Predictors of substance use among black urban adolescents with asthma: a longitudinal assessment

The physical and psychological consequences of asthma, a chronic respiratory disease disproportionately affecting black urban adolescents, may be amplified by substance use, yet studies have not assessed rates or predictors of substance use in this at-risk population. Therefore, this study examined rates of substance use and mental health/ asthma-related predictors of use among 110 black urban adolescents with asthma. Participants completed study questionnaires at baseline and 11 to 14 months post baseline. The mean age of the sample was 15.8 (SD +/- 1.85), 66 (60%) were female, and 82 (74%) of the participants had intermittent/mild persistent asthma. At follow-up, 37 (34%) participants endorsed using at least 1 substance in the past 30 days, including cannabis (n = 18 [16%]), cigarettes (n = 13 [12%]), and/or alcohol (n = 23 [21%]). The substance use variables were dichotomized for analyses (1 = use, 0 = nonuse). Logistic regression results indicated that older age (odds ratio [OR], 1.83; p < .05) was significantly associated with cigarette use and had a marginally significant (p = .06) association with cannabis use at follow-up. Increased anxiety symptoms were significantly associated with alcohol use (OR, 1.12; p < .05) and cannabis use (OR, 0.90; p < .05) at follow-up. Targeting adolescents earlier, those with anxiety difficulties, and those who report early substance initiation may improve prevention/intervention efforts for substance use reduction in this population. Asthma-related factors were not significantly associated with substance use. Future studies should assess the relationship between other asthma-related variables, as well as social and community factors, and substance use among black adolescents with asthma.     

A Twin Study of Drinking and Smoking Onset and Latencies from First Use to Regular Use

The early onset of alcohol and tobacco use has been associated with increased risk for later substance abuse and dependence problems. This study investigated genetic and environmental influences on age at onset of alcohol and tobacco use by examining twin resemblance for several retrospectively reported onset milestones including age at first use, age at first alcohol intoxication experience, and age at regular use. In addition, we also examined the latency between age at first use and age at regular use of tobacco and alcohol. The subjects were a volunteer sample of older adult twins 50 to 96 years of age. MZ twin correlations for age at first alcohol use and age at first tobacco use were .57 and .44, respectively, compared to .45 and .37 for DZ same-sex twins. MZ twins correlated .30 and .26 for the latencies between first use and regular use of alcohol and of tobacco, while DZ correlations were –.01 and .05, respectively. Biometrical model-fitting results confirmed that familial resemblance for age at first use for both alcohol and tobacco was largely the result of shared environmental factors, while the latencies between first use and regular patterns of use were more genetically influenced. These findings add to a growing body of literature suggesting that initiation of substance use is influenced primarily by environmental rather than genetic factors.     

The association between psychosis and problematical drug use among Australian adults: findings from the National Survey of Mental Health and Well-Being

BACKGROUND: The present paper aimed to: (a) provide Australian estimates of the population-level association between psychotic 'caseness' and substance use; (b) examine liability to problematical substance use according to 'caseness' via the conditional prevalence (prevalence among users); and (c) examine associations between problematical substance use and the number of psychotic symptoms using ordinal logistic regression. METHOD: Data were from the National Survey of Mental Health and Well-Being (NSMHWB), a stratified multi-stage probability sample of Australian adults, using a subset of persons under the age of 50 years (N = 6722). A screener assessed the presence of characteristic psychotic symptoms. Associations between 'case' status and DSM-IV alcohol, cannabis and other drug use disorders were examined. Ordinal logistic regressions predicting psychosis scores were carried out, including demographic, mental health and drug use variables. RESULTS: Ninety-nine persons (1.2%) screened positively for psychosis. Regular tobacco, alcohol and cannabis use were much more common among persons screening positively, as were alcohol, cannabis and other drug use disorders. Among alcohol and cannabis users, psychosis 'cases' were much more likely to be dependent. Ordinal logistic regressions revealed that regular tobacco use, cannabis and alcohol dependence, and opiate abuse were predictors of psychosis scores. CONCLUSIONS: The mental health risks of problematical substance use need to be disseminated to persons at risk of, or suffering from, psychotic illness, and to heavy substance users. Work is needed to develop effective treatment approaches for problematical substance use among persons with psychosis.     

Primary anxiety disorders and the development of subsequent alcohol use disorders: a 4-year community study of adolescents and young adults

BACKGROUND: Cross-sectional findings in community surveys of adults suggest that adolescent anxiety disorders are strong predictors of the subsequent onset of alcohol use, abuse and dependence. However, prospective data that follow a sample of adolescents into adulthood are needed to confirm these associations. METHOD: Baseline and 4-year follow-up data from the EDSP-Study, a prospective community survey of 3021 (2548 at follow-up) adolescents and young adults aged 14 to 24 years at baseline carried out in Munich, were used. DSM-IV anxiety disorders, alcohol use and alcohol use disorders were assessed with the Munich-Composite-International-Diagnostic-Interview (M-CIDI). Multiple logistic regression analysis, controlling for age, gender, other mental disorders, substance use disorders and antisocial behaviour was used to study the associations of baseline anxiety disorders with the subsequent onset and course of alcohol use and alcohol disorders. RESULTS: Baseline social phobia significantly predicts the onsets of regular use and hazardous use and the persistence of dependence. Panic attacks significantly predict the onsets of hazardous use and abuse as well as the persistence of combined abuse/dependence. Panic disorder significantly predicts the persistence of combined abuse/dependence. Other anxiety disorders do not significantly predict any of the outcomes. CONCLUSIONS: Panic and social phobia are predictors of subsequent alcohol problems among adolescents and young adults. Further studies are needed to investigate the underlying mechanisms and the potential value of targeted early treatment of primary panic and social phobia to prevent secondary alcohol use disorders.     

Indirect Associations of Anxiety Sensitivity with Tobacco,Alcohol, and Other Drug Use Problems Through Emotional Disorder Symptoms in Adolescents

Abstract

Theoretically, anxiety sensitivity—fear of anxiety symptoms—enhances perception of and emotional reactivity to autonomic arousal and mental distress, thereby increasing negative affect and motivation to use substances for negative reinforcement. Because no prior study of adolescents has tested if anxiety sensitivity is indirectly associated with substance use problems through symptoms of emotional disorders (i.e., disorders involving high levels of negative affect), the current cross-sectional study examined this theoretical pathway. Participants included ninth-grade students from 10 different high schools in the Los Angeles metropolitan area (N?=?3005; 54.3% female). Self-report measures of anxiety sensitivity, emotional disorder symptoms, tobacco dependence, and alcohol and other drug problems were administered. Controlling for sex, race/ethnicity, parental education, school, and impulsiveness, we tested the associations of anxiety sensitivity with tobacco, alcohol, and other drug use problems as well as the indirect effects of anxiety sensitivity on each domain of substance use problems through emotional disorder symptoms. Anxiety sensitivity was associated with more severe tobacco dependence and greater alcohol problems and other drug problems, and anxiety sensitivity further was indirectly associated with all three domains of substance use problems through emotional disorder symptoms. Current findings suggest that adolescents high in anxiety sensitivity tend to experience emotional disorder symptoms, which may increase risk for substance use problems. Interventions that target anxiety sensitivity and enhance negative-affect coping skills may assist in preventing and reducing adolescent substance use problems.     

Social skills as precursors of cannabis use in young adolescents: a TRAILS study

Social skills (cooperation, assertion, and self-control) were assessed by teachers for a longitudinal cohort of (pre)adolescents, with measurements at average ages 11.1 (baseline) and 16.3 years (follow-up). Prospective associations with participants' self-reported use of cannabis, (age of) onset of cannabis use, and frequency of use at follow-up were examined using multinomial logistic regression analyses. Teacher-reported social skills predicted different aspects of cannabis use independent of better known factors such as presence of externalizing behavior and use of other substances. The direction of associations depended on the type of social skill. Good cooperation skills during early adolescence were associated with a reduced risk of lifetime cannabis use and a reduced risk of using cannabis on a regular basis. On the other hand, assertion at age 11 increased the risk of lifetime cannabis use and of using cannabis on an experimental basis.     

Early Onset Cannabis Use and Progression to other Drug Use in a Sample of Dutch Twins

One possible explanation of the commonly reported associations between early onset cannabis use and elevated risks of other illicit drug use is that early onset cannabis use increases access and availability to other drugs. It was this argument that in part motivated policy changes in the Netherlands that led to the de facto legalization of cannabis there. This study examines, using a co-twin control design, whether previously observed associations between early onset cannabis use and elevated lifetime rates of other illicit drug use would also be observed in a sample of 219 same sex Dutch twin pairs discordant for cannabis use before age 18. After adjustment for covariates, rates of lifetime party drug use (OR=7.4, 95% CI=2.3–23.4), hard drug use (OR=16.5, 95% CI=2.4–111.3), but not regular cannabis use (OR=1.3, 95% CI=0.3–5.1) were significantly elevated in individuals who reported early onset cannabis use, relative to their co-twin who had not used cannabis by age 18. The elevated odds of subsequent illicit drug use in early cannabis users relative to their non early using co-twins suggests that this association could not be explained by common familial risk factors, either genetic or environmental, for which our co-twin methodology provided rigorous control.     

Modeling transitions in latent stage-sequential processes: a substance use prevention example

This article illustrates the use of latent transition analysis (LTA), a methodology for testing stage-sequential models of individual growth. LTA is an outgrowth of latent class theory and is a particular type of latent Markov model emphasizing the use of multiple manifest indicators. LTA is used to compare the fit of two models of early adolescent substance use onset and to assess the effects of a school-based substance use prevention program on Ss measured in 7th grade and again in 8th grade. Several interesting findings emerged. First, a model of substance use onset including both alcohol and tobacco use as possible starting points fit better than a model that included alcohol use as the only starting point. Second, Ss who had tried tobacco but not alcohol in in 7th grade seemed to be on an accelerated onset trajectory. Third, the normative education prevention program was generally successful, except for the students who had tried only tobacco in 7th grade.     

Risky Sex,Drugs, Sensation Seeking,and Callous Unemotional Traits in Justice-Involved Male Adolescents

The current study examined whether callous-unemotional (CU) traits predicted risky sexual behavior (i.e., unprotected sex, casual sex) and whether substance use and sensation seeking mediated this relationship over 24 months in justice-involved young men. Participants (N = 1,216) were an ethnically and racially diverse sample (46.3% White Latino, 38% Black, 15.7% White non-Latino) of first-time offending male adolescents (ages 13–17 years) from 3 U.S. cities. Participants completed 5 self-reported interviews at 6-month intervals over 2 years. Bootstrapped mediation analyses were conducted to test direct effects of CU traits on risky sexual behaviors, as well as indirect effects through substance use and sensation seeking. CU traits at baseline were positively associated with risky sexual behavior 18–24 months later. CU traits were also associated with the hypothesized mediators, sensation seeking and substance use, measured 6–12 months after baseline. CU traits exerted direct effects on later unprotected sex and casual sex, as well as indirect effects through substance use but not sensation seeking. These effects were largely unchanged when accounting for the youth’s level of self-reported delinquency. These findings demonstrate that CU traits predict later risky sexual outcomes, and this is at least partly explained by substance use. Further, the findings highlight the importance of CU traits for several outcomes that are of significant public health concern among justice-involved adolescents, namely, risky sexual behavior and substance use.     

The CHRNA5/A3/B4 gene cluster and tobacco, alcohol, cannabis, inhalants and other substance use initiation: replication and new findings using mixture analyses

Multiple studies have provided evidence for genetic associations between single nucleotide polymorphisms (SNPs) located on the CHRNA5/A3/B4 gene cluster and various phenotypes related to Nicotine Dependence (Greenbaum et al. 2009). Only a few studies have investigated other substances of abuse. The current study has two aims, (1) to extend previous findings by focusing on associations between the CHRNA5/A3/B4 gene cluster and age of initiation of several different substances, and (2) to investigate heterogeneity in age of initiation across the different substances. All analyses were conducted with a subset of the Add Health study with available genetic data. The first aim was met by modeling onset of tobacco, alcohol, cannabis, inhalants, and other substance use using survival mixture analysis (SMA). Ten SNPs in CHRNA5/A3/B4 were used to predict phenotypic differences in the risk of onset, and differences between users and non-users. The survival models aim at investigating differences in the risk of initiation across the 5-18 age range for each phenotype separately. Significant or marginally significant genetic effects were found for all phenotypes. The genetic effects were mainly related to the risk of initiation and to a lesser extent to discriminating between users and non-users. To address the second goal, the survival analyses were complemented by a latent class analysis that modeled all phenotypes jointly. One of the ten SNPs was found to predict differences between the early and late onset classes. Taken together, our study provides evidence for a general role of the CHRNA5/A3/B4 gene cluster in substance use initiation that is not limited to nicotine and alcohol.     

Efficacy of cognitive-behavioral interventions targeting personality risk factors for youth alcohol misuse.

Sensation seeking, anxiety sensitivity, and hopelessness are personality risk factors for alcohol use disorders, each associated with specific risky drinking motives in adolescents. We developed a set of interventions and manuals that were designed to intervene at the level of personality risk and associated maladaptive coping strategies, including alcohol misuse. Manuals contained psychoeducational information on the target personality risk factor and how it is associated with maladaptive coping, as well as exercises targeting maladaptive cognitions and behaviors specific to each personality type. We tested the efficacy of these novel interventions on reducing drinking behavior by randomly assigning 297 Canadian high school students (56% girls, mean age 16, mean grade 11) to personality-targeted interventions (group format; 2 sessions) or to a no-treatment control group. Intent-to-treat analyses indicated beneficial effects of the intervention and Intervention x Personality interactions on drinking rates, drinking quantity, binge drinking, and problem drinking symptoms at 4-month follow-up.     

Genetic and Neurophysiological Correlates of the Age of Onset of Alcohol Use Disorders in Adolescents and Young Adults

Discrete time survival analysis was used to assess the age-specific association of event-related oscillations (EROs) and CHRM2 gene variants on the onset of regular alcohol use and alcohol dependence. The subjects were 2,938 adolescents and young adults ages 12–25. Results showed that the CHRM2 gene variants and ERO risk factors had hazards which varied considerably with age. The bulk of the significant age-specific associations occurred in those whose age of onset was under 16. These associations were concentrated in those subjects who at some time took an illicit drug. These results are consistent with studies which associate greater rates of alcohol dependence among those who begin drinking at an early age. The age specificity of the genetic and neurophysiological factors is consistent with recent studies of adolescent brain development, which locate an interval of heightened vulnerability to substance use disorders in the early to mid teens.     

Drug abuse among medical students at a Nigerian university: Part 1. Prevalence and pattern of use

Using a structured pro forma, 728 out of 775 medical undergraduates at a Nigerian university were surveyed for the prevalence and pattern of drug use. An operational definition of substance abuse was made, and 28 percent of students fell within that criterion. Male abusers (81 percent) exceeded female abusers (19 percent). Substances most commonly abused were alcohol (60 percent), minor tranquilizers (48 percent), tobacco (35 percent), and narcotics (29 percent), particularly codeine. Only 11 percent abused cannabis. While most students were polydrug users, there was a low frequency of daily drug use. A general lifetime (occasional use) prevalence of substance use of 56 percent was found. Drugs consumed on a daily basis were alcohol (2 percent) and tobacco (6 percent). The prevalence of drug use was highest among the fourth and final year students. The majority of students were occasional abusers; there was no evidence of physical dependence.     

Development of Psychiatric Comorbidity With Substance Abuse in Adolescents: Effects of Timing and Sex

Examined the impact of childhood psychiatric disorders on the prevalence and timing of substance use and abuse and tested for sex differences. A representative population sample of 1,420 children, ages 9, 11, and 13 at intake, were interviewed annually. American Indians and youth with behavioral problems were oversampled; data were weighted back to population levels for analysis. By age 16, more than half the sample reported substance use, and 6% had abuse or dependence. Alcohol use began by age 9, and smoking in the 13th year. Mean onset of dependence was 14.8 years, and mean onset of abuse was 15.1 years. Substance use began earlier in boys, but not girls, who later developed abuse or dependence. Disruptive behavior disorders and depression were associated with a higher rate and earlier onset of substance use and abuse in both sexes, but anxiety predicted later onset of smoking. Family drug problems were the strongest correlate of early onset. Despite differences in prevalence of psychopathology, boys and girls showed more similarities than differences in the course of early substance use and abuse, and its associations with psychopathology.     

Cannabis use and expression of mania in the general population

BACKGROUND: Cannabis use is common in patients with bipolar disorder, however little is known about cannabis as a risk factor for mania. In order to investigate the association between exposure to cannabis and subsequent development of manic symptoms whilst controlling for psychotic symptoms, a longitudinal population-based study was carried out. METHODS: 4815 individuals aged 18 to 64 years were interviewed using the Composite International Diagnostic Interview at baseline, 1 year follow up and 3 year follow up, including assessment of substance use, manic symptoms and psychotic symptoms. RESULTS: Use of cannabis at baseline increased the risk for manic symptoms during follow-up (adjusted OR 2.70, 95% CI: 1.54, 4.75), adjusted for age, sex, educational level, ethnicity, single marital status, neuroticism, use of other drugs, use of alcohol, depressive symptoms and manic symptoms at baseline. The association between cannabis use and mania was independent of the prevalence and the incidence of psychotic symptoms. There was no evidence for reverse causality, as manic symptoms at baseline did not predict the onset of cannabis use during follow-up (OR = 0.35, 95% CI: 0.03, 3.49). LIMITATIONS: As 3 years is a relative short period of follow-up, long-term effects of cannabis use on mania outcomes could not be detected. CONCLUSION: The results suggest that cannabis use may affect population expression of manic symptoms (and subsequent risk to develop bipolar disorder [Regeer, E.J., Krabbendam, L., R, DE Graaf, Ten Have, M., Nolen, W.A., Van Os, J., 2006. A prospective study of the transition rates of subthreshold (hypo)mania and depression in the general population. Psychol Med, 1-9.]). These findings may not be due to the emergence of psychotic symptoms or the effects of self-medication.     

Age at onset of psychotic disorder: Cannabis,BDNF Val66Met,and sex‐specific models of gene–environment interaction

Discovering modifiable predictors for age at onset may help to identify predictors of transition to psychotic disorder in the “at‐risk mental state.” Inconsistent effects of sex, BDNF Val66Met (rs6265), and cannabis use on age of onset were previously reported. BDNF Val66Met and cannabis use before illness onset were retrospectively assessed in a sample of 585 patients with schizophrenia and their association with age at onset was evaluated. Cannabis use was significantly associated with earlier age at onset of psychotic disorder (AOP; average difference 2.7 years, P < 0.001), showing dose–response effects with higher frequency and earlier age at first use. There was a weak association between BDNF Val66Met genotype and AOP (difference 1.2 years; P = 0.050). No evidence was found for BDNF × cannabis interaction (interaction χ²(1) = 0.65, P = 0.420). However, a significant BDNF × cannabis × sex interaction was found (interaction χ²(1) = 4.99, P = 0.026). In female patients, cannabis use was associated with earlier AOP in BDNF Met‐carriers (difference 7 years), but not in Val/Val‐genotypes. In male patients, cannabis use was associated with earlier AOP irrespective of BDNF Val66Met genotype (difference 1.3 years). BDNF Val66Met genotype in the absence of cannabis use did not influence AOP, neither in female or male patients with psychotic disorder. Complex interactions between cannabis and BDNF may shape age at onset in female individuals at risk of psychotic disorder. No compelling evidence was found that BDNF genotype is associated with age at onset of psychotic disorder in the absence of cannabis use. © 2011 Wiley‐Liss, Inc.     

The role of self-control in early escalation of substance use: a time-varying analysis

This research tested predictions about the role of temperament and self-control in early substance use (tobacco, alcohol, and marijuana). A sample of 1,526 participants was assessed in 6th grade (mean age = 11.5 years) and followed with yearly assessments through 9th grade. Latent growth models showed temperament dimensions were related to early substance use, and their effects were mediated through generalized self-control ability. Time-varying effects indicated rate of growth in substance use was higher among participants who showed increases in poor self-control and lower among participants who showed increases in good self-control. Results in self-report data were corroborated by independent teacher ratings. Findings are discussed with reference to epigenetic models of protection and vulnerability.     

Beyond prevalence and pattern: problematic extent of alcohol and substance use among adolescents in Ibadan South-west Nigeria

Background

Previous research on adolescent alcohol/substance use in Nigeria had focused on the pattern of use without consideration for the extent of use. Socio-demographic correlates have also not been well explored. Information about socio-demographic correlates can also inform target-points in preventive strategies. Knowledge of the prevalence of problematic pattern of alcohol/substance use can inform the inclusion of rehabilitation strategies in intervention policies.

Objectives

To determine the prevalence, pattern and extent-as well as socio-demographic correlates-of alcohol/substance use among a cohort of adolescents in Nigeria.

Methods

Pattern and extent of alcohol/substance use was examined using the CRAFFT instrument.

Results

A total of 538 adolescents with a mean age of 15.1 ± 1.4years returned completed questionnaires. 12-month prevalence of alcohol and other substance use was 21.4%. About 46% of those who reported use of alcohol or any other substance had a CRAFFT score of >2 which suggests problematic pattern of use. Older age, male gender, parental alcohol and substance and lower than average school performance were independently associated with 12-momth use of alcohol or any other substance.

Conclusions

Adolescent alcohol and substance use is common in Nigeria and a large proportion of users show a problematic pattern of use that warrants rehabilitative intervention.     

Social support and substance use in early adolescence

In data from two cohorts of urban adolescents, measures of coping through support-seeking from peers and adults were related to indices of cigarette smoking and alcohol use. Peer support was positively related to substance use, whereas parental and other adult support were inversely related to substance use. Peer support had interactive relationships (positively weighted) with peer smoking and alcohol use: support had no effect when there were no friends who smoked/drank but had an increasingly greater effect for higher levels of peer smoking/drinking. Adult support had a similar (negatively weighted) interactive effect in relation to peer smoking and alcohol use. Peer and adult support interacted, with an increasingly greater effect of peer support on substance use for subjects with lower levels of adult support. Interactions with gender indicated peer support more strongly related to substance use for females than males. Implications for the theory of social networks and the prevention of substance use are discussed.This study was supported by Grant HRRP 80A-23 from the Centers for Disease Control.Versions of this paper were presented at the meeting of the Society for Experimental Social Psychology, and the Nags Head Conference on Social Processes in Adjustment and Health.     

The consistency of peer and parent influences on tobacco,alcohol, and marijuana use among young adolescents

The purpose of this study was to determine the degree to which the use of tobacco, alcohol, and marijuana by young adolescents can be described using a common theoretical model. Structural models were created in which psychosocial variables hierarchically predicted the use of each substance. The fit of a model in which paths from predictor variables were constrained to be equal was not inferior in any meaningful way to that of a model in which all path coefficients were freely estimated, thus suggesting that use of tobacco, alcohol, and marijuana by young adolescents may be considered to be a unitary phenomenon. A simplified model, in which these substances were combined into a single latent variable, showed a good fit. The results of these analyses suggest that it may be beneficial to consider adolescent substance use to be a unitary phenomenon.This research was supported by National Institute on Drug Abuse Grant 1-R18-DA-003406.