Adoption of electronic-cigarette-free, hookah-free and American College Health Association recommended tobacco-free policies among a national sample of postsecondary educational institutions.

Objective: To examine the prevalence of various types of tobacco-free policies among a US national sample of postsecondary educational institutions (PEIs). Participants: A national sample of US PEIs (N = 605) attended by the participants of the NEXT Generation Health Study. Methods: Tobacco policies of these PEIs were reviewed to determine if they were e-cigarette-free (yes/no), hookah-free (yes/no), and ACHA-recommended tobacco-free (yes/no) in June-December 2017. Logistic regression models were used to examine the relationships between institutional characteristics and tobacco policies. Results: Overall, 39.2, 26.0, and 20.0% of the sample adopted e-cigarette-free, hookah-free, and ACHA-recommended tobacco-free policies, respectively. Proprietary PEIs (vs. public) were less likely to have ACHA-recommended tobacco-free policies, while PEIs in the South and Midwest (vs. West) were more likely to have ACHA-recommended tobacco-free policies (p < 0.05). Conclusions: Most sampled PEIs did not have ACHA-recommended tobacco-free polices. Subsequent research needs to investigate how ACHA-recommended tobacco policies influence tobacco use.

Sexual Minority Status and Adolescent Eating Behaviors, Physical Activity, and Weight Status.

INTRODUCTION: This study examined sexual orientation differences in eating behaviors, physical activity, and weight status among adolescents in the U.S. Moreover, this study tested whether parental and peer influences contribute to sexual orientation disparities in adolescent eating behaviors, physical activity, BMI, and examined disparities in weight misperception. METHODS: Cross-sectional data were from 1,926 adolescents who participated in the NEXT Generation Health Study in 2010-2011. Linear and multinomial logistic regressions conducted in 2017-2018 were used to test disparities and interactions with social influences. RESULTS: Relative to their heterosexual peers, sexual minority males and females consumed fruits and vegetables more frequently; sexual minority males engaged in less frequent physical activity; and sexual minority females were more likely to be overweight, perceive themselves as overweight, and to overestimate their weight. High parental expectation for physical activity was associated with more frequent vigorous physical activity among heterosexual adolescents, but less frequent vigorous physical activity among sexual minority males. Exercising with a same-sex peer buffered against the risk of higher BMI among sexual minority females. CONCLUSIONS: Parental and peer influences may serve as potential intervention targets to reduce disparities in weight-related behaviors. Longitudinal research is needed to understand the consequences of weight misperception among sexual minority females.

Adoption of Tobacco- and Smoke-Free Policies in a US National Sample of Postsecondary Educational Institutions.

OBJECTIVES: To examine the institutional characteristics associated with the adoption of tobacco- and smoke-free policies among US postsecondary educational institutions. METHODS: In 2017, we collected information on tobacco policy types and institutional characteristics of a national sample of US postsecondary educational institutions (n = 605) attended by the participants of the NEXT Generation Health Study. We used logistic regression to examine the relationships between these variables. RESULTS: Overall, 35.2% of these institutions adopted tobacco-free policies (i.e., prohibit all tobacco product use on campus), 10.1% had smoke-free policies (i.e., prohibit smoking but not other tobacco product use on campus), and 53.7% did not have tobacco- or smoke-free policies. Proprietary (privately owned, for-profit) institutions (vs public institutions) were the least likely to have tobacco- or smoke-free policies (P < .05), which were disproportionately attended by racial/ethnic minority students. Adoption of these policies also varied by census region (P < .05). CONCLUSIONS: Prevalence of tobacco- and smoke-free policies among US postsecondary educational institutions is low. Public Health Implications. Wide dissemination of evidence-based interventions to accelerate adoption of tobacco-free policies in all postsecondary educational institutions is warranted.

Prospective associations between cannabis use and negative and positive health and social measures among emerging adults.

BACKGROUND: In light of on-going policy changes related to cannabis use in the United States, it is important to examine possible associations between cannabis use and subsequent behaviors of public health interest. This study identified prospective associations between cannabis use during first-year post high-school and a wide range of positive and negative health and social measures one year later. METHODS: Data were from Waves 4 (Time 1; 1st year after high-school) and 5 (Time 2; one year later) of the NEXT Generation Health Study, a national sample of emerging adults in the United States (n = 1915; mean age = 20.2; 61% female). Multinomial logistic regressions adjusting for pertinent covariates were conducted to examine odds of substance use, nutrition, physical activity, sedentary behaviors, school performance, family relations, mental health, driving behaviors and health perceptions at Time 2. RESULTS: Compared with non-use, frequent use (20+ times in the past year) at Time 1 was associated with Time 2 negative health and social measures, including risky driving behaviors (AOR = 1.78, CI-1.45-2.19), depressive symptoms (AOR = 1.68, CI-1.43-1.98), unhealthy weight control behaviors (AOR = 1.55, CI-1.31-1.84), psycho-somatic symptoms (AOR = 1.55, CI-1.30-1.83), and low school achievement (AOR = 1.46, CI-1.23-1.75). Frequent users relative to non-users had a lower probability of being overweight and obese (AOR = 0.75, CI-0.60-0.92). Regarding positive measures frequent users relative to non-users had a higher probability of meeting recommendation of physical activity (AOR = 1.28, CI-1.09-1.51), but a lower probability of consuming fruits and vegetables (AOR = 0.82, CI-0.70-0.96) or attending college/university (AOR = 0.57, CI-0.44-0.75). FINDINGS: on occasional cannabis use (1-19 times in the past year) were more similar to frequent cannabis use for negative than positive health and social measures. CONCLUSION: Results demonstrate complex prospective patterns in which significant prospective associations with most adverse measures were found for both occasional and frequent users, and with few significant associations of positive health measures mostly among occasional cannabis users.

Personal Income and Substance Use among Emerging Adults in the United States.

BACKGROUND: Taxation and other policy measures have been implemented across the United States to curb the accessibility of substance use, especially among youth. While the inverse relationship between price and youth consumption is well known, available research on youth earned income and substance use is sparser, particularly among emerging adults. OBJECTIVES: We examined the association between emerging adult past-year personal income and 30-day substance use. METHODS: We analyzed data from Wave 5 (n = 2,202) of the NEXT Generation Health Study, an annual survey study administered to a nationally representative sample of emerging adults in the U.S. Wave 5 (mean age = 20.28 years, SE = 0.02 years) was administered during the 2013-2014 academic year. After grouping participants into five levels of self-reported, pre-tax personal income, we used binomial logistic regression to examine the association between personal income and cigarette smoking, marijuana use, alcohol use, and heavy episodic drinking (HED). RESULTS: In unadjusted models, those at certain levels of higher past-year income were more likely to smoke cigarettes, consume alcohol, or engage in HED at least once in the past 30 days. Several associations remained significant after controlling for covariates. Most associations were no longer significant after including perceived peer norms as additional covariates. Personal income was not associated with 30-day marijuana use in unadjusted or adjusted models. Conclusions/Importance: Higher earned income may provide emerging adults greater economic access to cigarettes and alcohol, but the association might be partly attenuated by social factors, particularly perceived peer norms.

Post-High School Changes in Tobacco and Cannabis Use in the United States.

BACKGROUND: The transition from high school into young adulthood is a critical developmental period with many young people going to college, moving residence, and entering the work force for the first time. The NEXT Generation Health Study (NEXT) is a nationally representative longitudinal study of adolescent health behaviors. Previous NEXT research has found that the post-high school environment is associated with changes in alcohol use. OBJECTIVES: The current study investigated the impact of school status, residential status, and work status on cannabis and cigarette use among post-high school participants. RESULTS: Living in a dorm/fraternity/sorority was associated with an increased prevalence in cannabis use while attending a 4-year college was associated with a decreased prevalence in cigarette use. CONCLUSIONS: Some aspects of the post-high school environment are related to cannabis and cigarette use. Differences in the social circumstances of cigarette and cannabis use and recent campaigns in colleges to reduce smoking may explain some of these trends.

High school cigarette smoking and post-secondary education enrollment: Longitudinal findings from the NEXT Generation Health Study.

The inverse association between smoking and educational attainment has been reported in cross-sectional studies. Temporality between smoking and education remains unclear. Our study examines the prospective association between high school cigarette and smoking post-secondary education enrollment. Data were collected from a nationally representative cohort of 10th graders who participated in the Next Generation Health Study (2010-2013). Ethnicity/race, urbanicity, parental education, depression symptoms, and family affluence were assessed at baseline. Self-reported 30-day smoking was assessed annually from 2010 to 2012. Post-secondary education enrollment was measured in 2013 and categorized as either not enrolled or enrolled in technical school, community college, or 4-year college/university. Multinomial logistic regression was used to evaluate the association between cigarette smoking duration and post-secondary education enrollment (N=1681). Participants who smoked 1, 2, or 3years during high school had lower odds of attending a 4-year college (relative to a no enrollment) than non-smokers (adjusted OR: smoking 1year=0.30, 2years=0.28, 3years=0.14). Similarly, participants who smoked for 2 or 3years were less likely than non-smokers to enroll in community college (adjusted OR: 2years=0.31, 3years=0.40). These associations were independent of demographic and socioeconomic factors. There was a prospective association between high school smoking and the unlikelihood of enrollment in post-secondary education. If this represents a causal association, strategies to prevent/delay smoking onset and promote early cessation in adolescents may provide further health benefits by promoting higher educational attainment.

Sexual Orientation Differences in Adolescent Health Care Access and Health-Promoting Physician Advice.

PURPOSE: Physician screening and advice on health-related behaviors are an integral part of adolescent health care. Sexual minority adolescents encounter more barriers to health services; yet, no prior research has examined whether they also experience disparity in physician screening and advice. We examined possible sexual orientation disparities in health care access, physician screening, and advice on six health-related behaviors. METHODS: Data were from a national sample of U.S. adolescents who participated in wave 2 of the NEXT Generation Health Study (n = 2023). Poisson regressions were conducted separately for males and females to estimate sexual orientation differences in health care access and health-related screening and advice. RESULTS: Compared with heterosexual males, sexual minority males were more likely to report unmet medical needs in the past year (adjusted relative risk [ARR] = 2.23) but did not differ with respect to receiving physician advice concerning health-related behaviors. Compared with heterosexual females, sexual minority females were more likely to report no routine physical checkup in the past year (ARR = 1.67) but were more likely to receive physician advice to reduce or stop drinking, smoking, drug use, increase physical activity, and improve diet (ARRs = 1.56-1.99), even after controlling for corresponding health-related behaviors. Sexual minority females were also more likely to receive advice about risk associated with sexual behavior (ARR = 1.35) and advice to avoid sexually transmitted diseases (ARR = 1.49). CONCLUSIONS: Both sexual minority males and females experienced disparities in some aspects of health care access. Improved health-promoting advice would better serve sexual minority males.

Relationships Between Smoking and Sleep Problems in Black and White Adolescents.

Study Objectives: The relationship between sleeping and smoking during adolescence remains unclear and is likely complex. We aim to evaluate the longitudinal reciprocal associations between sleep problems, sleep duration, and smoking among non-Hispanic white (NHW) and non-Hispanic black (NHB) youth. Design: Prospective cohort study. Setting: NEXT Generation Health Study. Participants: A national sample (N = 1394) of NHB and NHW 10th graders were surveyed annually between 2009 (Wave 1) and 2012 (Wave 3). Interventions: N/A. Measurements and Results: Past 30-day smoking, chronic difficulty falling asleep, recent difficulty falling asleep, difficulty staying asleep, and weekday and weekend sleep duration were measured at each wave. Using structural equation models, we observed significant autocorrelations over time for sleep problems and sleep duration. We found significant reciprocal, prospective relationships between smoking and sleep problems. The strengths of the relationships differed by race, with a stronger association between sleep problems and subsequent smoking for NHB than NHW youth. Conversely, a stronger association between smoking and subsequent sleep problems for NHW than NHB youth was observed. These association were independent of demographics, snoring or sleep apnea, body mass index, depressive symptoms, alcohol use, and soda consumption. Conclusions: Reciprocal and prospective relationships exist for youth smoking and sleep problems and duration in both NHW and NHB youth. Further research is needed to unravel the complex relationship between the direct effects of nicotine, lifestyle choices that may link smoking and sleep problems, and racial differences.

Variability in measures of health and health behavior among emerging adults 1 year after high school according to college status.

OBJECTIVE: To examine changes in health behaviors among US emerging adults 1 year after high school. PARTICIPANTS: The national sample of participants (N = 1,927), including those attending 4-year college/university (n = 884), 2-year colleges/technical schools (n = 588), and no college (n = 455), participated in annual spring surveys 2013-2014. METHODS: Health behaviors were assessed the last year of high school and first year of college; differences by college status controlling for previous-year values were estimated using regression analyses. RESULTS: Relative to 4-year college attendees, those attending technical school/community college were less likely to binge drink (odds ratio [OR] = 0.57, confidence interval [CI] = 0.38-0.86) but more likely to speed (OR = 1.26, CI = 1.0-2.84), consume sodas (OR = 1.57, CI = 1.0-2.47), and report lower family satisfaction (p < .01), with marginally more physical and depressive symptoms. College nonattendees reported more DWI (driving while intoxicated; OR = 1.60, CI = 1.05-2.47), soda drinking (OR = 2.51, CI = 1.76-3.59), oversleeping (OR = 4.78, CI = 3.65-8.63), and less family satisfaction (p < .04). CONCLUSIONS: Health risk behaviors among emerging adults varied by college status.

Marijuana-, alcohol-, and drug-impaired driving among emerging adults: Changes from high school to one-year post-high school.

INTRODUCTION: Driving while impaired (DWI) increases the risk of a motor vehicle crash by impairing performance. Few studies have examined the prevalence and predictors of marijuana, alcohol, and drug-specific DWI among emerging adults. METHODS: The data from wave 3 (W3, high school seniors, 2012, N=2407) and wave 4 (W4, one year after high school, N=2178) of the NEXT Generation Health Study with a nationally representative cohort. W4 DWI (≥1day of past 30days) was specified for alcohol-specific, marijuana-specific, alcohol/marijuana-combined, illicit drug-related DWI. Multinomial logistic regression models estimated the association of W4 DWI with W3 covariates (perceived peer/parent influence, drinking/binge drinking, marijuana/illicit drug use), and W4 environmental status variables (work/school/residence) adjusting for W3 overall DWI, demographic, and complex survey variables. RESULTS: Overall DWI prevalence from W3 to W4 changed slightly (14% to 15%). W4 DWI consisted of 4.34% drinking-specific, 5.02% marijuana-specific, 2.41% drinking/marijuana combined, and 3.37% illicit drug-related DWI. W3 DWI was significantly associated with W4 alcohol-related and alcohol/marijuana-combined DWI, but not other DWI. W3 marijuana use, binge drinking, and illicit drug use were positively associated with W4 marijuana-specific, alcohol/marijuana-combined, and illicit drug-related DWI, respectively. W3 friend drunkenness and marijuana use were positively associated with W4 alcohol-specific and marijuana-related DWI, respectively. W3 peer marijuana use was negatively associated with W4 alcohol-specific DWI. CONCLUSIONS: Driving under the influence of alcohol, marijuana, and illicit drugs is a persistent, threatening public health concern among emerging U.S. adults. High school seniors' binge drinking as well as regular alcohol drinking and marijuana/illicit drug use were independently associated with respective DWI one year after high school. Peer drunkenness and marijuana use in high school may be related to subsequent DWI of emerging adults. PRACTICAL APPLICATIONS: The results support the use of injunctive peer norms about getting drunk and smoking marijuana in guiding the development of prevention programs to reduce youth DWI.

Dynamic Patterns of Adolescent Substance Use: Results From a Nationally Representative Sample of High School Students.

OBJECTIVE: Use of tobacco, alcohol, marijuana, and other drugs increases during the high school years, yet little is known about individual patterns over time, particularly patterns of contemporaneous multiple-substance use. This study examined trajectories of contemporaneous substance use and how individual and social factors differentially predict patterns of substance use. METHOD: Longitudinal trajectories of substance use were examined in a nationally representative sample of students (N = 2,512) over a 3-year period (10th through 12th grades) using latent class analysis. Individual, parental, and peer risk factors in 10th grade were examined in relation to membership in trajectory classes. RESULT: A five-class model was identified: nonusers (45.5%); tobacco, alcohol, and other drug users (9.2%); alcohol and other drug users (9.2%); increasing multiple-substance users (16.7%); and decreasing multiple-substance users (19.4%). Depressive symptoms at baseline were associated with a higher likelihood of membership in all classes except the increasing multiple-substance-user class, but the association becomes insignificant when social influence factors were adjusted. Parental-monitoring knowledge was associated with a lower likelihood of membership in all classes except increasing multiple-substance-user class, whereas perceived parental disapproval was associated with a lower likelihood of membership in the tobacco, alcohol, and other drug user class. Peer substance use was associated with a higher likelihood of membership in each of the substance use classes. CONCLUSIONS: The identified longitudinal profiles highlight the pervasiveness and dynamic patterns of contemporaneous multiple-substance use during 10th through 12th grades. Negative peer influence increased risk, whereas positive parenting behaviors decreased risk. The findings are consistent with the need to foster social influences and protective factors against adolescent substance use.

Trajectories of eating behaviors in a nationally representative cohort of U.S. adolescents during the transition to young adulthood.

BACKGROUND: Diets of U.S. adolescents and adults do not meet recommendations, increasing risk of chronic disease. This study examined trajectories and predictors of eating behaviors in U.S. youth from age 16-20 years, and evaluated longitudinal associations of eating behaviors with weight outcomes. METHODS: Data come from the first four waves (years) of the NEXT Generation Health Study, a nationally representative cohort of U.S. students in 10(th) grade during the 2009-2010 school year (n = 2785). Annual surveys queried frequency of food group intake (times/day of fruit and vegetables, whole grains, sugar-sweetened soda, sweet and salty snacks), and meal practices (days/week of breakfast, family meals, fast food, and television during meals). Body mass index (BMI, kg/m(2)) was calculated from self-reported height and weight. Adjusted generalized estimating equations and linear mixed models with multiple imputation for missing data estimated eating behavior trajectories overall and by baseline weight status (normal weight = 5 ≤ BMI%ile < 85, overweight = 85 ≤ BMI%ile < 95, obese = BMI%ile ≥ 95), accounting for the complex sampling design. Separate GEE models estimated longitudinal associations of food group frequencies with meal practices and of BMI with eating behaviors. RESULTS: Eating behaviors tracked strongly from wave 1-4 (residual intraclass correlation = 41% - 51%). Across all baseline weight categories, frequency of food group intake and meal practices decreased over time, except for fast food, which remained stable. Fruit/vegetable intake frequency was associated positively with family meals (ß ± SE = 0.33 ± 0.05) and breakfast (0.18 ± 0.03), and inversely with fast food (-0.31 ± 0.04), while whole grain intake frequency was associated positively with family meals (0.07 ± 0.02), television meals (0.02 ± 0.009) and breakfast (0.04 ± 0.01). Soda and snacks were positively associated with television meals (0.08 ± 0.008 and 0.07 ± 0.009, respectively) and fast food (0.24 ± 0.02 and 0.20 ± 0.03, respectively), while soda was inversely associated with breakfast frequency (-0.05 ± 0.01). Time-varying BMI was unrelated to eating behaviors other than an inverse association with time-varying snacks (-0.33 ± 0.12). CONCLUSIONS: Strong tracking over time supports the importance of early establishment of health-promoting eating behaviors in U.S. adolescents. Findings suggest meal practices may be important intervention targets. Lack of evidence for hypothesized associations of BMI and eating behaviors indicates the need for research confirming these findings using more precise measures of dietary intake.

Using the theory of planned behavior to predict aggression and weapons carrying in urban African American early adolescent youth.

Aggressive and weapons carrying behaviors are indicative of youth violence. The theory of planned behavior is used in the current analysis to improve our understanding of violence-related behaviors. We examine the influence of perceived behavioral control (self-control and decision making) as a part of the overall framework for understanding the risk and protective factors for aggressive behaviors and weapons carrying. As the baseline assessment of an intervention trial, survey data were collected on 452 sixth-grade students (50% girls; 96.6% African American; mean age 12.0 years) from urban middle schools. A total of 18.4% carried a weapon in the prior 12 months, with boys more likely to carry a weapon than girls (22.5% vs. 14.2%, p = .02). Of the youth, 78.4% reported aggressive behaviors with no significant differences found between girls (81.3%) and boys (75.5%). In logistic regression models, having peers who engage in problem behaviors was found to be a significant risk factor. Youth with peers who engaged in numerous problem behaviors were five times more likely to be aggressive than those who reported little or no peer problem behaviors. Teens who reported that their parents opposed aggression (odds ratio [OR] = 0.76; confidence interval [CI] = 0.66, 0.88) and who used self-control strategies (OR = 0.59; CI = 0.39, 0.87) were found to report less aggressive behaviors. For weapons carrying, being a girl (OR = 0.56; CI = 0.32, 0.97) and self-control (OR = 0.52; CI = 0.29, 0.92) were protective factors. This study demonstrated that the theory of planned behavior may provide a useful framework for the development of violence prevention programs. Practitioners should consider integrating strategies for developing healthy relationships and improving self-control.

Motivation and planning as mediators of the relation between social support and physical activity among U.S. adolescents: a nationally representative study.

BACKGROUND: More than half of U.S. high-school students do not meet the moderate and vigorous physical activity (MVPA) 5 hours per week recommendation. The purpose of this study was to determine how individual dimensions (motivation and planning) mediate the relationship of social context with physical activity by integrating available measures of personal characteristic including internal/external motivations (derived from Self-Determination Theory -SDT]) for MVPA, MVPA planning, peer MVPA, and parental support to better understand adolescent MVPA. METHODS: Survey responses of a nationally representative cohort of 11th graders (N=2439) in the NEXT Generation Health Study were analyzed with structural equation modeling. RESULTS: Adolescent MVPA was directly, significantly associated with MVPA planning (ß=0.17), peer MVPA (ß=0.21), and internal motivation (ß=0.50). Internal motivation was associated with peer MVPA (ß=0.31), parental support for MVPA (ß=0.16), and external motivation (ß=0.40). A significant relation between parental support and external motivation (ß=0.31) was also found. CONCLUSIONS: Adolescents with higher internal motivation and more active friends were more likely to engage in MVPA. The results are consistent with SDT and suggest that planning is an important construct for adolescent MVPA.

Substance use across adolescence: do gender and age matter? / Consumo de substâncias na adolescência: o género e a idade são importantes?

Many of the choices which impact in lifetime health, such as substance use, are made in adolescence. It becomes, therefore, important to know the factors associated to these behaviours in adolescence in different contexts of life. To analyze these factors, an explanatory model was developed using structural equation modeling. Data from 12.881 state school students from Portugal who participated in two waves of the Health Behaviours in School-aged Children (HBSC) / World Health Organization (WHO) survey were analyzed. The model fits well the data [CFI: .985; NNFI: .980; RMSEA: .018 (.017-.020); SRMR: .018]. For each of the dependent factors, the levels of variance ranged from 12% (tobacco use) to 47% (alcohol and illicit drugs use). Alcohol and tobacco present the strongest associations to illicit drugs use. Relationships with family, friends, classmates, and teachers were also associated with substance use, being this association mediated by certain factors, including psychological symptoms, well-being, and school satisfaction. Several non-invariant paths were obtained in gender and age comparisons. The results showed that substance use is associated with several factors and that social factors are mediated by personal factors. Results have also shown that gender and age are important factors on substance use.

Muitas das escolhas com impacto na saúde a longo prazo, como o consumo de substâncias, são feitas na adolescência. Torna-se pois importante conhecer os fatores associados a estes comportamentos em diferentes contextos de vida. Para analisar estes fatores, foi desenvolvido um modelo explicativo através da modelação de equações estruturais. Para este estudo foram analisados dados de 12881 alunos de escolas públicas participantes em duas recolhas do estudo HBSC/OMS. O modelo apresenta uma boa adequação [CFI:.985; NNFI:.980; RMSEA:.018 (.017-.020); SRMR:.018]. Para cada um dos fatores dependentes, os níveis de variância explicada variaram entre 12% (tabaco) e 47% (álcool e drogas ilícitas). Os consumos de álcool e tabaco apresentaram as associações mais fortes com o consumo de drogas ilícitas. As relações com a família, amigos, colegas e professores estão associadas ao consumo de substâncias, sendo esta associação mediada por vários fatores, nomeadamente sintomas psicológicos, bem-estar, e satisfação com a escola. Ligações não-invariantes foram obtidas nas comparações de género e idade. Os resultados mostraram que o consumo de substâncias está associado a vários fatores, e que o impacto dos fatores sociais é mediado por fatores pessoais. Os resultados mostraram ainda que o género e a idade são fatores importantes no consumo de substâncias.

Do societal wealth, family affluence and gender account for trends in adolescent cannabis use? A 30 country cross-national study.

AIMS: To examine cross-national changes in frequent adolescent cannabis use (40+ times consumed over life-time at age 15) over time and relate these trends to societal wealth, family affluence and gender. DESIGN: Data from three cycles (2002, 2006, 2010) of the Health Behaviour in School-aged Children (HBSC) Study were used for cross-sectional and trend analyses of adolescent cannabis use. SETTING: Representative surveys in 30 European and North American countries. PARTICIPANTS: A total of 160 606 15-year-old students. MEASUREMENTS: Respondents' life-time cannabis use, demographics, family affluence (FAS) and frequency of peer contacts were measured individually. Indicators of wealth (gross domestic product per capita, GDP) and perceived availability of cannabis were obtained from national public data bases. FINDINGS: The frequency of life-time cannabis use decreased over time among adolescents in Europe and North America, particularly in western European countries and the United States (relative risk (RR) = 0.86: confidence interval (CI) 0.79-0.93). This trend was not observed consistently in rapidly developing countries in eastern, central and southern Europe. Over time (2002-10), cannabis use became: (i) less characteristic of high GDP countries in contrast to lower GDP countries (RR = 0.74: CI 0.57-0.95); (ii) less characteristic of youth from high FAS families in contrast to youth from low FAS families (RR = 0.83: CI 0.72-0.96); and (iii) characterized by an increasing gender gap, i.e. consumption was higher among males (RR 1.26: CI 1.04-1.53). Perceived availability of cannabis and peer contacts remained strong predictors of frequent cannabis use. CONCLUSIONS: Among 30 European and North American countries, cannabis use appears to have 'trickled down' over time, with developing countries taking on the former (heavier) use pattern of richer countries, and less affluent youth taking on the former (heavier) use pattern of more affluent youth. Cannabis use continues to be more common among adolescent males than females.

Trends in Substance Use Among 6th- to 10th-Grade Students From 1998 to 2010: Findings From a National Probability Study.

Of the handful of national studies tracking trends in adolescent substance use in the United States, only the Health Behavior in School-Aged Children (HBSC) study collects data from 6th through 10th graders. The purpose of this study was to examine trends from 1998 to 2010 (four time points) in the prevalence of tobacco, alcohol, and marijuana use among 6th through 10th graders. Differences in trends by grade, gender, and race/ethnicity were examined for each substance use behavior, with a primary focus on trends for sixth and seventh graders. Overall, there were significant declines in tobacco, alcohol, and marijuana use from 1998 to 2010. The declines were largest for the younger grades, which suggest promise for future declines among high school students as these cohorts age into high school.

Prevalence and patterns of polysubstance use in a nationally representative sample of 10th graders in the United States.

PURPOSE: The current study examines the prevalence and demographic correlates of self-reported substance use and identifies subgroups of polysubstance users among a cohort of United States 10th-grade students. METHODS: A nationally representative school-based cohort of United States 10th-grade students completed the NEXT Generation Health Study baseline survey in spring 2010 (N = 2,524). RESULTS: Past-year use of marijuana was most common among illicit drugs (26%), followed by misuse of medication (9%) and use of other illicit drugs (8%). During the past month, alcohol use was reported by more than one third (35%), binge drinking by 27%, and cigarette smoking by 19%. Results further show that substance use varied somewhat by demographic characteristics. Results from the latent class analysis of polysubstance use indicated a four-class solution as the best-fitting model; class 1 (59%) included the nonuser group; class 2 (23%) comprised the predominant alcohol user group; class 3 (11%) formed the predominant marijuana user group; and class 4 (8%) was characterized as the predominant polysubstance user group. Somatic and depressive symptoms varied significantly by class membership, with predominant polysubstance users reporting elevated levels of somatic and depressive symptoms. CONCLUSIONS: The findings from this national study of 10th-grade students indicate high rates of substance and polysubstance use. The high level of depressive and somatic symptoms among polysubstance users indicates the need for mental health screening and referral.