Historical trends in the grade of onset and sequence of cigarette, alcohol, and marijuana use among adolescents from 1976-2016: Implications for "Gateway" patterns in adolescence

Changes in the Order of Cigarette and Marijuana Initiation and Associations with Cigarette Use, Nicotine Vaping, and Marijuana Use: U.S. 12th Grade Students, 2000-2019

This study (a) examined changes in marijuana and cigarette initiation sequencing and (b) considered implications of such changes for prevention efforts by examining associations between initiation sequencing and current adolescent substance use. Analyses used 2000-2019 cross-sectional data from the national Monitoring the Future (MTF) study (78,252 U.S. 12th grade students). Models examined trends in six distinct patterns of initiation order, and multivariable associations between order of initiation and 30-day cigarette and marijuana use prevalence, cigarette and marijuana use frequency among users, and nicotine and marijuana vaping prevalence. While the percentage of students initiating neither cigarettes nor marijuana increased, increases also were observed in marijuana-only initiation (the fastest-growing pattern) and initiation of marijuana before cigarettes; these increases were accompanied by a significant decrease in cigarette-only initiation. Cigarette use prevalence and frequency were highest among students initiating cigarettes before marijuana; marijuana use prevalence and frequency were highest among students initiating marijuana before cigarettes. Cigarette and marijuana prevalence, as well as marijuana frequency, were lowest among students initiating only a single substance. Nicotine vaping was less prevalent among students initiating a single substance versus both substances, but no significant differences were observed in nicotine vaping prevalence between those initiating only cigarettes versus only marijuana. Implications of these findings for prevention efforts are discussed in the frameworks of both the common liability model and route of administration model.

Short term effects of the REAL media e-learning media literacy substance prevention curriculum: An RCT of adolescents disseminated through a community organization

BACKGROUND

The primary aim of this study was to evaluate the short-term effects of testing an e-learning program to reduce adolescent substance use and abuse. Early initiation of substance use is linked to a variety of negative outcomes, thus effective intervention programs are needed. One approach is to use media literacy to capitalize on adolescents' immersion with media in a variety of forms. We developed, implemented, and tested an engaging substance use prevention program by collaborating with a youth-oriented community partner (4-H).

METHODS

639 middle adolescents from nine U.S. states participated in an RCT of REAL media. Participants completed a series of online surveys and were randomized to use an online substance prevention program (REAL media) or serve as control (delayed program use). Self-report surveys were administered at three points in time. This short-term evaluation uses data from the pretest (Time 1) and short-term posttest three-month surveys, which measured demographics, self-efficacy to counterargue, and injunctive and descriptive substance use norms.

RESULTS

Participants who completed the REAL media program reported increased self-efficacy to counterargue and decreased positive injunctive norms compared to control participants who did not complete the program. No significant differences were observed for descriptive norms.

CONCLUSIONS

We found support for the REAL media program in changing key predictors of youth substance use demonstrating (1) the efficacy of media literacy interventions targeting adolescents and (2) that e-learning substance use prevention efforts can be adapted for and implemented through community organizations.

Initial use of tobacco or marijuana and later use profiles in young adults

INTRODUCTION

Given the relatively limited literature regarding risk factors for progression of alternative tobacco and marijuana use, this study examined initially-used tobacco or marijuana products and psychosocial risk factors such as adverse childhood events (ACEs), mental health (depression, ADHD), and parental substance use, in relation to young adult lifetime and current (past 30-day) tobacco and marijuana use.

METHODS

Using cross-sectional data from a 2014–2016 study of 3418 young adult college students in Georgia, we analyzed lifetime and current use of various tobacco products (cigarettes, cigar products, smokeless tobacco, e-cigarettes, hookah) and marijuana among lifetime tobacco or marijuana users (N=1451) in relation to initially-used product as well as sociodemographic characteristics and psychosocial risk factors.

RESULTS

Multivariable analyses indicated that more products ever used correlated with cigarettes being first used (vs cigars, B=-0.66; e-cigarettes, OR=-1.33; hookah, B=-0.99; and marijuana, B=-1.05; p<0.001), as well as being older (B=0.06), male (B=-0.72) and White (vs Black, B=-0.30; or Asian, B=-0.60), more adverse childhood events (ACEs, B=0.07), and parental marijuana use (B=0.47; p<0.05). Currently-used products correlated with cigarettes being first used (vs cigars, B=-0.18; e-cigarettes, B=-0.37; and hookah, B=-0.18; p<0.05), being younger (B=-0.04), male (B=-0.15), more depressive symptoms (B=0.01), and parental marijuana use (B=0.40; p<0.05). Current cigarette, smokeless tobacco, hookah and marijuana use demonstrated specificity to initially-used products.

CONCLUSIONS

Initially-used products, specifically cigarettes, with well-documented and communicated risks, correlated with using more products subsequently among young adults, underscoring needed research on such risks and risk communication, and early intervention strategies.

Adolescent Smoking Susceptibility: Gender-Stratified Racial and Ethnic Differences, 1999-2018

INTRODUCTION

Susceptibility, or openness to smoking, is a predictor of future smoking. This study examines within-gender racial/ethnic differences in smoking susceptibility over historical time (1999-2018) and developmental age (11-18 years).

METHODS

Data were obtained from 205,056 adolescent never smokers in 14 waves of the National Youth Tobacco Survey. Weighted time-varying effect models were used to estimate nonlinear trends in smoking susceptibility among minority (versus white) adolescents. Analyses were conducted in 2019.

RESULTS

Compared with whites, Latino/a adolescents were consistently more susceptible to smoking, whereas black and Asian adolescents fluctuated between being less and equally susceptible over time. American Indian, Alaska Native, Native Hawaiian, and Pacific Islander adolescents were more susceptible from 2014 to 2017, with differences being larger for girls. Susceptibility peaked at age 14 years. Compared with whites, Latino/a adolescents were more susceptible throughout adolescence. Black adolescents were more susceptible in early adolescence, whereas Asian adolescents were less or equally susceptible to smoking in early to mid-adolescence. American Indian, Alaska Native, Native Hawaiian, and Pacific Islander girls were more susceptible in early and mid-adolescence, but boys were more susceptible in early adolescence only. American Indian, Alaska Native, Native Hawaiian, and Pacific Islander girls were less susceptible than white girls aged 18 years.

CONCLUSIONS

Twenty-year racial/ethnic differences in smoking susceptibility were evident, particularly among girls, but were mostly equivalent between genders over developmental age. Targeting susceptible adolescents with gender-, race/ethnic-, and age-tailored prevention efforts may prevent or delay adolescents' transition to tobacco use and reduce tobacco-related disparities.

Trends in the sequence of first alcohol, cannabis and cigarette use in Australia, 2001-2016

BACKGROUND

Recent analyses of data from the US found that young people were increasingly engaging in cannabis use before alcohol and cigarettes. These shifts are important for public health, but it is not clear whether such trends extend beyond the US. The aim of this study is to examine whether and how the age and sequencing of initiation into alcohol, cannabis and cigarette use has changed in Australia since the early 2000s.

METHODS

Data came from six waves of the Australian National Drug Strategy Household Survey, spanning 2001-2016. We used data from 18 to 21 year-olds (n = 6849) and examined trends in the age at first use for each of the three substances plus any changes in the order of initiation.

RESULTS

The mean age of initiation increased steadily for all three substances (e.g. from 14.9 in 2001 to 16.4 in 2016 for alcohol), while the prevalence of any use declined. There were some changes in ordering of use. For example, in 2001, 62 % of respondents who used both cigarettes and cannabis had first used cigarettes at an earlier age than cannabis, compared with 41 % in 2016. Young people who used both alcohol and cannabis remained more likely to try alcohol before cannabis across the study period.

CONCLUSIONS

Our results partly replicated US findings, with differences potentially reflecting the substantially different environment around these substances in the US compared to Australia. The age of initiation for alcohol, cigarette and cannabis use in Australia has increased sharply over the past 15 years.

Intergenerational congruence in adolescent onset of alcohol, tobacco, and marijuana use

We examined alcohol, tobacco, and marijuana (ATM) use onset across early to late adolescence in a sample of fathers and their offspring. We tested a theory of developmental congruence in polysubstance use, or the extent to which fathers' ATM use onset in early adolescence increased risk for earlier ATM onset by their offspring. Average rates of adolescent ATM use onset were also compared across generations, which may reflect intergenerational discontinuity and secular trends. Children (n = 223, 44% boys) and their fathers (n = 113; originally recruited as boys at neighborhood risk for delinquency) contributed repeated prospective self-reports of their ATM use across adolescence (as late as age 18 years). Mothers' ATM use (retrospective) through age 18 years was available for 205 children. Data were analyzed using discrete-time survival mixture analysis. Compared with their fathers, boys and girls showed later onset for tobacco use, and girls showed later onset alcohol use. Developmental congruence was partially supported: Children showed earlier ATM use onset if their fathers were assigned to the early adolescent polysubstance use onset class, compared to the late-adolescent predominantly alcohol and tobacco onset class; mothers' ATM use in adolescence attenuated this effect. Consistent with national secular trends, rates of adolescent onset tobacco and alcohol use declined across generations, whereas marijuana use onset did not. However, there was intergenerational transmission of risk for early polysubstance use onset. Prevention that delays early substance use may have early life span effects as well as transgenerational implications. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Why Are Suicide Rates Increasing in the United States? Towards a Multilevel Reimagination of Suicide Prevention

Suicide, a major public health concern, takes around 800,000 lives globally every year and is the second leading cause of death among adolescents and young adults. Despite substantial prevention efforts, between 1999 and 2017, suicide and nonfatal self-injury rates have experienced unprecedented increases across the United States - as well as in many other countries in the world. This chapter reviews the existing evidence on the causes behind increased suicide rates and critically evaluates the impact of a range of innovative approaches to suicide prevention. First, we briefly describe current trends in suicide and suicidal behaviors and relate them to recent time trends in relevant suicide risk markers. Then, we review the existing evidence in suicide prevention at the individual and the population levels, including new approaches that are currently under development. Finally, we advocate for a new generation of suicide research that examines causal factors beyond the proximal and clinical and fosters a socially conscious reimagining of suicidal prevention. To this end, we emphasize the need for the conceptualization of suicide and suicidal behaviors as complex phenomena with causes at several levels of organization. Future interdisciplinary research and interventions should be developed within a multilevel causal framework that can better capture the social, economic, and political settings where suicide, as a process, unfolds across the life course.

A Decline in Propensity Toward Risk Behaviors Among U.S. Adolescents

PURPOSE

Over the past two decades, substance use, delinquent behaviors, and promiscuous sexual activity have declined substantially among U.S. adolescents. We aimed to determine the extent to which these trends represent declines in a general propensity to engage in risk behaviors (i.e., declines in a latent factor).

METHODS

We used Youth Risk Behavior Survey data (1999-2017) (n = 147,800) and examined trends in substance use (e.g., alcohol), delinquency (e.g., fighting), and sexual activity (e.g., number of partners). We conducted two types of analyses stratified by grade (9th/10th vs. 11th/12th) and sex: (1) estimation of year-specific prevalence of each behavior and modeled prevalence changes over time and (2) factor analysis and application of alignment methods to determine changes in the mean of the latent factor over time while correcting for measurement noninvariance.

RESULTS

A single factor explained 53% (girls 11th/12th grade) to 62% (boys 9th/10th grade) of the variance in risk behaviors. Average relative annual declines in the prevalence of each behavior-except for weapon carrying-ranged from 1% to 6%. The structure of the latent factor was mostly unchanged over time, with notable exceptions related to differential changes in prevalence for cigarette and cannabis use. Between 1999 and 2017, the mean of the latent factor declined by between .54 and .73 standard deviations.

CONCLUSIONS

Results suggest that much of the decline in the prevalence of substance use, delinquent, and sexual behaviors among American youth from 1999 to 2017 reflect an approximately two-thirds standard deviation decline in the mean of a latent risk behavior factor.

Changes in urban and rural cigarette smoking and cannabis use from 2007 to 2017 in adults in the United States

INTRODUCTION

Rural-urban differences in cigarette and cannabis use have traditionally shown higher levels of cigarette smoking in rural areas and of cannabis use in urban areas. To assess for changes in this pattern of use, we examined trends and prevalence of cigarette, cannabis, and co-use across urban-rural localities.

METHODS

Urban-rural trends in current cigarette and/or cannabis use was evaluated using 11 cohorts (2007-2017) of the National Survey on Drug Use and Health (NSDUH; N = 397,542). We used logistic regressions to model cigarette and cannabis use over time, adjusting for demographics (age, gender, race/ethnicity, income, education), in addition to assessing patterns of cannabis use among cigarette smokers and nonsmokers.

RESULTS

Despite decreases in cigarette smoking overall, between 2007 and 2017, the urban-rural disparity in cigarette smoking increased (AOR = 1.17), with less reduction in rural as compared to urban cigarette smokers. Cannabis use increased in general (AOR = 1.88 by 2017), with greater odds in urban than rural regions. Cannabis use increased more rapidly in non-cigarette smokers than smokers (AOR = 1.37 by 2017), with 219% greater odds of cannabis use in rural non-cigarette smokers in 2017 versus 2007.

CONCLUSIONS

Rurality remains an important risk factor for cigarette smoking in adults and the fastest-growing group of cannabis users is rural non-cigarette smokers; however, cannabis use is currently still more prevalent in urban areas. Improved reach and access to empirically-supported prevention and treatment, especially in rural areas, along with dissemination and enforcement of policy-level regulations, may mitigate disparities in cigarette use and slow the increase in rural cannabis use.

Psychiatric comorbidities in alcohol use disorder

Alcohol use disorder is a major contributor to the morbidity and mortality burden worldwide. It often coexists with other psychiatric disorders; however, the nature of this comorbidity is still a matter of debate. In this Series paper, we examine the main psychiatric disorders associated with alcohol use disorder, including the prevalence of co-occurring disorders, the temporal nature of the relationship, and mechanisms that might explain comorbidity across the lifespan. Overall, this disorder co-occurs with a wide range of other psychiatric disorders, especially those disorders involving substance use and violent or aggressive behaviour. The causal pathways between alcohol use disorder and other psychiatric disorders are heterogeneous. Hypotheses explaining these relationships include reciprocal direct causal associations, shared genetic and environmental causes, and shared psychopathological characteristics of broader diagnostic entities (eg, externalising disorders). Efforts to untangle the associations between alcohol use disorder and other disorders across the lifespan remain a crucial avenue of research.

Behavioral Treatments for Adolescent Cannabis Use Disorder: a Rationale for Cognitive Retraining

Purpose of Review

Adolescent cannabis use represents a significant public health concern. Cannabis experimentation typically begins in adolescence and increases the odds of meeting criteria for cannabis use disorder. Cannabis use disorder is associated with numerous short- and long-term adverse consequences for adolescents, highlighting the critical need for efficacious behavioral treatments. This brief review aims to synthesize the state of the behavioral treatment literature on adolescents with cannabis use disorder and to discuss new pathways to leverage neuroscience to inform novel targets for behavioral intervention.

Recent Findings

To date, effective treatment options for adolescent cannabis use disorder that have been tested in randomized controlled trials include cognitive behavioral therapy, motivational enhancement therapy, and multidimensional family therapy. However, established behavioral treatment approaches focus on higher-order cognitive control and have only been modestly effective.

Summary

There is a need to develop new pathways that translate neuroscience findings into novel targets for behavioral interventions.

Differences in Substance Use Disparities Across Age Groups in a National Cross-Sectional Survey of Lesbian, Gay, and Bisexual Adults

PURPOSE

Lesbian, gay, and bisexual (LGB) adults have elevated rates of substance use (SU) relative to heterosexual adults, yet the extent to which these disparities vary across age groups is unknown. Using national survey data, we test for age group differences in lifetime and recent SU disparities among LGB adults.

METHODS

Using data on 67,354 adults (including 4868 LGB adults) from the 2015 and 2016 National Survey on Drug Use and Health (NSDUH), we examined LGB disparities in lifetime and recent use of cigarettes, marijuana, and illicit drugs. Analyses were stratified by age groups (18-25, 26-34, and 35-49 years) and compared lesbian/gay (L/G) and bisexual adults, respectively, with heterosexual adults of the same gender and age group.

RESULTS

Among L/G women, disparities (relative to same-age heterosexual women) were significantly larger in the youngest age group compared with the older age groups for numerous measures of lifetime and recent SU. Conversely, among bisexual men and bisexual women, multiple SU disparities (relative to heterosexual adults of the same age and gender) were significantly smaller among the youngest age group compared with the oldest age group.

CONCLUSION

Contrary to hypotheses of decreased minority stress among more recent generations of LGB individuals, we found that SU disparities were not systematically smaller in younger age groups. Rather, disparities exhibited distinct trends across age groups. As NSDUH data are cross-sectional, differences by age group may reflect the influence of both age-varying developmental factors as well as time-varying social and contextual factors.