Patterns of drug use from adolescence to young adulthood: I. Periods of risk for initiation, continued use, and discontinuation

Patterns of initiation, continued use, and decline in drug use are described on the basis of detailed drug histories in a longitudinal cohort representative of former New York State adolescents. In this cohort, the period of major risk for initiation to cigarettes, alcohol, and marijuana, is completed for the most part by age 20, and to illicit drugs other than cocaine by age 21. Those who have not experimented with any of these substances by that age are unlikely to do so thereafter. Initiation into prescribed psychoactive drugs occurs at a later age than for the licit and illicit drugs and continues through the age period covered by the survey. A potential maturational trend in marijuana use in this cohort is apparent with a decline beginning approximately at age 22.5 for most usage patterns. The periods of highest marijuana and alcohol usage decline beginning at ages 20-21 and contrast sharply with cigarettes which exhibit climbing rates of highest use through the end of the surveillance period (age 25). Overall patterns are similar for men and women, with men initiating all drugs at higher rates than women, except for prescribed psychoactives .     

Patterns of drug use from adolescence to young adulthood: III. Predictors of progression.

Possible linkages of influence among classes of drugs in the observed sequential progression from adolescence to young adulthood are investigated through event history analyses. Three stages are examined: initiation to marijuana, to the use of other illicit drugs, and to prescribed psychoactive drugs. The data are based on a follow-up cohort of former adolescents representative of high school students in grade 10 and 11 in New York State who were reinterviewed nine years later at ages 24-25. The sequential order between alcohol and/or cigarettes and marijuana reflects not only the effect of the use of legal drugs on marijuana initiation, but also age effects on onset of these drugs, controlling for individual characteristics measured in adolescence; marijuana use by one''s friends in adolescence is an additional important predictor of marijuana initiation. Prior use of marijuana is necessary for progression to other illicit drugs. Multiple factors are involved in the progression to prescribed drugs, with adolescent depressive symptomatology and use of other illicit drugs important for both sexes, and maternal use of psychoactive drugs, dropping out of school, and prior use of marijuana of additional importance for women. Although licit drugs influence initiation into marijuana independently of age effects, it is especially for the progression from marijuana to other illicit drugs that the earlier drug is associated with the progression to a higher stage drug.     

Patterns of drug use from adolescence to young adulthood: II. Sequences of progression

Major pathways of progression among legal, illegal, and medically prescribed psychoactive drugs from adolescence to young adulthood are described. The data are based on a follow-up cohort of former adolescents representative of high school students in grades 10 and 11 in New York State who were reinterviewed nine years later at ages 24-25. Various models of progression are tested for their goodness of fit. The patterns formerly observed in adolescence involving progression from one class of legal drug (either alcohol or cigarettes) to marijuana to the use of other illicit drugs appear in the transitional period into young adult, with an additional stage, that of prescribed psychoactive drugs. Some differences appear between men and women, with cigarettes more important for women than for men in the total progression.     

Risk for initiation of substance use as a function of age of onset of cigarette, alcohol and cannabis use: findings in a Midwestern female twin cohort

OBJECTIVE: We investigated whether use and early-onset use of cigarettes, alcohol and cannabis contributed an increase in risk for initiation of subsequent psychoactive substances in women (N = 3729, mean age = 21.7). METHODS: Drugs were ordered in ascending order of initiation: cigarettes, alcohol, cannabis and other illicit drugs, with early-onset use of each drug used as a time-varying covariate to predict initiation of subsequent drugs. Interactions of use and early-onset use, with age of initiation of subsequent drugs, were evaluated using discrete-time Cox survival analyses. RESULTS: The association between each substance and the early-onset of subsequent drug use was strong (ORs 1.54-19.9). Women who initiated cigarette, alcohol or cannabis use at an early age were at elevated risk for early experimentation with each subsequent drug class. Furthermore, early-onset of more than one substance contributed greater risk for initiation of subsequent drugs. CONCLUSION: Prevention efforts should target risk factors that contribute to early initiation of cigarette and alcohol use and may subsequently correlate with hard drug involvement.     

Initiation of use of alcohol, cigarettes, marijuana, cocaine, and other substances in US birth cohorts since 1919.

OBJECTIVES: This study examined recent trends in initiation of psychoactive drug use. METHODS: Data from the 1991 through 1993 National Household Surveys on Drug Abuse were used to compare the percentages of US cohorts born from 1919 through 1975 who began using drugs before the ages of 15, 21, and 35. RESULTS: Initiation of cigarette smoking by males peaked in the 1941-1945 cohort, then declined steadily. For females, early smoking initiation rose through the 1951-1955 cohort and then stabilized. Initiation of alcohol use was less common than smoking for pre1950 cohorts but increased steadily, approaching cigarette use for cohorts born in the early 1970s. Only 2% of teenagers born in 1930-1940 tried marijuana; half the teenagers born in 1956-1965 did so. The percentage initiating marijuana use declined in the 1980s, more so among young adults than among teenagers. The use of cocaine and other illicit drugs echoed the rise of marijuana use but peaked later and showed less evidence of subsequent decline. Sex differences declined over time for every drug. CONCLUSIONS: Cohorts born since World War II have had much higher rates of illicit drug use initiation, but trends have varied by drug type, possibly reflecting changes in relative prices.     

Cohort trends in the age of initiation of drug use in Australia

AIM: To examine birth cohort trends in the prevalence of use and the age of initiation of use of: alcohol, tobacco, cannabis, amphetamines, LSD, and heroin. METHOD: Data were taken from the 1998 National Drug Strategy Household Survey, a survey of a representative sample of Australians aged 14 years and over. Nine five-year cohorts were examined among persons born between 1940 and 1984. The weighted prevalence of use by ages 15 years, 21 years, and lifetime use, was estimated, as was the average age of first use among users. The significance of trends was tested using logistic regression (for lifetime use, use by 15 and 21 years) and linear regression (for age of first use). RESULTS: Lifetime prevalence of alcohol and tobacco use was similar among all birth cohorts. The prevalence of illicit drug use--cannabis, amphetamines, LSD and heroin--increased with successive birth cohorts and more recent birth cohorts reported using licit and illicit drugs at a younger age. CONCLUSIONS: More recent cohorts are more likely to use illicit drugs at some point in their lives. Greater numbers of persons from more recent birth cohorts may be at risk of developing substance-related problems.     

Infant Birth Outcomes Among Substance Using Women: Why Quitting Smoking During Pregnancy is Just as Important as Quitting Illicit Drug Use

Poor birth outcomes are associated with illicit drug use during pregnancy. While prenatal cigarette exposure has similar effects, cessation of illicit drug use during pregnancy is often prioritized over cessation of smoking. The study goal was to examine the impact of pregnancy tobacco use, relative to use of illicit drugs, on birth outcomes. Women were recruited at entry to prenatal care, with background and substance use information collected during pregnancy. Urine drug screens were performed during pregnancy, and the final sample (n = 265) was restricted to infants who also had biologic drug testing at delivery. Participants were classified by pregnancy drug use: no drugs/no cigarettes, no drugs/cigarette use, illicit drugs/no cigarettes, and illicit drugs/cigarette use. Groups differed significantly on infant birthweight, but not gestational age at delivery after control for confounders including background and medical factors. Among women who smoked, the adjusted mean birthweight gain was 163 g for those not using hard illicit drugs, while marijuana use had no effect on birth weight beyond the effect of smoking cigarettes. Women who used hard illicit drugs and did not smoke had an adjusted mean birthweight gain of 317 g over smokers. Finally, women who refrained from hard illicit drugs and smoking had a birthweight gain of 352 g. Among substance using pregnant women, smoking cessation may have a greater impact on birthweight than eliminating illicit drug use. Intervention efforts should stress that smoking cessation is at least as important to improving pregnancy outcomes as abstaining from illicit drug use.     

From beer to crack: developmental patterns of drug involvement.

OBJECTIVES. Prior research has identified developmental stages in drug use in adolescence, from substances that are legal for adults to illicit drugs. The position of crack in patterns of drug involvement remains to be established. METHODS. The analyses are based on a sample (n = 1108) representative of 12th graders attending New York State public and private schools. From reported ages of first use of five classes of drugs (alcoholic beverages, cigarettes, marijuana, cocaine but not crack, crack), alternate models of progression were tested for their goodness of fit through log-linear models. RESULTS. The sequence involves at the earliest stage the use of at least one licit drug, alcohol or cigarettes. Subsequent stages involve marijuana and cocaine; crack is the last drug in the sequence. The results confirm the more important role of alcohol among males and cigarettes among females in the progression into various drug classes. Age of first drug use at a lower stage is a strong predictor of further progression. CONCLUSIONS. The developmental pattern of drug involvement identified in the early 1970s still characterizes adolescent pathways of drug involvement in the late 1980s.     

Women and substance use disorders

In the United States, 45% of all women use alcohol, and nearly 26% smoke cigarettes. Approximately 13% use illicit substances, prescribed medications, or both in recreational ways. Although women use these substances less often than men, the health consequences of their use for women, particularly the use of alcohol, are either equivalent or greater. Women's social relationships play key roles in the onset of substance use disorders, treatment, and continued recovery. Major psychoactive substances include nicotine, alcohol, illicit drugs, and recreational use of nonprescribed medications. Biopsychosocial aspects unique to women are reviewed, followed by treatment approaches, concluding with implications for primary care providers.     

Predictors of the initiation of psychotherapeutic medicine use.

This study examined the hypothesized predictive association between illicit drug use and the onset of prescribed psychotherapeutic medicine use. The effect of psychiatric symptoms on this relationship was also explored. Data were gathered retrospectively, through standardized household interviews conducted in 1981 for the Baltimore site of the National Institute of Mental Health Epidemiologic Catchment Area Program. For this analysis, the sample was restricted to 1,716 respondents ages 18-44 at the time of interview, drawn by probability sampling area household residents of all adult ages. Using Cox proportional hazards models, the onset of psychotherapeutic medicine use was modeled as a function of illicit drug use and psychiatric symptoms, both defined as time-dependent covariates. Newly observed in this analysis was an independent association of illicit drug use with psychotherapeutic medicine use, which was unexplained by psychiatric symptoms (relative hazard = 2.61, 95% confidence interval (CI) = 2.15, 3.18). Adjustment for age of onset of alcohol intoxication did not alter the impression that illicit drug users were more likely to initiate use of prescribed psychotherapeutic medicines (relative hazard = 2.52, 95% CI = 2.02, 3.11).     

Period,age, and cohort effects on substance use among American youth, 1976-82.

Period, age, and cohort effects on substance use are differentiated for American youth 18 to 24 years old during the period from 1976 to 1982. The data are provided by the Monitoring the Future project, an ongoing study which employs a cohort-sequential design. Weighted least squares regression is used to find plausible and parsimonious models to account for the observed variation in 12 different classes of drugs, both licit and illicit. The point is made that there are no definitive ways to differentiate among the types of effects; thus, any interpretation is open to debate. Period effects involving increased use occurred for cocaine, amphetamines, and methaqualone, while decreases occurred for barbiturates, tranquilizers, and psychedelics other than LSD. Marijuana showed a curvilinear period effect, first increasing then decreasing. Effects of age were more complex. There were increases in the year after high school for daily cigarette use, but not for monthly use. Monthly and daily alcohol use increased with age. A measure of heavy drinking showed a curvilinear trend, first increasing and then decreasing. Annual use of cocaine showed an increase between the ages of 18 and 21. Annual use of narcotics other than heroin showed a linear age decrease. Clear class (or cohort) effects appeared for cigarette use, with each successive class smoking less.     

Truancy and perceived school performance: an alcohol and drug study of UK teenagers

This study is based on a subsample of 15- and 16-year-old school students from the UK, part of the European School Project on Alcohol and Other Drugs (ESPAD). Information was available on truancy rates, perceived school performance, family structure, lifestyle, and usage of alcohol, cigarettes and illicit drugs in 6409 teenagers. Living in a single-parent family, lack of constructive hobbies, presence of psychiatric symptoms, and an aggressive outgoing delinquent lifestyle bore the strongest associations to truancy and to perceived school performance. There were also strong relationships between both these last two variables and use of alcohol, cigarettes, and illicit drugs. However, the effects of alcohol, cigarettes, and illicit drugs were largely accounted for by other variables. Having at least one parent who both supported the respondent and who exercised some control was predictive of better perceived school performance.     

武汉市大学生毒品尝试情况及其相关因素研究

目的了解武汉市大学生尝试毒品的情况及其危险因素。方法通过分层整群随机抽样抽取武汉市11所大学在读大学生5850人,进行问卷调查及分析。结果实际调查5677名大学生,毒品尝试率高达2.0%,其中男生的尝试率高达2.8%,大学四年级毒品尝试率高达5.5%,存在睡眠障碍、抑郁情绪、吸烟、饮酒、缺少父母关爱、同学关系处理不良情况的大学生的毒品尝试率分别为3.3%、3.8%、18.0%、16.3%、12.0%、16.0%,家庭经济情况很好或困难的大学生的毒品尝试率分别高达4.0%和3.1%。结论武汉市大学生的毒品尝试率较高,主要危险因素为:经常吸烟、经常饮酒、有抑郁情绪、同学人际关系不良和高年级。     

Substance abuse by adolescents in Israel and France: a cross-cultural perspective

Household surveys of urban youths 14-18 years of age were conducted in 1979 with 609 Israeli adolescents and in 1977 with 499 French adolescents. The overall order in the prevalence of use of legal and illegal drugs was identical in both countries. Cigarettes and alcohol were used by a larger proportion of young people than the illegal drugs; marijuana was used much more frequently than any other illicit drug. The same cumulative sequence of drug use appeared in the survey data for French and Israeli adolescents as in comparative data for adolescents in the United States--cigarette and alcohol use preceded the use of illicit drugs. Striking cross-cultural differences appeared in the overall lifetime and current prevalences of use of all drugs, in the frequency of use, and in the age- and sex-specific rates for adolescents in Israel and in France. French youths uniformly reported greater lifetime and current use of all alcoholic beverages, cigarettes, and illegal drugs, more extensive involvement, and smaller sex differences than the Israeli youths. Prevalence of the use of drugs in a culture appears to be associated with four social processes: higher number of times each drug has been used; greater persistence of involvement, as reflected by the proportions of current users among those who ever tried a particular drug; earlier age of first use; and a spread of the phenomenon throughout all groups in society that attenuates group differences in drug experiences. These cross-cultural results suggest a relatively conservative position with regard to accessibility and availability of substances: reducing availability may be one way to reduce individual consumption by impinging not on individual persons directly but on society.     

The epidemiology of drug use among New York State high school students: Distribution, trends, and change in rates of use.

A two-wave panel survey was carried out on a representative sample of New York State public secondary school students in fall 1971 and spring 1972. The majority of adolsecents have drunk beer or wine (82 per cent) smoked cigarettes (72 per cent) or used hard liquor (65 per cent). Better than one third (35 per cent) report the use of one or more illegal drugs. The illicit drugs most frequently used are marijuana (29 per cent) and hashish (21 per cent). About one in eight adolescents have used pills such as amphetamines and barbiturates, and about one in 12 have tried LSD or other psychedelics. Four per cent have used cocaine and 3 per cent heroin. Use of illicit drugs tends to be experimental and sporadic rather than regular. By contrast, about one in four regularly use beer or wine or smoke cigarettes. Self-reported rates of use increase over the course of a school year, and there is considerable turnover with respect to which adolescents are users. The increased number of hard liquor and marijuana users through the high school years results predominantly from more stability among users, rather than increased conversion of nonusers to users over the teen years.     

Kindergarten children's knowledge and perceptions of alcohol, tobacco, and other drugs

Kindergarten children's knowledge and perceptions of alcohol, tobacco, and other drugs (ATODs) were assessed and the congruence between parent ATOD use and children's knowledge of ATODs was examined. Data were collected during the pre-intervention phase of an ATOD prevention trial with 5- and 6-year-old children and their parents. Three elementary schools were randomly selected from a population of 15 high-risk elementary schools in Lexington, Ky., (n = 126 parent-child dyads). Children were interviewed about their knowledge, feelings, and attitudes toward ATODs using the Child Drug Awareness Inventory. Parents self-reported ATOD use. Almost all (95%) kindergarten children recognized cigarettes; 56% correctly identified alcoholic beverages; and 17% recognized at least one illicit drug. Minority children were almost four times more likely to recognize illicit drugs than were non-minority children. Children's knowledge of ATODs was not correlated with the parents' reported drug use. ATOD prevention programs for young children merit greater emphasis.     

Messages from teens on the big screen: smoking, drinking, and drug use in teen-centered films

Smoking, drinking, and drug use endure as popular yet dangerous behaviors among American teenagers. Films have been cited as potential influences on teens' attitudes toward and initiation of substance use. Social cognitive theory suggests that teen viewers may be especially likely to learn from teen models who they perceive as similar, desirable, and attractive. Yet, to date, no studies systematically have analyzed teen characters in films to assess the frequency, nature, and experienced consequences of substance use depictions. Assessments of content are necessary precursors to effects studies because they can identify patterns of representations that warrant further examination. Accordingly, a content analysis of top grossing films from 1999, 2000, and 2001 was conducted. Overall, two-fifths of teen characters drank alcohol, one-sixth smoked cigarettes, and one-seventh used illicit drugs (N=146). Almost no differences existed between substance users and nonusers with regard to physical attractiveness, socioeconomic status (SES), virtuosity, or gender. Drinkers and drug users were unlikely to suffer any consequences--let alone negative consequences--in either the short or long term. Characters rarely were shown refusing offers to drink or do drugs, or regretting their substance usage. Girls were more likely than boys to be shown engaging in multiple substance use activities (e.g., smoking and drinking). Overall, recent teen-centered films may teach teen viewers that substance use is relatively common, mostly risk-free, and appropriate for anyone.     

Smoking,alcohol consumption,and illicit substances use among adolescents in Poland

Background

The use of alcohol, tobacco, and illicit substances typically first occurs in adolescence. The purpose of this study was to examine alcohol, cigarette, and illicit substance use among adolescents in Poland, including the age of initiation, frequency of use, methods of access, location of use, and parental knowledge and attitude.

Methods

An author-derived questionnaire was used to cross-sectionally survey 541 participants aged 13–17?years old. Due to the fact that some answers were lacking, the number of questionnaires analysed was 538 in case of smoking and illicit substances use, and 535 in case of alcohol drinking.

Results

The use of alcohol, cigarette, and illicit substance among the investigated group was 36.1, 37.6, and 10.8% respectively. The average age of initiation was 13–14?years old. Parents were aware of alcohol, cigarette, and illicit substance use 49.5, 35.8 and 22.4% of the time, respectively, and the rate of acceptance was 5.7 and 6.7% for alcohol and cigarettes. More than 28% of participants smoked in school, and 32.7% accessed illicit substances in the school’s neighborhood.

Conclusions

The rate of alcohol, cigarette, and illicit substance use in Poland is high and increasing, despite globally designed preventative actions. Parents’ awareness of children’s alcohol, cigarette, or illicit substance use is low, and schools hardly fulfil their educational and protective role. Preventative actions are necessary, and local challenges should be considered.

     

Racial/Ethnic differences in smoking, drinking, and illicit drug use among American high school seniors, 1976-89.

BACKGROUND. This paper reports racial/ethnic differences in the use of licit and illicit drugs by high school seniors in the United States. METHODS. The study uses questionnaire data from annual, nationally representative surveys of seniors from 1976 through 1989. Combined sample sizes were 57,620 for 1976-79; 75,772 for 1980-84; and 73,527 for 1985-89. RESULTS. Native American had the highest prevalence rates for cigarettes, alcohol, and most illicit drugs; White students had the next highest rates for most drugs. Asian Americans had the lowest prevalence rates, and Black students had levels nearly as low except for marijuana. Prevalence rates for the Hispanic groups were mostly in the intermediate ranges except for relatively high cocaine use among the males. Trend patterns for most forms of drug use were similar across subgroups, although cigarette use declined more sharply for Black than White seniors, resulting in greater Black-White differences in recent years. CONCLUSIONS. This study, other school-based studies, and general population surveys all show relatively low levels of drug use by most non-White youth, especially Black Americans and Asian Americans. Multivariate analyses indicate that such subgroup differences in high school seniors' drug use are not primarily attributable to family composition, parents' education, region, or urban-rural distinctions.