Are homeschooled adolescents less likely to use alcohol, tobacco, and other drugs?

What differentiates youths who use e-cigarettes from those who smoke traditional tobacco products?

Background

Electronic cigarette (e-cigarette) use has spread among adolescents in many countries, however users’ characteristics are not well known. We aimed to compare characteristics of exclusive e-cigarette users to those of exclusive tobacco users and dual users.

Methods

Data come from a representative sample of 11–19 years old students in Paris, surveyed each year between 2013 and 2017. Current e-cigarette and tobacco use were ascertained in the preceding 30 days. Data were analyzed using random intercept multinomial logistic regression models, exclusive tobacco smokers being the reference group.

Results

Among the 17,435 students included, 2.3% reported exclusive e-cigarette use, 7.9% exclusive tobacco use and 3.2% dual e-cigarette and tobacco use. Compared to exclusive tobacco smokers, e-cigarette users were: a) less likely to use cannabis (adjusted Odds-Ratio (aOR) = 0.15, 95% confidence interval (95% CI) = 0.09–0.25); b) more likely to initiate smoking with an e-cigarette or a hookah rather than traditional cigarettes (aOR = 2.91, 95% CI = 1.74–4.87 and aOR = 15.99, 95% CI = 8.62–29.67, respectively). Additionally, exclusive e-cigarette users are younger with an aOR = 0.29 (95% CI = 0.17–0.49) among 13–15 years and aOR = 0.11 (95% CI = 0.06–0.21) among > 17 years as compared to 11–13 years. The probability of being an exclusive e-cigarette user is lower among participants whose best friend smokes tobacco (aOR = 0.30, 95% CI = 0.20–0.44). Exclusive tobacco users and dual users have similar profiles.

Conclusions

Adolescents who only used e-cigarettes had intermediate levels of risk compared to nonusers and those who used tobacco and/or e-cigarettes, suggesting that e-cigarettes use extends to young people at low-risk of using tobacco products.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13673-0.

School types in adolescence and subsequent health and well-being in young adulthood: An outcome-wide analysis

While past empirical studies have explored associations between types of primary and secondary schools and student academic achievement, outcomes beyond academic performance remain less well-understood. Using longitudinal data from a cohort of children (N = 12,288, mean age = 14.56 years) of nurses, this study examined associations between the types of schools participants attended in adolescence and a wide range of subsequent psychological well-being, social engagement, character strengths, mental health, health behavior and physical health outcomes. Results in this sample suggested little difference between attending private independent schools and public schools across outcomes in young adulthood. There were, however, notable differences in subsequent outcomes comparing homeschooling and public schools, and possibly some evidence comparing religious schools and public schools. Specifically, there was some evidence that attending religious schools versus public schools was associated with a higher likelihood of frequent religious service attendance and becoming registered voters, a lower risk of overweight/obese, fewer lifetime sexual partners, and a higher risk of subsequently being binge drinkers; however, these associations were not robust to correction for multiple testing. Homeschooling compared with public schooling was associated with subsequently more frequent volunteering (ß = 0.33, 95% CI = 0.15, 0.52), greater forgiveness (ß = 0.31, 95% CI = 0.16, 0.46), and more frequent religious service attendance (Risk Ratio [RR] = 1.51, 95% CI: 1.27, 1.80), and possibly also with greater purpose in life, less marijuana use, and fewer lifetime sexual partners, but negatively associated with college degree attainment (RR = 0.77, 95% CI: 0.67, 0.88) and possibly with greater risk of posttraumatic stress disorder. These results may encourage education stakeholders to consider a wider range of outcomes beyond academic performance in decision-making.

Substance Use and Mental Health in Homeschooled Adolescents in the United States

PURPOSE

U.S. homeschooling increased by 50% over 2007-2016. Homeschooled adolescents may have lower substance use rates, but previous research treated other adolescents as homogeneous despite within-group differences. We used the 2015-2018 National Survey on Drug Use and Health to compare adolescent substance use and psychopathology by homeschooled/educational status.

METHODS

Data were from 52,089 adolescents, classified by educational status (i.e., homeschooled; public/private school, low dropout risk; public/private school, at risk for dropout; and not in school) and compared on substance use and psychopathology variables.

RESULTS

Substance use rates were lowest in adolescents at low dropout risk, with significantly lower past-year prescription opioid misuse, tobacco use, nonmarijuana illicit drug use, and nicotine dependence rates than homeschooled adolescents. Psychopathology treatment prevalence was lowest in homeschooled adolescents. Those at risk for dropout had the highest rates of substance use.

CONCLUSIONS

Although homeschooled adolescents have relatively low substance use rates, they exceed those of low dropout risk adolescents.

Associations Between Early Onset of E-cigarette Use and Cigarette Smoking and Other Substance Use Among US Adolescents: A National Study

Introduction

This study examines the associations between early onset of e-cigarette use and cigarette smoking and other substance use behaviors among US adolescents.

Methods

Data were collected via self-administered questionnaires from a nationally representative sample of 2299 US high school seniors attending public and private high schools during the spring of their senior year in 2015 as part of the Monitoring the Future study.

Results

A higher percentage of adolescents who began using e-cigarettes in ninth grade or earlier (early onset) were found to report current and lifetime cigarette smoking and other substance use relative to those individuals who never used e-cigarettes or those who began using e-cigarettes later in the 12th grade. Multivariate logistic regression analyses indicated that the adjusted odds of alcohol use, cigarette smoking, marijuana use, nonmedical prescription drug use, and other illicit drug use among early onset e-cigarette users were significantly greater than those for individuals never having used e-cigarettes (adjusted odds ratios [AORs] ranged 9.5-70.6, p < .001). While these associations were significant for both experimental and frequent e-cigarette users, the effects of early onset were stronger among frequent e-cigarette users. Similarly, the odds of these substance use behaviors (except alcohol) among early onset e-cigarette users were also significantly greater than the odds for later onset e-cigarette users (AORs ranged 2.8-4.1, p < .05).

Conclusions

Early onset of e-cigarette use was significantly associated with increased odds of cigarette smoking and other substance use behaviors. E-cigarette use is often preceded by alcohol use, cigarette smoking, and marijuana use, suggesting that more long-term prospective studies are warranted.

Implications

To date, no studies have examined the probability of cigarette smoking and other substance use behaviors as a function of age at onset of e-cigarette use. In the present study, early onset of e-cigarette use was significantly associated with increased odds of cigarette smoking and other substance use behaviors. The findings reinforce the importance of addressing a wide range of substances including alcohol, traditional cigarettes, and marijuana when developing early primary prevention efforts to reduce e-cigarette use among youth.

Sources of Nonmedical Prescription Drug Misuse Among US High School Seniors: Differences in Motives and Substance Use Behaviors

OBJECTIVE

To examine whether sources of nonmedical use of prescription drugs (NMUPD) involving anxiolytics, opioids, and stimulants were associated with sociodemographic characteristics, NMUPD characteristics (eg, frequency), and other substance use.

METHOD

Nationally representative samples of US high school seniors (N = 18,549) were surveyed by self-administered questionnaires (2009-2016). Design-based latent class analysis and Rao-Scott χ2 tests were used to test associations among sociodemographic characteristics, NMUPD characteristics, other substance use behaviors (eg, binge drinking, cigarette smoking, marijuana use), and NMUPD sources.

RESULTS

Approximately 11.0% of high school seniors reported past-year NMUPD (n = 1,917). A substantial proportion of nonmedical users obtained the prescription drugs from multiple sources (44.2%). Latent class analysis identified 5 subgroups of NMUPD sources (friend/relative sources, friend/purchased sources, own leftover prescription, multiple sources, and other sources). Nonmedical users who obtained prescription drugs from friend/purchased sources were more likely to be adolescent boys, whereas those who used their own leftover prescriptions were more likely to be adolescent girls. Nonmedical users who obtained prescription drugs from multiple sources were more involved in substance use. In contrast, adolescent nonmedical users who used their own leftover prescriptions were less involved in substance use.

CONCLUSION

Growing evidence indicates that different NMUPD sources are associated with different substance use behaviors. All NMUPD sources should be discouraged, because they place individuals, families, and communities at risk. Patients and their families should receive education on how to manage and properly dispose of controlled medications to avoid diversion into the community. Prescribers are encouraged to check prescription monitoring programs and screen adolescents for substance use/misuse when prescribing controlled medications.

Initiation Sequence of E-Cigarette and Cigarette Smoking among US Adolescents: A National Study

BACKGROUND AND OBJECTIVES

The primary objectives were to: (1) examine the initiation sequence of e-cigarette use and cigarette smoking; (2) assess other substance use as a function of the initiation sequence of e-cigarettes and cigarettes; and (3) investigate the role of early e-cigarette initiation among US secondary school students.

METHODS

Data were collected via self-administered questionnaires from independent 2015 and 2016 nationally representative cross-sectional samples of 8th grade, 10th grade, and 12th grade students (N = 36 410).

RESULTS

The lifetime initiation sequence included: (1) e-cigarette use before cigarette smoking (1.7%); (2) e-cigarette use and cigarette smoking in same grade (4.2%); (3) cigarette smoking before e-cigarette use (6.1%); (4) e-cigarette use only (12.6%); (5) cigarette smoking only (3.6%); and (6) no e-cigarette use or cigarette smoking (71.8%). The risk of substance use was highest among dual users (regardless of initiation sequence), followed by cigarette smokers, e-cigarette users, and no e-cigarette use or cigarette smoking. The most prevalent initiation sequence of e-cigarette use involved initiating other substances before e-cigarettes, especially among older adolescents. Early initiation of e-cigarette use was associated with increased odds of substance use behaviors for all three age groups.

DISCUSSION AND CONCLUSIONS

Adolescents who report a history of both e-cigarette use and cigarette smoking should be considered at high risk for substance-related problems. Early initiation of e-cigarette use is a signal for other substance use.

SCIENTIFIC SIGNIFICANCE

Youth substance use prevention programs and prospective studies must take into account polysubstance use when addressing the relationships between e-cigarette use and cigarette smoking. (Am J Addict 2019;28:285-294).

Trends in Perceived Access to Marijuana Among Adolescents in the United States: 2002-2015

OBJECTIVE

There is concern that changes in marijuana-related policy and public opinion may lead to increased access to marijuana among young people in the United States. However, little research has been conducted on changes in youth's perceptions of marijuana access, and studies have yet to systematically examine trends in perceived access across key sociodemographic and externalizing behavioral subgroups.

METHOD

Using population-based data collected between 2002 and 2015 as part of the National Survey on Drug Use and Health, we examined trends in perceived marijuana access among non-Hispanic White, African American, and Hispanic adolescents (ages 12-17, n = 221,412). Following the trend analysis method outlined by the Centers for Disease Control and Prevention, we conducted logistic regression analyses to test for secular trends.

RESULTS

Between 2002 and 2015, we observed a 27% overall reduction in the relative proportion of adolescents ages 12-17-and a 42% reduction among those ages 12-14-reporting that it would be "very easy" to obtain marijuana. This pattern was uniformly observed among youth in all sociodemographic subgroups (i.e., across age, gender, race/ethnicity, household income) and among youth reporting involvement/no involvement in most measures of substance use (alcohol, marijuana) and delinquency (handgun carrying, attacks). However, perceived very easy access remained stable among youth reporting tobacco use and criminal justice system involvement.

CONCLUSIONS

Despite the legalization of recreational and medical marijuana in some states, our findings suggest that, with the notable exception of adolescent tobacco users and juvenile offenders, perceptions that marijuana would be very easy to obtain are on the decline among American youth.

How Collegiate Fraternity and Sorority Involvement Relates to Substance Use During Young Adulthood and Substance Use Disorders in Early Midlife: A National Longitudinal Study

PURPOSE

To assess how social fraternity involvement (i.e., membership and residence) in college relates to substance use behaviors and substance use disorder symptoms during young adulthood and early midlife in a national sample.

METHODS

National multi-cohort probability samples of US high school seniors from the Monitoring the Future study were assessed at baseline (age 18) and followed longitudinally via self-administered surveys across seven follow-up waves to age 35. The longitudinal sample consisted of 7,019 males and 8,661 females, of which 10% of males and 10% of females were active members of fraternities or sororities during college.

RESULTS

Male fraternity members who lived in fraternity houses during college had the highest levels of binge drinking and marijuana use relative to non-members and non-students in young adulthood that continued through age 35, controlling for adolescent sociodemographic and other characteristics. At age 35, 45% of the residential fraternity members reported alcohol use disorder (AUD) symptoms reflecting mild to severe AUDs; their adjusted odds of experiencing AUD symptoms at age 35 were higher than all other college and noncollege groups except non-residential fraternity members. Residential sorority members had higher odds of AUD symptoms at age 35 when compared with their noncollege female peers.

CONCLUSIONS

National longitudinal data confirm binge drinking and marijuana use are most prevalent among male fraternity residents relative to non-members and non-students. The increased risk of substance-related consequences associated with fraternity involvement was not developmentally limited to college and is associated with higher levels of long-term AUD symptoms during early midlife.

Gender differences in the trends and correlates of major depressive episodes among juvenile offenders in the United States

PURPOSE

Although it is well-established that juvenile offenders are at an elevated risk for depression and that, within this group, females have the highest risk, little is known regarding the trends in the prevalence of depression among juvenile offenders in the United States. In the present study, we systematically examine secular trends in major depressive episodes (MDE) and their correlates among male and female juvenile offenders and non-offenders in the United States.

METHODS

Data were collected between 2005 and 2014 as part of the National Survey on Drug Use and Health (NSDUH). The NSDUH uses multistage area probability sampling methods to select a representative sample of the civilian, non-institutionalized population in the United States. Participants included 171,118 youth aged 12-17 (159,449 non-offenders and 11,669 offenders). The primary variable of interest was self-reported past year MDE. Logistic regression assessed whether sociodemographic factors and psychosocial and behavioral correlates affected the risk of MDE.

RESULTS

Between 2005 and 2014, the prevalence of MDE among female youth increased for both offender and non-offender groups: from 24.4% to 33.0% for the offenders and from 12.4% to 16.7% for the non-offenders. No significant trend changes were observed among male youth. In both male and female juvenile offenders, MDEs were associated with increased risk of illicit drug use (males OR=1.61, 95% CI=1.18-2.18; females OR=1.83, 95% CI=1.45-2.31). Additional correlates include alcohol use among male offenders (OR=1.36, 95% CI=1.01-1.83), and binge drinking in female offenders (OR=1.24, 95% CI=1.02-1.49).

CONCLUSIONS

The prevalence of past year major depressive episodes is increasing for female juvenile offenders, highlighting a need for improved efforts to target these populations for prevention and treatment.

E-cigarette Use, Cigarette Smoking, Dual Use, and Problem Behaviors Among U.S. Adolescents: Results From a National Survey

PURPOSE

There is a need to obtain greater clarity regarding adolescents' e-cigarette use and the associations of use with a wider range of risk behaviors. This study examines the associations among past-month e-cigarette use only, traditional cigarette smoking only, dual use (i.e., concurrent e-cigarette use and cigarette smoking), school-related (i.e., truancy and poor academic performance) risk behaviors, and substance-related (i.e., alcohol use, binge drinking, marijuana use, illicit drug use, and nonmedical prescription drug use) risk behaviors.

METHODS

Data were collected via self-administered questionnaires from a nationally representative sample of 8,696 high school seniors.

RESULTS

An estimated 9.9% of U.S. high school seniors reported past-month e-cigarette use only, 6.0% reported past-month cigarette smoking only, and 7.3% reported past-month dual use. School- and substance-related risk behaviors had strong associations with past-month e-cigarette use. Adolescents who only used e-cigarettes had significantly greater odds of all school- and substance-related risk behaviors relative to nonusers. Dual users had significantly greater odds of frequent/daily e-cigarette use as well as all school- and substance-related risk behaviors relative to those who only used e-cigarettes. Finally, adolescents who engaged in frequent/daily e-cigarette use had significantly greater odds of binge drinking, marijuana use, other illicit drug use and nonmedical prescription drug use, relative to experimental e-cigarette users.

CONCLUSIONS

E-cigarette use is common among U.S. adolescents, and there are robust associations between e-cigarette use and school- and substance-related risk behaviors. There is evidence that e-cigarette use clusters with risk behaviors and appears to represent a problem behavior, especially dual use of e-cigarettes and traditional cigarettes.

Smoking behaviors and intentions among current e-cigarette users, cigarette smokers, and dual users: A national survey of U.S. high school seniors

E-cigarette use among adolescents has increased significantly in recent years, but it remains unclear whether cigarette smoking behaviors and intentions for future cigarette smoking differ among current (i.e., 30-day) non-users, only e-cigarette users, only cigarette smokers, and dual users. A nationally representative sample of 4385 U.S. high school seniors were surveyed during the spring of their senior year via self-administered questionnaires in 2014. An estimated 9.6% of U.S. high school seniors reported current e-cigarette use only, 6.3% reported current cigarette smoking only, and 7.2% reported current dual use of e-cigarettes and cigarette smoking. There were no significant differences between current only cigarette smokers and dual users in the odds of early onset of cigarette smoking, daily cigarette smoking, intentions for future cigarette smoking, friends' cigarette smoking behaviors, attempts to quit cigarette smoking, or the inability to quit cigarette smoking. Adolescents who only used e-cigarettes had higher odds of intentions for future cigarette smoking in the next 5years (AOR=2.57, 95% CI: 1.21-5.24) than current non-users. Dual users and only cigarette smokers had higher odds of cigarette smoking behaviors and intentions for future cigarette smoking than non-users or only e-cigarette users. Adolescents who engage in current dual use have cigarette smoking behaviors and intentions for future cigarette smoking that more closely resemble cigarette smokers than e-cigarette users. Adolescents who only use e-cigarettes have higher intentions to engage in future cigarette smoking relative to their peers who do not engage in e-cigarette use or cigarette smoking.

Behavioral Risk Profiles of Homeschooled Adolescents in the United States: A Nationally Representative Examination of Substance Use Related Outcomes

BACKGROUND

The homeschool population continues to grow in size and now accounts for 3.4% of all students in the United States.

OBJECTIVE

Given the heterogeneous nature of the population, this study examines the relationship between different types of homeschoolers and a number of substance use related outcomes.

METHODS

To conduct this study, we used pooled data (2002-2013) from the National Survey on Drug Use and Health (NSDUH). Respondents aged 12-17 who reported they had been homeschooled at any time during the previous 12 months were classified as homeschoolers (N = 1,321). Latent profile analysis (LPA) was conducted to identify latent subgroups of homeschoolers and multinomial regression was executed to assess the relationship between the subgroups and perceived substance use risk, availability, and past 12-month use.

RESULTS

The LPA yielded four subgroups, which were summarized as (1) highly religious and engaged, (2) limited parental monitoring, (3) high parental warmth and support, and (4) secular permissive. Of these, the highly religious and engaged subgroup was the least likely to report using substances.

CONCLUSION

The results underscore the variation that exists among homeschoolers and the importance of examining the relationship between different types of homeschoolers and outcomes of interest.