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CORK Bibliography: Adolescents-Initiation of Alcohol and Drug Use

112 citations. January 2003 to present

Prepared: December 2009

Ajdacic-Gross V; Landolt K; Angst J; Gamma A; Merikangas KR; Gutzwiller F et al. Adult versus adolescent onset of smoking: How are mood disorders and other risk factors involved? Addiction 104(8): 1411-1419, 2009. (53 refs.)

Aims: To examine the strength of association between smoking and mood disorders and the association between smoking and its traditional risk factors, comparing those who started smoking in adolescence with those who started smoking in early adulthood. Design and participants The analyses relied on prospective data from the Zurich Study. This longitudinal community study started in 1979 with a stratified sample of 591 participants aged 20/21 years, weighted towards those with mental disorders. Follow-up interviews were conducted at ages 23, 28, 30, 35 and 41. Measurements: In this analysis the adult versus adolescent onset of smoking was regressed on the cumulative prevalence of mood disorders, personality characteristics measured by the Freiburg Personality Inventory, common risk factors such as parental smoking, conduct and school problems, troubles with the family and basic socio-demographic variables (sex, education). Findings: In the Zurich Study cohort we found that 61.6% were former or current smokers, of whom 87% started smoking before the age of 20 and 13% after the age of 20. Adolescent onset of smoking was associated strongly with later major depression, dysthymia or bipolar disorders and, furthermore, with parental smoking, extroverted personality and discipline problems and rebelliousness in youth. However, only depression and dysthymia were associated with adult onset smoking and other risk factors associated with smoking were not so associated in this group. Conclusions: Correlates of smoking onset in adolescence are mainly not applicable to the onset of smoking in young adulthood. Smoking onset beyond adolescence is an open research issue.

Amuedo-Dorantes C; Mach T; Clapp JD. The impact of schools on juvenile substance initiation and use. Prevention Science 5(2): 91-99, 2004. (31 refs.)

We use data from the two rounds of the NLSY97 and the corresponding QED data to examine the effectiveness of school endowments and curricula in targeting juvenile use of tobacco, alcohol, and marijuana. Our results support the notion that schools matter in reducing juvenile involvement in substance use. Higher discretionary dollars per pupil are linked to reduced rates of juvenile initiation and repetitive use rates of cigarettes and marijuana. Additionally, school curricula, as indicated by the implementation of year round classes and some innovative and after-school programs-such as gifted and talented, attendance monitoring, homework hot-line, international baccalaureate, extended-day, and mentoring, programs, affect both juvenile initiation to tobacco and alcohol use and juvenile repetitive use of tobacco and alcohol. In particular, we find that juvenile initiation to cigarette use is approximately between 2 percentage points and 3 percentage points lower among youths attending schools with gifted and talented and international baccalaureate programs. In addition, juvenile repetitive cigarette use is approximately 54%, 52%, and 48% lower among youths attending schools offering year round classes, international baccalaureate, and twenty-first century programs, respectively. Finally, juvenile initiation to alcohol use and juvenile repetitive use of alcohol are approximately 3% and 20% lower, respectively, among youths in schools offering gifted and talented programs. In sum, while these programs are not implemented to address substance use problems among the student body, we find that the implementation of these programs is often accompanied by a reduction in juvenile initiation and repetitive substance use.

Audrain-McGovern J; Rodriguez D; Patel V; Faith MS; Rodgers K; Cuevas J. How do psychological factors influence adolescent smoking progression? The evidence for indirect effects through tobacco advertising receptivity. Pediatrics 117(4): 1216-1225, 2006. (62 refs.)

OBJECTIVES. To determine whether novelty seeking and depressive symptoms had mediated or indirect effects on adolescent smoking progression through tobacco advertising receptivity. METHODS. More than 1000 adolescents were monitored from 9th grade to 12th grade and completed annual surveys that measured demographic characteristics, smoking behavior, tobacco advertising receptivity, novelty-seeking personality, depressive symptoms, family and peer smoking, alcohol use, and marijuana use. RESULTS. Latent growth modeling indicated that novelty seeking had a significant indirect effect on smoking progression through baseline tobacco advertising receptivity. For each 1-SD increase in novelty seeking, the odds of being more receptive to tobacco advertising increased by 12% (ie, being in a specific category or higher), which in turn resulted in an 11% increase in the odds of smoking progression from 9th grade to 12th grade. The indirect effect from depressive symptoms to smoking progression did not reach significance. CONCLUSIONS. These findings may inform future research on other factors that influence tobacco advertising receptivity, as well as programs aimed at preventing adolescent smoking initiation and progression.

Bachman JG; O'Malley PM; Schumberg SE; Johnston LD; Freedman-Doan P; Messersmith EE. The Education-Drug Use Connection. New York: Lawrence Erlbaum, 2007

Does success in school protect teenagers from drug use? Does drug use impair scholastic success? This book tackles a key issue in adolescent development and health -- the education-drug use connection. Drawing upon data from the University of Michigan's Monitoring the Future, the authors examine the links and likely causal connections between educational experiences, delinquent behavior, and adolescent use of tobacco, alcohol, marijuana, and cocaine. The findings convincingly demonstrate that if young people can be successful in school, it can improve a broad range of outcomes in their lives, not the least of which is their ability to resist pressures to use drugs. The book provides a summary of the findings and conclusions; a review of relevant literature; a detailed discussion of the survey and analysis methods; the academic attainment of those in the longitudinal panel; the delinquent behaviors of panel members as they relate to measures of educational success; and the patterns of initiation, continuation, and cessation for each substance: cigarettes, marijuana, cocaine, and alcohol.

Barber P; Lopez-Valcarcel BG; Pinilla J; Santana Y; Calvo JR; Lopez A. Attitudes of teenagers towards cigarettes and smoking initiation. Substance Use & Misuse 40(5): 625-643, 2005. (57 refs.)

This paper contributes to the empirical knowledge of determinants of smoking initiation in adolescents. The instrument we used was a structural equation model, which is a powerful tool to analyze causal relationships in nonexperimental studies. We used a school-based sample of 1198 teenagers from Spain. We measured the attitude of the adolescents towards tobacco. Attitudes and smoking status are related. Attitudes become more favorable to smoking, as experimentation with cigarettes progresses and pupils become older. Teenagers who have tried at least one cigarette are on average more favorable to smoking than those who had never smoked. The study's limitations were noted.

Beck F; Godeau E; Legleye S; Spilka S. Drug consumptions by the young adolescents: Epidemiological data. M S-Medicine Sciences 23(12): 1162-1168, 2007. (25 refs.)

Adolescence is often the time of experimentation with psychoactive substances, sometimes leading to more regular use. This paper gives an update of drug consumptions by the young adolescents, from results of recent general population surveys in France, and focuses on the specificity of this consumption when compared to that of older adolescents. It shows that regular uses of such substances usually do not start before the age of 14, but that early initiated adolescents show a higher risk of moving towards more intensive or problematic uses. Through presenting the limitations of such surveys, the authors discuss the nature of the link observed between early experimentation and level of use: while acknowledging the unquestionable prognostic value of early initiation to predict future problematic use, they show that its interpretation should be made with caution when based on such transversal epidemiological surveys.

Bolognini M; Plancherel B; Laget J; Stephan P; Chinet L; Bernard M et al. Adolescent drug use escalation and de-escalation: A 3-year follow-up study. Addiction Research & Theory 13(1): 19-33, 2005. (32 refs.)

This study aims to assess adolescents drug use with a longitudinal perspective in order to identify factors interacting with drug use onset and course. Supported by the Swiss Federal Office of Publicic Health, the study was initiated in 1999 with a follow-up in 2001 and 2002. The first objective was to measure risk factors for substance use initiation. The second objective was to analyse the co-variation of substance use with environmental, social, relational, medical and psychological factors. A total of 102 adolescents, aged 14-19 years, were recruited for the study in the French-speaking part of Switzerland. Results clearly show that substance use is not a disorder per se in adolescence, but that it is part of a multidimensional complex of problems that some adolescents may encounter: increase and decrease in substance use is paralleled with an increase or decrease in the other areas. This implies that prevention of substance use should not be focused mainly on substances but should consider the adolescent's environment and significant life areas.

Bolognini M; Plancherel B; Winnington ME; Bernard M; Stephan P; Halfon O. Substance use early initiation among violent and nonviolent antisocial adolescents. Addiction Research & Theory 15(6): 561-574, 2007. (48 refs.)

The relationship between delinquency and substance use and abuse has been much studied. Investigating this relationship as a function to the type of adolescent delinquent behavior presented, whether antisocial or violent, might help explain this complex issue. To this end, 211 adolescents completed the Adolescent Drug Abuse Diagnosis ( ADAD), a multidimensional evaluation instrument that provided information regarding their substance use and antisocial behavior. Subjects were separated into three groups ( violent, antisocial, and control) as a function of their reported antisocial behavior. The three groups were compared on the lifetime use of tobacco, alcohol and cannabis, and any illicit substance. The ages of initiation for these substances were also examined. Results indicated a high percentage of lifetime and problem substance use among violent and antisocial adolescents. However, on the issue of substance use initiation age, the violent adolescents

Braithwaite RL; Conerly RC; Robillard AG; Stephens TT; Woodring T. Alcohol and other drug use among adolescent detainees. Journal of Substance Use 8(2): 126-131, 2003. (13 refs.)

This article describes alcohol and other drug use among a sample of male and female adolescent detainees (N = 2,280) at two state juvenile justice facilities. Trained interviewers collected information on several alcohol and other drug use and delinquency measures. Substance use was measured with an adaptation of the Youth Risk Behavior Surveillance questionnaire and explored by age of initiation, race/ethnicity, gender, delinquent behaviors, and recidivism. Alcohol and marijuana were the substances of choice, followed by powder cocaine and ecstasy and other designer drugs. Alcohol use also preceded marijuana use for both males and females. Males engaged in more alcohol and other drug use than females did, and they engaged in marijuana use at a younger age. White adolescents reported more alcohol use than did adolescents in all other racial and ethnic categories, while there were no differences in reported marijuana use. White adolescents, however, were younger when they began using marijuana. Finally, adolescents who engaged in alcohol and other drug use reported more delinquent activities and were more likely to have been detained previously. The results are discussed in the context of other studies of substance use in the general adolescent population and in at-risk and detained adolescents.

Brecht ML; Greenwell L; Anglin MD. Substance use pathways to methamphetamine use among treated users. Addictive Behaviors 32(1): 24-38, 2007. (57 refs.)

Considerable research has focused on patterns of substance use initiation among adolescents and for users of selected drugs; however, few data are available for methamphetamine (MA) users. This study describes substance initiation patterns for 352 MA users and assesses predictors of age of MA initiation and its sequencing. Subjects were randomly selected from treatment admissions in a large California county and interviewed using an extensive natural history protocol. Average age of MA initiation was 19 years. Nearly all (95%) had used alcohol, marijuana, and tobacco (average initiation age 13); inhalants, hallucinogens, and crack were also commonly used earlier in the drug sequence than MA. Earlier age of MA initiation was related to race/ethnicity (being non-African-American), younger age of first use of any substance, more types of early criminal behavior, and initiating MA use for sensation-seeking reasons. Following initiation of alcohol, marijuana, and/or tobacco, 27% initiated MA before other illicit drugs, 18% initiated another illicit drug before MA, and 56% initiated two or more other illicit drugs before MA. Later MA order in the initiation sequence was related to ethnicity (being African-American) and initiating MA to substitute for another drug. Results may support targeted prevention efforts and development of more effective interventions.

Bricker JB; Rajan KB; Zalewski M; Andersen MR; Ramey M; Peterson AV. Psychological and social risk factors in adolescent smoking transitions: A population-based longitudinal study. Health Psychology 28(4): 439-447, 2009. (37 refs.)

Objective: This study longitudinally investigated psychological and social risk factors consistent with the Theory of Triadic Influence (TTI) as predictors of adolescent smoking transitions. Design: Among 4218 adolescents, five psychological risk factors (i.e., parent-noncompliance, friend-compliance, rebelliousness, low achievement motivation, and thrill seeking) were assessed in 9th grade (age 14), two social influence risk factors (i.e., parents' and close friends' smoking) were assessed in Grades 3 (age 8) and 9 (age 14), respectively. Main Outcome Measures: Adolescent smoking transitions occurring between the 9th and 12th (ages 14-17) grade interval. Results: The probabilities contributed by each of the five psychological risk factors to the overall probability of making a specific smoking transition were: 22% to 27% for the transition from never to trying smoking, 10% to 13% for the transition from trying to monthly smoking, and, for three of the five risk factors, 11% to 16% for the transition from monthly to daily smoking. For predicting trying smoking, the probability contributed by these psychological factors was greater than the probability contributed by each parent's and close friend's smoking. Parent-compliance had a higher contribution to the probability of trying smoking when an adolescent's parent smoked (p < .05), whereas friend-compliance had a higher contribution to the probability of trying smoking when an adolescent's friend smoked (p < .001). Conclusion: These psychological and social factors have an important influence on adolescent smoking transitions. Implications for TTI and smoking prevention interventions are discussed.

Carvajal SC; Granillo TM. A prospective test of distal and proximal determinants of smoking initiation in early adolescents. Addictive Behaviors 31(4): 649-660, 2006. (44 refs.)

This study tests a broad array of determinants of utility for developing smoking preventive interventions using a population-based cohort of early adolescents. Multivariable logistic regressions using never-smokers at baseline (N = 1137; age 11-14) showed a model of distal determinants was more predictive of initiation within the approximate 10 month follow up period than one of proximal determinants. When all determinants were simultaneously considered, lesser academic achievement and fewer environmental impediments to smoking most strongly predicted initiation. The findings are consistent with some current smoking prevention programs, however such programs may be further potent by using theory-based social development approaches and through reducing tobacco availability or social contexts where youth can smoke without another adult knowing.

Cawley J; Markowitz S; Tauras J. Lighting Up and Slimming Down. The Effects of Body Weight and Cigarette Prices on Adolescent Smoking Initiation. National Bureau of Economic Research Working Paper No. w9561. Cambridge MA: National Bureau of Economic Research, 2003. (43 refs.)

This paper examines the influence of body weight, body image, and cigarette prices in determining adolescent smoking initiation. Adolescents who desire to lose weight may initiate smoking as a method of appetite control. Such behavior may undermine the goals of tobacco control policies that seek to prevent smoking initiation. Using a nationally representative panel of adolescents, we show that smoking initiation is more likely among females who are overweight, who report trying to lose weight, or who describe themselves as overweight. In contrast, neither objective nor subjective measures of weight predict smoking initiation by males. Higher cigarette prices decrease the probability of smoking initiation among males but have no impact on female smoking initiation. These gender-specific differences may help explain the mixed and inconclusive evidence of the impact of price on smoking initiation found in previous literature

Chiang SC; Chen SJ; Sun HJ; Chan HY; Chen WJ. Heroin use among youths incarcerated for illicit drug use: Psychosocial environment, substance use history, psychiatric comorbidity, and route of administration. American Journal on Addictions 15(3): 233-241, 2006. (49 refs.)

This study examines differences in psychosocial characteristics, substance use history, and psychiatric comorbidity in relation to heroin use among youths aged 15 to 22 incarcerated in 2003 for illicit drug use in northern Taiwan. Factors associated with heroin use included experiences of child abuse, having friends with illicit drug use, poor school attendance, polydrug use, and early age of drug initiation. Heroin users were found to have more severe clinical manifestation and experiences of conduct and anxiety disorders than non-heroin users; injection users tended to have a longer heroin history. This information may help guide future prevention programs to reduce heroin problems in youth.

Clayton RR. The importance of adolescence in the development of nicotine dependence. Introduction to Part V. Annals of the New York Academy of Sciences. Adolescent Brain Development: Vulnerabilities and Opportunities 1021: 162-166, 2004. (3 refs.)

This article sets the stage for the papers in Part V by describing the research work of the Tobacco Etiology Research Network (TERN), an initiative of the Robert Wood Johnson Foundation. Two studies coming from this matrix include one on the acquisition of tobacco use and another on the trajectories of tobacco use among college freshman.

Conwell LS; O'Callaghan MJ; Andersen MJ; Bor W; Najman JM; Williams GM. Early adolescent smoking and a web of personal and social disadvantage. Journal of Paediatrics and Child Health 39(8): 580-585, 2003. (31 refs.)

Objective: To examine concurrent physical, educational, behavioural, social and family factors associated with cigarette smoking in adolescents at 14 years.Methodology: This study reports cross-sectional data on 14-year-old adolescents and their mothers, drawn from a prospective cohort study commencing at the time of the first antenatal visit. At 14 years, 5247 adolescents completed questionnaires on current cigarette smoking. Adolescents and mothers completed health, psychological, school and social questionnaires relating to the youth. A total of 3864 adolescents were assessed physically, and undertook the Wide Range Achievement Test (WRAT) and Ravens Progressive Matrices Test. Results: Cigarette smoking at 14 years was associated with externalizing and internalizing behaviour problems, school suspension, contact with children's services and alcohol/illicit drug use. Apart from internalizing behaviour problems, these problems were more prevalent in boys. Poor school performance on maternal/adolescent reports was associated with increased smoking quantity for both genders, though WRAT scores were only decreased in male smokers. The Ravens Progressive Matrices Test scores were lower for boys with greater smoking quantity. The trend was less marked in girls. Body mass index and exercise frequency were not associated with cigarette smoking at 14 years, though girls who smoked had a higher reported prevalence of asthma. Parental smoking, marital conflict, maternal depression, lower income, and mothers aged in their teens and with a lower level of education at the time of this pregnancy were also positively associated with adolescent tobacco use. Conclusion: Findings of this study indicate that cigarette smoking, at this critical time of smoking initiation, is associated with a broad spectrum of personal and social disadvantage that needs to be considered in intervention strategies.

Cropsey KL; Linker JA; Waite DE. An analysis of racial and sex differences for smoking among adolescents in a juvenile correctional center. Drug and Alcohol Dependence 92(1/3): 156-163, 2008. (43 refs.)

The purpose of this study was to investigate racial and sex differences on the risk factors for smoking initiation and daily smoking among juvenile justice adolescents, a population that is traditionally ignored in school-based epidemiological samples. This study used archival data collected by juvenile justice authorities for a large sample of juvenile justice adolescents (N = 4381), examining interaction terms to determine race and sex differences for risk factors. About 70% of juvenile justice adolescents reported ever having smoked cigarettes while almost half reported daily smoking. Overall predictors of ever and daily smoking included older age, being female, White, use of alcohol, cannabis, and cocaine in the past year, affiliation with smoking peers, not living with at least one parent, and a diagnosis of ADHD. While differences were seen between individual predictor models for both race and sex, the interaction terms did not add significantly to the overall model. These important racial and gender differences in this study suggest that tailored prevention messages and interventions may be needed to be most effective with adolescents in the juvenile justice system. While this study provides a basic foundation of risk factors for smoking among juvenile justice adolescents, future research is needed to assess the efficacy of treatment and prevention interventions with this high risk group of adolescent smokers.

D'Amico EJ; McCarthy DA. Escalation and initiation of younger adolescents' substance use: The impact of perceived peer use. Journal of Adolescent Health 39(4): 481-487, 2006. (39 refs.)

Purpose: The middle school years are peak years for substance use initiation. The current study assessed the impact of peer influence on both initiation and escalation of cigarette, alcohol, and marijuana use among sixth, seventh, and eighth graders. Methods: Youth (n = 974; 45% male) were surveyed twice over an academic year and reported on their personal substance use and their perception of peer substance use. The sample ranged in age from 10 to 15 years at Time 1 (M age = 11.95) and was 44% White, 26% Latino, 7% Asian American/Pacific Islander, 4% African American, and 14% mixed ethnic origin. Results: Hierarchical regressions examined whether personal and perceived peer substance use predicted later substance involvement, and logistic regressions assessed whether Time 1 perceived peer and personal use of other substances discriminated between initiates and noninitiates. After controlling for personal substance use, perceived peer alcohol use predicted both increased alcohol and marijuana use, and perceived peer marijuana use predicted increased alcohol use. Only perceived peer alcohol use was associated with initiation of alcohol, and both perceived peer alcohol and marijuana use predicted onset of marijuana use. Conclusions: Results highlight the importance of perceived peer use in predicting both onset and escalation of use and suggest utilizing a multifaceted prevention approach that targets multiple substances.

Daosodsai P; Bellis MA; Hughes K; Hughes S; Daosodsai S; Syed Q. Thai War on Drugs: Measuring changes in methamphetamine and other substance use by school students through matched cross sectional surveys. Addictive Behaviors 32(8): 1733-1739, 2007. (10 refs.)

In 2003 the Thai government announced a radical shift in drug policy with the implementation of a War on Drugs. Although consequences of this controversial measure (e.g. drug dealer deaths) have received widespread attention relatively little work has evaluated changes in substance use. We used two anonymous representative samples of secondary school students to compare drug use in Northeast Thailand before (1998; n = 4217) and after (2004/5; n=3489) the War on Drugs. Results indicate that reported levels of current illicit drug use reduced significantly between 1998 and 2004/5 (for methamphetamine from 4.2% to 0.9%). By examining trends in year of first methamphetamine use we identify that observed reductions in drug initiation are temporally consistent with the War on Drugs. However, while prevalence of alcohol use has also fallen, there was a three-fold increase in daily alcohol use. We suggest that this rise, combined with other negative impacts of 'wars' on drugs, means drug control requires a public health perspective that sees eliminating drug use as part of a wider strategy that has improvement in population health, not just drug prevention, as its core objective.

Degenhardt L; Coffey C; Carlin JB; Moran P; Patton GC. Who are the new amphetamine users? A 10-year prospective study of young Australians. Addiction 102(8): 1269-1279, 2007. (47 refs.)

Aims: Despite good evidence of increased availability and use of amphetamines world-wide, relatively little is known about the epidemiology of young adult amphetamine use; relationships with social functioning, other drug use and mental health at this age; nor of the adolescent predictors of such use. We examined these issues using a representative cohort of young people followed-up in Victoria, Australia. Methods: A stratified, random sample of 1943 adolescents was recruited from secondary schools across Victoria at age 14-15 years. This cohort was interviewed on eight occasions until the age of 24-25 years (78% follow-up at that age). Cross-sectional and predictive associations were assessed using logistic regression. Results: At age 24 years, 12% of the sample had used amphetamines in the past year, with 1-2% using at least weekly. Young adult amphetamine use was predicted strongly by adolescent drug use and was associated robustly with other drug use and dependence in young adulthood. Associations were stronger for more frequent users. Among young adults who had not been using amphetamines at age 20 years, the strongest predictor of use at age 24 years was the use of other drugs, particularly cannabis, at 20 years. Psychological distress did not predict independently an increased likelihood of amphetamine use in this cohort. Conclusion: Young people in Australia using amphetamine at age 24 years are highly likely to be significant polydrug users. The risks for both initiation of young adult amphetamine use, and maintenance of such use, pertain to the heavy use of other drugs. Interventions for heavy amphetamine users at this age are likely to require attention to multiple drug problems.

DiNapoli PP. Early initiation of tobacco use in adolescent girls: Key sociostructural influences. Applied Nursing Research 22(2): 126-132, 2009. (14 refs.)

Background: An important developmental task during adolescence is ego development. Millions of adolescents choose to initiate cigarette smoking at a young age as a result of transitional conflicts during this phase of normal developmental progression. Unfortunately, the decision to use tobacco compromises both the short- and long-term health status of smokers as well as the health of those around them. Objective: It was hypothesized that in early adolescence, girls choose to begin smoking cigarettes as a result of sociostructural influences, including media, peers, and family. The purpose of this study was to investigate what modifiable sociostructural variables will decrease the risk of initiating cigarette smoking before the age of 12 years among adolescent girls. The aim of the study was to develop a risk reduction model that increases the likelihood of healthy behavior choices in girls during early adolescence. Method: Data collected for the New Hampshire Teen Assessment Project survey were used for this secondary data analysis. The original study included a multicommunity sample of 7,648 students from eight school districts enrolled in New Hampshire schools between January 2000 and October 2001. This current analysis focused only on the health behavior of the adolescent girls enrolled in the larger study (n = 3,775). With the use of a socioecological theoretical framework as a guide, this secondary data analysis first identified correlates of the early initiation of tobacco use using Pearson's correlations. Then, the data were explored for variables that decreased the relative fisk for the early initiation of cigarette smoking among adolescent girls. The dependent variable of interest (i.e., early initiation of tobacco use) referred to girls who reported having smoked their first cigarette at or before the age of 12 years. Twenty-eight percent of the sample had initiated tobacco use before they were 12 years old. Multiple logistic regression was used to predict the final risk reduction model. Results: The first level of analysis confirmed previously reported evidence that there is a correlation between adolescent girls' initiation of smoking early (n = 1,047) and their engagement in other health risk behaviors such as daily use of alcohol (n = 859), daily use of marijuana (93%), and engaging in unprotected intercourse (15%). Next, logistic regression was used to predict a risk reduction model that demonstrated the importance of community, family, and school variables in decreasing the relative risk for the early initiation of tobacco use. Those sociostructural variables that decrease the relative risk for the initiation of tobacco use were noted in the following: (1) 71% of the girls who feel that it is important to contribute to their community (odds ratio [OR] = 1.71, 95% confidence interval [CI] = 1.31-2.23) are less likely to initiate tobacco use and (2) 54% of the girls are more likely to feel that their community is a good place to live in (OR = 1.54, 95% CI = 1.201.97), are more than twice as likely to have parents who think smoking is wrong (OR = 2.09, 95% CI = 1.77-2.48). are 9% more likely to have parents whom they can talk to when they have personal problems (OR = 1.09, 95% CI = 1.02-1.17), and are 38% more likely to enjoy school. Discussion: The findings of this study may be an important portal for prevention intervention in the area of early adolescent tobacco use. A risk reduction model is presented based on the theory that both the environment and modeling play an important role in the development of health behavior.

Doherty EE; Green KM; Ensminger ME. Investigating the long-term influence of adolescent delinquency on drug use initiation. Drug and Alcohol Dependence 93(1/2): 72-84, 2008. (64 refs.)

Prior research has found a positive relationship between delinquency and early onset of drug use. However, little is known about the influence of delinquency on drug initiation through mid-adulthood. This paper investigates the long-term relationship between serious adolescent delinquency and the onset of marijuana and cocaine use among an epidemiologically defined community sample of African American males and females followed from first grade through age 42. Using propensity score methods we match individuals on several etiological variables that may explain both delinquency and drug use in an attempt to examine the extent to which there may be a causal link between delinquency and drug use initiation. Through a comparison of survival curves on the unmatched and matched samples of serious delinquents and non-serious delinquents, we find that serious adolescent delinquency has at least some causal influence on drug use initiation that extends into mid-life. We discuss how these results can inform future research and delinquency and drug prevention and intervention initiatives.

Dunn MS. The relationship between religiosity, employment, and political beliefs on substance use among high school seniors. Journal of Alcohol and Drug Education 49(1): 73-88, 2005. (17 refs.)

The purpose of this study was to provide a descriptive profile of the alcohol, cigarette, marijuana and cocaine use practices among adolescents and to examine the relationship between employment, political beliefs, religious beliefs and substance use behaviors among high school seniors participating in the Monitoring the Future Study during the 2002 academic schoolyear. Data from the Monitoring the Future (MTF) study (2002 12th grade core data) was used for this study. Logistic regression models were used to examine the relationship between substance use behaviors and employment, political beliefs, and religiosity. Analysis showed that males and females who believed religion was very important were less likely to have initiated alcohol use, to be a current user, and to have binge drank. A significant association was found for all alcohol use variables for those individuals who worked moderate amounts at an after school job. Political beliefs were found to be associated for initiation and current alcohol use but not for binge drinking. Political beliefs, religion, and employment were all significantly associated with cigarette use and cocaine use. Conceptualization of substance use behavior and its prevention and treatment should include consideration of such key cultural and social factors as religiosity, employment and political beliefs of adolescents.

Eaves CS. Heroin use among female adolescents: The role of partner influence in path of initiation and route of administration. American Journal of Drug and Alcohol Abuse 30(1): 21-38, 2004. (33 refs.)

This study examined heroin initiation and route of administration among 16 female adolescents in the greater Baltimore Metropolitan area. Participants were more than twice as likely to be introduced to heroin by a male friend or boyfriend (IHM) than introduced to heroin by other means (IHO). The majority of IHM females were introduced by a male friend rather than a romantic partner. No relationship was found between path of initiation (IHM, IHO) and initial route of administration (inhalation, smoking, injecting) or history of injection (ever injected, never injected). The effect of opposite-gender peer influence in the initiation of female adolescent heroin use is discussed along with how the current findings may influence treatment and prevention efforts. A statistically significant relationship was found for initial route of administration and for history of injection. Ninety-four percent of participants reported initiation of heroin use by inhalation, while an alarming 75% of participants reported injecting heroin at some time during their history of use. Participants were no more likely to be introduced to injection by a boyfriend or male friend than by other means. The finding that the majority of females first try heroin through inhalation is consistent with an increased use of heroin by this method among young people in recent years. However, the majority of users in this study used heroin through injection at least once in their addict career, a route of administration associated with increased health and safety risks. Potential explanations for the progression from snorting to injection are presented as well as implications for the delivery of prevention and treatment services.

Edvardsson I; Lendahls L; Hakansson A. When do adolescents become smokers? Scandinavian Journal of Primary Health Care 27(1): 41-46, 2009. (26 refs.)

Objective. To follow the development of a class of pupils' tobacco habits for seven years, and to study differences in tobacco use between girls and boys. Setting. Kronoberg County in southern Sweden. Subjects. All the approximately 2000 pupils were followed from approximately age 12 to approximately age 18. Design. Yearly cross-sectional surveys from 1994 to 2000. Each year, the pupils filled in an established tobacco questionnaire. They did it anonymously in the classroom. Main outcome measures. Percentage of smokers, number of cigarettes smoked per day, and percentage of pupils using snus, the Swedish variety of oral moist snuff. Results. From grade 6 of compulsory school to grade 12 of upper secondary school, the proportion of daily smokers rose, from 0.2% to 22% for girls and from 0.5% to 14% for boys. Among both genders, the increase occurred mainly between grades 7 and 10, and from grade 10 onwards the daily smokers were the largest group of smokers. Starting from grade 9, boys had higher total tobacco consumption than girls, as a result of their increased use of snus, and at the end of the study 39% of the boys used tobacco compared with 34% of the girls. Conclusion. Studying young people's tobacco habits over time gives an understanding of when preventive measures should be implemented. In order for these to influence attitudes, they should be put in place well before tobacco is introduced.

Ellickson PL; D'Amico EJ; Collins RL; Klein DJ. Marijuana use and later problems: When frequency of recent use explains age of initiation effects (and when it does not). Substance Use & Misuse 40(3): 343-359, 2005. (58 refs.)

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.

Ellickson PL; McCaffrey DF; Ghosh-Dastidar B; Longshore DL. New inroads in preventing adolescent drug use: Results from a large-scale trial of project ALERT in middle schools. American Journal of Public Health 93(11): 1830-1836, 2003. (49 refs.)

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.

Ernst M; Luckenbaugh DA; Moolchan ET; Leff MK; Allen R; Eshel N et al. Behavioral predictors of substance-use initiation in adolescents with and without attention-deficit/hyperactivity disorder. Pediatrics 117(6): 2030-2039, 2006. (74 refs.)

OBJECTIVE. Our goal was to examine substance-use initiation in healthy adolescents and in adolescents who have been diagnosed with attention-deficit/hyperactivity disorder. METHODS. Seventy-eight adolescents (28 healthy and 50 with attention-deficit/hyperactivity disorder) participated in an ongoing longitudinal study of predictors of substance use. The substances most commonly reported were tobacco, alcohol, and marijuana. Aggression, conduct problems, hyperactivity, impulsivity, inattention, anxiety/depression, social difficulties, and somatic complaints were assessed at study entry and tested as predictors for later substance use. RESULTS. With an average of 4 years into the study, 37 adolescents had not used any substances, 41 had experimented with at least 1 substance, and 29 experimented with > 1 substance. Psychiatric diagnoses (attention-deficit/hyperactivity disorder, attention-deficit/hyperactivity disorder and conduct disorder, and attention-deficit/hyperactivity disorder and depression/anxiety) did not influence reports of substance use. Distinct behavioral measures collected at study entry predicted use of different substances. In a multivariate analysis, aggression had the greatest association with tobacco smoking and marijuana use. Impulsivity was associated with alcohol use. Severity of drug exposure, indexed by the number of substances used, was predicted by aggression. CONCLUSIONS. This 4-year longitudinal study captured the onset of substance use, not abuse. Behavioral predictors differed with the type of substance used. These behavioral characteristics may raise suspicion among pediatricians for enhanced risk for substance-use initiation.

Faden VB. Trends in initiation of alcohol use in the United States 1975 to 2003. Alcoholism: Clinical and Experimental Research 30(6): 1011-1022, 2006. (30 refs.)

Alcohol is the drug of choice for youth in the United States. By 8th grade, more than 40% of youth have used alcohol; by 12th grade, almost 80% have done so (MTF, 2003). And many of these young people begin drinking at relatively early ages. On average, boys start drinking earlier than girls, and whites and Native Americans start drinking earlier than youth of other race/ethnicities. As alcohol consumption is such a high prevalence behavior among young people, it is crucial to understand the initiation of drinking as well as possible, so as to facilitate and inform interventions to delay this behavior. One facet of this involves investigating trends in the initiation of drinking. Multiple years of data from 3 national surveys, Monitoring the Future (MTF)-1975 to 2003 for 12th graders, 1993 to 2003 for 8th and 10th graders; the National Household Survey on Drug Abuse (NHSDA) [now called the National Survey on Drug Use and Health (NSDUH)]-1991 to 1998; and the Youth Risk Behavior Surveillance System (YRBSS)-1991 to 2003, were analyzed using joinpoint analysis to further understanding of trends in the initiation of drinking by youth. The present analysis examines whether the age of drinking initiation has changed over time and evaluates trends in the percentages of youth who start drinking by various grades. Simultaneous examination of data from the 3 surveys indicates that 7th and 8th grades (when most youth are 13-14) are peak years for the initiation of drinking. Further, the present analysis shows that although the percentage of youth who start drinking early (before age 13) has declined (YRBSS, MTF), the average age of initiation of drinking for these "very early starters" did not change over the period 1991 to 1998 (NHSDA/NSDUH). At the same time, an upward shift in the "normative" age of initiation has occurred (NHSDA/NSDUH, MTF). Results of analyses by gender and race/ethnicity indicate similar trends over time. A more nuanced understanding of the initiation of drinking can have important implications for prevention.

Fisher LB; Miles IW; Austin B; Camargo CA; Colditz GA. Predictors of initiation of alcohol use among US adolescents - Findings from a prospective cohort study. Archives of Pediatrics & Adolescent Medicine 161(10): 959-966, 2007. (77 refs.)

Objective: To identify precursors of adolescent alcohol initiation and binge drinking. Design: Prospective cohort study. Setting: Self-report questionnaires. Participants: A total of 5511 Growing Up Today Study participants aged 11 to 18 years in 1998. Main Exposures: Individual, family, and social factors. Main Outcome Measures: First whole drink of alcohol and binge drinking. Results: Between 1998 and 1999, 611 girls (19%) and 384 boys (17%) initiated alcohol use. Older age, later maturational stage, smoking, adults drinking in the home, underage sibling drinking, peer drinking, possession of or willingness to use alcohol promotional items, and positive attitudes toward alcohol were associated with an increased likelihood of alcohol initiation. Girls who ate family dinner at home every day were less likely to initiate alcohol use than girls who ate family dinner only on some days or never (odds ratio, 0.66; 95% confidence interval, 0.50-0.87). Girls with higher social self-esteem and boys with higher athletic self-esteem were more likely to initiate alcohol use than those with lower self-esteem. Among teens who initiated alcohol use, 149 girls (24%) and 112 boys (29%) further engaged in binge drinking. Among girls, positive attitudes toward alcohol, underage sibling drinking, and possession of or willingness to use alcohol promotional items were associated with binge drinking; among boys, positive attitudes toward alcohol and older age were associated with binge drinking. Conclusions: Eating family dinner at home every day may delay alcohol uptake among some adolescents. Alcohol promotional items appear to encourage underage alcohol initiation and binge drinking; this may warrant marketing restrictions on the alcohol industry.

Forrester K; Biglan A; Severson HH; Smolkowski K. Predictors of smoking onset over two years. Nicotine & Tobacco Research 9(12): 1259-1267, 2007. (29 refs.)

The objective of this analysis was to identify variables that predict the initiation of smoking among adolescents, and the development of susceptibility to smoking, over a 2-year period. We assessed variables that might predict later smoking among nonsmoking students in grades 7 and 9 and assessed their smoking status 2 years later, when they were in grades 9 and 11, thus receiving data from 4,130 students at two time points. Initiation of weekly smoking over the 2 years was associated with having a parent, sibling, or close friend who smokes; low school grades; higher levels of deviant behavior; susceptibility to smoking; use of smokeless tobacco; and for 7th graders, perception of higher levels of normative smoking. Susceptibility, defined as not being able to rule out the idea of smoking a year after the survey, was identified as a strong predictor of smoking and a valuable intermediary measure. We also assessed factors associated with the prediction of susceptibility 2 years post-test. Susceptibility to smoking was associated with deviant behavior, low grades, lower parental monitoring, relaxed parental attitude toward youth smoking, ease of access to tobacco, and lower exposure to anti-tobacco messages. This study provides support for the idea that susceptibility to smoking could be a useful outcome variable for tobacco research, as an intermediary to the initiation of smoking. In addition, evidence indicates that theoretically manipulable variables, including access to tobacco and exposure to anti-tobacco information, have the potential to influence susceptibility to smoking over a time.

Gilman SE; Rende R; Boergers J; Abrams DB; Buka SL; Clark MA et al. Parental smoking and adolescent smoking initiation: An intergenerational perspective on tobacco control. Pediatrics 123(2): E274-E281, 2009. (67 refs.)

OBJECTIVE. Adolescence is an important period of risk for the development of lifelong smoking behaviors. Compelling, although inconsistent, evidence suggests a relationship between parental smoking and the risk of smoking initiation during adolescence. This study investigates unresolved issues concerning the strength and nature of the association between parent smoking and offspring smoking initiation. METHODS. We enrolled 564 adolescents aged 12 to 17, along with 1 of their parents, into the New England Family Study between 2001 and 2004. Lifetime smoking histories were obtained from parents and their adolescent offspring. Discrete-time survival analysis was used to investigate the influence of parental smoking histories on the risk of adolescent smoking initiation. RESULTS. Parental smoking was associated with a significantly higher risk of smoking initiation in adolescent offspring. In addition, the likelihood of offspring smoking initiation increased with the number of smoking parents and the duration of exposure to parental smoking, suggesting a dose-response relationship between parental smoking and offspring smoking. Offspring of parents who had quit smoking were no more likely to smoke than offspring of parents who had never smoked. The effects of parental smoking on offspring initiation differed by sex (with a stronger effect of fathers' smoking on boys than girls), developmental period (with a stronger effect of parental smoking before the adolescent was age 13 than afterward), and residence of parents (with effects of fathers' smoking being dependent on living in the same household as the adolescent). Parental smoking was also associated with stronger negative reactions to adolescents' first cigarette, a potential marker of the risk of progression to higher levels of use. CONCLUSIONS. Parental smoking is an important source of vulnerability to smoking initiation among adolescents, and parental smoking cessation might attenuate this vulnerability.

Gilpin EA; Lee L; Pierce JP. How have smoking risk factors changed with recent declines in California adolescent smoking? Addiction 100(1): 117-125, 2005. (47 refs.)

Aim: To compare predictors of smoking initiation in two longitudinal studies in California conducted during periods when adolescent smoking prevalence was increasing (1993-96) and decreasing (1996-99). Design, setting and participants: Cohorts of 1215-year-old never smokers were identified from the cross-sectional 1993 and 1996 California Tobacco Surveys (large population-based telephone surveys) and followed-up 3 years later (199396, n = 1764; 199699, n = 2119). Measures: We compared cohort transition rates to any smoking by follow-up in risk groups defined by known predictors of smoking initiation at baseline. Besides examining predictors individually, risk groups were defined using a multivariate analysis. Findings: Overall, transition to any smoking by follow-up occurred in 38.3 plus or minus 4.0% (% plus or minus 95% confidence interval) of never smokers in the 1993-96 cohort and 31.1 plus or minus 2.6% in the 199699 cohort. For most predictors, the transition rate for adolescents with the characteristic was the same or only slightly lower in the 1996-99 cohort compared to the 1993-96 cohort, but the transition rate in those without the characteristic was generally much lower, thus increasing the power of the predictor. The multivariate analysis confirmed that compared to the 1993-96 cohort, transition occurred much less often in the 1996-99 cohort for adolescents at low rather than at medium or high risk of future smoking. Conclusions:The turnaround in California adolescent smoking in the mid-1990s, when smoking began to decline, appears to come primarily from adolescents already at low risk of future smoking (as defined by a variety of predictors), who transitioned to smoking at much lower rates than previously.

Ginzler JA; Cochran BN; Domenech-Rodraguez M; Cauce AM; Whitbeck LB. Sequential progression of substance use among homeless youth: An empirical investigation of the gateway theory. Substance Use & Misuse 38(3/6): 725-758, 2003. (41 refs.)

We examined the sequence of substance-use initiation in 375 street youth (age 13-21) who were interviewed from 1994-99 in Seattle, Washington. Based on the "gateway theory," participants were categorized into six profiles to describe the order in which they initiated use of various substances (i.e., alcohol, marijuana, other drugs), or classified as nonprogressors if they had not tried all three classes of drugs. Youth progressing in the hypothesized gateway order (i.e., alcohol preceding marijuana, followed by other drugs) initiated their use at an earlier age than youth who had not progressed through all three substance classes. However, there was no relationship between a substance initiation profile and current substance-use. Implications include the recognition that street youth may follow different patterns of use than normative groups, and that interventions geared toward youth who use substances heavily must include contextual factors, in addition to substance-use history.

Glied S. Is smoking delayed smoking averted? American Journal of Public Health 93(3): 412-416, 2003. (93 refs.)

Antismoking efforts often target teenagers in the hope of producing a new generation of never smokers. Teenagers are more responsive to tobacco taxes than are adults. The author summarizes recent evidence suggesting that delaying smoking initiation among teenagers through higher taxes does not generate proportionate reductions in prevalence rates through adulthood. In consequence, the impact of taxes on smoking among youths overstates the potential long-term public health effects of this tobacco control strategy.

Guo B; Aveyard P; Fielding A; Sutton S. The factor structure and factorial invariance for the decisional balance scale for adolescent smoking. International Journal of Behavioral Medicine 16(2): 158-163, 2009. (23 refs.)

The transtheoretical model is a framework to explain smoking uptake and cessation in adolescence. Decisional balance is proposed as a driver of stage movement. The purpose of this study was to examine the factor structure and measurement equivalence/invariance (ME/I) of the decisional balance scale. In this study, we used confirmatory factor analysis followed by measurement equivalence/invariance testing to examine the factorial validity of the decisional balance scale in adolescent smokers and nonsmokers. Unlike previous studies, we found that a four-factor solution splitting cons into esthetic and health cons significantly improved the fit of model to the data. ME/I testing showed that the same structure and measurement model held for both smokers and nonsmokers, girls and boys, and across the three occasions the scale was administered. Cons showed strong evidence that it constituted two separate first order factors. Decisional balance for smoking in adolescence has good evidence of factorial validity.

Gutschoven K; Van den Bulck J. Television viewing and age at smoking initiation: Does a relationship exist between higher levels of television viewing and earlier onset of smoking? Nicotine & Tobacco Research 7(3): 381-385, 2005. (19 refs.)

This cross-sectional study of children assessed the association between television viewing and age at smoking initiation, using self-reports administered by research assistants in schools. Participants were 909 students in their first and fourth years of secondary education in a random sample of 15 secondary schools in Flanders, Belgium, who had smoked at least one cigarette. The main outcome measure was age at smoking initiation. The independent variable was weekly television viewing volume. Gender, educational level, parental smoking, and peer smoking were the control variables. The relationship between television viewing and age at smoking initiation was significant. Higher levels of television viewing were related to earlier onset of smoking behavior in adolescents. The relationship of television viewing with age at smoking initiation was stronger than that of peer smoking, parental smoking, and gender. For each hour of television viewing per day, the average smoking initiation age decreased by 60 days. Heavier television viewers start smoking at an earlier age. Two possible explanations for this relationship are suggested. Social learning theory suggests that actors and actresses serve as behavioral role models for heavy viewers. Cultivation theory suggests that exposure to positive messages influences smoking attitudes. Further research should examine whether the relationship is causal and whether television acts as a provider of smoking role models or whether it influences smoking attitudes.

Harakeh Z; Engels RCME; Vermulst AA; De Vries H; Scholte RHJ. The influence of best friends and siblings on adolescent smoking: A longitudinal study. Psychology & Health 22(3): 269-289, 2007. (74 refs.)

The present study investigated whether best friend and/or siblings' smoking affected adolescent smoking. Data of the Dutch Family and Health study was used in which 428 families participated with two adolescent children between the age of 13 and 17 years. Our findings showed that adolescents with older siblings who smoked were more likely to smoke one year later. In contrast, older adolescents were not affected by smoking of their younger siblings. Smoking of the best friend influenced smoking of the younger sibling. With regard to the specific transition from never smoking to smoking initiation, older and younger siblings with a smoking best friend were more likely to start smoking one year later. Younger siblings with older siblings who smoked were more likely to initiate smoking one year later. The influence of friends and siblings on adolescent smoking appeared to be small to moderate.

Hellandsjo Bu ET. Alcohol debut and consumption among Norwegian athletes: The impact of environmental and personal factors. IN: Bouroncle A; Rauhamaki S, eds. Sport and Substance Use in the Nordic Countries. NAD Monograph No. 45. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2005. pp. 111-132. (53 refs.)

This is one of three chapters dealing with alcohol in relation to modern sports. In Norway nearly 50% of children and young people aged 8 and 24 are actively engaged in organized sports. This chapter examines the initiation of drinking and intoxication among Norwegian teenagers. Research has shown that participation in organized sports delayed drinking and intoxication. This is of importance as later use of alcohol is related to fewer alcohol problems later. Data is presented here on the use of alcohol among athletes, and the relationship to the type of sport and level of performance, places for drinking, and motives for drinking. Consumption is lower among athletes at the national, than at the local level, and even lowest at the international level. There is also discussion of environmental factors: parents, peers, and coaches as role models; goal-oriented environment; the role of cohesion in sports clubs; pressures to achieve. Personal factors such as win orientation, goal orientation, reactive and proactive negatives, self-esteem, and physical self are also discussed. The author concludes that athletes drink less than non-athletes, within certain sports groups, and the difference is marked. The age of initiation and intoxication is higher among athletes. There are gender differences as well as differences by type of sport and level of participation. Also important, environmental factors are significant as are personal factors. Support and structure from family and sports club, good role models by family and coaches are associated with less alcohol use.

Henriksen L; Feighery EC; Schleicher NC; Fortmann SP. Receptivity to alcohol marketing predicts initiation of alcohol use. Journal of Adolescent Health 42(1): 28-35, 2008. (40 refs.)

Purpose: This longitudinal study examined the influence of alcohol advertising and promotions on the initiation of alcohol use. A measure of receptivity to alcohol marketing was developed from research about tobacco marketing. Recall and recognition of alcohol brand names were also examined. Methods: Data were obtained from in-class surveys of sixth, seventh, and eighth graders at baseline and 12-month follow-up. Participants who were classified as never drinkers at baseline (n = 1,080) comprised the analysis sample. Logistic regression models examined the association of advertising receptivity at baseline with any alcohol use and current drinking at follow-up, adjusting for multiple risk factors, including peer alcohol use, school performance, risk taking, and demographics. Results: At baseline, 29% of never drinkers either owned or wanted to use an alcohol branded promotional item (high receptivity), 12% students named the brand of their favorite alcohol ad (moderate receptivity), and 59% were not receptive to alcohol marketing. Approximately 29% of adolescents reported any alcohol use at follow-up; 13% reported drinking at least 1 or 2 days in the past month. Never drinkers who reported high receptivity to alcohol marketing at baseline were 77% more likely to initiate drinking by follow-up than those were not receptive. Smaller increases in the odds of alcohol use at follow-up were associated with better recall and recognition of alcohol brand names at baseline. Conclusions: Alcohol advertising and promotions are associated with the uptake of drinking. Prevention programs may reduce adolescents' receptivity to alcohol marketing by limiting their exposure to alcohol ads and promotions and by increasing their skepticism about the sponsors' marketing tactics.

Henry KL; Smith EA; Caldwell LL. Deterioration of academic achievement and marijuana use onset among rural adolescents. Health Education Research 22(3): 372-384, 2007. (54 refs.)

This study utilizes discrete-time survival analysis to assess the effect of level of academic achievement (both contemporaneously and prospectively) and changes in academic achievement on initiation of marijuana use among rural adolescents in junior high school. In the sample under consideration, 36% of boys and 23% of girls initiated use of marijuana by the end of ninth grade. Consistent with our hypothesis, poor academic achievement is a salient predictor of initiation of marijuana use among both boys and girls. Both contemporaneous and lagged levels of achievement significantly predict initiation. In addition, change in academic achievement is an important predictor of initiation. That is, students who demonstrate a deterioration of their academic achievement over time are more likely to start using marijuana. Poor academic achievement and deterioration of academic achievement should be considered as risk factors for initiation of marijuana use among rural adolescents. Initiatives targeted at improving academic achievement and/or drug use prevention initiatives designed for poor achieving students may help to prevent initiation of marijuana use.

Hser YI; Grella CE; Collins C; Teruya C. Drug-use initiation and conduct disorder among adolescents in drug treatment. Journal of Adolescence 26(3): 331-345, 2003. (27 refs.)

This study investigated effects of drug-use initiation and conduct disorder (CD) among 1031 adolescents who participated in the Drug Abuse Treatment Outcomes Studies for Adolescents (DATOS-A) sponsored by the National Institute on Drug Abuse (NIDA). The mean age of first drug use was 12.7 (S.D.=2.2), 57% met DSM-III-R criteria for CD, and earlier initiators were more likely to have CD. About 78% of the adolescents with CD reported that their first CD symptom occurred prior to drug-use initiation. The proportions of adolescents who had prior treatment were similar (about 28%) across all groups, but earlier initiators reported a greater number of treatment episodes and younger ages at their first treatment. Conduct disordered adolescents revealed greater problems prior to DATOS-A treatment, but they appeared to be more motivated and ready for treatment. Although adolescents with CD still showed worse outcomes after treatment, the impact of CD appeared to lessen when pretreatment differences were controlled. To a lesser extent, adolescents who began using drugs at earlier ages had greater alcohol and drug use and other problems at intake, but their treatment outcomes appeared to be similar to later initiators. There were few significant interaction effects of initiation and CD. Findings from this study highlight the importance of better understanding the progression of drug use, treatment utilization, and psychiatric comorbidity among adolescents with substance abuse problems.

Hu M-C; Muthen B; Schaffran C; Griesler PC; Kandel DB. Developmental trajectories of criteria of nicotine dependence in adolescence. Drug and Alcohol Dependence 98(1/2): 94-104, 2008. (71 refs.)

We describe the nature and predictors of developmental trajectories of symptoms of DSM-IV nicotine dependence in adolescence following smoking initiation. Data are from a longitudinal cohort of 324 new smokers from grades 6-10 in the Chicago Public Schools, interviewed 5 times at 6-month intervals. Monthly data on DSM-IV symptoms of nicotine dependence were available for 36 months. Growth mixture modeling was applied to the monthly histories to identify trajectories of DSM-IV criteria of nicotine dependence. A four-class solution best fitted the data: no DSM criterion (47.7%); early onset/chronic course (19.8%); early onset/remission (17.3%); late onset (15.2%). Blunt use prior to cigarette use was associated with the three symptomatic trajectories. Conduct disorder and prior heavy smoking were associated with Class 2 (chronic). Conduct disorder differentiated Class 2 from Class 4 (late onset), while pleasant initial sensitivity to the first tobacco experience was associated with Classes 2 and 3 (remit) and differentiated Class 2 from Class 4. Novelty seeking characterized Class 3. Parental dependence differentiated chronicity (Class 2) from remission (Class 3) among those who developed symptoms early. Being Hispanic reduced membership in Classes 3 and 4, and being male for Class 3. The data highlight the importance of parental nicotine dependence as a risk factor for early and sustained nicotine dependence by the offspring, pleasant initial sensitivity and conduct disorder for early onset of dependence, and blunt use prior to smoking for all trajectories. The factors important for onset of dependence are not necessarily the same as those for sustained course.

Ilomaki R; Riala K; Hakko H; Lappalainen J; Ollinen T; Rasanen P et al. Temporal association of onset of daily smoking with adolescent substance use and psychiatric morbidity. European Psychiatry 23(2): 85-91, 2008. (27 refs.)

Objective. - The association between cigarette smoking and psychiatric disorders is well established for adult populations. However, only limited number of studies has investigated whether the young onset age of daily smoking (DS) among adolescents is associated with psychiatric morbidity and vice versa. Methods. - Data from 508 adolescents admitted to psychiatric hospitalization were collected. Cox proportional hazard model were used to compare the initiation of DS between adolescents with and without substance use (SUD), and other psychiatric disorders. Results. - Rates of DS were high in each diagnostic category. Boys started smoking at younger age (mean 12.4 years) than girls (13.0 years). Both boys and girls diagnosed with conduct or oppositional defiant disorders (COD) and also girls with SUD started daily smoking earlier as compared to those of same gender without these disorders. COD were found to be primary to the initiation of DS among boys. SUD, psychotic, and depressive disorders (DEP) were found to be secondary to DS among both genders. Conclusions. - DS in adolescence is related with later SUD. COD are associated with subsequent initiation of DS among boys. The temporal gap between smoking initiation and COD is shorter among girls. Gender difference plays a role in association of DS and DER Initiation of DS at very early age should alert health care professionals of development of later psychopathology, especially SUD.

Jackson C; Brown JD; L'Engle KL. R-rated movies, bedroom televisions, and initiation of smoking by white and black adolescents. Archives of Pediatrics & Adolescent Medicine 161(3): 260-268, 2007. (45 refs.)

Objective: To test movie exposure and television use as predictors of smoking initiation among white and black adolescents who had never smoked cigarettes. Design: Survey research using audio computerassisted self-interviews at baseline and at 2- year followup ( 2002- 2004). Setting: Participants' homes located in central North Carolina. Participants: A sample of 735 12- to 14- year- old adolescents drawn from 14 public middle schools. Main Exposure: Frequency of exposure to movies rated R, PG- 13, PG, or G; frequency, location, and parental oversight of television viewing. Main Outcome Measure: Initiation of smoking, indicated by the first occasion of puffing on a cigarette. Results: Among white adolescents, high relative exposure to R- rated movies predicted a significantly greater likelihood of smoking initiation at follow- up, and private access to television during early adolescence, indicated by having a bedroom television, was also a significant independent predictor of smoking initiation at follow- up. No significant associations were observed between any movie- exposure or television- use variables and likelihood of smoking among black adolescents. Conclusions: Indicators of risky media use were associated with a significantly greater likelihood of smoking for white but not for black adolescents. These results diverge strongly from past results, which have indicated that all adolescents, regardless of race or place of residence, have a higher risk of smoking initiation as their exposure to movie smoking increases. Research is needed to identify the antecedents of risky media use and to understand how audience attributes, including race and other factors, moderate the effects of risky media use on health related behaviors.

Kaminer Y; Bukstein OG. Treating adolescent substance abuse. IN: Frances RJ; Miller SI; Mack AH, eds. Clinical Textbook of Addictive Disorders, 3rd edition. New York: Guilford Press, 2005. pp. 559-587. (184 refs.)

It is recognized that between 7 and 10% of adolescents are in need of substance abuse treatment. The goal of this chapter is to review the trends in adolescent substance use, psychiatric co-morbidity, prevention, assessment, and the treatment aftercare continuum. The authors deals with the epidemiology, age of initiation, and prevalence by gender and ethnic groups, and etiology in terms of biological factors, environment, and parental as well as peer influences. Separate sections are devoted to prevention, assessment, level of care, and treatment. discharge and after care.

Kandel DB; Kiros GE; Schaffran C; Hu MC. Racial/ethnic differences in cigarette smoking initiation and progression to daily smoking: A multilevel analysis. American Journal of Public Health 94(1): 128-135, 2004. (49 refs.)

Objectives. We sought to identify individual and contextual predictors of adolescent smoking initiation and progression to daily smoking by race/ethnicity. Methods. We used data from the National Longitudinal Study of Adolescent Health to estimate the effects of individual (adolescent, family, peer) and contextual (school and state) factors on smoking onset among nonsmokers (n = 5374) and progression to daily smoking among smokers (n = 4474) with multilevel regression models. Results. Individual factors were more important predictors of smoking behaviors than were contextual factors. Predictors of smoking behaviors were mostly common across racial/ethnic groups. Conclusions. The few identified racial/ethnic differences in predictors of smoking behavior suggest that universal prevention and intervention efforts could reach most adolescents regardless of race/ethnicity. With 2 exceptions, important contextual factors remain to be identified.

Kaplan CP; Nguyen TT; Weinberg V. Longitudinal study of smoking progression in Chinese and Vietnamese American adolescents. Asian Pacific Journal of Cancer Prevention 9(2): 335-341, 2008. (41 refs.)

The use of tobacco remains a significant public health concern among Asian American (AA) adolescents. Understanding the factors that affect smoking progression among Chinese and Vietnamese adolescents in particular, may help in illuminating potential interventions that can be implemented to maximize scarce programming and resources. This study is a longitudinal cohort study with data collected in California via telephone over a two-year period. 1,270 Chinese and Vietnamese American adolescents were recruited via telephone listings from one southern and four northern California counties. Main outcomes were smoking susceptibility and change in smoking status. Examination of these adolescents indicated that in both groups: boys were more likely than girls to become susceptible to smoking, risk behaviors were associated with becoming smokers, having been susceptible at baseline was associated with susceptibility and smoking at follow-up, and the influence of friends was a predictor of susceptibility and smoking.

Kendler KS; Schmitt E; Aggen SH; Prescott CA. Genetic and environmental influences on alcohol, caffeine, cannabis, and nicotine use from early adolescence to middle adulthood. Archives of General Psychiatry 65(6): 674-682, 2008. (31 refs.)

Context: While both environmental and genetic factors are important in the etiology of psychoactive substance use (PSU), we know little of how these influences differ through development. Objective: To clarify the changing role of genes and environment in PSU from early adolescence through middle adulthood. Design: Retrospective assessment by life history calendar, with univariate and bivariate structural modeling. Setting: General community. Participants: A total of 1796 members of male-male pairs from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Main Outcome Measures: Levels of use of alcohol, caffeine, cannabis, and nicotine recorded for every year of the respondent's life. Results: For nicotine, alcohol, and cannabis, familial environmental factors were critical in influencing use in early adolescence and gradually declined in importance through young adulthood. Genetic factors, by contrast, had little or no influence on PSU in early adolescence and gradually increased in their effect with increasing age. The sources of individual differences in caffeine use changed much more modestly over time. Substantial correlations were seen among levels of cannabis, nicotine, and alcohol use and specifically between caffeine and nicotine. In adolescence, those correlations were strongly influenced by shared effects from the familial environment. However, as individuals aged, more and more of the correlation in PSU resulted from genetic factors that influenced use of both substances. Conclusions: These results support an etiologic model for individual differences in PSU in which initiation and early patterns of use are strongly influenced by social and familial environmental factors while later levels of use are strongly influenced by genetic factors. The substantial correlations seen in levels of PSU across substances are largely the result of social environmental factors in adolescence, with genetic factors becoming progressively more important through early and middle adulthood.

Kim MJ; Fleming CB; Catalano RF. Individual and social influences on progression to daily smoking during adolescence. Pediatrics 124(3): 895-902, 2009. (33 refs.)

OBJECTIVES: The goal was to identify individual and social predictors of progression to daily smoking by the end of high school among youths who initiated smoking by grade 8. METHODS: The analysis sample of 270 adolescent smokers was taken from the Raising Healthy Children project. Data were taken from annual interviews in grades 7 and 12. Daily smoking was defined as having smoked >= 1 cigarette per day in the past 30 days at the time of each interview. Discrete-time survival analysis was used to assess associations with individual, family, peer, and school predictors. RESULTS: A total of 58% (n = 156) of the analysis sample made the transition to daily smoking by grade 12. The likelihood of onset of daily smoking among those who had not yet demonstrated onset was smallest in grade 9 (probability: 0.12) and greatest in grade 12 (probability: 0.25). Youth depression, prosocial beliefs, and antisocial behavior had overall associations with risk of smoking escalation. In addition, parents' and peers' smoking, family management, academic grades, and school commitment had significant univariate associations with smoking progression. After adjustment for gender, low-income status, and other potential predictors, youths' antisocial behavior and parents' and peers' smoking predicted greater likelihood of escalation to daily smoking, whereas parental use of positive family management predicted lower likelihood of escalation. CONCLUSIONS: This study supports preventing escalation in adolescent smoking by targeting parents' and peers' smoking and involvement in other forms of antisocial behavior and working with parents to improve their use of positive family management practices.

Kokkevi A; Gabhainn SN; Spyropoulou M; Risk Behav Focus Grp HBSC. Early initiation of cannabis use: A cross-national European perspective. Journal of Adolescent Health 39(5): 712-719, 2006. (40 refs.)

Purpose: To examine the relationship of the early initiation of cannabis use with other high risk behaviors and with psychosocial and health-related correlates in 15-year-old adolescents in six European countries. Methods: This study reports on nationwide cross-sectional surveys in six European countries in 2001-2002, within the framework of the World Health Organization's collaborative study, Health Behaviour in School-aged Children (HBSC). Data were collected through anonymous questionnaires self-completed in classrooms. Descriptive and multivariate analyses were used to assess differences between countries in age of first cannabis use and associations with health and related psychosocial variables. Results: The prevalences of lifetime and last-year cannabis use ranged from 30.7% and 27.5%, respectively, in the Czech Republic, to 5.4% and 4.1%, respectively, in Greece. Age at first use was lower in the high prevalence countries than in countries with lower prevalence. For 15-year-olds, frequent use of tobacco and alcohol and other risk behaviors were correlated with early (13-15 years old) and especially very early (<= 13 years old) cannabis initiation. Conclusions: Although different patterns of prevalence and age of initiation were observed between participating countries, early cannabis use was almost uniformly associated with higher odds of more frequent use of cannabis and other substances, and with a common set of other problems. Our findings suggest that prevention of drug abuse must commence in preadolescence.

Koval JJ; Pederson LL; Chan SSH. Psychosocial variables in a cohort of students in grades 8 and 11: A comparison of current and never smokers. Preventive Medicine 39(3): 1017-1025, 2004. (72 refs.)

Background. Specific hypotheses regarding putative mechanisms by which stressful life events might be related to smoking initiation among adolescents have been tested cross-sectionally on a cohort of 1598 grade 6 students in Scarborough, Canada. The purpose of this study was to examine the utility of these cross-sectional models in accounting for current smoking as compared to never smoking when this cohort was in grades 8 and 11. Methods. Current smoking was defined as reported regular or occasional smoking. Logistic regression and multiple regression models were tested separately for each gender and grade with variables entered in prespecified steps. Results. Current smoking is more strongly related to psychosocial variables and environmental variables among older male adolescents as compared to younger ones. In older female adolescents, current smoking appears to be more strongly related to attitude variables and less strongly related to psychosocial variables than among younger female adolescents. There is some evidence that grade 11 males may use cigarettes as a coping strategy for depression. Conclusions. Male and female students differ in how stress and a range of psychosocial factors are interrelated with regards to current smoking and these relationships appear to change over time.

Krainuwat K. Smoking initiation prevention among youths: Implications for community health nursing practice. Journal of Community Health Nursing 22(4): 195-204, 2005. (69 refs.)

Cigarette smoking among youths has long been documented as a national problem affecting health and economic status in the United States. A number of studies have documented that cigarette-smoking initiation occurs primarily between late childhood and young adolescence. This evidence has brought about the need for awareness among community health nurses to find and deliver effective antismoking programs to reduce the prevalence of youth smoking initiation. Generally, community health nurses are in an excellent position to help the nation achieve its goals in terms of reducing the incidence of youth smoking initiation. However, current knowledge about community health nursing practice and smoking initiation interventions is limited. This article raises awareness about smoking initiation prevention in youth and the need to implement effective smoking prevention programs in practice settings and encourages community health nurses to increase their involvement in antismoking initiation research and interventions.

Kremers SPJ; de Vries H; Mudde AN; Candel M. Motivational stages of adolescent smoking initiation: Predictive validity and predictors of transitions [rapid communication]. Addictive Behaviors 29(4): 781-789, 2004. (10 refs.)

The present study tested the use and validity of a stage model of adolescent smoking initiation. The model aims to identify adolescents who are currently not smoking, but who are cognitively predisposed to start smoking in the future. Research on subtypes within the precontemplation stage of adolescent smoking initiation and the concept of susceptibility to smoking led to the construction of a motivational stage model of four distinct stages: committer, immotive, progressive, and contemplator. Using longitudinal data on a large international sample of European adolescents (n=7117), the model proved to have value in predicting smoking initiation at 12 months follow up. The odds ratio to take up regular smoking behavior appeared to double with each forward stage transition. Although effect sizes were small to moderate, unique predictors of transitions from the various stages were identified. Implications of the findings are discussed

Lillehoj C; Trudeau L; Spoth R. Longitudinal modeling of adolescent normative beliefs and substance initiation. Journal of Alcohol and Drug Education 49(2): 7-41, 2005. (70 refs.)

The current study investigated the effects of baseline levels of academic achievement and longitudinal trends in normative beliefs on adolescent substance initiation across a 42-month time period. Participants were 272 rural adolescents who were an average of 12.3 years old at the baseline assessment. Academic achievement positively predicted the intercept and negatively predicted the growth-trajectory of normative beliefs regarding peer substance behavior. Further, baseline academic achievement negatively predicted initial levels, as well as the growth-trajectory, of substance initiation. The discussion addresses the influence of academic achievement and normative beliefs on substance initiation and the utility of latent growth curve modeling in studying longitudinal change. In addition, implications for prevention programming are discussed.

Lillehoj CJ; Trudeau L; Spoth R; Madon S. Externalizing behaviors as predictors of substance initiation trajectories among rural adolescents. Journal of Adolescent Health 37(6): 493-501, 2005. (40 refs.)

Purpose: The purpose of the current study was to investigate the influence of externalizing behaviors on substance initiation trajectories arnong rural adolescents over a 42-month period. Methods: Data were obtained from 198 rural adolescents (105 boys, 93 girls) who were participating in a longitudinal study. At the baseline assessment, Subjects were on average 12.3 years of age. Results: Controlling for gender, higher baseline levels of externalizing were associated with a greater number of substances initiated over time. The initiation trajectory was curvilinear girls, compared with boys, reported a lower number of substances initiated at baseline, a greater linear growth trajectory, and a deceleration of growth over time. Conclusions: The influence of adolescent externalizing behaviors on baseline levels and growth trajectories of substance initiation and the utility of latent growth curve modeling in the study of longitudinal change are discussed.

Lintonen TP; Konu AI. Adolescent alcohol beverage type choices reflect their substance use patterns and attitudes. Journal of Youth and Adolescence 32(4): 279-289, 2003. (40 refs.)

Alcoholic beverage type choices were studied in relation to adolescents' substance use patterns and attitudes towards substance use, utilizing the national 1999 Adolescent Health and Lifestyle Survey data (N = 4943) collected among Finns aged 14 and 16 years by mail. Frequencies of drinking, drunkenness and smoking, and chewing tobacco use as well as attitudes towards substance use and exposure to other drugs were all strongly related to beverage type choices. The amount of alcohol consumed was associated with the beverage choice. The relationships between beverage choices and substance use patterns were partly mediated through amounts drunk. Beverage type choices seemed to reflect substance use patterns and attitudes more generally. Wine and cider appeared beverages related to moderation and control in relation to substance use, but beer drinking may be interpreted as a sign of initiation into a substance use pattern favoring smoking and heavier use of alcohol and other drugs.

Longest KC; Vaisey S. Control or conviction: Religion and adolescent initiation of marijuana use. Journal of Drug Issues 38(3): 689-716, 2008. (53 refs.)

Much research on adolescent deviance has supported a theory of social control, asserting that the lack of ties to institutions (such as school and parents) increases an adolescent's likelihood of using illicit substances. Researchers in this tradition often posit religion as one among many sources of norm enforcement. Yet religion may impact adolescents' behavior more directly through its ability to create beliefs and identities that are incompatible with illegal substance use. This paper uses a nationally representative, longitudinal data set of adolescents, the National Study of Youth and Religion, to examine the influence of traditional measures of social control, religious social control, and a new measure of religious salience on the probability of adolescents' first marijuana use. Results demonstrate that religious salience is more predictive of this initiation than are measures of involvement with religious organizations and several common social control indicators. We also find substantial interactions between different forms of religiosity. In the conclusion, we consider broader implications for understanding religion's influence on deviance.

Maggs JL; Schulenberg JE. Initiation and course of alcohol consumption among adolescents and young adults. IN: Galanter M, ed. Recent Developments in Alcoholism. Volume 17: Alcohol Problems in Adolescents and Young Adults -- Epidemiology, Neurobiology, Prevention, Treatment. New York: Kluwer Academic, 2005. pp. 29-47. (88 refs.)

This chapter takes a normative developmental perspective on the etiology of alcohol use, focusing on the initiation and course of alcohol use (rather than alcohol use disorders) during adolescence and early adulthood. We review evidence regarding the sequelae and meaning of the age of initiation of alcohol use, consider variable- and pattern-centered approaches to modeling trajectories describing the course of alcohol use across adolescence and young adulthood, and offer developmental conceptualizations of risk and protective factors for alcohol use and related problems.

Maggs JL; Schulenberg JE. Initiation and course of alcohol consumption among adolescents and young

McAllister I; Makkai T. Antisocial behaviour among young Australians while under the influence of illicit drugs. Australian and New Zealand Journal of Criminology 36(2): 211-222, 2003. (32 refs.)

While the link between illicit drug use and criminal behaviour is frequently noted, comparatively little is known about which drugs are most likely to shape this behaviour, and about the role of early initiation into drug use. This study uses a large, national population survey to examine these relationships, focusing on adolescents and young adults who report illicit drug use. The results show that about one in 10 young Australians had engaged in some form of antisocial behaviour in the previous 12 months following drug use, and that such behaviour peaked at almost one in five males at the age of 19 years. Antisocial behaviour while under the influence of drugs is closely associated with the use of marijuana, amphetamines and inhalants. Age of initiation was relatively unimportant in predicting this antisocial behaviour, with the exception of the early use of marijuana. Overall, the results confirm the importance of delaying marijuana use for as long as possible in order to reduce these behaviours.

McCarthy WJ; Mistry R; Lu Y; Patel M; Zheng H; Dietsch B. Density of tobacco retailers near schools: Effects on tobacco use among students. American Journal of Public Health 99(11): 2006-2013, 2009. (37 refs.)

Objectives. We examined the relationship between students' tobacco use and the density and proximity of tobacco retailers near their schools. Methods. We used data from the 2003-2004 California Student Tobacco Survey and California retail licensing data. Measures included students' self-reported tobacco use and geocoded state-reported locations of tobacco retailers. We used random-intercept generalized linear mixed modeling to jointly evaluate individual-level and school-level predictors. Results. Density of retailers was associated with experimental smoking (odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.02, 1.21) but not established smoking (OR = 1.06; 95% CI = 0.94, 1.20). The effects on experimental smoking were confined to high school students (OR = 1.17; 95% CI = 1.06, 1.29) in urban areas (OR = 1.11; 95% CI = 1.01, 1.21); no effects were observed among middle school students or in rural schools. High school students were more likely to obtain cigarettes from a retailer; middle school students relied more heavily on social sources. Conclusions. Our results support the plausibility of reducing rates of students' experimental smoking, but not established smoking, by restricting their access to commercial sources of tobacco in urban areas.

Mermelstein RJ; Colvin PJ; Klingemann SD. Dating and changes in adolescent cigarette smoking: Does partner smoking behavior matter? Nicotine & Tobacco Research 11(10): 1226-1230, 2009. (18 refs.)

Adolescents' relationships can play an influential role in adopting, maintaining, or changing health behaviors. Previous research has suggested that adolescent dating is a risk factor for both concurrent and prospective tobacco use. This study extends previous research by examining whether a partner's smoking status moderated the relationship between dating and adolescent smoking. Participants were 1,263 9th and 10th grade students who took part in a longitudinal study investigating the social and emotional contexts of adolescent smoking patterns. Adolescents were recruited into the longitudinal study based on prior smoking history. The presence of a romantic partner, the partner's smoking status, and the adolescents' smoking behavior were assessed at baseline and at 15 months. Our findings indicated that a change in dating status from not dating to having a partner significantly increased the odds of the adolescent smoking at 15 months but significantly only for those who dated a smoker. This effect was especially pronounced among boys. All boys who dated a smoker smoked themselves. Among adolescents who smoked at 15 months, there was also a strong protective effect among boys for dating a nonsmoker, compared with either those who did not have partners or those with smoking partners; boys with nonsmoking partners smoked significantly less than those with partners who smoked or those without partners. These results highlight the importance of considering the smoking status of the romantic partner in the smoking-dating relationship in adolescents.

Mrug S; Windle M. Initiation of alcohol use in early adolescence: Links with exposure to community violence across time. Addictive Behaviors 34(9): 779-781, 2009. (12 refs.)

Early alcohol use initiation has been linked with exposure to community violence, but the direction of these associations and the roles of witnessing violence vs. victimization are not clear. This study used a cross-lagged structural equation model to examine the prospective relationships between alcohol use initiation and witnessing community violence and victimization in early adolescence. A sample of 603 boys and girls provided two waves of data 16 months apart. After controlling for continuity in alcohol use and violence exposure, early initiation of alcohol use predicted later victimization in the community. Witnessing community violence increased and victimization decreased the risk of subsequent alcohol use. Prevention programs targeting early alcohol initiation may result in decreased victimization, while interventions addressing constructive ways of coping with witnessing community violence may also reduce early adolescents' alcohol use.

Munafo MR; Hitsman B; Rende R; Metcalfe C; Niaura R. Effects of progression to cigarette smoking on depressed mood in adolescents: evidence from the National Longitudinal Study of Adolescent Health. Addiction 103(1): 162-171, 2008. (36 refs.)

Aims To investigate the relationship between smoking status and continuously distributed depressed mood among a cohort of adolescents. Design Quasi-experimental design, selecting the subset of adolescents who reported never having smoked a cigarette at baseline, some of whom progressed subsequently to smoking at follow-up approximately 1 year later. Setting Data were drawn from the National Longitudinal Study of Adolescent Health, an ongoing study designed to assess the health status of adolescents, and explore the causes of adolescent health-related behaviours. Participants Nationally representative sample of adolescents from the USA (n = 12 149), including a subsample who reported never having smoked a cigarette at baseline (n = 5475), aged on average 15 years at baseline and of predominantly European ancestry. Measurements Logistic and linear regression models controlling for potential confounders to explore the relationship between smoking status and depressed mood measured using the Centers for Epidemiological Studies Depression Scale (CES-D). Findings Various relationships between smoking status and depressed mood were observed, with a general trend for these effects to be greater among females. Smoking status at baseline did not significantly predict CES-D score at follow-up, although this effect approached significance in females (P = 0.077). Among never smokers at baseline, level of depressed mood at baseline predicted subsequent progression to smoking initiation (P = 0.022) but not progression to regular smoking (P = 0.229). Among never smokers at baseline, progression to smoking initiation during the follow-up period was associated with higher CES-D scores at follow-up, even after adjusting for baseline depressed mood (P < 0.001), with this effect greater for females than for males. Among those who initiated smoking, progression to regular smoking was associated with higher CES-D score at follow-up among females (P = 0.001), but not males (P = 0.966). Conclusions These data appear to support a complex model of the relationship between depressed mood and smoking status which includes elements of both confounding and causal models. The relationship between cigarette smoking and depression may be a factor in the development of subsequent dependence.

Novins DK; Baron AE. American Indian substance use: The hazards for substance use initiation and progression for adolescents aged 14 to 20 years. Journal of the American Academy of Child and Adolescent Psychiatry 43(3): 316-324, 2004. (44 refs.)

Objective: To describe the risks and risk factors for substance use initiation and progression among a large sample of American Indian (AI) adolescents. Method: Data came from surveys completed by 2,356 AI adolescents aged 14 to 20 years who participated in two or more consecutive waves of a longitudinal study between 1993 and 1996 (response rate 74%.). Discrete-time survival analysis was used to describe the risks and risk factors for substance use initiation and progression. Results: The risk for initiating use of any substance accelerated in early adolescence and peaked at age 18. The risk for progression from use of alcohol, marijuana, and/or inhalants to the use of other illicit drugs (e.g., cocaine) increased over the first 4.5 years after initiating substance use, then diminished in subsequent years. The risk of substance use initiation and progression varied across the four participating communities and by season of the year. Compared to adolescents who initiated substance use with alcohol only, adolescents who initiated substance use with marijuana or inhalants were more likely to progress to use other illicit drugs. Conclusions: Prevention programs for AI communities should be designed to address these community, age, and seasonal variations in the risks for substance use initiation and progression.

Office of Applied Studies, Division of Population Surveys. Results from the 2005 National Survey on Drug Use and Health: National Findings. NSDUH Series H-30. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (223 Report refs.)

This is the first report based on the 2005 National Survey of Drug Use and Health, an annual survey conducted by the Substance Abuse and Mental Health Services Administration. It is the primary source of information on the use of alcohol, tobacco, and illicit drugs among the US population age 12 and older. The report is organized into nine chapters. Following an initial introduction setting forth the highlights of the report, the first chapter summarizes the nature of the survey, how the data is presented, and other sources of survey data and reports. Chapters 2 through 4 deal with illicit drug use, alcohol use, and tobacco use with data on use patterns by age, gender, racial and ethnic groups, geographic area, employment status, association with other substance use, and relation to driving. Chapter 5 provides data on the initiation of use of the major drug classes. Chapter 6 provides information related to prevention efforts: perceptions of risks associated with use, perceived availability, attitudes toward peers' substance use, parental attitudes toward use, exposures to prevention efforts, and parental involvement. Chapter 7 sets forth information on treatment, risk factors for abuse and dependence, treatment history, and the needs for specialty treatment. Chapter 8 addresses the prevalence of co-occurring psychiatric illness, with discussion of the prevalence of different mental disorders, treatment history in both the adult and adolescent (age 12-17) populations. The concluding chapter discusses trends in substance use among adolescents and young adults. The Report is accompanied by seven appendices, with information on methodology, statistical analysis, references, and selected prevalence tables. Data is presented in 146 figures and tables.

Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Characteristics of Recent Adolescent Inhalant Initiates. Issue 11. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (2 refs.)

This an issue in an min-report in an occasional series focusing on area of data gathered by the annually conducted National Survey of Drug Use and Health. This focuses upon the initiation of inhalant use by adolescents. An average of 598,000 youth between the ages of 12 and 17 had initiated inhalant use in the preceding 12 months between 2002 and 2004. In respect to demographic characteristics, a recent inhalant users were most likely to be aged 14 or 15, be white, and in contrast to the general population, be from a family with an income of 400 percent or more of the poverty level, and less likely to be from families at 120% or less of the poverty level. [Thus, initiation of inhalant use is not primarily associated with the lowest income levels.] The substances most commonly reported being used included glue, shoe polish, toluene, gasoline or lighter fluid, nitrous oxide, and spray paint. Among those who began use in the preceding year, about 20% reported use on 13 or more days. In addition for those who began using inhalants about 60% reported a prior history of nicotine use, drinking alcohol (68%); or using marijuana (42%); or having used all three (36%).

Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Trends in Adolescent Inhalant Use: 2002 to 2007. (March 16, 2009). Rockville MD: Substance Abuse and Mental Health Administration, 2009. (3 refs.)

This issue of "The NSDUH Report" examines trends in the use, dependence or abuse, and initiation of inhalants among adolescents (those ages 12 to 17). The National Survey on Drug Use and Health (NSDUH) defines inhalants as "liquids, sprays, and gases that people sniff or inhale to get high or to make them feel good." NSDUH collects data not only about the use of any inhalant, but also about the use of specific types of inhalants. Respondents who used inhalants were asked when they first used them, and responses to this question were used to identify persons who had initiated use in the 12 months before the survey. Adolescents have easy access to some dangerous substances-ordinary household products such as glue, shoe polish, and aerosol sprays. These products are safe when used as intended, but they can be dangerous and even deadly when sniffed or "huffed" to get high. The percentage of adolescents (i.e., youths aged 12 to 17) who used inhalants in the past year was lower in 2007 (3.9%) than in 2003, 2004, and 2005 (4.5, 4.6, and 4.5%, respectively). Among adolescents who used inhalants for the first time in the past year (i.e., past year initiates), the rate of use of nitrous oxide or "whippits" declined between 2002 and 2007 among both genders (males: 40.2 to 20.2%; females: 22.3 to 12.2%). In 2007, 17.2% of adolescents who initiated illicit drug use during the past year indicated that inhalants were the first drug that they used; this rate remained relatively stable between 2002 and 2007.

Public Domain

Ohannessian CM; Hesselbrock VM. A finer examination of the role that negative affect plays in the relationship between paternal alcoholism and the onset of alcohol and marijuana use. Journal of Studies on Alcohol and Drugs 70(3): 400-408, 2009. (48 refs.)

Objective: This study was designed to separately examine the relations between four fundamental components of negative affect (sadness, fear, guilt, and hostility) and the onset of substance use. An additional goal was to examine the potential mediating roles that these components of negative affect play in the relationship between paternal alcoholism and the initiation of substance use. Method: The sample included 200 adolescents ages 15-19 years (62% girls; 68% white: 56% children of alcoholics [COAs]) and their fathers. The adolescents were followed up 5 years later when they were in early adulthood. Participants completed a clinical psychiatric interview and self-report questionnaires that assessed negative affect and substance use. Results: Results from structural equation modeling indicated that higher levels of hostility and lower levels of guilt were associated with earlier substance-use initiation. In addition, hostility played an indirect role in the relationship between paternal alcoholism and the onset of marijuana use, with COAs reporting higher hostility levels than non-COAs and higher hostility predicting earlier marijuana use. Conclusions: These results underscore the importance of separately examining different components of negative affect when investigating the role that negative affect plays in substance use.

Okoli CTC; Richardson CG; Ratner PA; Johnson JL. Non-smoking youths' "perceived" addiction to tobacco is associated with their susceptibility to future smoking. Addictive Behaviors 34(12): 1010-1016, 2009. (45 refs.)

Smoking initiation places adolescents at risk for adult onset diseases, including heart disease, respiratory illness, and cancer. Adolescents that smoke have levels of 'perceived' tobacco addiction that are associated with several measures of nicotine dependence. Nonsmoking adolescents also report feeling addicted to tobacco even with minimal or no prior tobacco use, suggesting some vulnerability to tobacco use. The purpose of this study was to examine the association between perceived tobacco addiction and smoking susceptibility among adolescents with very minimal tobacco use. A cross-sectional analysis was conducted of data obtained from 5155 nonsmokers who completed the British Columbia Youth Survey of Smoking and Health 11, a school-based survey conducted during 2004. Measures included demographics, tobacco use (ever puffed a cigarette), substance use (marijuana and alcohol), exposure to family members' smoking in the home, peers' tobacco use, depressive symptoms, perceived physical and mental addiction to tobacco, and smoking susceptibility. The adolescents who were most susceptible to smoking were female, younger and in a lower school grade: had ever puffed a cigarette, had used alcohol or marijuana; had family members or peers who smoked; had higher depression scores, and higher perceived physical and mental addiction to tobacco. In multivariate logistic regression analysis, perceived mental addiction but not perceived physical addiction to tobacco was significantly associated with smoking susceptibility. Understanding factors associated with smoking initiation, and ways to identify "at-risk" adolescents can enhance early intervention and prevention programs. Perceived mental addiction to tobacco appears to be an important indicator of smoking susceptibility.

O'Loughlin J; Karp I; Koulis T; Paradis G; DiFranza J. Determinants of first puff and daily cigarette smoking in adolescents. American Journal of Epidemiology 170(5): 585-597, 2009. (65 refs.)

Few prospective studies of smoking initiation have investigated a wide range of time-varying and invariant predictor variables at the individual and contextual levels concurrently. In this study (1999-2005), 877 Canadian students (mean age = 12.7 years) who had never smoked at baseline completed self-report questionnaires on cigarette smoking and 32 predictor variables in 20 survey cycles during secondary school. Height and weight were measured in survey cycles 1, 12, and 19. School administrators completed questionnaires on school tobacco control policies/activities, and trained observers collected data on access to tobacco products in commercial establishments near schools. Younger age, single-parent family status, smoking by parents, siblings, friends, and school staff, stress, impulsivity, lower self-esteem, feeling a need to smoke, not doing well at school, susceptibility to tobacco advertising, alcohol use, use of other tobacco products, and attending a smoking-tolerant school were independent determinants of smoking initiation. Independent determinants of daily smoking onset among initiators of nondaily smoking included smoking by siblings and friends, feeling a need to smoke, susceptibility to tobacco advertising, use of other tobacco products, and self-perceived mental and physical addiction. Adolescent tobacco control programs should address multiple individual and contextual-level risk factors. Strategies that address nicotine dependence symptoms are also needed for adolescents who have already initiated smoking.

O'Loughlin J; Karp I; Koulis T; Paradis G; DiFranza J. Determinants of first puff and daily cigarette smoking in adolescents. American Journal of Epidemiology 170(5): 585-597, 2009. (65 refs.)

Ompad DC; Ikeda RM; Shah N; Fuller CM; Bailey S; Morse E; Collaborative Injection Drug User. Childhood sexual abuse and age at initiation of injection drug use. American Journal of Public Health 95(4): 703-709, 2005. (50 refs.)

Objectives. We examined the relation between childhood sexual abuse and injection drug use initiation among young adult injection drug users. Methods. We used mixed effect linear models to compare age at first injection among 2143 young injection drug users by first sexual abuse age categories. Results. The participants were predominantly male (63.3%) and White (52.8%). Mean age and age at first injection were 23.7 and 19.6 years, respectively; 307 participants (14.3%) reported childhood sexual abuse. After adjustment for gender, race/ethnicity, noninjection drug use before first injection drug use, and recruitment site, childhood sexual abuse was independently associated with younger age at first injection. Conclusions. Childhood sexual abuse was associated with earlier initiation of injection drug use. These data emphasize the need to integrate substance abuse prevention with post victimization services for children and adolescents.

Orlando M; Tucker JS; Ellickson PL; Klein DJ. Developmental trajectories of cigarette smoking and their correlates from early adolescence to young adulthood. Journal of Consulting and Clinical Psychology 72(3): 400-410, 2004. (47 refs.)

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 5,9 14 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.

Ottenbacher KJ; Graham JE; Al Snih S; Raji M; Samper-Ternent R; Ostir GV et al. Mexican Americans and frailty: Findings from the Hispanic Established Populations Epidemiologic Studies of the Elderly. American Journal of Public Health 99(4): 673-679, 2009. (34 refs.)

Objectives. We examined the prevalence of frailty among Mexican American older adults and explored the correlates associated with becoming frail to determine their affect on disability and morbidity in this population. Methods. We studied the trajectory of frailty over 10 years in 2049 Mexican Americans participating in the Hispanic Established Populations Epidemiologic Studies of the Elderly. We constructed a frailty index based on weight loss, exhaustion, grip strength, walking speed, and physical activity and collected data on sociodemographic and health status, comorbidities, and functional measures of performance. Results. The sample was 58% female, with a mean age of 74.43 years (SD=6.04) at baseline. Fifty-five percent of participants at baseline and 75% of the surviving sample at follow-up (n=777) were classified as prefrail or frail. Of persons identified as frail at baseline, 84% died by the end of follow-up. Baseline age, diabetes, arthritis, smoking status, body mass index, cognition, negative affect, and number of comorbid conditions were predictors of frailty at follow-up (R-2=0.29; P<.05). Conclusions. Further research into ways to reduce the number of Mexican American older adults who become frail and disabled and therefore lose their independence is needed. Future studies should continue to examine the trajectory of frailty as a dynamic process that includes psychosocial and cognitive components.

Ozawa M; Washio M; Kiyohara C. Factors related to starting and continuing smoking among senior high school boys in Fukuoka, Japan. Asian Pacific Journal of Cancer Prevention 9(2): 239-245, 2008. (49 refs.)

The purpose of this study was to identify factors that influence starting and quitting smoking among Japanese male adolescents aged 15-18. Two thousand and twelve senior high school boys in Fukuoka City, Japan, answered unsigned self-administrated anonymous questionnaires in July 2001. Odds ratios (ORs) and their 95% confidence intervals (CIs) were computed to assess the strength of associations between students' smoking status and alcohol consumption habits. Additionally, the link between a students' smoking status and parental influence (parental smoking) was also assessed. Approximately 90% of the students, both current and ex-smokers, had ever smoked prior to senior high school while 77% of the students (smokers and non-smokers) had the experience of drinking alcohol prior to admission to senior high school. After adjustment for school year (i.e., freshman, sophomore, junior, senior), academic education level, after-school club activities, time of first drinking experience and the frequency of drinking, there was a significant increased risk to become a smoker when one parent is a smoker (OR = 1.67, 95% CI = 1.18-2.37) or when both parents are smokers (OR = 2.94, 95% CI = 1.66-5.18) compared to both parents being non-smokers. The consumption of alcohol prior to entering senior high school was significantly associated with more than 2.5-fold greater risk for the onset of smoking when compared to the risk of becoming a smoker when alcohol consumption started after entering senior high school. An increased frequency of drinking was also associated with starting smoking (OR = 14.00, 95% CI = 8.08-24.26; 2-3 times/week vs. never). Similarly, an increase in drinking frequency resulted in less likelihood of smoking cessation. For instance, the data showed that, the subjects were 1/3 less likely to quit smoking. Paternal smoking had a significant impact on whether or not a child would quit smoking (OR = 0.55, 95% CI = 0.38-0.81) as compared to a child that had paternal and maternal non-smokers. This study suggested that drinking habits started earlier than smoking habits among adolescents. Many students had already experienced drinking before admission to senior high school, while the experience of smoking mostly typically started after admission to high school. These data show the urgency of developing anti-smoking educational programs that could be developed and introduced prior to admission to high school.

Park S; Weaver TE; Romer D. Predictors of the transition from experimental to daily smoking among adolescents in the United States. Journal for Specialists in Pediatric Nursing 14(2): 102-111, 2009. (38 refs.)

This study examined factors affecting the transition from experimental smoking at baseline to two types of daily smoking, temporary daily smoking, and continued daily smoking, at 1-year follow-up. This study analyzed data from the National Longitudinal Study of Adolescent Health (n = 4,903 U.S. adolescents). Baseline predictors were selected based on Problem Behavior Theory. Important problem behavior theory-related predictors of smoking were the number of friends who smoke, academic performance, and alcohol, marijuana, and other illicit drug use. Other significant predictors were age, gender, race, depression, perceived general health, and cigarette availability at home. To prevent teens from progressing to daily smoking, nursing professionals should consider multifaceted factors based on multiple theories.

Patton GC; Coffey C; Carlin JB; Sawyer SM; Lynskey M. Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence. Addiction 100(10): 1518-1525, 2005. (37 refs.)

Aims: To examine the risk posed by cannabis use in young people for tobacco use disorders. Specifically we examined whether cannabis use in non-smokers predicted later initiation of tobacco use and whether cannabis use predicted later nicotine dependence in tobacco users. Design: A 10-year eight-wave cohort study. Setting: State of Victoria, Australia. Participants: A community sample of 1943 participants initially aged 14-15 years. Measuerments Self-report of tobacco and cannabis use was assessed in the teens using a computerized interview assessment and in young adulthood with a CATI assessment. The Fagerstrom Test for Nicotine Dependence was used to define nicotine dependence. Findings: For teen non-smokers, at least one report of weekly cannabis use in the teens predicted a more than eightfold increase in the odds of later initiation of tobacco use (OR 8.3; 95% CI 1.9-36). For 21-year-old smokers, not yet nicotine-dependent, daily cannabis use raised the odds of nicotine dependence at the age of 24 years more than threefold (OR 3.6, 1.2, 10) after controlling for possible confounders, including level of tobacco use and subsyndromal signs of nicotine dependence. Conclusions: Weekly or more cannabis use during the teens and young adulthood is associated with an increased risk of late initiation of tobacco use and progression to nicotine dependence. If this effect is causal, it may be that a heightened risk of nicotine dependence is the most important health consequence of early frequent cannabis use.

Peters RJ; Kelder SH; Prokhorov AV; Meshack A; Agurcia C; Yacoubian G et al. Beliefs and social norms about smoking onset and addictions among urban adolescent cigarette smokers. Journal of Psychoactive Drugs 37(4): 449-453, 2005. (23 refs.)

Cigarette smoking is a behavior which is most often developed during adolescence. The association between smoking onset and nicotine addiction has not been clearly established among ethic minorities. To better understand this relationship, this study used a qualitative approach to investigate relevant beliefs and norms associated with cigarette smoking initiation and development of nicotine addiction among 52 high school students who identified themselves as current smokers. In general, it was found that both boys and girls believed nicotine addiction starts during an individual's initial cigarette smoking event. The majority of both groups reported that their second smoking event was initiated during the same or next day after their first event. In addition, this research confirmed that friends and siblings who use tobacco are strong reinforcers in youth smoking initiation.

Pierce JP; Distefan JM; Kaplan RM; Gilpin EA. The role of curiosity in smoking initiation. Addictive Behaviors 30(4): 685-696, 2005. (31 refs.)

Context: Although advertising theories have long viewed curiosity as an intermediate goal to encouraging consumption of a product among previous nonusers, this variable is rarely discussed in psychological theories and its role in smoking uptake has not been addressed adequately. Design and setting: Using a longitudinal design, in 1999, we reinterviewed 12- to 15-year-old adolescent never smokers (N=2119; 970 committed never smokers, 1199 susceptible never smokers) 3 years after they responded to a population survey on tobacco use in California. Results: Logistic regression showed curiosity and susceptibility to smoke were independently associated with increased future smoking in all never smokers. Committed never smokers reporting curiosity were more likely to become susceptible by follow-up than those not curious. A multivariate analysis of committed never smokers from the cross-sectional survey identified best friends who smoke and receptivity to tobacco advertising and promotions as associated with curiosity. Conclusions: Curiosity may be a critical precursor to smoking. Future research on smoking initiation should examine curiosity and investigate factors influencing it.

Pokorny SB; Jason LA; Schoeny ME. The relation of retail tobacco availability to initiation and continued smoking. Journal of Clinical Child and Adolescent Psychology 32(2): 193-204, 2003. (55 refs.)

Used an ecological analysis employing multilevel random-effects regression analyses to model Level 1 (individual and social) and Level 2 (environmental) correlates of smoking initiation and continued smoking among 6th-, 7th-, and 8th-grade students. Data from 5,234 youth in 11 Midwestern communities were examined. Results indicate higher levels of retail tobacco availability (RTA) were associated with increased odds that a youth initiated smoking but not continued smoking. Among the Level 1 factors, youth who were older, male, had an adult tobacco user in the home, and had more peers who use tobacco had increased odds of initiating smoking. In contrast, only the presence of an adult tobacco user in the home and the number of peers who use tobacco were associated with increased odds that a youth continued smoking. Examining individual, social, and environmental factors simultaneously provides a clearer and more accurate model of these complex ecological influences.

Prinz RJ; Kerns SEU. Early substance use by juvenile offenders. Child Psychiatry & Human Development 33(4): 263-277, 2003. (20 refs.)

Although the interconnection between delinquency and substance use in adolescence is well documented, considerably less is known about substance-use initiation in childhood for juvenile delinquent populations. This descriptive study examined early substance initiation in childhood as reported by adolescents who were incarcerated for juvenile offenses (93 males, 96 females; 58% African American, 42% European American). Youth were individually interviewed using an adapted version of substance-related questions from the National Household Survey. Juvenile justice system records were reviewed to characterize offense histories. A majority of males and females reported using at least one substance (other than cigarettes) such as alcohol, marijuana, or inhalants by age 13. Alcohol use reportedly occurred by age 10 for 17% of the youth. For a substantial portion, early initiation turned into frequent early use. For example, 32% of the males and 39% of the females reported drinking alcoholic beverages at a frequency of several times per month or greater by age 13. Limited evidence related early substance initiation with subsequent substance abuse. Offense status was related to early substance initiation for females but not males. The study provided clear evidence that very early substance use is a significant problem among youth who end up in the juvenile justice system and that we need to find out more about the environmental and social variables affecting very early substance initiation.

Rhee SH; Hewitt JK; Young SE; Corley RP; Crowley TJ; Stallings MC. Genetic and environmental influences on substance initiation, use, and problem use in adolescents. Archives of General Psychiatry 60(12): 1256-1264, 2003. (43 refs.)

Background: We conducted a sibling/twin/adoption study of substance initiation, use, and problem use, estimating the relative contribution of genetic and environmental influences on these phenotypes in adolescents. Methods: The participants were 345 monozygotic twin pairs, 337 dizygotic twin pairs, 306 biological sibling pairs, and 74 adoptive sibling pairs assessed by the Colorado Center for the Genetics and Treatment of Antisocial Drug Dependence, Denver and Boulder. The initiation, use, and problem use of tobacco, alcohol, marijuana, and other illicit drugs were assessed. Tetrachoric correlations were computed for each group, and univariate model-fitting analyses were conducted. Results: There were moderate to substantial genetic influences, with the exception of alcohol use and any drug use, and modest to moderate shared environmental influences on substance initiation, use, and problem use. For alcohol and any drug, heritability was higher and the magnitude of shared environmental influences was lower for problem use than for initiation or use. Environmental influences shared only by twin pairs had a significant effect on tobacco initiation, alcohol use, and any drug use. For tobacco use, tobacco problem use, and marijuana initiation, heritability was higher and the magnitude of shared environmental influences was lower in female than in male adolescents. There was no evidence for sex-specific genetic or shared environmental influences on any variable. Conclusions: The moderate to substantial heritabilities found for adolescents in the present study are comparable to those found in twin studies of adult substance use and substance use disorders. The finding that problem use is more heritable than initiation and use is also consistent with the results of adult twin studies. The significance of environmental influences shared only by twin pairs on tobacco initiation, alcohol use, and any drug use suggests the influences of peers, accessibility of substances, and sibling interaction.

Ribeiro SN; Jennen-Steinmetz C; MH; Becker K. Nicotine and alcohol use in adolescent psychiatric inpatients: Associations with diagnoses, psychosocial factors, gender and age. Nordic Journal of Psychiatry 62(4): 315-321, 2008. (49 refs.)

The aim of the survey was to describe the proportion of smokers and alcohol users in a group of children and adolescents admitted to a German department of child and adolescent psychiatry and psychotherapy. In addition, the proportion of smokers in this group of patients was compared with the proportion in the general population of the same age. The sample was composed of all children and adolescent inpatients (n = 432, 8-17 years old meeting inclusion criteria) admitted to a German department of child and adolescent psychiatry between May 2001 and June 2003. A shortened adaptation of the questionnaire on legal and illegal drug use, developed by the Swiss Professional Service for Alcohol Problems, Lausanne, was used. Initiation, frequency and quantity of drug use, and parental substance use were assessed. The results showed an association between conduct disorder (CD) and attention-deficit/hyperactivity disorder (ADHD) and an early initiation of nicotine and alcohol use. Girls and boys with CD and ADHD were significantly more likely to be involved in higher levels of nicotine use compared with the general population. Parental nicotine use was associated with smoking in girls, while maternal nicotine use was associated with smoking in boys. Furthermore, regular alcohol use in both girls and boys was associated with nicotine use. To conclude, early initiation and elevated rates of nicotine and alcohol use are a particular risk for adolescents with CD and ADHD.

Roy E; Haley N; Leclerc P; Boudreau JF; Boivin JF. Risk factors for initiation into drug injection among adolescent street youth. Drugs: Education, Prevention and Policy 14(5): 389-399, 2007. (45 refs.)

Young injectors are a group with high-risk behaviours, particularly with respect to HIV infection and hepatitis C. A leading strategy to prevent these infections could be the prevention of injection, especially among the youngest individuals. We report analyses on initiation into drug injection from a prospective cohort study of street youth conducted in Montreal, Canada. Among 118 non-injector participants under 18 years of age followed for an average of 1.31 years, we estimated an incidence rate of injection of 22.7 per 100 person-years. Independent predictors of initiation were: a lifetime history of use of >= 4 types of drugs, recent daily alcohol drinking, a recent episode of homelessness, a lifetime history of rape, and recent involvement in survival sex. The observed high rate of initiation into injection clearly indicates that interventions to prevent injection should target especially adolescent street youth. These interventions should address simultaneously individual and structural factors, such as substance abuse and living conditions.

Sargent JD; Gibson J; Heatherton TF. Comparing the effects of entertainment media and tobacco marketing on youth smoking. Tobacco Control 18(1): 47-53, 2009. (46 refs.)

Objectives: To examine the concurrent effects of exposure to movie smoking and tobacco marketing receptivity on adolescent smoking onset and progression. Methods: Cross-sectional study of 4524 northern New England adolescents aged 10-14 in 1999 with longitudinal follow-up of 2603 baseline never-smokers. Cross-sectional outcomes included ever tried smoking and higher level of lifetime smoking among 784 experimenters. The longitudinal outcome was onset of smoking among baseline never-smokers two years later. Movie smoking exposure was modelled as four population quartiles, tobacco marketing receptivity included two levels having a favourite tobacco advert and wanting/owning tobacco promotional items. All analyses controlled for sociodemographics, other social influences, personality characteristics of the adolescent and parenting style. Results: In the full cross-sectional sample, 17.5% had tried smoking; both exposure to movie smoking and receptivity to tobacco marketing were associated with having tried smoking. Among experimental smokers, the majority (64%) were receptive to tobacco marketing, which had a multivariate association with higher level of lifetime smoking (movie smoking did not). In the longitudinal study 9.5% of baseline never-smokers tried smoking at follow-up. Fewer never-smokers (18.5%) were receptive to tobacco marketing. Movie smoking had a multivariate association with trying smoking (receptivity to tobacco marketing did not). Conclusions: The results suggest separate roles for entertainment media and tobacco marketing on adolescent smoking. Both exposures deserve equal emphasis from a policy standpoint.

Sherman SG; Fuller CM; Shah N; Ompad DV; Vlahov D; Strathdee SA. Correlates of initiation of injection drug use among young drug users in Baltimore, Maryland: The need for early intervention. Journal of Psychoactive Drugs 37(4): 437-443, 2005. (23 refs.)

This article examines individual and social factors associated with initiation of illicit drug injection, with a focus on racial differences. Data were derived from across-sectional survey of young injection and noninjection drug users in Baltimore, Maryland. Participants were aged 15 to 30 and had initiated use of heroin, cocaine, and/or crack within the prior five years. Bivariate and multivariate logistic regression models were used to identify correlates of injection initiation. Of 579 drug users, 73% were injectors, 56% were male, and 41% were African American. In a multivariate model controlling for age, correlates of injection initiation were: being an African American male [Adjusted Odds Ratio (AOR): 0.08; 95% Confidence Interval (Cl): 0.04, 0.17] or female (AOR = 0.12; 95%CI: 0.06,0.27) compared to being a White male; younger age of first use of alcohol, marijuana, or inhalants (AOR=0.73; 95%CI: 0.65,0.82); shorter time between first use of alcohol, marijuana, or inhalants and first use of heroin, crack, or cocaine (per year decrease, AOR=0.63, 95%CI: 0.40, 0.87); parental drug use (AOR=0.54, 95%CI: 0.32, 0.92); seeing someone inject prior to injection, AOR=1.96, 95%CI: 1.01, 3.50); and crack smoking (AOR=1.77, 95%CI: 1.07, 2.99). Early drug use patterns and drug exposure factors are associated with initiation injection. Interventions are needed that target noninjection drug users to prevent transition to injection drug use.

Sichletidis LT; Chloros DA; Tsiotsios AI; Spyratos DG. Prevalence and risk factors for initiation of smoking in Greek high-school students. International Journal of Environmental Research and Public Health 6(3): 971-979, 2009. (25 refs.)

The smoking habits of 9,276 high-school students (15-18 years old) in six cities of Northern Greece were studied using a questionnaire in order to determine the prevalence and possible risk factors for initiation of smoking. We observed that 29.6% of high-school students (32.6% of boys and 26.7% of girls) were current smokers. A percentage of 43.3% had started smoking before the age of 14. Reactive behaviour towards parents' and teachers' advice (40.2%) and the existence of smoking friends (40.1%) were the main reasons of initiation. A well-planned integrated anti-smoking campaign is urgently required, especially among students and teachers.

Simons-Morton B. Prospective association of peer influence, school engagement, drinking expectancies, and parent expectations with drinking initiation among sixth graders. Addictive Behaviors 29(2): 299-309, 2004. (30 refs.)

Early initiation of drinking increases the lifetime risk for substance abuse and other serious health and social problems. An understanding of the predictors of early initiation is needed if successful preventive interventions are to be developed. Surveys were completed by 1009 sixth grade students at the beginning (Time 1) and end (Time 2) of the school year in four schools in one suburban school district. At Time 1, 55/1009 (5.5%) reported drinking in the past 30 days. From Time 1 to Time 2, the percentage of drinkers increase to 127/1009 (10.9%) of whom 101 were new drinkers. In multiple logistic regression analyses, school engagement was negatively associated and peer influence and drinking expectancies were positively associated with drinking initiation. A significant interaction was found between drinking expectancies and parental expectations. Among sixth graders with high drinking expectancies, those with low parental expectations for their behavior were 2.6 times more likely to start drinking than those with parents with high expectations for their behavior. Positive drinking expectancies were significantly associated with drinking initiation only among teens who believed their parents did not hold strong expectations for them not to drink. This finding held for boys and girls, Blacks and Whites and was particularly strong for Black youth. This finding provides new information about the moderating effect of parental expectations on drinking expectancies among early adolescents.

Spoth R; Redmond C; Shin C; Azevedo K. Brief family intervention effects on adolescent substance initiation: School-level growth curve analyses 6 years following baseline. Journal of Consulting and Clinical Psychology 72(3): 535-542, 2004. (32 refs.)

This study examines the effects of 2 brief family-focused interventions on the trajectories of substance initiation over a period of 6 years following a baseline assessment. The 2 interventions, designed for general-population families of adolescents, were the 7-session Iowa Strengthening Families Program (ISFP) (Molgaard & Spoth, 2001) and the 5-session Preparing for the Drug Free Years Program (PDFY) (Catalano, Kosterman, Haggerty, Hawkins, & Spoth, 1999). Thirty-three rural public schools were randomly assigned to the ISFP, the PDFY, or a minimal-contact control condition. The authors evaluated the curvilinear growth observed in school-level measures of initiation using a logistic growth curve analysis. Alcohol and tobacco composite use indices -- as well as lifetime use of alcohol, cigarettes, and marijuana-and lifetime drunkenness, were examined. Significant intervention-control differences were observed, indicating favorable delays in initiation in the intervention groups.

Spoth R; Redmond C; Shin C; Greenberg M; Clair S; Feinberg M. Substance-use outcomes at 18 months past baseline: The PROSPER community-university partnership trial. American Journal of Preventive Medicine 32(5): 395-402, 2007. (48 refs.)

Background: The study's objective was to examine the effects of "real-world," community-based implementation of universal preventive interventions selected from a menu, including effects specific to higher- and lower-risk subsamples. Design: School districts were selected based on size and location, and then randomly assigned to a control condition or to an experimental condition in a cohort sequential design. Setting/Participants: The study included 28 public school districts in Iowa and Pennsylvania that were located in rural towns and small cities, ranging in size from 6975 to 44,510. Sixth and seventh graders in these school districts participated in the study. Intervention: Community teams were mobilized; each team implemented one of three evidence-based, family-focused interventions (5 to 12 sessions) and one of three evidence-based school interventions (11 to 15 sessions), for 6th and 7th graders, respectively. Observations showed that interventions were implemented with fidelity. Main Outcomes Measures: Outcomes included student reports of past month, past year, and lifetime use of alcohol, cigarettes, marijuana, methamphetamines, ecstasy, and inhalants, as well as indices of gateway and illicit substance initiation, at pretest and at a follow-up assessment 18 months later. Results: Intent-to-treat analyses demonstrated significant effects on substance initiation (marijuana, inhalants, methamphetamines, ecstasy, gateway index, illicit-use index), as well as past-year use of marijuana and inhalants, with positive trends for all substances measured. For three outcomes, intervention effects were stronger for higher-risk students than lower-risk students. Conclusions: Community-based implementation of brief universal interventions designed for general populations has potential for public health impact by reducing substance use among adolescents.

Storr CL. Characteristics associated with rapid transition to tobacco dependence in youth. Nicotine & Tobacco Research 10(6): 1099-1104, 2008. (25 refs.)

Epidemiologic data suggests the smoking trajectory for some adolescents escalates rapidly and that tobacco dependence can develop quickly after initiation. In this study, we examine variation in cigarette consumption and individual characteristics associated with the rapid development of tobacco dependence, focusing particularly on the 24-month interval after tobacco initiation. The analysis is based on public use data files of the National Household Survey on Drug Abuse conducted in 1994-1996. Representative samples of adolescents aged 12-17 years old, totaling 13,831, completed a standardized interview assessing demographic characteristics, tobacco involvement and past year dependence, and psychological functioning over the preceding 6-month period as assessed by the Youth Self-Report. Analyses were restricted to the 1,734 youth who had started smoking within 0-24 months prior to being assessed, of which the onset for 70% of them was between 11-24 months. Logistic regression models took into account sample weights and used a variance estimation procedure appropriate for the complex multistage sampling design. Overall, 210 recent initiators met dependence criteria (13.5%, 95% CI=12.0-15.2). Dependent smokers had greater cigarette involvement than youth who had not transitioned to being tobacco dependent by the time of assessment. Variation in mental health and sociodemographic characteristics were also detected. Disruptive behavior (p=.05) and being female (p=.02) were associated with being tobacco dependent. The rapid transition to dependence in youth depends not only on cigarette consumption features, but may also be associated with individual characteristics.

Sun P; Unger JB; Sussman S. A new measure of smoking initiation and progression among adolescents. American Journal of Health Behavior 29(1): 3-11, 2005. (25 refs.)

Objective: To develop a new measure of smoking initiation and progression among adolescents. Method. This study used data from 2504 regular and alternative high school students to evaluate the psychometric properties of a new 3-item, 5-stage measure of smoking initiation and progression. Results: The categorization method showed good 4-week test-retest reliability (.83 among boys and.87 among girls). The demographic distribution of adolescents into stages was consistent with previous research. Conclusion: This 5-stage classification method could be a useful framework for describing variation along the smoking uptake and progression continuum.

Taylor CR; Bonner PG. Comment on "American media and the smoking-related behaviors of Asian adolescents." (editorial). Journal of Advertising Research 43(4): 419-430, 2003. (83 refs.)

In the March 2003 issue of the Journal of Advertising Research, Marvin Goldberg suggests that correlations found in his study correspond with findings of other studies and, hence, suggest a causal relationship between exposure to cigarette advertising (as well as promotional items and American movies) and the smoking-related behaviors of Hong Kong adolescents. In an earlier comment, Robert Reitter pointed out that the study provides no evidence of causality. We point out additional methodological flaws including inappropriate reclassification of data, the need to consider potential sources of bias, and lack of internal consistency of reported data. Additionally, the design of the study does not allow for a test of the proposed theories. We note that the study cites only literature that supports the author's views on the effects of cigarette advertising. The weight of the evidence from the academic literature suggests that (1) advertising does not play a significant role in smoking initiation; (2) advertising does not increase primary demand for cigarettes; and (3) advertising bans do not appear to reduce demand for cigarettes in mature markets.

Tercyak KP; Rodriguez D; Audrain-McGovern J. High school seniors' smoking initiation and progression 1 year after graduation. American Journal of Public Health 97(8): 1397-1398, 2007. (23 refs.)

We explored cigarette smoking prevalence rates in former high school seniors 1 year after graduation and found that among 12th grade never smokers, 25% initiated smoking, and among 12th grade ever smokers, 39% increased their cigarette use. Alcohol use in 12th grade, along with not attending college, were both positively related to smoking progression. Risk for smoking initiation does not end at adolescence, and the public health community must continue tobacco control initiatives throughout adolescence and young adulthood.

Thomson CC; Hamilton WL; Siegel MB; Biener L; Rigotti NA. Effect of local youth-access regulations on progression to established smoking among youths in Massachusetts. Tobacco Control 16(2): 119-126, 2007. (40 refs.)

Objective: To test whether community-level restrictions on youth access to tobacco (including both ordinances and enforcement) are associated with less smoking initiation or less progression to established smoking among adolescents. Design: Prospective cohort study of a random sample of adolescents in Massachusetts whose smoking status was assessed by telephone interviews at baseline and 2-year follow-up, and linked to a state-wide database of town-level youth-access ordinances and enforcement practices. Participants: A random sample of 2623 adolescents aged 12-17 years who lived in 295 towns in Massachusetts in 2001-2 and were followed in 2003-4. Main outcome measures: The relationship between the strength of local youth access restrictions (including both ordinances and level of enforcement) and (1) never-smokers' smoking initiation rates and (2) experimenters' rate of progression to established smoking was tested in a multilevel analysis that accounted for town-level clustering and adjusted for potential individual, household and town-level confounders. Results: Over 2 years, 21% of 1986 never-smokers initiated smoking and 25% of 518 experimenters became established smokers. The adjusted odds ratio (OR) for smoking initiation was 0.89 (95% CI 0.61 to 1.31) for strong versus weak youth-access policies and 0.93 (95% CI 0.67 to 1.29) for medium versus weak policies. The adjusted OR for progression to established smoking among adolescents who had experimented with smoking was 0.79 (95% CI 0.45 to 1.39) for strong versus weak local smoking restrictions and 0.85 (95% CI 0.50 to 1.45) for medium versus weak restrictions. Conclusions: This prospective cohort study found no association between community-level youth-access restrictions and adolescents' rate of smoking initiation or progression to established smoking over 2 years.

Titus JC; Godley SH; White MK. A post-treatment examination of adolescents' reasons for starting, quitting, and continuing the use of drugs and alcohol. Journal of Child & Adolescent Substance Abuse 16(2): 31-49, 2006. (36 refs.)

Qualitative data from 923 adolescents treated in outpatient and residential settings were used to create taxonomies of their reasons for starting, continuing, and quitting use of drugs and alcohol. Three raters independently categorized reasons by dominant theme. The final sets of taxonomies were defined within several iterations and the raters' use of the categories showed strong inter-rater agreement. Frequencies of reasons were examined overall and by level of care. Adolescents reported initiating use due largely to experimentation and peer influence, continuing use due to liking the effects and assistance with coping, and quitting due to negative appraisals and effects. Reasons differed by level of care.

van den Bree MBM; Pickworth WB. Risk factors predicting changes in marijuana involvement in teenagers. Archives of General Psychiatry 62(3): 311-319, 2005. (84 refs.)

Background: Marijuana use during adolescence has various adverse psychological and health outcomes. It is poorly understood whether the same risk factors influence different stages of marijuana involvement. Objective: To establish which risk factors best explain different stages of marijuana involvement. Design: Data were collected at 2 points using computer-assisted personal interview (wave I and wave 2 were separated by I year). Twenty-one well-established risk factors of adolescent substance use/abuse were used to predict 5 stages of marijuana involvement: (1) initiation of experimental use, (2) initiation of regular use, (3) progression to regular use, (4) failure to discontinue experimental use, and (5) failure to discontinue regular use. Data were analyzed- using logistic regression analysis. Participants: Middle school and high school students (N = 13 718, aged 11-21 years) participating in the National Longitudinal Study of Adolescent Health (Adol Health). Results: Three risk factors (own and peer involvement with substances, delinquency, and school problems) Were the strongest predictors of all stages. Their combined presence greatly increased risk of initiation of experimental (odds ratio, 20) and regular (odds ratio, 87) marijuana use over the next year. Personality, family, religious, and pastime factors exerted stage-specific, sex-specific, and age-specific influences. Conclusions: Assessment of substance, school, and delinquency factors is important in identifying individuals at high risk for continued involvement with marijuana. Prevention and/or intervention efforts should focus on these areas of risk.

van Lier PAC; Huizink A; Crijnen A. Impact of a preventive intervention targeting childhood disruptive behavior problems on tobacco and alcohol initiation from age 10 to 13 years. Drug and Alcohol Dependence 100(3): 228-233, 2009. (57 refs.)

The distal impact of a school based universal preventive intervention targeting disruptive behavior problems on tobacco and alcohol use from age 10 to 13 years was explored. Second grade classrooms (children aged 7 years) were randomly assigned to the intervention or a control condition. Tobacco and alcohol use from age 10 to 13 years was available for 477 children (72% of original sample). The impact of intervention on the initial level and growth in probability of substance use was explored. Results showed that intervention children had lower probabilities of tobacco use over the ages 10-13 years. This effect remains significant when controlling for (male) sex, pre-intervention levels of conduct problems, exposure to prenatal smoking or current parental smoking. For alcohol use, no effect of intervention during childhood was found. However, intervention children reported having a lower probability in alcohol use with age among those children reporting having used in the last week. The results underscore the importance of the early prevention of disruptive behavior problems substance use initiation. Implications for prevention and research are discussed.

van Ours JC; Williams J. Why parents worry: Initiation into cannabis use by youth and their educational attainment. Journal of Health Economics 28(1): 132-142, 2009. (26 refs.)

In this paper we use individual level data from the Australian National Drug Strategy Household Survey to study the relationship between initiation into cannabis use and educational attainment. Using bivariate duration analysis we find that those initiating into cannabis use are much more likely to dropout of school, and that the reduction in years of education depends on the age at which initiation into cannabis occurs. We also find that the impact of cannabis uptake is larger for females than males.

Vaughn MG; Howard MO; Foster KA; Dayton MK; Zelner JL. Substance use in a state population of incarcerated juvenile offenders. IN: Hilarski C, ed. Addiction, Assessment, and Treatment with Adolescents, Adults, and Families. New York: Haworth Social Work Practice Press, 2005. pp. 155-174. (29 refs.)

This study examined the prevalence and patterns of illicit drug use among a state population of 723 incarcerated juvenile offenders. In addition to alcohol and marijuana, results indicated high rates of illicit substance use involving a wide range of substances, including amphetamines, opiate drugs, prescription drugs, and solvents. Further, significant gender and ethnic differences were observed with regard to alcohol and drug related problems, suicidal ideation, and age of substance use initiation.

Verkooijen KT; De Vries N; Nielsen GA. Youth crowds and cigarette smoking: A prospective study. Addiction Research & Theory 17(3): 333-342, 2009. (25 refs.)

This study examined the prospective relationship between crowd affiliation and smoking behavior among a national sample of 16-22 year old Danes (N = 952). Self-reported data were collected by means of a postal questionnaire at baseline and at 18 months follow-up. The sample included participants, who at baseline reported to identify with a crowd with either a low-smoking norm (n = 705) or a high-smoking norm (n = 247). The results showed that participants, who at baseline identified with a crowd with a high-smoking norm were compared to those, who identified with a low-smoking norm crowd, more likely to have started smoking at time of the follow-up (OR = 2.15). Further, discordance between one's behavior and the norm of the crowd resulted more often in a change in smoking behavior (OR = 2.00) and crowd identification (OR = 2.15) than the absence of such discordance. The results confirm the importance of crowds in smoking initiation and call for more attention to this issue in smoking prevention.

Vieira DL; Ribeiro M; Laranjeira R. Evidence of association between early alcohol use and risk of later problems. Revista Brasileira de Psiquiatria 29(3): 222-227, 2007. (33 refs.)

Objective: To investigate the relationship between age of onset, alcohol consumption patterns and related problems. Method: In 2004, one self-administered questionnaire was completed by 1, 990 students from the 5(th) to 11(th) grades of schools in Paulinia-SP Data collection was conducted at the classroom without the presence of the teacher The participation in the study was voluntary and anonymous. Results: Prevalence of lifetime alcohol use was 62.2%. The mean age of first use of alcohol was 12.35 (sd = 2.72) and ranged between 5 and 19 years of age. In 78% of the cases, the first use occurred before the age of 15, and more than 22% of the students reported having tried alcohol before 10 years of age. There were significant differences regarding current pattern of use: those who started earlier consumed more drinks per occasion (p = 0.013) and had more drunkenness episodes in the last 30 days (p = 0.05). A relationship between the age of first alcohol use and the use of tobacco (p = 0.017) and other drugs (p = 0.047) was observed. Conclusions: Adolescents first use alcohol in early ages, what impacts the current consumption patterns. This study emphasizes the need of actions regarding public alcohol policies in Brazil in order to prevent or delay the initiation of alcohol use and its related problems.

Wagner FA; Velasco-Mondragon HE; Herrera-Vazquez M; Borges G; Lazcano-Ponce E. Early alcohol or tobacco onset and transition to other drug use among students in the State of Morelos, Mexico. Drug and Alcohol Dependence 77(1): 93-96, 2005. (24 refs.)

In this study, we explored if patterns in the transition from alcohol/tobacco in the Mexican State of Morelos, Mexico are similar to those observed in other countries. Methods: The data were from a representative sample of youth age 11-21 years (n = 13,105), who participated in a paper-and-pencil survey in middle schools, high schools, and colleges in the State of Morelos, Mexico. Drug use was assess-sed via the standardized instrument mostly used in Mexican student surveys. Cox's models for discrete time-survival analyses, stratified by school and age group were used to estimate the risk of drug use in relation to age of alcohol and tobacco use initiation by gender, while accommodating the complex survey design. Results: About 5% of the students were estimated to have used drugs in their life. Male early users of alcohol or tobacco were more likely to use other drugs, compared to students who did not have an early alcohol or tobacco onset. Comment: Further studies on social mechanisms might help to account for observed similarities in patterns of drug involvement in different countries. even in the context of important differences in rates of drug use.

Warner LA; White HR. Longitudinal effects of age at onset and first drinking situations on problem drinking. Substance Use & Misuse 38(14): 1983-2016, 2003. (91 refs.)

The purpose of this study was to describe aspects of the first alcohol-use experience, and examine the predictive relations among age of first use, context of alcohol use initiation, and problem drinking with and without controls for psychosocial risk factors. Data were from the Rutgers Health and Human Development Project, a five-wave, prospective study of substance-use behaviors in a community sample. Respondents, who were first interviewed at age 12 (1979-81) and most recently at age 30 or 31 (1999-2000) (N=371), reported on their first drinking experience, and on a range of known risk factors for alcohol abuse. Most alcohol initiation occurred during a family gathering. Regardless of initiation context, youth who drank at an early age were more likely than youth who initiated later to become problem drinkers, although the risk was relatively greater for the youth who first drank outside a family gathering. Based on multivariate logistic regressions, feeling drunk at initiation was the only onset-related variable significantly associated with problem drinking; other significant risks factors included male gender, delinquency, and family history of alcoholism. Further research focusing on the subjective effects experienced by youth when they first drink may be merited.

Warner LA; White HR; Johnson V. Alcohol initiation experiences and family history of alcoholism as predictors of problem-drinking trajectories. Journal of Studies on Alcohol and Drugs 68(1): 56-65, 2007. (85 refs.)

Objective: The purpose of this study was to identify developmental trajectories of problem drinking from adolescence into young adulthood and to determine if alcohol use initiation experiences and family history of alcoholism, as well as their interactions, would predict trajectory group membership. Method: Five waves of data were collected from respondents who were 12 years old at the time of recruitment to the Rutgers Health and Human Development Project and followed until age 31 (n = 438). A standardized measure of problem drinking (Rutgers Alcohol Problem Index) was used to develop trajectories with growth-mixture modeling. Differences across groups in first-use experience (age of onset, pleasantness of the experience, and feeling intoxicated), a family history of alcoholism, and gender were analyzed with chi-square and analysis of variance tests, and logistic regression analyses were used to estimate the odds of group membership. Results: Three trajectory groups of drinkers were identified: no or low problem (66.2%), adolescence-limited problem (ALP; 21.6%), and escalating problem (EP; 12.1%) drinkers. Age at drinking onset, feeling drunk during the first alcohol experience, and family history of alcoholism were associated with significantly greater odds of being in a problem trajectory group relative to the no or low problem trajectory. Early experiences did not differentiate the ALP and EP trajectories. None of the interactions was significantly associated with membership in any of the groups. Conclusions: The levels and patterns of problem drinking during early to mid-adolescence point to a need for secondary prevention efforts that target problematic users in addition to the current emphasis on primary prevention of alcohol consumption. Prevention-based research may benefit from special focus on the meaning and consequences of self-perception of drunkenness when alcohol is first used.

Weiss JW; Merrill V; Gritz ER. Ethnic variation in the association between weight concern and adolescent smoking. Addictive Behaviors 32(10): 2311-2316, 2007. (13 refs.)

This study examined differences in associations between weight concern and smoking initiation among culturally diverse adolescents. Statistical analyses were conducted on responses from 3515 students in the 8th and 9th grades from three school districts in Los Angeles County. The restrained eating scale, adapted from the Dutch Eating Behavior Questionnaire, was used to measure students' weight concerns. Our results indicated that weight concern was significantly associated with increased risk for smoking. Those who scored higher on weight concern were approximately 40% more likely to report having tried smoking and smoked in the past 30 days. Compared to White students who reported weight concerns, Asian-American and African-American students were significantly less likely to report having tried smoking whereas Hispanic students were more likely to report having tried smoking. Health educators may wish to design smoking prevention programs which advocate for alternative methods of weight reduction rather than using smoking as a means of weight control.

Wittchen HU; Behrendt S; Hofler M; Perkonigg A; Lieb R; Buhringer G et al. What are the high risk periods for incident substance use and transitions to abuse and dependence? Implications for early intervention and prevention. International Journal of Methods in Psychiatric Research 17(Special Issue 1): s16-s29, 2008. (43 refs.)

Background: For a better understanding of the evolution of addictive disorders and the timely initiation of early intervention and prevention, we have to learn when and how quickly the critical transitions from first substance use (SU) to regular use and from first SU and regular SU to abuse and dependence occur. Little data are currently available on the transitions to substance use disorders (SUDs) across the spectrum of legal and illegal drugs taking into account gender differences. It is the aim of this paper to describe the high density incidence and transition periods of SU and SUD for alcohol, nicotine, cannabis and other illicit drugs for young males and females. Methods: A sample of (N = 3021) community subjects aged 14-24 at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI. Results: Ages 10-16 are the high risk period for first alcohol and nicotine use (up to 38% of subjects start before age 14). Onset of illegal SU occurs later. Substantial proportions of transitions to regular SU and SUD occur in the first three years after SU onset. Only few gender differences were found for time patterns of SU/SUD incidence and transition. Conclusion: Except for alcohol the time windows for targeted intervention to prevent progression to malignant patterns in adolescence are critically small, leaving little time for targeted intervention to prevent transition. The fast transitions to abuse and dependence in adolescence may be indicative for the increased vulnerability to substance effects in this time period. Basic research on the determinants of transitions should thus target this period in adolescence.

Yen CF; Yang YH; Ko CH; Yen JY. Substance initiation sequences among Taiwanese adolescents using methamphetamine. Psychiatry and Clinical Neurosciences 59(6): 683-689, 2005. (33 refs.)

The aim of this study was to examine substance initiation sequences in Taiwanese adolescent methamphetamine (MAMP) users. Three hundred adolescent MAMP users were questioned about their use of cigarettes, alcohol, areca quid, benzodiazepine, glue, marijuana, MAMP and heroin. The sequences of substance use before MAMP use were determined in every subject according to their age at substance initiation. The sequences of substance initiation were compared between genders and between early-onset and late-onset MAMP users. The results revealed that the adolescents had used cigarettes, alcohol and areca quid before MAMP, and very few (4%) adolescents had started using MAMP before using other substances. Female MAMP users were more likely to use MAMP as their first substance and were less likely to use areca quid than males. Male early-onset MAMP users were more likely to drink alcohol and chew areca quid before MAMP use than were late-onset users. This study found that the sequences of substance initiation were different between genders and between the early-onset and late-onset MAMP users. There are several findings that are different from those in Western studies on the sequence of substance initiation in the adolescent population.

Zakrajsek JS; Shope JT. Longitudinal examination of underage drinking and subsequent drinking and risky driving. Journal of Safety Research 37(5): 443-451, 2006. (35 refs.)

Introduction: Alcohol use, alcohol misuse, and risky driving from adolescence into young adulthood were compared by drinking onset age. Methods: Surveys were administered in Grades 5/6, 6/7, 7/8, 10, 12, and at approximately age 23. Participants were placed into Drinking Onset groups based on self-reported alcohol use frequency on the adolescent surveys. Driving records were examined in three age periods: under 21, 21-25, and 26+. Results: The earliest drinking initiators reported higher alcohol use and misuse on each survey, and were more likely to have risky driving offenses before age 21 and to have alcohol driving offenses in all three age periods. Discussion: The earliest drinking initiators engaged in risky drinking behavior and risky driving behavior that was consistently higher than those with later drinking initiation, beginning in adolescence and persisting well into young adulthood.

Zimmerman DM; Sehnert SS; Epstein DH; Pickworth WB; Robinson ML; Moolchan ET. Smoking topography and trajectory of asthmatic adolescents requesting cessation treatment. Preventive Medicine 39(5): 940-942, 2004. (16 refs.)

Background. Teenage smokers cite health concerns as their primary motivators for tobacco smoking cessation. Smoke exposure aggravates the clinical course of asthma, yet few reports have examined the association between asthma and smoking topography and trajectory. Methods. Before their enrollment in a smoking cessation trial, we assessed the smoking topography (i.e., puff volume, maximum puff velocity, puff duration, and interpuff interval) and smoking trajectory (i.e., age of first cigarette, age of daily smoking, time to treatment request, and prior quit attempts) in 30 self-reported asthmatic and 92 nonasthmatic tobacco-dependent teenagers (mean age, 15.2 plus or minus 1.3 years, 28.7% African-American). Approximately one-half of asthmatics used prescribed medications for their asthma. Results. There was no significant difference in smoking topography or smoking trajectory variables between asthmatic and nonasthmatic adolescents, nor between medicated and nonmedicated asthma subgroups. Conclusions. Although tobacco smoking exacerbates asthmatic symptoms, these data suggest that age of smoking initiation, as well as smoking topography characteristics in asthmatic adolescents, does not differ from those of adolescents without asthma. These findings highlight the need for more effective health counseling of asthmatic youth regarding the physical and behavioral effects of smoking.

adults. IN: Galanter M, ed. Recent Developments in Alcoholism, Volume 17. Alcohol Problems in Adolescents and Young Adults: Epidemiology, Neurobiology, Prevention, Treatment. New York: Kluwer Academic/Plenum Press, 2005. pp. 29-47. (99 refs.)This chapter takes a normative developmental perspective on the etiology of alcohol use, focusing on the imitation and course of alcohol use (rather than alcohol use disorders) during adolescence and early adulthood. The chapter reviews evidence regarding the sequelae and meaning of the age of initiation of alcohol use, consider variable- and pattern centered approaches to modeling trajectories describing the course of alcohol use across adolescence and young adulthood, and offer developmental conceptualizations of risk and protective factors for alcohol use and related problems.