Factors Associated with Early Pregnancy Smoking Status Among Low-Income Smokers

Objectives To compare pregnant women who are current smokers at their first prenatal visit with those who recently quit smoking in the 90 days prior to their first prenatal visit (i.e., spontaneous quitters) to identify differences between them and factors that predict their intake smoking status. Methods One hundred and thirty participants were enrolled in this cross-sectional research study. The sample was drawn from a population of pregnant women attending their first prenatal visit at a low-income obstetrics clinic in Baltimore, Maryland; the large majority of which have characteristics that previous research has identified as putting them at high-risk of continued smoking during pregnancy. Participants were recruited through referrals from clinical staff. Intake data collection occurred between March and December, 2013. Results Of the 130 pregnant women enrolled in the study, 126 had complete intake data. The sample included 86 current smokers and 40 recent quitters. The large majority of participants were African American with an average age of 26. Current smokers were significantly more likely than recent quitters to have: more depression symptoms; self-perceived stress; internalizing and externalizing disorder symptoms; substance use disorders; and tobacco dependence. The most significant predictors of smoking status at first prenatal visit were depressive symptoms, readiness to quit, and number of children. Conclusions for Practice Differences were identified at intake among this sample of pregnant women already considered to be at high-risk for continued smoking throughout their pregnancy. This study identified relevant factors associated with whether or not a woman had recently quit smoking in early pregnancy or was continuing to smoke at her first prenatal visit. Knowledge of these factors may benefit physicians in understanding and promoting smoking cessation throughout the perinatal period and specifically intervening to decrease depressive symptoms and increasing readiness to quit may improve outcomes.     

Social Integration and Maternal Smoking: A Longitudinal Analysis of a National Birth Cohort

Objectives Social support and engagement are related to smoking behavior in general populations, but it is unknown whether these measures of social integration as experienced by recent mothers are related to longitudinal maternal smoking patterns. The purpose of this study is, first, to describe longitudinal patterns of maternal smoking before, during, and after pregnancy through the early childhood parenting years, as well as variation in these patterns; and second, to examine these patterns in relation to social integration, emotional, behavioral, and sociodemographic factors. Methods Among 9050 mothers of the Early Childhood Longitudinal Study-Birth Cohort (a nationally representative probability sample of children born in 2001), we estimated trajectories of maternal smoking with a general growth mixture model and examined how baseline predictors are associated with these patterns over a 5–6 year period beginning 3 months prior to pregnancy. Results A 5-class solution identified trajectories of nonsmokers (70.5 %), temporary quitters (9.4 %), pregnancy-inspired quitters (3.3 %), delayed initiators (5.1 %), and persistent smokers (11.7 %). Modifiable risk factors included postpartum alcohol consumption and behavioral cues from co-resident smokers, while breastfeeding beyond 6 months and social engagement through religious service attendance were protective characteristics. Conclusions for Practice Prevention of and treatment for maternal perinatal and postpartum smoking is best informed by mothers’ emotional, behavioral and sociodemographic characteristics. Religious service attendance, but not measures of social support or social engagement, was a protective factor for maternal smoking trajectories.     

Associations Among Excess Weight Status and Tobacco,Alcohol, and Illicit Drug Use in a Large National Sample of Early Adolescent Youth

Adolescent substance use and overweight/obesity each are public health priorities, with unique prevalences based on race/ethnicity. Whether these biobehavioral risks are linked in today’s youth is unknown, leaving critical gaps in prevention science. Utilizing a national epidemiological sample of 10th grade students (N?=?19,678; M _age?=?16.09 years; 69.5 % White, 14.5 % Black, 16.0 % Hispanic; 2008–2009 Monitoring the Future), we examined adolescent substance use behaviors (current use, grade of first use, polysubstance use) for adolescents of overweight (OV), obese (OB), or severely obese (SO) status compared to adolescents of healthy weight (HW) for each race/ethnicity group. We also examined how engagement in smoking behaviors (current, early grade at first use) was linked to other substance use behaviors for youth of varying degrees of excess weight. Relative to HW youth, White youth of excess weight, particularly SO, had higher odds of early (<grade 9) substance use and use of some illicit substances (inhalants, cocaine, amphetamines) within the past year. Among White early smokers, OB and SO had higher odds of other substance use, whereas White OB and SO recent smokers had lower odds of other substance use. Few significant findings based on weight status were identified for Black or Hispanic youth. These findings suggest adolescent health risk behaviors co-occur uniquely for White youth, in particular those who are SO and by early adolescence. Understanding the downstream public health consequences and how risk pathways of excess weight, tobacco, and other substance use may uniquely unfold for each race/ethnicity group is imperative.     

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.     

Transitions in Smoking Across a Pregnancy: New Information from the Growing Up in New Zealand Longitudinal Study

Introduction Maternal smoking remains a modifiable cause of adverse maternal and child health outcomes. This study investigated smoking transitions across pregnancy. Methods Data from the contemporary child cohort study Growing Up in New Zealand (n?=?6822) were used to analyse smoking status across three points across a pregnancy: pre-pregnancy, during pregnancy and after pregnancy. Odds-ratios (OR) were calculated for maternal, socio-economic and pregnancy-related factors associated with each transition using multivariate logistic regression. Results The prevalence of smoking pre-pregnancy was 20.3%. The cessation rate during pregnancy was 48.5%, while the postpartum relapse rate was 36.0%. Heavy smokers were less likely to quit during pregnancy (OR 0.13, 95% CI 0.08–0.20), and more likely to relapse at 9 months (OR 2.63, CI 1.60–4.32), relative to light smokers. Women in households with another smoker were less likely to quit during pregnancy (OR 0.35, CI 0.25–0.48), and more likely to relapse postpartum (OR 2.00, CI 1.14–3.51), relative to women in a smoke-free household. Women without high school qualifications were less likely to quit during pregnancy than women with bachelor degrees (OR 0.21, CI 0.11–0.41) but no more likely to relapse. Maori women were less likely to quit during pregnancy than European women (OR 0.35, CI 0.25–0.49) but no more likely to relapse. Conclusion Heavy smokers and those with another smoker in the household are at high risk of smoking during pregnancy or relapsing after pregnancy. Decreasing smoking across a pregnancy therefore requires a focus on cessation in all households with heavy smokers of child-bearing age. The association between smoking and ethnicity may be confounded as it not consistent across the pregnancy.     

Smoking status and health-related quality of life: a longitudinal study in young adults

Purpose

The possibility that tobacco use affects health-related quality of life (HRQoL) has attracted interest. However, a lack of prospective evidence weakens the case for a causal relationship. The aim was to examine the longitudinal relationship between change in smoking status and change in HRQoL in young adults.

Methods

We conducted a population-based cohort study with data collected in 2004–2006 (aged 26–36) and 2009–2011 (aged 31–41). Exposure was change in self-reported smoking status during follow-up. Outcomes were changes in physical and mental HRQoL measured by SF-12.

Results

For physical HRQoL (n = 2080), quitters had a 2.12 (95 % confidence interval (CI) 0.73, 3.51) point improvement than continuing smokers, whereas former smokers who resumed smoking had a 2.08 (95 % CI 0.21, 3.94) point reduction than those who maintained cessation. Resumed smokers were 39 % (95 % CI 10, 75 %) more likely to have a clinically significant (>5 point) reduction of physical HRQoL than former smokers who maintained cessation. In contrast, quitters were 43 % (95 % CI 3, 98 %) more likely to have a clinically significant (>5 point) improvement in physical HRQoL than continuing smokers. Change in smoking status was not significantly associated with change in mental HRQoL (n = 1788).

Conclusions

Smoking by young adults was cross-sectionally associated with lower physical HRQoL and longitudinally associated with reductions in physical HRQoL. The expectation of short- to medium-term gains in physical HRQoL as well as long-term health benefits may help motivate young adult smokers to quit.

     

Epidemiology of substance use in a representative sample of 18-year-old males

AIMS: To assess recent drug use through urine testing as well as the prevalence of tobacco and alcohol dependence among young males and to analyse the associations between tobacco dependence and cannabis use (delta-9-tetrahydrocannabinol, THC), tobacco dependence, and alcohol dependence as well as between THC use and other illicit drug use. METHODS: Urine samples were collected, and nicotine and alcohol questionnaires were administered. Carbon monoxide was assessed in exhaled air. Data from young males from representative, selected districts of Lower Austria were recorded during the annual physical examination for mandatory military service. Out of all 18-year-old males in Austria 3.8% (n = 1902) were included in the study. Prevalence of recent illicit drug use, tobacco dependence (heavy smoking index, HSI), alcohol dependence (The 4-item cutting down, annoyance by criticism, guilty feeling, and eye-openers (CAGE) questionnaire), and associations between substance categories by means of logistic regression analyses were calculated. RESULTS: Alcohol abuse was found in 15.1% and alcohol dependence was found in 3.2%. According to the HSI 51.5% of males reported daily smoking, of whom 43.7% showed a mild level, and 7.8% a high level, of nicotine dependence. About 5.1% of the sample evidenced THC in urine. Opiates were identified in 2.7% of urine samples. Smokers showed a higher risk of THC use. THC users had a tendency to use cocaine and amphetamines more frequently than THC abstainers. CONCLUSION: Nicotine and alcohol dependence is common among young males. Biological assessment of illicit drug use seems to confirm previous questionnaire-based findings of associations between THC use and other illicit drugs. Urine testing seems to be an adequate method to analyse associations of THC use and other illicit drugs. In combination with questionnaires urine testing may be used for the assessment of associations of tobacco dependence and recent illicit drug use based on epidemiological surveys.     

E-Zigaretten und Tabakerhitzer: repräsentative Daten zu Konsumverhalten und assoziierten Faktoren in der deutschen Bevölkerung (die DEBRA-Studie)

Background

Electronic cigarettes (ECs) and heat-not-burn (HNB) devices are relatively new products that are increasingly used alternatively or complementary to ordinary tobacco products.

Objectives

To analyse current data from the German Study on Tobacco Use (DEBRA) regarding the prevalence of EC and HNB device use and associated socioeconomic factors and smoking behaviour; compare reasons for EC use between adolescents and adults; describe the self-perceived risk of HNB devices.

Material and methods

DEBRA is an ongoing, representative, face-to-face household survey of the population aged 14 years and older. We analysed data from the first nine waves (June/July 2016 to October/November 2017; n?=?18,415) for the current study.

Results

During the observation period, 1.9% (95% confidence interval (CI)?=?1.7–2.2%) of the German population used ECs (2.8% of the 14- to17-year-olds) and 74.5% (95% CI?=?69.4–79.2%) of current EC users also smoked tobacco (“dual use”). Three-quarters of adolescents used ECs mainly “for fun”, whereas reasons for use among adults related more to smoking tobacco (e.?g., less harmful, to quit smoking). Among current smokers and recent ex-smokers (<12 months smoke-free), 0.3% (95% CI?=?0.09–0.64%) currently used HNB devices, and 6.0% (95% CI?=?5.0–7.2%) had ever used them. Consumption of HNB products increased with increasing education and income. The majority perceived HNB products as somewhat (41.0%, n?=?25) or much (14.8%, n?=?9) less harmful, and 37.7% (n?=?23) as equally harmful compared with tobacco cigarettes.

Conclusions

In Germany, ECs are mainly consumed as “dual use” together with tobacco. Consumption of HNB products currently occurs at a very low rate and is relatively more common among smokers with higher education and income. It remains important to monitor the use of new electronic inhalation products in the total population and in relevant subgroups.

     

Demographic Characteristics,Components of Sexuality and Gender,and Minority Stress and Their Associations to Excessive Alcohol,Cannabis, and Illicit (Noncannabis) Drug Use Among a Large Sample of Transgender People in the United States

The current study examined demographics, sexual orientation, gender characteristics, and gender minority stress and their association to excessive alcohol, cannabis, and illicit (noncannabis) drug use among 1210 transgender adults living in the United States. The authors conducted a secondary analysis of data that included 680 transgender women (M _age = 32.63, SD _age = 12.29) and 530 transgender men (M _age = 26.14, SD _age = 7.42). A modified version of the Risk Behavioral Assessment quantified participants’ alcohol, cannabis, and illicit drug use in the past 3 months. Overall, 21.5% of participants reported excessive alcohol use; no significant differences were found on the rates of excessive alcohol use between transgender women and men. Cannabis use among our sample was 24.4%; trangender men reported significantly higher rates of cannabis use compared to transgender women. Illicit drug (noncannabis) use among our sample was 11.6%; transgender men also reported significantly higher rates of illicit drug use compared to transgender women. Multivariate analyses suggested that gender dysphoria was significantly associated with: excessive alcohol use for transgender women, cannabis use among both transgender women and men, and illicit (noncannabis) drug use among transgender women. A nonheterosexual orientation was associated with increased odds of cannabis use among transgender women and men; a nonheterosexual orientation was associated with greater odds of illicit substance use among transgender men but not among transgender women. Gender minority stressors were independently associated with excessive alcohol use among transgender men and cannabis use among transgender women. The authors suggest that minority stress may only partially account for substance use among transgender people. Consequently, the authors suggest that in addition to minority stress, other biopsychosocial mechanisms should continue to be examined to identify pathways that may lead to the development of effective substance use prevention efforts and treatment programs.     

Tobacco, betel quid, alcohol, and illicit drug use among 13- to 35-year-olds in I-Lan, rural Taiwan: prevalence and risk factors.

OBJECTIVES: This study determined the prevalence of and risk factors for substance use among rural Taiwanese. METHODS: We used a survey of a representative sample of 6318 participants aged 13 to 35 years in I-Lan, Taiwan, in 1996 through 1997. RESULTS: Perceived use of illicit drugs by peers, tobacco smoking, betel quid chewing, and male gender were the strongest predictors of illicit drug use. The prevalence of illicit drug use ranged from 0.3% among those who did not use any other substance to 7.1% among those using tobacco, betel quid, and alcohol. CONCLUSIONS: Preventive measures should address substance use in general rather than aiming at single substances.     

Tobacco Use and Cessation Among Pregnant Alaska Natives from Western Alaska Enrolled in the WIC Program, 2001–2002

Objectives This study examined the rate of tobacco use (cigarette smoking and smokeless tobacco [ST]) at three time points: during the 3 months before pregnancy, during pregnancy, and at 6 weeks postpartum among Alaska Native women residing in the Y-K Delta region of Western Alaska. Methods A retrospective, non-randomized observational cohort design was utilized. The sample consisted of 832 Alaska Natives (mean maternal age = 26.2 years, average length of gestation = 3.8 months) seen at their first prenatal visit and enrolled in the women, infant, and children (WIC) program at the Yukon-Kuskokwim Delta Regional Hospital in Bethel, Alaska, during a 2-year-period (2001–2002). Tobacco use was assessed using an interview format at the first prenatal and at the 6-week postpartum visits. Results The rates of any tobacco use were 48% (95% CI 45%, 52%) 3 months before pregnancy, 79% (95% CI 76%, 82%) during pregnancy, and 70% (95% CI 67%, 74%) at 6 weeks postpartum. The proportion of women using ST changed significantly (P < 0.001) over the three time points (14%, 60%, and 61%, respectively) as well as the proportion of women who smoked cigarettes (P < 0.001) (40%, 42%, and 19%, respectively). Conclusions This study documents the high rate of tobacco use, particularly ST use, during pregnancy among Alaska Native women. Development of tobacco use prevention and cessation interventions during pregnancy for Alaska Native women is warranted.     

A Typology of Substance Use Among Pregnant Teens in the United States

Objectives Previous research suggests that, in general, youth who become pregnant during their teenage years tend to report elevated levels of substance use prior to conception and substantial reductions in use during pregnancy. While such studies provide insight into aggregate patterns of adolescent substance use in relation to pregnancy, they may have the unintended effect of masking the behavioral heterogeneity of pregnant teens. Methods The present study employs data from a large, population-based study of adolescents in the United States. We employ latent class analysis to identify subgroups of pregnant adolescents (ages 12–17; n = 810) on the basis of variables measuring the past 12-month and past 30-day use of an extensive array of substances. Results Results revealed a four class solution. Classes were identified as Class 1: Abstainers (n = 344, 42.47 %), Class 2: Drinkers (n = 303, 37.41 %), Class 3: Alcohol and Cannabis Users (n = 77, 9.51 %), and Class 4: Polydrug Users (n = 86, 10.62 %). The Abstainers class had the highest proportion of Hispanic youth (34.3 %) as well as the highest proportion of youth residing in households earning less than $20,000 per year (44.2 %). The Polydrug Users class had the highest proportion of youth who were in late adolescence (75.58 %), non-Hispanic white (54.65 %), high-income (13.95 %), and in their first trimester of pregnancy (58.33 %). Conclusions for Practice Findings point to an important degree of heterogeneity among pregnant teens and may have implications for the development of interventions designed for youth exhibiting disconcerting patterns of substance use prior to pregnancy.     

Factors associated with illicit opioid use in methadone maintenance treatment clients in 5 Provinces,China

Objectives

To investigate factors associated with illicit opioid use among methadone maintenance treatment (MMT) population.

Methods

Participants were recruited from Beijing (2 clinics), Shanghai (2 clinics), Guangdong (2 clinics), Chongqing (2 clinics) and Gansu (1 clinic) provinces. Information about heroin use and MMT was obtained from a self-reported questionnaire, illicit opioid use was obtained from monthly medical records. Binary logistic regression was used to investigate factors associated with illicit opioid use.

Results

Five hundred ninety-eight eligible MMT participants were used for data analysis. Variables such as age, gender, route of heroin use and daily MMT dosages were associated with illicit opioid use. Compared with MMT participants aged <40 years, participants aged 40–44 years (P = 0.027, OR = 0.57, 95 % CI 0.35–0.94), 45–49 years (P < 0.001, OR = 0.41, 95 % CI 0.24–0.67) and ≥50 years (P = 0.008, OR = 0.52, 95 % CI 0.33–0.85) were more likely not to have illicit opioid use. Compared with male participants, females were more likely to have illicit opioid use (P = 0.044, OR = 1.53, 95 % CI 1.01–2.32). Compared with inhalation heroin abusers, abusers with route of inhalation + injection heroin use were more likely to have illicit opioid use (P = 0.009, OR = 2.00, 95 % CI 1.19–3.36). Compared with daily MMT dosages <60 mg participants, participants with daily MMT dosages >80 mg were more likely to have illicit opioid use (P = 0.003, OR = 2.37, 95 % CI 1.35–4.15).

Conclusions

Age, gender, route of heroin use and daily MMT dosages were associated with illicit opioid use. A tailored intervention is needed for a promotion of MMT.

     

Smoking,smoking cessation,and 7-year mortality in a cohort of Thai adults

Background

Smoking is a strong risk factor for mortality in both the developed and the developing world. However, there is still limited research to examine the impact of smoking cessation and mortality in middle-income Southeast Asian populations.

Methods

We use longitudinal data from a large Thai cohort of adult Open University students residing nationwide, linked with official death records to assess the association of smoking status and mortality risks during a 7-year follow-up. The log-rank test was used to evaluate the statistical probability of differential survival according to baseline smoking status. Multivariate hazard ratios (HR) were reported for smoking status and all-cause and cause-specific mortality.

Results

From 2005 baseline to 2012, current smokers were more likely to die than cohort members who ceased smoking and never smokers (1.9 vs 1.3 vs 0.6 %, p?<?0.05). The hazard of all-cause mortality increased with the daily amount of cigarette consumption among both current and former smokers. Cause of death analyses showed that current male smokers had a significantly increased risk of cardiovascular disease related mortality (HR 3.9 [95 % CI 1.8–8.1]). Former male smokers had a moderate increase in risk of dying from cardiovascular diseases compared to never smokers (HR 1.6 [95 % CI 0.7–3.4]). Current male smokers between 2005 and 2009 experienced highest subsequent mortality hazards during the period 2009–2012 compared to never smokers (HR 2.1 [95 % CI 1.4–3.4]). The higher risk of dying reduced if people quit smoking during the 2005–2009 follow-up period (HR 1.5 [95 % CI 0.7–3.3]). Risk for mortality fell even further among long-term quitters (HR 1.4 [95 % CI 0.9–2.2]).

Conclusion

Among a large nationwide cohort of Thai adults, current smokers were at a significantly and substantially higher risk of all-cause mortality, especially cardiovascular-related mortality. The higher risk of dying fell if people quit smoking and the risk for mortality was even lower among long-term quitters. Promotion of smoking cessation will contribute substantially to the reduction in avoidable mortality in Thailand.

     

Association Between Maternal Multivitamin Use and Preterm Birth in 24 States,Pregnancy Risk Assessment Monitoring System, 2009–2010

Objectives The study objective was to examine the prevalence of maternal multivitamin use and associations with preterm birth (<37 weeks gestation) in the United States. We additionally examined whether associations differed by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System, we analyzed 2009–2010 data among women aged ≥18 years with a singleton live birth who completed questions on multivitamin use 1 month prior to pregnancy (24 states; n = 57,348) or in the last 3 months of pregnancy (3 states, n = 5095). Results In the month prior to pregnancy, multivitamin use ≥4 times/week continued to remain low (36.8 %). In the last 3 months of pregnancy, 79.6 % of women reported using multivitamins ≥4 times/week. Adjusting for confounders, multivitamin use 1–3 times/week or ≥4 times/week prior to pregnancy was not associated with preterm birth overall. Though there was no evidence of dose response, any multivitamin use in the last 3 months of pregnancy was associated with a significant reduction in preterm birth among non-Hispanic black women. Conclusions for Practice Multivitamin use during pregnancy may help reduce preterm birth, particularly among populations with the highest burden, though further investigations are warranted.     

Prevalence and related risk factors of licit and illicit substances use by adolescent students in Southern Taiwan

Deleterious health sequelae caused by licit and illicit substance use is a serious problem in our society. Adolescent students and particularly those who are prone to substance use are of special concern in the prevention of drug abuse. The purpose of this study was to investigate the prevalence of alcohol consumption, tobacco smoking and illicit drug use and to identify the risk factors related to these habits among adolescent students. A total of 1358 adolescent students aged 16–18 y old were recruited into this study via stratified random sampling from a vocational school in Kaohsiung city. Students were asked to complete a structured questionnaire anonymously and a 96.7% response rate was achieved. Prevalence of substances use was estimated as follows: alcohol drinking, 70.7% (boys 75.1%, girls 51.4%); tobacco smoking, 56% (boys 61.8%, girls 30.2%); illicit drug use 6.4% (boys 6.6%, girls 5.6%). Significant risk factors that emerged as common correlates with substances use were behaviour problems, non-negative attitude toward parent's substance use, and peer influence. A dose–response relationship was found between the prevalence of drinking, smoking, illicit drug use and the number of risk factors adolescents were exposed to. Prevention of adolescent substance abuse should be attempted and risk factors should be reduced. An educational approach is essential not only to gain/impart knowledge of substance abuse, but also to develop an effective program for health and social development.     

Rural adolescent alcohol, tobacco, and illicit drug use: a comparison of students in Victoria, Australia, and Washington State, United States

Purpose: There are inconsistent research findings regarding the impact of rurality on adolescent alcohol, tobacco, and illicit substance use. Therefore, the current study reports on the effect of rurality on alcohol, tobacco, and illicit drug use among adolescents in 2 state representative samples in 2 countries, Washington State (WA) in the United States and Victoria (VIC) in Australia. Participants: The International Youth Development Study (IYDS) recruited representative samples of students from Grade 7 (aged 12 to 13 years) and Grade 9 (aged 14 to 15) in both states. A total of 3,729 students responded to questions about alcohol, tobacco, cannabis, and other illicit substance use (n_VIC= 1,852; n_WA= 1,877). In each state, males and females were equally represented and ages ranged from 12 to 15 years. Methods: Data were analyzed to compare lifetime and current (past 30 days) substance use for students located in census areas classified as urban, large or small town, and rural. Findings were adjusted for school clustering and weighted to compare prevalence at median age 14 years. Findings: Rates of lifetime and current alcohol, tobacco, and cannabis use were significantly higher in rural compared to urban students in both states (odds ratio for current substance use = 1.31). Conclusions: In both Washington State and Victoria, early adolescent rural students use substances more frequently than their urban counterparts. Future studies should examine factors that place rural adolescents at risk for alcohol, tobacco, and illicit drug use.     

Prevalence of illicit drug use among youth: results from the Australian School Students' Alcohol and Drugs Survey

OBJECTIVE: To estimate the prevalence of illicit drug use among Australian secondary school students. METHOD: Data was collected as part of the Australian School Student's Alcohol and Drugs Survey, a national survey of 29,447 secondary school students. RESULTS: Of all students aged 12-17 years, 39.9% (44.1% of males and 35.9% of females) reported having used at least one illicit drug in their lifetime. Cannabis was the most widely used illicit drug with 36.4% of all students reporting having used cannabis. Substantially fewer students reported using other drugs: hallucinogens (8.6%), amphetamines (6.1%), cocaine (3.6%), ecstasy (3.6%), opiates (3.7%) and steroids (1.8%). There were clear gender and age differences in the prevalence of illicit drug use: more males than females reported illicit drug use and the lifetime prevalence of illicit drug use increased with age. Most of those who reported illicit drug use had used drugs on relatively few occasions although there was a small minority of the sample who reported more frequent use. Finally, there were strong association between regular cannabis use and the use of other illicit drugs in the past year, and moderate associations between illicit drug use and the extent of both tobacco and alcohol use. CONCLUSIONS: The findings of this, the first national survey of illicit drug use among Australian school students, indicate a high prevalence of illicit drug use. Comparisons with previous regionally based surveys suggest there may have been a recent increase in the prevalence of cannabis use and highlight the need for further monitoring of and prevention efforts aimed at reducing illicit drug use among students.