10, and 12, data were collected from 2,000 early smokers drawn from California and Oregon. Multivariate regression analyses tested predictors of the two grade 12 outcomes in separate models using data from grades 7 and 10. Gender interactions and buffering of risk factors by protective factors were assessed. RESULTS: For at-risk youth, consistent protective factors against future smoking and problem behavior included living in an intact nuclear family (all four models) plus getting good grades and parental disapproval of smoking/drug use (three of four models). Consistent risk factors included exposure to substance-using peers (four models) and problems in school (three of four models). Adult substance use was a predictor during early, but not later, adolescence; pro-smoking/drug use beliefs were significant predictors during later adolescence. There were few differences across gender and no significant buffers against risk. CONCLUSIONS: At-risk youth would likely benefit from peer resistance training, parental involvement in prevention efforts, and efforts to improve educational performance during both middle school and high school. Changing pro-drug beliefs may be more effective among older adolescents.

Temporal associations of cigarette smoking with social influences, academic performance, and delinquency: a four-wave longitudinal study from ages 13-23.

This study examined the temporal associations of cigarette smoking with prosmoking social influences, academic performance, and delinquency in a cohort of 6,527 adolescents surveyed at ages 13, 16, 18, and 23 years. Prosmoking peer and family influences were risk factors for future smoking throughout adolescence, with family influences perhaps also operating indirectly through the adolescent's exposure to prosmoking peers. There were reciprocal associations of youth smoking with parental approval, peer smoking, and poor grades (but not delinquency), with youth smoking emerging as a stronger antecedent than consequence of these psychosocial factors. Few gender differences in these associations were observed. Implications of these findings for efforts to prevent youth smoking are discussed.

School-based drug prevention among at-risk adolescents: effects of ALERT plus.

In a recent randomized field trial, Ellickson et al. found the Project ALERT drug prevention curriculum curbed alcohol misuse and tobacco and marijuana use among eighth-grade adolescents. This article reports effects among ninth-grade at-risk adolescents. Comparisons between at-risk girls in ALERT Plus schools (basic curriculum extended to ninth grade with five booster lessons) and at-risk girls in control schools showed the program curbed weekly alcohol and marijuana use, at-risk drinking, alcohol use resulting in negative consequences, and attitudinal and perceptual factors conducive to drug use. Program-induced changes in perceived social influences, one's ability to resist those influences, and beliefs about the consequences of drug use mediated the ALERT Plus effects on drug use. No significant effects emerged for at-risk boys or at-risk adolescents in schools where the basic ALERT curriculum (covering seventh and eighth grades only) was delivered. Possible reasons for gender differences and implications for prevention programming are discussed.

The role of substance use in young adult divorce.

AIM: To test the relationships between various forms of substance use during marriage and subsequent divorce among US young adults. DESIGN: Three waves of survey data collected at approximately ages 18, 23 and 29 years were used. Using multivariate logistic regression and controlling for factors present at the two early waves, we tested for prospective relationships between substance use at the second assessment and divorce by the third. PARTICIPANTS: A longitudinal panel following adolescents on the west coast of the United States into young adulthood. The analytic subsample consisted of the 454 individuals currently married at the age 23 survey. MEASUREMENTS: Predictors were past-year frequency of alcohol intoxication, marijuana use and cigarette use, as well as any hard drug use in the past year. Covariates included substance use prior to marriage, demographic and socio-economic factors, marital discord and religiosity. FINDINGS: Controlling for other factors, more frequent alcohol intoxication during marriage was an independent predictor of later divorce. Frequency of marijuana use had a significant bivariate relationship with divorce that was not significant in the multivariate model. CONCLUSION: These data are consistent with the notion that alcohol intoxication is related causally to divorce among young adults.

A discrete time hazards model of smoking initiation among West Coast youth from age 5 to 23.

OBJECTIVE: To identify factors associated with age of smoking initiation and distinguish vulnerable periods for initiation according to those factors. METHOD: Discrete time hazards analysis was used to model smoking initiation as a function of age (5-23), demographic and familial influence variables (measured at age 13), and their interactions in a cohort of 6255 youths who completed six assessments over a 10-year period from age 13 to 23 years. RESULTS: Half of the sample had initiated smoking by age 13, and the hazard for initiation was greatest between ages 13 and 15. In addition to differences associated with race/ethnicity, protective factors for smoking initiation included high parental education and having an intact family of origin. Having an older sibling and participant's exposure to smoking by an important adult were both risk factors, with the latter having a stronger effect for females and Blacks. For all effects, the strength of the association differed across the age range. CONCLUSIONS: The impact of demographic and family influence factors on smoking initiation varies over time. However, the maximum risk for initiation is during the early teen years, and the range of considerable vulnerability is during middle school and high school.

Does solitary substance use increase adolescents' risk for poor psychosocial and behavioral outcomes? A 9-year longitudinal study comparing solitary and social users.

This longitudinal study compared Grade 8 solitary cigarette smokers (n = 541), drinkers (n = 577), and marijuana users (n = 148) with adolescents who restricted their use of these substances to social settings (ns = 562, 1,426, and 388, respectively) on adolescent functioning and young adult outcomes. In Grade 8, solitary users held more positive beliefs about the consequences of substance use, earned poorer grades, engaged in more deviant behavior, and devoted less time to school and more time to social activities. By age 23, these solitary users had lower educational attainment, poorer self-rated health, and greater substance use problems. Results indicate the importance of better understanding and addressing the needs of this understudied group of high-risk youth.

Are drug experimenters better adjusted than abstainers and users?: a longitudinal study of adolescent marijuana use.

PURPOSE: Experimentation with substance use is normative during adolescence and prior research suggests that adolescents who refrain from experimentation may be psychologically maladjusted. This longitudinal study compared lifetime marijuana abstainers (n = 1177), experimenters (n = 873), and frequent users (n = 205) at grade 12 on psychosocial functioning during late adolescence and young adulthood. METHODS: Participants were recruited from middle schools in 1985 (grade 7) and assessed repeatedly, including in 1990 (grade 12) and 1995 (age 23). Self-report surveys assessed lifetime substance use at grade 12, and psychosocial functioning at grade 12 and age 23. Group differences after controlling for key demographics were estimated using multivariate logistic regression and analysis of covariance. RESULTS: Adolescent abstainers from marijuana often fared better (and in no case worse) than experimenters and frequent users both concurrently and later in life on school engagement, family and peer relations, mental health, and deviant behavior. Similar results were found in ancillary analyses using a definition of adolescent "abstainer" that also accounted for cigarette and alcohol use. CONCLUSIONS: Results refute the idea that adolescents who abstain from substance use are maladjusted, and suggest instead that they function better than experimenters later in life, during the transition to young adulthood.

Exploring the link between substance abuse and abortion: the roles of unconventionality and unplanned pregnancy.

CONTEXT: Several studies have found a relationship between abortion and prior substance use, suggesting that a reduction in substance use might help decrease abortion rates. However, such a conclusion requires a greater understanding of the processes linking abortion and prior substance use. METHOD: Path analysis of longitudinal data from 1,224 women was used to simultaneously test two pathways from adolescent substance use to abortion by age 29, one mediated by higher rates of unplanned pregnancy and the other independent of unplanned pregnancy rates. The model was then expanded to examine how these pathways change when unconventional attitudes and behaviors (such as rebelliousness and low religiosity) are taken into consideration. RESULTS: In the analysis that did not control for unconventionality, women who reported smoking cigarettes or using marijuana or hard drugs at age 18 had an increased likelihood of subsequent unplanned pregnancy and, as a result, higher rates of abortion. In addition, women who had used marijuana had an increased likelihood of abortion independent of unplanned pregnancy rates. In the final model, unconventionality strongly predicted both abortion and unplanned pregnancy. Moreover, it explained the associations between the use of hard drugs or marijuana and abortion that were due to higher unplanned pregnancy rates. CONCLUSIONS: Unconventionality mediates certain associations between substance use and abortion, perhaps because unconventional women are more likely both to use substances and to engage in behaviors that increase their risk of unplanned pregnancy. Hence, it seems unlikely that reducing substance use will result in substantially fewer abortions.

Cigarette smoking from adolescence to young adulthood: women's developmental trajectories and associates outcomes.

OBJECTIVES: This study aimed to compare 1,442 women with distinct developmental trajectories of smoking from ages 13-23 on important young adult outcomes at age 29 (e.g., education, income, mental and physical health, arrest history, drug and alcohol abuse), as well as early transitions to sexual intercourse, parenthood, and marriage. METHODS: Women were classified as Abstainers or into 1 of 5 trajectory classes for which they had the highest probability of membership: Stable Highs, Early Increasers, Late Increasers, Triers, and Decreasers. Regression analysis was used to model outcomes as a function of trajectory class membership. RESULTS: Abstainers and Triers generally had more favorable outcomes than Stable Highs and Early Increasers. Decreasers were more likely to graduate from college than Stable Highs and Early Increasers and had a lower arrest rate than Stable Highs. Women who increased their smoking from initial low levels (Late Increasers) generally had poorer young adult outcomes compared to Triers and Abstainers, but lower risk for early sex and early parenthood compared to Stable Highs and Early Increasers. CONCLUSIONS: Women with certain patterns of smoking from age 13-23 are at heightened risk for early transitions to sexual activity and parenthood, as well as health, behavioral, and socioeconomic problems during young adulthood.

National Youth Anti-Drug Media Campaign and school-based drug prevention: Evidence for a synergistic effect in ALERT Plus.

This analysis examined the possible synergistic effect of exposure to the National Youth Anti-Drug Media Campaign and a classroom-based drug prevention curriculum among 9th grade students participating in a randomized trial of ALERT Plus. A total of 45 South Dakota high schools and their middle-school feeder(s) were randomly assigned to an ALERT condition (basic prevention curriculum delivered in 7th and 8th grades), an ALERT Plus condition (basic curriculum with booster lessons added for 9th and 10th grades), or a control condition. Marijuana use in the past month was significantly less likely among ALERT Plus students reporting at least weekly exposure to anti-drug media messages. The National Youth Anti-Drug Media Campaign may have led to reductions in marijuana use among youth who simultaneously received school-based drug prevention.

Concurrent use of alcohol and cigarettes from adolescence to young adulthood: an examination of developmental trajectories and outcomes.

Concurrent use of alcohol and tobacco is common among adolescents, yet little is known about the developmental patterns of concurrent use, or the consequences associated with such patterns during young adulthood. Using data collected at six time points during 1985-1995 as part of an evaluation of a school-based substance abuse prevention program in California and Oregon, this study used latent growth mixture modeling to identify five distinct developmental trajectories of concurrent use of alcohol and tobacco from ages 13-23 in a cohort of 5873 individuals and compared these distinct groups with respect to demographic characteristics and young adult outcomes (at age 23 and age 29). Results suggest that while it is common during adolescence to drink but not smoke, it is very unusual to smoke and not drink. Compared to young people who smoked and drank consistently throughout their teens and early twenties, those who drank consistently but smoked only occasionally or dramatically decreased their smoking over time had lower rates of deviant behavior and predatory violence at age 23 and were less likely to have a history of arrest and substance use problems by age 29. This close examination of concurrent use of alcohol and cigarette use from ages 13-23 further accentuates the importance of curbing smoking behavior among adolescents before it becomes habitual.

Predictors of attempted quitting and cessation among young adult smokers.

BACKGROUND: This study compared young adult nonsmokers (n = 1216), light smokers (n = 406), and regular smokers (n = 360) on demographic, psychosocial, and behavioral characteristics, as well as identified predictors of attempted quitting and 6-month cessation among regular smokers. METHOD: Participants were recruited from middle schools in 1985 (age 13) and assessed repeatedly through 2001 (age 29). Mail surveys were used to obtain information on smoking status and hypothesized predictors of cessation at age 23, and quit attempts and cessation occurring between ages 23-39 among regular smokers. Logistic regression analysis was used to identify predictors of quit attempts and 6-month cessation. RESULTS: Among initial smokers, 76% attempted to quit and 26% quit for 6 months or longer between ages 23-29. Higher rates of substance use, illegal activity, poor mental health, and victimization were found among regular smokers than nonsmokers and lighter smokers at age 23. However, multivariate analyses indicated that these problems were less relevant to quitting than social transitions and interpersonal factors, demographics (e.g., race/ethnicity), and health status. CONCLUSIONS: Different risk and protective factors are relevant to understanding why smokers attempt to quit versus why they are able to quit for 6 months or longer. We discuss implications of these findings for cessation interventions and programs for young adults.

Marijuana use and later problems: when frequency of recent use explains age of initiation effects (and when it does not).

Tobacco, alcohol, and marijuana are among the most commonly used drugs during adolescence. Initiation of marijuana use typically peaks at age 15, with risk of initiation continuing throughout adolescence. The goal of the current study was to prospectively examine the influence of age of marijuana initiation on four outcomes: physical health, mental health, illicit drug use other than marijuana, and marijuana-use related consequences at age 18. We controlled for several important predictors of adolescent drug use and its associated consequences, including demographics, social bonding variables, personality variables, and recent use of marijuana. Baseline survey data were collected in 1984 at grade 7 and follow up surveys were conducted at grades 8, 9, 10, and 12 (N = 2079). This initiates-only sample was 47% female, 66% White, 11% African American, 13% Hispanic, 5% Asian, and 5% other race or ethnicity. Findings indicated that age of initiation predicted marijuana consequences and other illicit drug use after controlling for demographic, social, and behavioral factors. However, once frequency of recent marijuana use was included in the models, age of initiation was only associated with other illicit drug use. Both primary and secondary prevention are needed to curb marijuana use and its associated harms.

Mediation analysis of a school-based drug prevention program: effects of Project ALERT.

This study used mediation analyses, implemented in a longitudinal structural equation modeling framework, to examine the mechanisms by which a social-influence-based school drug use prevention program (Project ALERT) achieved its effects on past month cigarette use and alcohol misuse. Participants were 4277 South Dakotan middle-school students (2554 treatment and 1723 control) measured at baseline and 1 year later on past month cigarette use and alcohol misuse, as well as cigarette- and alcohol-related mediating variables targeted by the Project ALERT curriculum (i.e., resistance self-efficacy, positive and negative beliefs about use, and peer influence). Results for cigarettes showed that all hypothesized mediating variables were significant mediators of ALERT's effect on intentions to smoke and past month cigarette use, with peer influence being the strongest. Results for alcohol point to positive beliefs about the consequences of drinking as an important mediator for alcohol misuse. Taken together, the findings highlight an avenue for program improvement through increased impact on peer influence to use alcohol and drugs.

Antecedents and outcomes of marijuana use initiation during adolescence.

BACKGROUND: This study identified similarities and differences in risk factors for marijuana use initiation from grades 7 to 8, grades 8 to 9, and grades 9 to 10, and examined differences between earlier initiates, later initiates, and nonusers on various problem behaviors at grade 10. METHOD: Longitudinal data were used to examine predictors and outcomes associated with marijuana initiation from grade 7 (N = 1,955) to grade 10 (N = 909). Participants completed yearly surveys to assess problem behaviors, social influences, and marijuana-related attitudes and behavior. RESULTS: Earlier initiates were more likely than later initiates to exhibit problem-related marijuana use, hard drug use, polydrug use, poor grades, and low academic intentions at grade 10. Across ages, initiation was predicted by smoking, frequency of marijuana offers, and poor grades. Results provided some evidence for a shift from familial to peer influence on marijuana initiation with increasing age. Marijuana-related beliefs were relatively weak predictors of initiation at all ages after controlling for pro-marijuana social influences and engagement in other types of substance use and delinquent behavior. CONCLUSIONS: Results emphasize the importance of early intervention and identify a wide range of potentially modifiable risk factors that may be targeted.

Developmental trajectories of cigarette smoking and their correlates from early adolescence to young adulthood.

Smoking initiation typically occurs in adolescence and increases over time into emerging adulthood. Thus adolescence and emerging adulthood compose a critical time period for prevention and intervention efforts. To inform these efforts, this study used latent growth mixture modeling to identify 6 smoking trajectories from ages 13 to 23 among 5,914 individuals: nonsmokers (28%), stable highs (6%), early increasers (10%), late increasers (10%), decreasers (6%), and triers (40%). By age 23, the trajectories merged into 2 distinct groups of low- and high-frequency and their standing on age 23 outcomes reflected this grouping. Consideration of these results can help researchers identify at-risk individuals before their smoking becomes too problematic, providing an opportunity for intervention and possible prevention of nicotine dependence.

Modifying pro-drug risk factors in adolescents: results from project ALERT.

The objective of this study was to evaluate the impact of a revised state-of-the-art drug prevention program, Project ALERT, on risk factors for drug use in mostly rural midwestern schools and communities. Fifty-five middle schools from South Dakota were randomly assigned to treatment or control conditions. Treatment-group students received 11 lessons in Grade 7 and 3 more in Grade 8. Effects for 4276 eighth graders were assessed 18 months after baseline. Results indicate that Project ALERT had statistically significant effects on all the targeted risk factors associated with cigarette and marijuana use and more modest gains with the pro-alcohol risk factors. The program helped adolescents at low, moderate, and high risk for future use, with the effect sizes typically stronger for the low- and moderate-risk groups. Thus, school-based drug prevention programs can lower risk factors that correlate with drug use, help low- to high-risk adolescents, and be effective in diverse school environments.

Integrating four theories of adolescent smoking.

The ability of the Theory of Planned Behavior, Social Learning Theory, Social Attachment Theory, and Problem Behavior Theory to predict smoking at Grade 10 was tested against an integrated model incorporating predictors from all the theories. The integrated model also tested whether constructs from each theory contribute distinct variance to the prediction of smoking. Predictors measured at Grade 7 (in 1985) were used to model smoking 3 years later (in 1988) among 4186 youth, using logistic regression. Constructs emphasized by each theory were important, independent predictors of later smoking. The integrated model was superior to all of the theory-based models. A few predictors varied for current vs. frequent smoking outcomes. Results emphasize the need for a multifaceted approach to understanding and preventing adolescent smoking.

From adolescence to young adulthood: racial/ethnic disparities in smoking.

OBJECTIVES: We used data gathered from 6259 youths between the ages of 13 and 23 years to compare trends in smoking among 4 racial/ethnic groups. METHODS: We weighted trend data to represent baseline respondent characteristics and evaluated these data with linear contrasts derived from multiple regression analyses. RESULTS: Although African Americans exhibited higher initiation rates than Whites, they exhibited consistently lower rates of regular smoking than both Whites and Hispanics. This seeming anomaly was explained by African Americans' lower rates of transition to regular smoking and greater tendency to quit. Racial/ethnic disparities were accounted for by differences in pro-smoking influences. CONCLUSIONS: Reducing racial/ethnic disparities in smoking may require reducing differences in the psychosocial factors that encourage smoking.

New inroads in preventing adolescent drug use: results from a large-scale trial of project ALERT in middle schools.

OBJECTIVES: We evaluated the revised Project ALERT drug prevention program across a wide variety of Midwestern schools and communities. METHODS: Fifty-five South Dakota middle schools were randomly assigned to program or control conditions. Treatment group students received 11 lessons in 7th grade and 3 more in 8th grade. Program effects for 4276 8th-graders were assessed 18 months after baseline. RESULTS: The revised Project ALERT curriculum curbed cigarette and marijuana use initiation, current and regular cigarette use, and alcohol misuse. Reductions ranged from 19% to 39%. Program effects were not significant for initial and current drinking or for current and regular marijuana use. CONCLUSIONS: School-based drug prevention programs can prevent occasional and more serious drug use, help low- to high-risk adolescents, and be effective in diverse school environments.