Cigarette smoking and age of menopause: a large prospective study.

OBJECTIVES: One of the possible consequences of tobacco consumption is that it contributes to an earlier age of menopause, though the causal relationship is yet to be confirmed. This study aimed to examine the prospective association between smoking and earlier age of menopause in a cohort of middle age Australian women after adjustment for a number of potential confounders. STUDY DESIGN: 21-Year follow-up of a cohort prospective study, Brisbane, Australia. MAIN OUTCOME MEASURES: Age of menopause measured at the 21-year follow-up. Smoking and menopausal status were assessed by self-report. Other covariates were measured prospectively in the previous follow-ups. RESULTS: This study is based on 3545 women who provided data on their menopausal status at the 21-year follow-up of the study, and prospective as well as concurrent data on smoking. In univariate analysis tobacco smoking during the reproductive life course, socio-economic status and gravidity were significantly associated with earlier age of menopause. In multivariate analyses women who smoked cigarettes were more likely to experience earlier menopause than non-smokers. Compared to current smokers, risk of early menopause was significantly lower in those women who quit smoking in the past. CONCLUSIONS: The data suggest that the impact of smoking is independent of other covariates associated with both smoking and age of menopause. The findings raise the possibility that effective quit smoking interventions may lead to a later age of menopause, and reduce the risk of adverse health consequences of early menopause.

Young adults' gambling and its association with mental health and substance use problems.

OBJECTIVE: To examine the socio-demographic characteristics of young adults' gambling and its association with mental health and substance use behaviour. METHODS: The study is based on 3,512 young adults (1648 males) for whom data from the Mater-University of Queensland Study of Pregnancy (MUSP) were available on self-report gambling, gambling expenditure, Achenbach's Young Adult Self Report and substance use at the 21-year follow-up of the MUSP. The participants' age ranged between 18.2 and 23.6 (mean = 20.6, standard deviation = 0.8) years. RESULTS: Two-fifths of the young adults reported gambling. Males reported more money spent on gambling and were significantly more likely to be at risk of problem gambling. Gambling and problem gambling were significantly more common in less-educated individuals, those who had higher income or those who had a paid job. Individuals who reported gambling were more likely to smoke cigarettes, drink more than a glass of alcohol per day, use illicit drugs, or exhibit high levels of externalising behaviour than non-gamblers. CONCLUSIONS: The findings confirm the high prevalence of gambling and gambling expenditure in young adults. Individuals who are involved in gambling are more likely to report cigarette smoking, alcohol consumption, and use of illicit drugs. There is a need for further research to explore the mechanisms of association between gambling behaviour and individuals' mental health and substance use. IMPLICATIONS: Substance abuse and mental health services are recommended to consider co-morbid gambling problems in treatment-seeking patients.

Birth outcomes associated with cannabis use before and during pregnancy.

INTRODUCTION: This study aimed to examine the association between cannabis use before and during pregnancy and birth outcomes. RESULTS: Overall, 26.3% of women reported previous use of cannabis and 2.6% reported current use. Multivariate analysis, controlling for potential confounders, including tobacco smoking, alcohol consumption, and use of other illicit drugs, showed that cannabis use in pregnancy was associated with low birth weight (odds ratio (OR) = 1.7; 95% confidence interval (CI): 1.3-2.2), preterm labor (OR = 1.5; 95% CI: 1.1-1.9), small for gestational age (OR = 2.2; 95% CI: 1.8-2.7), and admission to the neonatal intensive care unit (OR = 2.0; 95% CI: 1.7-2.4). DISCUSSION: The results of this study show that the use of cannabis in pregnancy is associated with increased risk of adverse birth outcomes. Prevention programs that address cannabis use during pregnancy are needed. METHODS: Data were from women birthing at the Mater Mothers' Hospital in Brisbane, Australia, over a 7-y period (2000-2006). Women were interviewed in the initial antenatal visit about their use of cannabis and other substances. Records for 24,874 women who provided information about cannabis use, and for whom birth outcomes data were available, were included in the analysis.

Association between smoking and respiratory function before and after menopause.

There is a lack of evidence about whether menopausal status influences the effect of smoking on lung function. This study examined the association between smoking and menopausal status and lung function independent of each other. Data were from a cohort of women attending the 21-year follow-up of the Mater University of Queensland Study of Pregnancy. The study was based on 2020 women who provided data on respiratory function, smoking, and menopausal status. A Spirobank G spirometer system was used to measure forced vital capacity (FVC), forced expiratory volume in first second (FEV(1)), and forced expiratory flow between 25 and 75% of forced vital capacity (FEF(25-75)). Smoking and menopausal status were assessed by self-report. Respiratory function was associated with cigarette smoking, menopausal status, and hormone replacement therapy. Regardless of smoking status, postmenopausal women had poorer lung function when compared with premenopausal women. In multivariate analysis, cigarette smoking was associated with lower FVC, FEV(1), and FEF(25-75), with the magnitude of effect being stronger for women who were postmenopausal. The data suggest that the impact of smoking intensifies after menopause. It seems plausible that effective quit-smoking programs, particularly after menopause, may lead to better lung function and reduced morbidity and mortality in women.

Cannabis use and obesity and young adults.

BACKGROUND: There is shortage of evidence about the relationship between use of cannabis and obesity. OBJECTIVES: This study aimed to examine the association between cannabis use and overweight/obesity in young adults. METHODS: Data were from a 21-year follow-up of mothers and their children recruited into the Mater-University of Queensland Study of Pregnancy (MUSP), a longitudinal pre-birth cohort. The study is based on 2566 young adults (1264 males and 1302 females) who had data available on cannabis use and age of initiation to use of cannabis and BMI at the 21-year follow-up (MUSP children). Those who did not provide data on cannabis use and BMI were excluded from the analysis. RESULTS: Frequency of cannabis use and body mass index (BMI) was assessed at the 21-year follow-up. Potential confounders were prospectively measured between the child's birth and the 21-year follow-up. Some 50.9% of young adults reported use of cannabis in the last month or year and 34.1% had BMI ≤ 25. Multivariate analysis showed that those who had used cannabis were less likely to be categorised in the BMI ≥ 25 group with the least prevalence of overweight/obesity being observed in every day cannabis users (odds ratio = .2; 95% confidence interval [CI]:.1-.4). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The existing data suggest lower prevalence of overweight and obesity among young adult cannabis users. Further research is needed to examine the mechanism of this association.

Timing and chronicity of family poverty and development of unhealthy behaviors in children: a longitudinal study.

PURPOSE: To examine the impact of the timing and duration of family experiences of poverty over the child/adolescent early life course on child aggressive/delinquent behavior and tobacco and alcohol consumption. METHODS: Data were taken from a large scale population based birth cohort study with repeated follow-ups until 21 years after the birth. Poverty was measured during the pregnancy, 6 months, 5 years, and 14 years after the birth. Aggressive/delinquent behavior was measured at 14- and 21-year follow-ups. Tobacco and alcohol consumption were measured at the 21-year follow-up. RESULTS: In multivariate analysis, family poverty experienced at the 14-year follow-up predicted persistent aggressive/delinquent behavior as well as smoking and higher levels of alcohol consumption at the 21-year follow-up. However, the strongest associations were for recurrent experiences of family poverty, with the group that experienced repeated poverty (3-4 times) being more than twice more likely to be aggressive/delinquent at both 14 and 21 years, and to drink more than one glass of alcohol per day at 21 years. CONCLUSIONS: Repeated experiences of poverty in early childhood and adolescence are strongly associated with a number of negative health-related behavior outcomes. Experience of poverty in the early adolescence seems to be the most sensitive period for such exposure.

Cannabis use and educational achievement: findings from three Australasian cohort studies.

BACKGROUND: The associations between age of onset of cannabis use and educational achievement were examined using data from three Australasian cohort studies involving over 6000 participants. The research aims were to compare findings across studies and obtain pooled estimates of association using meta-analytic methods. METHODS: Data on age of onset of cannabis use (<15, 15-17, never before age 18) and three educational outcomes (high school completion, university enrolment, degree attainment) were common to all studies. Each study also assessed a broad range of confounding factors. RESULTS: There were significant (p<.001) associations between age of onset of cannabis use and all outcomes such that rates of attainment were highest for those who had not used cannabis by age 18 and lowest for those who first used cannabis before age 15. These findings were evident for each study and for the pooled data, and persisted after control for confounding. There was no consistent trend for cannabis use to have greater effect on the academic achievement of males but there was a significant gender by age of onset interaction for university enrolment. This interaction suggested that cannabis use by males had a greater detrimental effect on university participation than for females. Pooled estimates suggested that early use of cannabis may contribute up to 17% of the rate of failure to obtain the educational milestones of high school completion, university enrolment and degree attainment. CONCLUSIONS: Findings suggest the presence of a robust association between age of onset of cannabis use and subsequent educational achievement.

Multiple risk factor model predicting cannabis use and use disorders: a longitudinal study.

BACKGROUND: Identification of factors associated with the initiation and continuation of cannabis use is important for any preventive work. OBJECTIVES: This study aimed to examine the early life course predictors of cannabis use and the development of cannabis use disorder in early adulthood. METHODS: Data from Mater Hospital and University of Queensland Study of Pregnancy (MUSP), a population-based prospective birth cohort study. Participants were a cohort of 2,493 young adults who completed the life-time version of the Composite International Diagnostic Interview-computerized version (CIDI-Auto) at the 21-year follow-up, and for whom data were available from previous follow-ups. Ever use and age at first use of cannabis was assessed via self-report, and cannabis use disorder was measured based on Diagnostic and Statistical Manual version IV (DSM-IV) diagnostic criteria. Life course predictors were obtained between the child's birth and the 14-year follow-up. RESULTS: Of 2,493 young adults, 51.4% reported having ever used cannabis, and 21.1% of young adults were classified as having ever had a cannabis use disorder. Child's gender, changes in maternal marital status, maternal smoking, child school performance, childhood sexual abuse, early adolescence smoking and alcohol consumption, and adolescent aggression/delinquency were strongly associated with young adult cannabis use and use disorder. Exposure to multiple risk factors was associated with greater risk of outcomes. CONCLUSIONS: There are a number of strong predictors of cannabis use identified in this study. They suggest that the social context within which children are reared has a major influence on cannabis use and use disorders.

Childhood sexual abuse and cannabis use in early adulthood: findings from an Australian birth cohort study.

Childhood sexual abuse (CSA) is associated with a wide range of health problems later in life. The impact of CSA on young adults' use of cannabis remains under-studied. We examined the extent to which exposure to CSA was associated with increased rates of use of cannabis in early adulthood in a birth cohort of 3,285 Australian children followed-up to the age of 21 years, when retrospective reports of CSA were obtained from sample participants along with information on their use of cannabis at 21 years. Young adult men and women who reported experiencing CSA had significantly higher rates of frequent use of cannabis in early adulthood, defined as use of cannabis at least "every few days." In multivariate analyses, men who reported a history of CSA had an odds ratio (OR) of 2.1 (95% CI = 1.1-3.9) for frequent use of cannabis at the age of 21 years. For women, there was an OR of 3.9 (95% CI = 2.4-6.3). Family and individual factors measured earlier in the study did not confound these associations. The findings suggest that children experiencing CSA have a substantially greater risk of use of cannabis and, in particular, its frequent use in early adulthood. Further research is required to explore factors that explain the pathway linking CSA and use of cannabis in early adulthood.

Predictors of young adults' amphetamine use and disorders: a prospective study.

INTRODUCTION AND AIMS: Understanding the risk factors that predict amphetamine use and development of amphetamine abuse or dependence (disorder) may help guide preventive interventions. This study aimed to investigate the correlates and predictors of young adults' amphetamine use and use disorders. DESIGN AND METHODS: Prospective cohort, population-based study which started in Brisbane, South East Queensland (Australia) in 1981. The study participants were a cohort of 2042 young adults, followed up from birth to young adulthood. At the 21-year follow-up, amphetamine use was assessed via a self-report questionnaire, and amphetamine use disorder (AUD) was assessed using the Composite International Diagnostic Interview (CIDI-Auto). Potential predictors (15 risk factors) were assessed between baseline (antenatal visit) and the 21-year follow-up. These included participant's gender, mother's age and education, maternal marital status and quality of marital relationship, maternal tobacco and alcohol consumption, mother-child communication, child mental health and problem behaviours, child smoking and alcohol consumption and child school performance. RESULTS: Young adult amphetamine users were more likely to have concurrent symptoms of mental illness and problem behaviours and to use or abuse cigarettes, cannabis, or other illicit drugs. In multivariate analyses, young adults' amphetamine use and disorder were disproportionately more common among males and those who have prospectively reported aggression/delinquency or smoking at 14 years, or who have experienced childhood sexual abuse. CONCLUSIONS: Our findings suggest that problem behaviours, smoking and childhood sexual abuse are predictors of initiation to use of amphetamines and development of amphetamine abuse and dependence.

Early childhood predictors of early substance use and substance use disorders: prospective study.

OBJECTIVES: The purpose of the present study was to examine the longitudinal association between early childhood factors and early initiation of use of substances and substance use disorders in a large prospective study. METHOD: Data were from the Mater Hospital University of Queensland Study of Pregnancy, a prospective birth cohort study in Brisbane, Australia. Use of nicotine, alcohol and cannabis and age of initiation of such use were reported at the 21 year follow up. DSM-IV diagnosis of nicotine, alcohol and cannabis use disorders was assessed at 21 years using a computerized version of the Composite International Diagnostic Interview (CIDI-Auto). Early childhood factors were measured between mother's pregnancy and child age 5 years. RESULTS: Of the 3647 respondents with complete data, 15.4% had started to smoke cigarettes before 15 years. Another 17.4% and 12.2% reported having started to consume alcohol or use cannabis in early adolescence, respectively. Some 16.2%, 27.8% and 21.9% had ever had nicotine, alcohol or cannabis abuse or dependence (disorder) by 21 years, respectively. In multivariate models early initiation of use of substances, and substance use disorders were associated with disrupted families or drug-using parents, childhood problem behaviours, and poor parental monitoring and supervision in childhood. CONCLUSIONS: There are four independent factors in early or middle childhood that predict early initiation of use of substances and subsequent substance use disorders by early adulthood. There is a need to consider whether what is known about the risk factors that predict young age of substance use, and substance use disorders, may be incorporated into treatment and/or prevention initiatives.

Child and adolescent externalizing behavior and cannabis use disorders in early adulthood: an Australian prospective birth cohort study.

This study examined the association between age of onset and persistence of externalizing behavior and young adults' cannabis use disorders (CUDs). Data were from a 21 year follow-up of a birth cohort study in Brisbane, Australia. The present cohort consisted of 2225 young adults who had data available about CUDs at 21 years and externalizing behavior at 5 and 14 years. Young adults' CUDs were assessed using the CIDI-Auto. Child and adolescent externalizing behavior were assessed at the 5- and 14-year phases of the study. After controlling for confounding variables, children who had externalizing behavior at both 5 and 14 years (child-onset-persistent) (COP) had a substantial increase in risk of CUD at age 21 years (Odds ratio (OR)=2.5; 95% CI: 1.5, 4.2). This association was similar for those who had 'adolescent onset' (AO) externalizing behavior. However, there was no association between 'childhood limited' (CL) externalizing behavior and CUD. Externalizing behavior in adolescence is a strong predictor of subsequent CUD. Smoking and drinking at 14 years partially mediated the link between externalizing behavior and CUD.

Screening in early childhood for risk of later mental health problems: a longitudinal study.

Depression in childhood or adolescence is associated with increased rates of depression in adulthood. Does this justify efforts to detect (and treat) those with symptoms of depression in early childhood or adolescence? The aim of this study was to determine how well symptoms of anxiety/depression (A-D) in early childhood and adolescence predict adult mental health. The study sample is taken from a population-based prospective birth cohort study. Of the 8556 mothers initially approached to participate 8458 agreed, of whom 7223 mothers gave birth to a live singleton baby. Children were screened using modified Child Behaviour Checklist (CBCL) scales for internalizing and total problems (T-P) at age 5 and the CBCL and Youth Self Report (YSR) A-D subscale and T-P scale at age 14. At age 21, a sub-sample of 2563 young adults in this cohort were administered the CIDI-Auto. Results indicated that screening at age 5 would detect few later cases of significant mental ill-health. Using a cut-point of 20% for internalizing at child age 5 years the CBCL had sensitivities of only 25% and 18% for major depression and anxiety disorders at 21 years, respectively. At age 14, the YSR generally performed a little better than the CBCL as a screening instrument, but neither performed at a satisfactory level. Of the children who were categorised as having YSR A-D at 14 years 30% and 37% met DSM-IV criteria for major depression and anxiety disorders, respectively, at age 21. Our findings challenge an existing movement encouraging the detection and treatment of those with symptoms of mental illness in early childhood.

Pathways to ecstasy use in young adults: anxiety, depression or behavioural deviance?

AIMS: To investigate pathways to ecstasy use disorders from pre-birth to early adulthood with particular attention to the relationship between early depressive and anxiety symptoms and later ecstasy use disorders. DESIGN: Prospective, longitudinal, population-based study started in Brisbane, South East Queensland (Australia) in 1981. Participants were 2143 young adults, followed up from pre-birth to young adulthood. MEASUREMENTS: Ecstasy use disorders were assessed with the composite international diagnostic interview (CIDI-Auto). Maternal socio-economic position and mental health status were assessed at baseline (antenatal visit); maternal substance use was measured at the 5-year follow-up, adolescents' behaviour at the 5- and 14-year follow-up and tobacco and alcohol use were assessed at the 14-year follow-up. FINDINGS: Eight syndrome scales of childhood behaviour were examined. After adjustment for important confounders, delinquent and aggressive behaviour in early adolescence remained significantly associated with ecstasy use disorders in early adulthood. The associations became statistically non-significant when adolescent tobacco and alcohol use were included in the model [OR=1.50 (95%CI=0.75, 3.01) for delinquency and OR=1.69 (95%CI=0.92, 3.12) for aggression]. Formal mediation tests were statistically significant (p=0.001 for delinquent behaviour and p=0.05 for aggressive behaviour). CONCLUSIONS: Our findings suggest a pathway from early deviant behaviour to ecstasy use disorders, possibly mediated through licit drug experimentation in early adolescence.

Does childhood sexual abuse have an effect on young adults' nicotine disorder (dependence or withdrawal)? Evidence from a birth cohort study.

AIMS: To examine whether there is evidence of an independent association between childhood sexual abuse (CSA) and nicotine disorder in youth and to explore the mechanisms underlying this association in a prospective cohort study. DESIGN: Birth cohort study followed-up to 21 years. SETTING: One of two major obstetric hospitals in Brisbane, Australia. PARTICIPANTS: The Mater-University of Queensland Study of Pregnancy involves a prospective birth cohort from a population-based sample involving 7223 singletons whose mothers were enrolled between 1981 and 1984 at the first antenatal visit. The present cohort consisted of a subgroup of 2571 youth who completed the life-time version of the Composite International Diagnostic Interview--computerized version (CIDI-Auto) at the 21-year follow-up. MEASUREMENTS: Nicotine disorder was measured based on Diagnostic and Statistical Manual version IV (DSM-IV) diagnostic criteria and measures of CSA, including retrospective self-reports of rape, were obtained at 21 years. Results Of 2571 young adults, 16.6% met the criteria for either dependence (12.8%) or withdrawal (8.5%). Non-penetrative sexual abuse was reported by 15.5% of respondents and 8.0% reported penetrative sexual abuse. For any types of sexual abuse including non-penetrative, penetrative and self-reported rape before age 16 years, young adults had significantly higher rates of nicotine disorder than young adults who did not experience CSA. This relationship was independent and appeared direct after adjustment for a range of potential confounding and mediating factors. CONCLUSIONS: This study shows that CSA is associated with young adult nicotine disorder. The results extend the public health significance of findings in this area and highlight the importance of not only intensifying public health efforts to address substance use problems among those who have experienced CSA, but of early intervention, so that emerging risky behaviours may be targeted in the earliest stages.