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.     

Alcohol, tobacco, and other drug use among rural/small town and urban youth: a secondary analysis of the monitoring the future data set.

OBJECTIVES: This study compared prevalence of substance use among high school seniors in rural and urban areas from 1976 through 1992. METHODS: We used data collected for these years from urban (n = 75,916) and rural (n = 51,182) high school seniors. Thirty-day prevalence for alcohol, cigarettes, marijuana, cocaine, LSD, and inhalant use, binge drinking, smoking a pack or more of cigarettes a day, and daily alcohol and marijuana use were evaluated. RESULTS: Substance use declined from 1976 through 1992. In 1976, urban students had greater prevalence for most substances, but by 1992, rural and urban students were similar, with rural students having higher prevalence for alcohol and cigarette use (particularly excessive use). Trends were similar for both sexes, though rural girls showed a later catch-up to use levels of urban girls. CONCLUSIONS: Rural students are currently at risk approximately equal to that of urban students. Other studies have demonstrated the association of substance use with increased morbidity and mortality. Policy alterations and health education programs should address this pattern in the nation's rural areas.     

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.     

Explaining recent increases in students' marijuana use: impacts of perceived risks and disapproval, 1976 through 1996.

OBJECTIVES: Marijuana use among high school seniors increased during most of the 1970s, decreased throughout the 1980s, and has been increasing again during the 1990s. Earlier analyses of the classes of 1976 through 1986 attributed the historic trends during that period to specific changes in views about marijuana. This study examined whether recent increases in marijuana use among seniors and among students in earlier grades reflect similar processes. METHODS: Multivariate regression analyses were conducted on data from large annual nationwide surveys of high school seniors from 1976 through 1996 (approximate n = 61,000) and 8th and 10th graders from 1991 through 1996 (n''s = 87,911 and 82,475, respectively). RESULTS: Individual lifestyle factors (grades, truancy, religious commitment, evenings out for recreation) correlated substantially with marijuana use but did not explain the historic changes in marijuana use. Rather, decreases in perceived risk of harmfulness and in disapproval can account for the recent increases in all 3 grades and for earlier decreases among seniors. CONCLUSIONS: These findings indicate that perceived risks and disapproval are important determinants of marijuana use. Accordingly, prevention efforts should include realistic information about risks and consequences of marijuana use.     

Smoking, drinking, and drug use among American high school students: correlates and trends, 1975-1979.

This paper uses findings from five nationally representative surveys of high school seniors from 1975 through 1979 to examine the correlates of licit and illicit drug use, and to consider whether recent changes in youthful drug use are linked to any changes in the correlates. Males still exceed females in use of alcohol and marijuana, but no longer in cigarette smoking. Black seniors now report less drug use than Whites. Other dimensions of family background, region, and urbanicity show only modest associations with drug use. Above average drug use occurs among those less successful in adaptation to the educational environment, as indicated by truancy and low grades; those who spend many evenings out for recreation; and those with heavy time commitments to a job and/or relatively high incomes. Drug use is below average among seniors with strong religious commitments and conservative political views. From 1975 through 1979, among seniors cigarette use peaked and subsequently declined, marijuana use rose and then leveled off, and the (still infrequent) use of cocaine rose rapidly. However, these shifts in drug use were not accompanied by substantial shifts in the above correlates of use. The findings thus suggest that the kinds of young people most at risk remain much the same, while the types and amounts of substances they use shift somewhat from year to year.     

Cocaine and cigarettes: a comparison of risks

Summary. In order to provide additional data and perspective to current clinical, policy, and legal debates surrounding the prenatal use of cocaine in the USA, a retrospective cohort study was conducted to examine effects of cocaine on selected perinatal outcomes, and to compare the relative risks of adverse perinatal outcomes among users of cocaine and users of cigarettes. Using data from a large urban perinatal registry, relative risks of selected perinatal outcomes were determined for maternal cocaine users who were non-smokers of cigarettes, and used no marijuana, heroin, amphetamines, or alcohol (n = 64), and for cigarette smokers who do not use illicit drugs or alcohol during pregnancy (n = 3209). When compared with women with no recorded prenatal exposure to drugs or cigarettes (n = 13043), cocaine users had higher risks than smokers for the following adverse outcomes: low birthweight [Relative Risk (RR) 5.3, 95% Confidence Interval (CI) 3.0–9.3], small-for-ges-tational age (SGA) [RR4.2, 95% CI 2.4–7.3], prematurity [RR4.0, 95% CI 2.3–7.0], abruptio placentae [RR = 10.0,95% CI 3.5–29.0], placenta prae-via [RR = 2.4, 95% CI 0.3–17.8] and perinatal death [RR = 5.3, 95% CI 1.9–15.2]. Smokers who did not use any drugs experienced most of the same adverse perinatal outcomes as cocaine users, but the magnitude of risk was greater in cocaine users than in smokers for all outcomes. However, given the greater numbers of cigarette smokers than cocaine users in the population the numbers of infants in the population suffering these adverse outcomes is likely to be greater among offspring of cigarette smokers. The data support current concern about the risk of cocaine, and current efforts to provide treatment to pregnant cocaine users. The data also underline the continued substantial risks of cigarette smoking to large numbers of pregnant women.     

Ten-year evaluation of hypertension, overweight, cholesterol, and smoking control: the CHAD program in Jerusalem. Community Syndrome of Hypertension, Atherosclerosis and Diabetes

Control of hypertension, overweight, hypercholesterolemia, and smoking is a major objective of the CHAD program, a multifactorial cardiovascular risk factor program built into a family practice, which has operated in a neighborhood of western Jerusalem since 1971. By 1975-1976, there was a significantly larger decrease in risk factors in this population than in a neighboring population receiving ordinary medical care. Follow-up based on clinical records of a cohort of 441 people exposed to the program until 1981 revealed that the mean blood pressures decreased and the prevalence of hypertension continued to decrease between 1976 and 1981, from 12.5 to 9.1%. Prevalence of cigarette smoking among people ages 30 years or more also decreased in this period, mainly due to a decrease in heavy smoking, at a time when national surveys provided no evidence of a smoking decrease in this age group. Effects on overweight and cholesterol were not demonstrated during this period. This 10-year evaluation demonstrates the effects of intervention by primary care practitioners in the framework of a community-oriented program.     

Problem drinking and the dimension of involvement with drugs: a Guttman scalogram analysis of adolescent drug use.

Analyses of data from two nationwide surveys of high school students, one carried out in 1974 and the other in 1978, suggest that problem drinking may be seen as yet another step along an underlying dimension of involvement with both licit and illicit drugs. The dimension of involvement with drugs consists of the following levels: nonuse of alcohol or illicit drugs; nonproblem use of alcohol; marijuana use; problem drinking; use of pills (amphetamines, barbiturates, hallucinogenic drugs); and the use of "hard drugs" such as cocaine or heroin. The dimension possesses excellent Guttman-scale properties in both national samples as well as in subsamples differing in gender and ethnic background. The ordering of the levels of involvement was confirmed by the ordering of the alcohol-drug involvement groups based on their mean scores on measures of psychosocial proneness for involvement in problem behavior. The excessive use of a licit drug, i.e., problem drinking, appears to indicate greater involvement in drug use than does the use of an illicit drug, marijuana. This finding points to the importance of distinguishing between use and problem use of drugs in efforts to understand adolescent 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.     

The estimated predictive value of screening for illicit drugs in the workplace.

This paper estimates the predictive values of screening tests for six illicit drugs of common concern in the workplace (amphetamines, barbiturates, cocaine, hallucinogens, marijuana, and opiates) using published information on test sensitivity and specificity and survey data on prevalence. Estimated predictive values (negative) were generally high, whereas the estimated predictive value of a positive test ranged from 1 per cent for amphetamines to 100 per cent for hallucinogens and was only 38 per cent for marijuana, the most prevalent drug.     

Understanding Adolescent Parenthood From a Multisystemic Perspective

PurposeThis study examined the associations between social, behavioral, and environmental factors and adolescent parenthood.MethodsWe analyzed data from a subsample of participants, 18–30 years of age (n = 7,937), who took part in the 2001–2002 National Epidemiologic Study on Alcohol and Related Conditions, a nationally representative survey of adults. An extended Cox proportional hazards model was used to model time until becoming an adolescent parent (i.e., age at which first child was born if ≤18 years). Predictor variables of interest included initiation of alcohol, marijuana, cocaine, and daily cigarette use, age of earliest conduct disorder symptom, having a parent with alcohol and/or drug problems, parental death, divorce and/or separation, race/ethnicity, and gender.ResultsSeveral variables were associated with adolescent parenthood, including initiation of daily cigarette smoking, age of first antisocial/conduct disorder symptom, and race/ethnicity. Parental alcohol/drug problems and parental death were also associated with adolescent parenthood for women. A significant interaction between initiation of daily cigarette smoking and ethnicity was present for women. Daily cigarette smoking was associated with adolescent parenthood to a greater degree than nondaily cigarette smoking for white and Hispanic women but not African American women. No significant associations were found between adolescent parenthood and initiation of drinking, marijuana, or cocaine and parental divorce/separation.ConclusionsPrevention efforts should focus on adolescents who are at highest risk of adolescent parenthood.     

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.     

The Relationship Between Marijuana and Conventional Cigarette Smoking Behavior from Early Adolescence to Adulthood

Longitudinal analyses investigated (a) the co-occurrence of marijuana use and conventional cigarette smoking within time and (b) bidirectional associations between marijuana and conventional cigarette use in three developmental periods: adolescence, young adulthood, and adulthood. A cross-lag model was used to examine the bidirectional model of marijuana and conventional cigarette smoking frequency from ages 13 to 33 years. The bidirectional model accounted for gender, school-age economic disadvantage, childhood attention problems, and race. Marijuana use and conventional cigarette smoking were associated within time in decreasing magnitude and increased cigarette smoking predicted increased marijuana use during adolescence. A reciprocal relationship was found in the transition from young adulthood to adulthood, such that increased conventional cigarette smoking at age 24 years uniquely predicted increased marijuana use at age 27 years, and increased marijuana use at age 24 years uniquely predicted more frequent conventional cigarette smoking at age 27 years, even after accounting for other factors. The association between marijuana and cigarette smoking was found to developmentally vary in the current study. Results suggest that conventional cigarette smoking prevention efforts in adolescence and young adulthood could potentially lower the public health impact of both conventional cigarette smoking and marijuana use. Findings point to the importance of universal conventional cigarette smoking prevention efforts among adolescents as a way to decrease later marijuana use and suggest that a prevention effort focused on young adults as they transition to adulthood would lower the use of both cigarette and marijuana use.     

Effects of School-Level Norms on Student Substance Use

This study examines the relationship between school norms of substance use disapproval (disapproval by the student body) and students' use of cigarettes, alcohol, and marijuana. Data came from nationally representative samples of 8th (N = 16,051), 10th (N = 13,251), and 12th (N = 8,797) grade students, attending 150, 140, and 142 schools, respectively. These students participated in the Monitoring the Future Project in 1999. Measures of school norms of disapproval of substance use were obtained by aggregating students' personal disapproval of daily cigarette use, heavy drinking, and marijuana use within each school. Analysis using logistic nonlinear hierarchical models indicated that in general, school-level disapproval lowered the probability of students' use of these substances, controlling for their own disapproval and for student and school demographic characteristics. The beneficial effect of school-level disapproval of cigarette and marijuana use on 8th-grade students' probability of daily cigarette use and marijuana use was significantly higher than it was for the 12th-grade students. The effect of school-level disapproval of heavy drinking on the probability of students' drinking was not significantly different across the three grades. Further, a school environment of disapproval was also found to create a protective environment for those students in the 8th and 10th grades who were themselves not disapproving of daily cigarette use. These results argue for prevention programs that include creation of an overarching environment of disapproval of substance use in schools.     

Recreational drug use and the risk of primary infertility

Recreational drug (marijuana, lysergic acid diethylamide or LSD, speed, cocaine, and "other") exposures of women with primary infertility were compared with those of a matched control group of women with proven fertility. Women who reported smoking marijuana had a slightly elevated risk for infertility due to an ovulatory abnormality (RR = 1.7, 95% CI = 1.0 to 3.0). The risk was greatest among women who had used marijuana within one year of trying to become pregnant (RR = 2.1, 95% CI = 1.1 to 4.0). No consistent frequency or duration of use effects could be demonstrated, and the risk was confined to low-frequency users. Risks associated with the use of other drugs were not elevated. The risk of infertility from a tubal abnormality associated with cocaine use was greatly increased (RR = 11.1, 95% CI = 1.7 to 70.8). Our results are consistent with animal studies suggesting that smoking marijuana may cause a transient disruption of ovulatory function. The possibility that cocaine exposure influences the development of tubal infertility needs further investigation.     

Marijuana use and high school dropout: the influence of unobservables

In this study, we reconsider the relationship between heavy and persistent marijuana use and high school dropout status. Using a unique prospective panel study of over 4500 7th grade students from South Dakota who are followed through high school, we developed propensity score weights to adjust for baseline differences found to exist before marijuana initiation occurs for most students (7th grade). We then used weighted logistic regression that incorporates these propensity score weights to examine the extent to which time‐varying factors, including substance use, also influence the likelihood of dropping out of school. We found a positive association between marijuana use and dropping out (OR=5.6, RR=3.8), over half of which was explained by prior differences in observational characteristics and behaviors. The remaining association (OR=2.4, RR=1.7) became statistically insignificant when measures of cigarette smoking were included in the analysis. Because cigarette smoking is unlikely to seriously impair cognition, we interpret this result as evidence that the association between marijuana use and high school dropout is unlikely to be due to its adverse effects on cognition. We then explored which constructs drive this result, determining that they are time‐varying parental and peer influences. Copyright © 2009 John Wiley & Sons, Ltd.     

Adolescent religious commitment and their consumption of marijuana, cocaine, and alcohol

Using the National Education Longitudinal Study (NELS) data set from the 1988-1992 period, this study used longitudinal data to assess the effects of student religious commitment on the marijuana, cocaine, and alcohol consumption of those children. The results of this study support the notion that a high level of religious commitment among adolescents reduces their likelihood of consuming marijuana, cocaine, and alcohol. Religiously committed adolescents consumed marijuana, cocaine, and alcohol less frequently and were less likely to be under the influence of marijuana and alcohol at school than their less religious counterparts. There were, however, no differences in the likelihood of religious and less religious twelfth graders to be under the influence of cocaine while at school. The study also indicates that the use of marijuana, cocaine, and alcohol by adolescents was associated with lower levels of academic achievement than those students who did not use these substances.     

Trends in cigarette smoking: the Minnesota Heart Survey, 1980 through 1992.

OBJECTIVES: The purpose of this study was to describe trends in the prevalence of cigarette smoking between 1980 through 1982 and 1990 through 1992 in Minneapolis and St. Paul, Minn. METHODS: Three population-based surveys were conducted among adults 25 to 74 years of age in 1980 through 1982, 1985 through 1987, and 1990 through 1992. RESULTS: Overall age-adjusted prevalences of cigarette smoking declined significantly between 1980-1982 and 1985-1987 and between 1985-1987 and 1990-1992. Serum thiocyanate, a biochemical marker for tobacco use, also declined significantly over the 3 periods. CONCLUSIONS: Favorable trends in smoking prevalence and cigarette consumption among smokers were observed, but disturbing trends in some smoking behaviors were also noted.     

Effects of sales promotion on smoking among U.S. ninth graders

OBJECTIVE: The purpose of this study was to examine the association between tobacco marketing efforts and daily cigarette smoking by adolescents. DESIGN: This was a longitudinal study of uptake of smoking on a daily basis with smoking data from the Monitoring the Future project. Diffusion modeling was used to generate expected rates of daily smoking initiation, which were compared with actual rates. Study data were from a national survey, administered annually from 1978 through 1995. Between 4,416 and 6,099 high school seniors participated per year, for a total of 94,652. The main outcome measure was a deviation score based on expected rates from diffusion modeling vs actual rates of initiation of daily use of cigarettes by ninth graders. Annual data on cigarette marketing expenditures were reported by the Federal Trade Commission. RESULTS: The deviation scores of expected vs actual rates of smoking initiation for ninth graders were correlated with annual changes in marketing expenditures. The correlation between sales promotion expenditures and the deviation score in daily smoking initiation was large (r = 0. 769) and statistically significant (P = 0.009) in the 1983-1992 period. Correlations between sales promotion and smoking initiation were not statistically significant in 1978-1982. Correlations between advertising expenditures and smoking initiation were not significant in either period. CONCLUSIONS: In years of high promotional expenditures, the rate of daily smoking initiation among ninth graders was higher than expected from diffusion model predictions. Large promotional pushes by cigarette marketers in the 1980s and 1990s appear to be linked with increased levels of daily smoking initiation among ninth graders.