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CORK Bibliography: Adolescents-Initiation of Alcohol and Drug Use

63 citations. January 2003 to present

Prepared: December 2006

Amuedo-Dorantes C; Mach T; Clapp JD. The impact of schools on juvenile substance initiation and use. Prevention Science 5(2): 91-99, 2004. (31 refs.)

We use data from the two rounds of the NLSY97 and the corresponding QED data to examine the effectiveness of school endowments and curricula in targeting juvenile use of tobacco, alcohol, and marijuana. Our results support the notion that schools matter in reducing juvenile involvement in substance use. Higher discretionary dollars per pupil are linked to reduced rates of juvenile initiation and repetitive use rates of cigarettes and marijuana. Additionally, school curricula, as indicated by the implementation of year round classes and some innovative and after-school programs-such as gifted and talented, attendance monitoring, homework hot-line, international baccalaureate, extended-day, and mentoring, programs, affect both juvenile initiation to tobacco and alcohol use and juvenile repetitive use of tobacco and alcohol. In particular, we find that juvenile initiation to cigarette use is approximately between 2 percentage points and 3 percentage points lower among youths attending schools with gifted and talented and international baccalaureate programs. In addition, juvenile repetitive cigarette use is approximately 54%, 52%, and 48% lower among youths attending schools offering year round classes, international baccalaureate, and twenty-first century programs, respectively. Finally, juvenile initiation to alcohol use and juvenile repetitive use of alcohol are approximately 3% and 20% lower, respectively, among youths in schools offering gifted and talented programs. In sum, while these programs are not implemented to address substance use problems among the student body, we find that the implementation of these programs is often accompanied by a reduction in juvenile initiation and repetitive substance use.

Audrain-McGovern J; Rodriguez D; Patel V; Faith MS; Rodgers K; Cuevas J. How do psychological factors influence adolescent smoking progression? The evidence for indirect effects through tobacco advertising receptivity. Pediatrics 117(4): 1216-1225, 2006. (62 refs.)

OBJECTIVES. To determine whether novelty seeking and depressive symptoms had mediated or indirect effects on adolescent smoking progression through tobacco advertising receptivity. METHODS. More than 1000 adolescents were monitored from 9th grade to 12th grade and completed annual surveys that measured demographic characteristics, smoking behavior, tobacco advertising receptivity, novelty-seeking personality, depressive symptoms, family and peer smoking, alcohol use, and marijuana use. RESULTS. Latent growth modeling indicated that novelty seeking had a significant indirect effect on smoking progression through baseline tobacco advertising receptivity. For each 1-SD increase in novelty seeking, the odds of being more receptive to tobacco advertising increased by 12% (ie, being in a specific category or higher), which in turn resulted in an 11% increase in the odds of smoking progression from 9th grade to 12th grade. The indirect effect from depressive symptoms to smoking progression did not reach significance. CONCLUSIONS. These findings may inform future research on other factors that influence tobacco advertising receptivity, as well as programs aimed at preventing adolescent smoking initiation and progression.

Barber P; Lopez-Valcarcel BG; Pinilla J; Santana Y; Calvo JR; Lopez A. Attitudes of teenagers towards cigarettes and smoking initiation. Substance Use & Misuse 40(5): 625-643, 2005. (57 refs.)

This paper contributes to the empirical knowledge of determinants of smoking initiation in adolescents. The instrument we used was a structural equation model, which is a powerful tool to analyze causal relationships in nonexperimental studies. We used a school-based sample of 1198 teenagers from Spain. We measured the attitude of the adolescents towards tobacco. Attitudes and smoking status are related. Attitudes become more favorable to smoking, as experimentation with cigarettes progresses and pupils become older. Teenagers who have tried at least one cigarette are on average more favorable to smoking than those who had never smoked. The study's limitations were noted.

Blumberg D. Stage model of recovery for chemically dependent adolescents. Part 1, Methods and model. Journal of Psychoactive Drugs 36(3): 323-345, 2004. (52 refs.)

This qualitative study, presented in two parts, refines the model of how chemically dependent adolescents initiate and engage in the recovery process. Part I describes the research process and results used to derive the model. The model was derived from theory grounded in verbatim reports of 30 chemically dependent participants who first attempted recovery from chemical dependence during adolescence. The constant comparative method of grounded theory was used to analyze the data. This stage model of adolescent recovery includes the using/precontemplation, transition, early recovery, and ongoing recovery stages; the transition stage is divided into contemplation and action phases. The stages, phases, and significant events are similar, but not identical to, those presented in adult-based models of recovery from chemical dependence. In Part 2, the resulting theory is compared with extant theories on stages of recovery in chemically dependent adults, treatment implications for the adolescent population are reviewed, and topics for further research are suggested.

Bolognini M; Plancherel B; Laget J; Stephan P; Chinet L; Bernard M et al. Adolescent drug use escalation and de-escalation: A 3-year follow-up study. Addiction Research & Theory 13(1): 19-33, 2005. (32 refs.)

This study aims to assess adolescents drug use with a longitudinal perspective in order to identify factors interacting with drug use onset and course. Supported by the Swiss Federal Office of Publicic Health, the study was initiated in 1999 with a follow-up in 2001 and 2002. The first objective was to measure risk factors for substance use initiation. The second objective was to analyse the co-variation of substance use with environmental, social, relational, medical and psychological factors. A total of 102 adolescents, aged 14-19 years, were recruited for the study in the French-speaking part of Switzerland. Results clearly show that substance use is not a disorder per se in adolescence, but that it is part of a multidimensional complex of problems that some adolescents may encounter: increase and decrease in substance use is paralleled with an increase or decrease in the other areas. This implies that prevention of substance use should not be focused mainly on substances but should consider the adolescent's environment and significant life areas.

Braithwaite RL; Conerly RC; Robillard AG; Stephens TT; Woodring T. Alcohol and other drug use among adolescent detainees. Journal of Substance Use 8(2): 126-131, 2003. (13 refs.)

This article describes alcohol and other drug use among a sample of male and female adolescent detainees (N = 2,280) at two state juvenile justice facilities. Trained interviewers collected information on several alcohol and other drug use and delinquency measures. Substance use was measured with an adaptation of the Youth Risk Behavior Surveillance questionnaire and explored by age of initiation, race/ethnicity, gender, delinquent behaviors, and recidivism. Alcohol and marijuana were the substances of choice, followed by powder cocaine and ecstasy and other designer drugs. Alcohol use also preceded marijuana use for both males and females. Males engaged in more alcohol and other drug use than females did, and they engaged in marijuana use at a younger age. White adolescents reported more alcohol use than did adolescents in all other racial and ethnic categories, while there were no differences in reported marijuana use. White adolescents, however, were younger when they began using marijuana. Finally, adolescents who engaged in alcohol and other drug use reported more delinquent activities and were more likely to have been detained previously. The results are discussed in the context of other studies of substance use in the general adolescent population and in at-risk and detained adolescents.

Brecht ML; Greenwell L; Anglin MD. Substance use pathways to methamphetamine use among treated users. Addictive Behaviors 32(1): 24-38, 2007. (57 refs.)

Considerable research has focused on patterns of substance use initiation among adolescents and for users of selected drugs; however, few data are available for methamphetamine (MA) users. This study describes substance initiation patterns for 352 MA users and assesses predictors of age of MA initiation and its sequencing. Subjects were randomly selected from treatment admissions in a large California county and interviewed using an extensive natural history protocol. Average age of MA initiation was 19 years. Nearly all (95%) had used alcohol, marijuana, and tobacco (average initiation age 13); inhalants, hallucinogens, and crack were also commonly used earlier in the drug sequence than MA. Earlier age of MA initiation was related to race/ethnicity (being non-African-American), younger age of first use of any substance, more types of early criminal behavior, and initiating MA use for sensation-seeking reasons. Following initiation of alcohol, marijuana, and/or tobacco, 27% initiated MA before other illicit drugs, 18% initiated another illicit drug before MA, and 56% initiated two or more other illicit drugs before MA. Later MA order in the initiation sequence was related to ethnicity (being African-American) and initiating MA to substitute for another drug. Results may support targeted prevention efforts and development of more effective interventions.

Carvajal SC; Granillo TM. A prospective test of distal and proximal determinants of smoking initiation in early adolescents. Addictive Behaviors 31(4): 649-660, 2006. (44 refs.)

This study tests a broad array of determinants of utility for developing smoking preventive interventions using a population-based cohort of early adolescents. Multivariable logistic regressions using never-smokers at baseline (N = 1137; age 11-14) showed a model of distal determinants was more predictive of initiation within the approximate 10 month follow up period than one of proximal determinants. When all determinants were simultaneously considered, lesser academic achievement and fewer environmental impediments to smoking most strongly predicted initiation. The findings are consistent with some current smoking prevention programs, however such programs may be further potent by using theory-based social development approaches and through reducing tobacco availability or social contexts where youth can smoke without another adult knowing.

Cawley J; Markowitz S; Tauras J. Lighting Up and Slimming Down. The Effects of Body Weight and Cigarette Prices on Adolescent Smoking Initiation. National Bureau of Economic Research Working Paper No. w9561. Cambridge MA: National Bureau of Economic Research, 2003. (43 refs.)

This paper examines the influence of body weight, body image, and cigarette prices in determining adolescent smoking initiation. Adolescents who desire to lose weight may initiate smoking as a method of appetite control. Such behavior may undermine the goals of tobacco control policies that seek to prevent smoking initiation. Using a nationally representative panel of adolescents, we show that smoking initiation is more likely among females who are overweight, who report trying to lose weight, or who describe themselves as overweight. In contrast, neither objective nor subjective measures of weight predict smoking initiation by males. Higher cigarette prices decrease the probability of smoking initiation among males but have no impact on female smoking initiation. These gender-specific differences may help explain the mixed and inconclusive evidence of the impact of price on smoking initiation found in previous literature

Clayton RR. The importance of adolescence in the development of nicotine dependence. Introduction to Part V. Annals of the New York Academy of Sciences. Adolescent Brain Development: Vulnerabilities and Opportunities 1021: 162-166, 2004. (3 refs.)

This article sets the stage for the papers in Part V by describing the research work of the Tobacco Etiology Research Network (TERN), an initiative of the Robert Wood Johnson Foundation. Two studies coming from this matrix include one on the acquisition of tobacco use and another on the trajectories of tobacco use among college freshman.

Conwell LS; O'Callaghan MJ; Andersen MJ; Bor W; Najman JM; Williams GM. Early adolescent smoking and a web of personal and social disadvantage. Journal of Paediatrics and Child Health 39(8): 580-585, 2003. (31 refs.)

Objective: To examine concurrent physical, educational, behavioural, social and family factors associated with cigarette smoking in adolescents at 14 years.Methodology: This study reports cross-sectional data on 14-year-old adolescents and their mothers, drawn from a prospective cohort study commencing at the time of the first antenatal visit. At 14 years, 5247 adolescents completed questionnaires on current cigarette smoking. Adolescents and mothers completed health, psychological, school and social questionnaires relating to the youth. A total of 3864 adolescents were assessed physically, and undertook the Wide Range Achievement Test (WRAT) and Ravens Progressive Matrices Test. Results: Cigarette smoking at 14 years was associated with externalizing and internalizing behaviour problems, school suspension, contact with children's services and alcohol/illicit drug use. Apart from internalizing behaviour problems, these problems were more prevalent in boys. Poor school performance on maternal/adolescent reports was associated with increased smoking quantity for both genders, though WRAT scores were only decreased in male smokers. The Ravens Progressive Matrices Test scores were lower for boys with greater smoking quantity. The trend was less marked in girls. Body mass index and exercise frequency were not associated with cigarette smoking at 14 years, though girls who smoked had a higher reported prevalence of asthma. Parental smoking, marital conflict, maternal depression, lower income, and mothers aged in their teens and with a lower level of education at the time of this pregnancy were also positively associated with adolescent tobacco use. Conclusion: Findings of this study indicate that cigarette smoking, at this critical time of smoking initiation, is associated with a broad spectrum of personal and social disadvantage that needs to be considered in intervention strategies.

D'Amico EJ; McCarthy DA. Escalation and initiation of younger adolescents' substance use: The impact of perceived peer use. Journal of Adolescent Health 39(4): 481-487, 2006. (39 refs.)

Purpose: The middle school years are peak years for substance use initiation. The current study assessed the impact of peer influence on both initiation and escalation of cigarette, alcohol, and marijuana use among sixth, seventh, and eighth graders. Methods: Youth (n = 974; 45% male) were surveyed twice over an academic year and reported on their personal substance use and their perception of peer substance use. The sample ranged in age from 10 to 15 years at Time 1 (M age = 11.95) and was 44% White, 26% Latino, 7% Asian American/Pacific Islander, 4% African American, and 14% mixed ethnic origin. Results: Hierarchical regressions examined whether personal and perceived peer substance use predicted later substance involvement, and logistic regressions assessed whether Time 1 perceived peer and personal use of other substances discriminated between initiates and noninitiates. After controlling for personal substance use, perceived peer alcohol use predicted both increased alcohol and marijuana use, and perceived peer marijuana use predicted increased alcohol use. Only perceived peer alcohol use was associated with initiation of alcohol, and both perceived peer alcohol and marijuana use predicted onset of marijuana use. Conclusions: Results highlight the importance of perceived peer use in predicting both onset and escalation of use and suggest utilizing a multifaceted prevention approach that targets multiple substances.

Dunn MS. The relationship between religiosity, employment, and political beliefs on substance use among high school seniors. Journal of Alcohol and Drug Education 49(1): 73-88, 2005. (17 refs.)

The purpose of this study was to provide a descriptive profile of the alcohol, cigarette, marijuana and cocaine use practices among adolescents and to examine the relationship between employment, political beliefs, religious beliefs and substance use behaviors among high school seniors participating in the Monitoring the Future Study during the 2002 academic schoolyear. Data from the Monitoring the Future (MTF) study (2002 12th grade core data) was used for this study. Logistic regression models were used to examine the relationship between substance use behaviors and employment, political beliefs, and religiosity. Analysis showed that males and females who believed religion was very important were less likely to have initiated alcohol use, to be a current user, and to have binge drank. A significant association was found for all alcohol use variables for those individuals who worked moderate amounts at an after school job. Political beliefs were found to be associated for initiation and current alcohol use but not for binge drinking. Political beliefs, religion, and employment were all significantly associated with cigarette use and cocaine use. Conceptualization of substance use behavior and its prevention and treatment should include consideration of such key cultural and social factors as religiosity, employment and political beliefs of adolescents.

Eaves CS. Heroin use among female adolescents: The role of partner influence in path of initiation and route of administration. American Journal of Drug and Alcohol Abuse 30(1): 21-38, 2004. (33 refs.)

This study examined heroin initiation and route of administration among 16 female adolescents in the greater Baltimore Metropolitan area. Participants were more than twice as likely to be introduced to heroin by a male friend or boyfriend (IHM) than introduced to heroin by other means (IHO). The majority of IHM females were introduced by a male friend rather than a romantic partner. No relationship was found between path of initiation (IHM, IHO) and initial route of administration (inhalation, smoking, injecting) or history of injection (ever injected, never injected). The effect of opposite-gender peer influence in the initiation of female adolescent heroin use is discussed along with how the current findings may influence treatment and prevention efforts. A statistically significant relationship was found for initial route of administration and for history of injection. Ninety-four percent of participants reported initiation of heroin use by inhalation, while an alarming 75% of participants reported injecting heroin at some time during their history of use. Participants were no more likely to be introduced to injection by a boyfriend or male friend than by other means. The finding that the majority of females first try heroin through inhalation is consistent with an increased use of heroin by this method among young people in recent years. However, the majority of users in this study used heroin through injection at least once in their addict career, a route of administration associated with increased health and safety risks. Potential explanations for the progression from snorting to injection are presented as well as implications for the delivery of prevention and treatment services.

Ellickson PL; D'Amico EJ; Collins RL; Klein DJ. Marijuana use and later problems: When frequency of recent use explains age of initiation effects (and when it does not). Substance Use & Misuse 40(3): 343-359, 2005. (58 refs.)

Tobacco, alcohol, and marijuana are among the most commonly used drugs during adolescence. Initiation of marijuana use typically peaks at age 15, with risk of initiation continuing throughout adolescence. The goal of the current study was to prospectively examine the influence of age of marijuana initiation on four outcomes: physical health, mental health, illicit drug use other than marijuana, and marijuana-use related consequences at age 18. We controlled for several important predictors of adolescent drug use and its associated consequences, including demographics, social bonding variables, personality variables, and recent use of marijuana. Baseline survey data were collected in 1984 at grade 7 and follow up surveys were conducted at grades 8, 9, 10, and 12 (N = 2079). This initiates-only sample was 47% female, 66% White, 11% African American, 13% Hispanic, 5% Asian, and 5% other race or ethnicity. Findings indicated that age of initiation predicted marijuana consequences and other illicit drug use after controlling for demographic, social, and behavioral factors. However, once frequency of recent marijuana use was included in the models, age of initiation was only associated with other illicit drug use. Both primary and secondary prevention are needed to curb marijuana use and its associated harms.

Ellickson PL; McCaffrey DF; Ghosh-Dastidar B; Longshore DL. New inroads in preventing adolescent drug use: Results from a large-scale trial of project ALERT in middle schools. American Journal of Public Health 93(11): 1830-1836, 2003. (49 refs.)

Objectives. We evaluated the revised Project ALERT drug prevention program across a wide variety of Midwestern schools and communities. Methods. Fifty-five South Dakota middle schools were randomly assigned to program or control conditions. Treatment group students received 11 lessons in 7th grade and 3 more in 8th grade. Program effects for 4276 8th-graders were assessed 18 months after baseline. Results. The revised Project ALERT curriculum curbed cigarette and marijuana use initiation, current and regular cigarette use, and alcohol misuse. Reductions ranged from 19% to 39%. Program effects were not significant for initial and current drinking or for current and regular marijuana use. Conclusions. School-based drug prevention programs can prevent occasional and more serious drug use, help low- to high-risk adolescents, and be effective in diverse school environments.

Erguder T; Soydal T; Ugurlu M; Cakir B; Warren CW. Tobacco use among youth and related characteristics, Turkey. Sozial- und Praventivmedizin 51(2): 91-98, 2006. (17 refs.)

Objectives: To provide nationally representative data on smoking prevalence of Turkish adolescents; to examine their knowledge, attitude and exposure to tobacco Methods: A school-based representative survey of adolescents (13-15 years) was conducted within the frame of Global Youth Tobacco Survey (GYTS). 15957 students were selected using a two-stage cluster sampling method and completed an internationally standardized questionnaire on tobacco use and related factors. Results: About one-third of students had already experienced smoking and 10% were current smokers. Rate of exposure to passive smoking was high both in current smokers (89.0%) and never smokers (79.2%). More than one-third Of Current smokers had intended to quit. Susceptibility to initiate smoking was fairly high among never smokers, especially in boys (9.1% versus 5.8%). Considerable proportions of both never, and current smokers had positive attitude toward tobacco use. Half of the students had no school curriculum about the effects of tobacco use. Conclusions: Smoking prevalence among Turkish adolescents is alarmingly high and the gender gap is closing. A relevant legislation is a must for success in tobacco control but should be combined by other effective prevention and cessation programs.

Ernst M; Luckenbaugh DA; Moolchan ET; Leff MK; Allen R; Eshel N et al. Behavioral predictors of substance-use initiation in adolescents with and without attention-deficit/hyperactivity disorder. Pediatrics 117(6): 2030-2039, 2006. (74 refs.)

OBJECTIVE. Our goal was to examine substance-use initiation in healthy adolescents and in adolescents who have been diagnosed with attention-deficit/hyperactivity disorder. METHODS. Seventy-eight adolescents (28 healthy and 50 with attention-deficit/hyperactivity disorder) participated in an ongoing longitudinal study of predictors of substance use. The substances most commonly reported were tobacco, alcohol, and marijuana. Aggression, conduct problems, hyperactivity, impulsivity, inattention, anxiety/depression, social difficulties, and somatic complaints were assessed at study entry and tested as predictors for later substance use. RESULTS. With an average of 4 years into the study, 37 adolescents had not used any substances, 41 had experimented with at least 1 substance, and 29 experimented with > 1 substance. Psychiatric diagnoses (attention-deficit/hyperactivity disorder, attention-deficit/hyperactivity disorder and conduct disorder, and attention-deficit/hyperactivity disorder and depression/anxiety) did not influence reports of substance use. Distinct behavioral measures collected at study entry predicted use of different substances. In a multivariate analysis, aggression had the greatest association with tobacco smoking and marijuana use. Impulsivity was associated with alcohol use. Severity of drug exposure, indexed by the number of substances used, was predicted by aggression. CONCLUSIONS. This 4-year longitudinal study captured the onset of substance use, not abuse. Behavioral predictors differed with the type of substance used. These behavioral characteristics may raise suspicion among pediatricians for enhanced risk for substance-use initiation.

Faden VB. Trends in initiation of alcohol use in the United States 1975 to 2003. Alcoholism: Clinical and Experimental Research 30(6): 1011-1022, 2006. (30 refs.)

Alcohol is the drug of choice for youth in the United States. By 8th grade, more than 40% of youth have used alcohol; by 12th grade, almost 80% have done so (MTF, 2003). And many of these young people begin drinking at relatively early ages. On average, boys start drinking earlier than girls, and whites and Native Americans start drinking earlier than youth of other race/ethnicities. As alcohol consumption is such a high prevalence behavior among young people, it is crucial to understand the initiation of drinking as well as possible, so as to facilitate and inform interventions to delay this behavior. One facet of this involves investigating trends in the initiation of drinking. Multiple years of data from 3 national surveys, Monitoring the Future (MTF)-1975 to 2003 for 12th graders, 1993 to 2003 for 8th and 10th graders; the National Household Survey on Drug Abuse (NHSDA) [now called the National Survey on Drug Use and Health (NSDUH)]-1991 to 1998; and the Youth Risk Behavior Surveillance System (YRBSS)-1991 to 2003, were analyzed using joinpoint analysis to further understanding of trends in the initiation of drinking by youth. The present analysis examines whether the age of drinking initiation has changed over time and evaluates trends in the percentages of youth who start drinking by various grades. Simultaneous examination of data from the 3 surveys indicates that 7th and 8th grades (when most youth are 13-14) are peak years for the initiation of drinking. Further, the present analysis shows that although the percentage of youth who start drinking early (before age 13) has declined (YRBSS, MTF), the average age of initiation of drinking for these "very early starters" did not change over the period 1991 to 1998 (NHSDA/NSDUH). At the same time, an upward shift in the "normative" age of initiation has occurred (NHSDA/NSDUH, MTF). Results of analyses by gender and race/ethnicity indicate similar trends over time. A more nuanced understanding of the initiation of drinking can have important implications for prevention.

Gervais A; O'Loughlin J; Meshefedjian G; Bancej C; Tremblay M. Milestones in the natural course of onset of cigarette use among adolescents. Canadian Medical Association Journal 175(3): 255-261, 2006. (25 refs.)

Background: The natural course of onset of cigarette use has been conceptualized as progressing sequentially through 5 stages (preparation, trying, irregular use, regular use, nicotine-dependent smoking). However, recent studies suggest that symptoms of nicotine dependence can occur early in the onset process, raising questions about the validity of this model. The objective of our study was to describe the sequence and timing of 12 milestones (6 related to cigarette use and 6 to symptoms of nicotine dependence) during onset of cigarette use. Methods: Grade 7 students in 10 secondary schools in Montreal (n = 1293) were followed prospectively every 3-4 months for 5 years. Using Kaplan-Meier analysis, we computed the number of months after first puff at which the cumulative probability of attaining each milestone was 25%, among 311 participants who initiated cigarette use during follow-up. Results: Inhalation rapidly followed first puff. The cumulative probability of inhalation was 25% at 1.5 months (95% confidence interval [CI] 1.5-2.5). The cumulative probability (and 95% CI) was 2.5 months (1.5-2.5) for mental addiction, 2.5 (1.0-3.0) for smoking a whole cigarette, 4.5 (2.5-8.8) for cravings, 5.4 (3.8-9.7) for physical addiction, 8.8 (7.0-11.9) for monthly smoking, 11.0 (6.4-16.8) for withdrawal symptoms, 13.0 (10.3-20.5) for tolerance, 19.4 (14.5-31.7) for weekly smoking, 19.5 (14.0-23.9) for lifetime total of 100 cigarettes, 23.1 (19.7-37.6) for daily smoking and 40.6 (35.1-56.0) for conversion to tobacco dependence. Interpretation: Symptoms of nicotine dependence develop soon after first puff and can precede monthly, weekly and daily smoking. Cessation interventions that manage dependence symptoms may be needed soon after first puff.

Gilpin EA; Lee L; Pierce JP. How have smoking risk factors changed with recent declines in California adolescent smoking? Addiction 100(1): 117-125, 2005. (47 refs.)

Aim: To compare predictors of smoking initiation in two longitudinal studies in California conducted during periods when adolescent smoking prevalence was increasing (1993-96) and decreasing (1996-99). Design, setting and participants: Cohorts of 1215-year-old never smokers were identified from the cross-sectional 1993 and 1996 California Tobacco Surveys (large population-based telephone surveys) and followed-up 3 years later (199396, n = 1764; 199699, n = 2119). Measures: We compared cohort transition rates to any smoking by follow-up in risk groups defined by known predictors of smoking initiation at baseline. Besides examining predictors individually, risk groups were defined using a multivariate analysis. Findings: Overall, transition to any smoking by follow-up occurred in 38.3 plus or minus 4.0% (% plus or minus 95% confidence interval) of never smokers in the 1993-96 cohort and 31.1 plus or minus 2.6% in the 199699 cohort. For most predictors, the transition rate for adolescents with the characteristic was the same or only slightly lower in the 1996-99 cohort compared to the 1993-96 cohort, but the transition rate in those without the characteristic was generally much lower, thus increasing the power of the predictor. The multivariate analysis confirmed that compared to the 1993-96 cohort, transition occurred much less often in the 1996-99 cohort for adolescents at low rather than at medium or high risk of future smoking. Conclusions:The turnaround in California adolescent smoking in the mid-1990s, when smoking began to decline, appears to come primarily from adolescents already at low risk of future smoking (as defined by a variety of predictors), who transitioned to smoking at much lower rates than previously.

Ginzler JA; Cochran BN; Domenech-Rodraguez M; Cauce AM; Whitbeck LB. Sequential progression of substance use among homeless youth: An empirical investigation of the gateway theory. Substance Use & Misuse 38(3/6): 725-758, 2003. (41 refs.)

We examined the sequence of substance-use initiation in 375 street youth (age 13-21) who were interviewed from 1994-99 in Seattle, Washington. Based on the "gateway theory," participants were categorized into six profiles to describe the order in which they initiated use of various substances (i.e., alcohol, marijuana, other drugs), or classified as nonprogressors if they had not tried all three classes of drugs. Youth progressing in the hypothesized gateway order (i.e., alcohol preceding marijuana, followed by other drugs) initiated their use at an earlier age than youth who had not progressed through all three substance classes. However, there was no relationship between a substance initiation profile and current substance-use. Implications include the recognition that street youth may follow different patterns of use than normative groups, and that interventions geared toward youth who use substances heavily must include contextual factors, in addition to substance-use history.

Glied S. Is smoking delayed smoking averted? American Journal of Public Health 93(3): 412-416, 2003. (93 refs.)

Antismoking efforts often target teenagers in the hope of producing a new generation of never smokers. Teenagers are more responsive to tobacco taxes than are adults. The author summarizes recent evidence suggesting that delaying smoking initiation among teenagers through higher taxes does not generate proportionate reductions in prevalence rates through adulthood. In consequence, the impact of taxes on smoking among youths overstates the potential long-term public health effects of this tobacco control strategy.

Gordon MS; Kinlock TW; Battjes RJ. Correlates of early substance use and crime among adolescents entering outpatient substance abuse treatment. American Journal of Drug and Alcohol Abuse 30(1): 39-60, 2004. (45 refs.)

Although many studies have examined the relationship between early deviant behavior and subsequent life problems among adolescents drawn from the general population, such relationships have not been examined for youth attending substance abuse treatment. Based on in-depth psychosocial assessments conducted with adolescents entering an outpatient substance abuse treatment program (N=193), the current study examines individual characteristics, life circumstances, and other behavioral and psychological characteristics that are correlated with the age at which these youth initiated substance use and criminal activity. Early onset of substance use was associated with greater levels of family deviance and a variety of problems including school adjustment, drug use, criminal involvement, bullying and cruelty to people and animals, and involvement in risky sexual activities. In contrast, early onset of crime was related only to male gender, early onset of substance use, and cruelty to people. Findings suggest that treatment providers may need to consider the ages at which their adolescent clients initiated substance use given its association with illegal activity, other deviant behavior, and precocious and high-risk sexual behaviors.

Gutschoven K; Van den Bulck J. Television viewing and age at smoking initiation: Does a relationship exist between higher levels of television viewing and earlier onset of smoking? Nicotine & Tobacco Research 7(3): 381-385, 2005. (19 refs.)

This cross-sectional study of children assessed the association between television viewing and age at smoking initiation, using self-reports administered by research assistants in schools. Participants were 909 students in their first and fourth years of secondary education in a random sample of 15 secondary schools in Flanders, Belgium, who had smoked at least one cigarette. The main outcome measure was age at smoking initiation. The independent variable was weekly television viewing volume. Gender, educational level, parental smoking, and peer smoking were the control variables. The relationship between television viewing and age at smoking initiation was significant. Higher levels of television viewing were related to earlier onset of smoking behavior in adolescents. The relationship of television viewing with age at smoking initiation was stronger than that of peer smoking, parental smoking, and gender. For each hour of television viewing per day, the average smoking initiation age decreased by 60 days. Heavier television viewers start smoking at an earlier age. Two possible explanations for this relationship are suggested. Social learning theory suggests that actors and actresses serve as behavioral role models for heavy viewers. Cultivation theory suggests that exposure to positive messages influences smoking attitudes. Further research should examine whether the relationship is causal and whether television acts as a provider of smoking role models or whether it influences smoking attitudes.

Hellandsjo Bu ET. Alcohol debut and consumption among Norwegian athletes: The impact of environmental and personal factors. IN: Bouroncle A; Rauhamaki S, eds. Sport and Substance Use in the Nordic Countries. NAD Monograph No. 45. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2005. pp. 111-132. (53 refs.)

This is one of three chapters dealing with alcohol in relation to modern sports. In Norway nearly 50% of children and young people aged 8 and 24 are actively engaged in organized sports. This chapter examines the initiation of drinking and intoxication among Norwegian teenagers. Research has shown that participation in organized sports delayed drinking and intoxication. This is of importance as later use of alcohol is related to fewer alcohol problems later. Data is presented here on the use of alcohol among athletes, and the relationship to the type of sport and level of performance, places for drinking, and motives for drinking. Consumption is lower among athletes at the national, than at the local level, and even lowest at the international level. There is also discussion of environmental factors: parents, peers, and coaches as role models; goal-oriented environment; the role of cohesion in sports clubs; pressures to achieve. Personal factors such as win orientation, goal orientation, reactive and proactive negatives, self-esteem, and physical self are also discussed. The author concludes that athletes drink less than non-athletes, within certain sports groups, and the difference is marked. The age of initiation and intoxication is higher among athletes. There are gender differences as well as differences by type of sport and level of participation. Also important, environmental factors are significant as are personal factors. Support and structure from family and sports club, good role models by family and coaches are associated with less alcohol use.

2006, Project Cork

Hser YI; Grella CE; Collins C; Teruya C. Drug-use initiation and conduct disorder among adolescents in drug treatment. Journal of Adolescence 26(3): 331-345, 2003. (27 refs.)

This study investigated effects of drug-use initiation and conduct disorder (CD) among 1031 adolescents who participated in the Drug Abuse Treatment Outcomes Studies for Adolescents (DATOS-A) sponsored by the National Institute on Drug Abuse (NIDA). The mean age of first drug use was 12.7 (S.D.=2.2), 57% met DSM-III-R criteria for CD, and earlier initiators were more likely to have CD. About 78% of the adolescents with CD reported that their first CD symptom occurred prior to drug-use initiation. The proportions of adolescents who had prior treatment were similar (about 28%) across all groups, but earlier initiators reported a greater number of treatment episodes and younger ages at their first treatment. Conduct disordered adolescents revealed greater problems prior to DATOS-A treatment, but they appeared to be more motivated and ready for treatment. Although adolescents with CD still showed worse outcomes after treatment, the impact of CD appeared to lessen when pretreatment differences were controlled. To a lesser extent, adolescents who began using drugs at earlier ages had greater alcohol and drug use and other problems at intake, but their treatment outcomes appeared to be similar to later initiators. There were few significant interaction effects of initiation and CD. Findings from this study highlight the importance of better understanding the progression of drug use, treatment utilization, and psychiatric comorbidity among adolescents with substance abuse problems.

Iacono WG; Mcgue M. Association between P3 event-related brain potential amplitude and adolescent problem behavior. Psychophysiology 43(5): 465-469, 2006. (38 refs.)

This study examined P3 event-related brain potential amplitude and the age of onset of adolescent problem behaviors associated with the development of externalizing psychopathology. Five hundred and one male and 627 female 17-year-old twins reported whether and when they had initiated tobacco, alcohol, or illicit drug use, had police contact, or had sexual intercourse. P3 amplitude was recorded using a visual oddball task. Each of these behaviors was associated with reduced P3 amplitude. When these five behaviors were used to create a composite early problem behavior scale reflecting onset prior to age 15, higher scores were associated with smaller P3 amplitudes. P3 amplitude reduction has been associated with genetic risk for alcoholism and other externalizing disorders associated with disinhibited behavior. Our results suggest that reduced P3 may also be associated with early expression of behaviors that predict the development of these disorders.

Jacobsen LK; Krystal JH; Mencl WE; Westerveld M; Frost SJ; Pugh KR. Effects of smoking and smoking abstinence on cognition in adolescent tobacco smokers. Biological Psychiatry 57(1): 56-66, 2005. (85 refs.)

Background: In adult animals and humans, nicotine can produce short-term cognitive enhancement and, in some cases, neuroprotection. Recent work in animals, however, suggests that exposure to nicotine during adolescence might be neurotoxic. We tested for evidence of acute and chronic effects of tobacco smoking on cognition in adolescents who smoked tobacco daily and were tested for evidence of acute and chronic effects compared with adolescent nonsmokers. Methods: Verbal working memory, verbal learning and memory, selective, divided, sustained attention, mood, symptoms of nicotine withdrawal, and tobacco craving were examined in 41 adolescent daily smokers and 32 nonsmokers who were similar in age, gender, and education. Analyses were controlled for general intelligence, reading achievement, parental educational attainment, baseline affective symptoms, and lifetime exposure to alcohol and cannabis. Results: In adolescent smokers, cessation of tobacco use increased tobacco craving, symptoms of nicotine withdrawal, and depressed mood. Adolescent smokers were found to have impairments in accuracy of working memory performance irrespective of recency of smoking. Performance decrements were more severe with earlier age of onset of smoking. Adolescent smokers experienced further disruption of working memory and verbal memory during smoking cessation. As a group, male smokers initiated smoking at an earlier age than female smokers and were significantly more impaired during tests of selective and divided attention than female smokers and nonsmokers. Conclusions: Adolescent daily tobacco smokers experience acute impairments of verbal memory and working memory after smoking cessation, along with chronic decrements in cognitive performance that are consistent with preclinical evidence that neurotoxic effects of nicotine are more severe when exposure to nicotine occurs at earlier periods in development.

Kaminer Y; Bukstein OG. Treating adolescent substance abuse. IN: Frances RJ; Miller SI; Mack AH, eds. Clinical Textbook of Addictive Disorders, 3rd edition. New York: Guilford Press, 2005. pp. 559-587. (184 refs.)

It is recognized that between 7 and 10% of adolescents are in need of substance abuse treatment. The goal of this chapter is to review the trends in adolescent substance use, psychiatric co-morbidity, prevention, assessment, and the treatment aftercare continuum. The authors deals with the epidemiology, age of initiation, and prevalence by gender and ethnic groups, and etiology in terms of biological factors, environment, and parental as well as peer influences. Separate sections are devoted to prevention, assessment, level of care, and treatment. discharge and after care.

Kandel DB; Kiros GE; Schaffran C; Hu MC. Racial/ethnic differences in cigarette smoking initiation and progression to daily smoking: A multilevel analysis. American Journal of Public Health 94(1): 128-135, 2004. (49 refs.)

Objectives. We sought to identify individual and contextual predictors of adolescent smoking initiation and progression to daily smoking by race/ethnicity. Methods. We used data from the National Longitudinal Study of Adolescent Health to estimate the effects of individual (adolescent, family, peer) and contextual (school and state) factors on smoking onset among nonsmokers (n = 5374) and progression to daily smoking among smokers (n = 4474) with multilevel regression models. Results. Individual factors were more important predictors of smoking behaviors than were contextual factors. Predictors of smoking behaviors were mostly common across racial/ethnic groups. Conclusions. The few identified racial/ethnic differences in predictors of smoking behavior suggest that universal prevention and intervention efforts could reach most adolescents regardless of race/ethnicity. With 2 exceptions, important contextual factors remain to be identified.

Kokkevi A; Gabhainn SN; Spyropoulou M; Risk Behav Focus Grp HBSC. Early initiation of cannabis use: A cross-national European perspective. Journal of Adolescent Health 39(5): 712-719, 2006. (40 refs.)

Purpose: To examine the relationship of the early initiation of cannabis use with other high risk behaviors and with psychosocial and health-related correlates in 15-year-old adolescents in six European countries. Methods: This study reports on nationwide cross-sectional surveys in six European countries in 2001-2002, within the framework of the World Health Organization's collaborative study, Health Behaviour in School-aged Children (HBSC). Data were collected through anonymous questionnaires self-completed in classrooms. Descriptive and multivariate analyses were used to assess differences between countries in age of first cannabis use and associations with health and related psychosocial variables. Results: The prevalences of lifetime and last-year cannabis use ranged from 30.7% and 27.5%, respectively, in the Czech Republic, to 5.4% and 4.1%, respectively, in Greece. Age at first use was lower in the high prevalence countries than in countries with lower prevalence. For 15-year-olds, frequent use of tobacco and alcohol and other risk behaviors were correlated with early (13-15 years old) and especially very early (<= 13 years old) cannabis initiation. Conclusions: Although different patterns of prevalence and age of initiation were observed between participating countries, early cannabis use was almost uniformly associated with higher odds of more frequent use of cannabis and other substances, and with a common set of other problems. Our findings suggest that prevention of drug abuse must commence in preadolescence.

Koval JJ; Pederson LL; Chan SSH. Psychosocial variables in a cohort of students in grades 8 and 11: A comparison of current and never smokers. Preventive Medicine 39(3): 1017-1025, 2004. (72 refs.)

Background. Specific hypotheses regarding putative mechanisms by which stressful life events might be related to smoking initiation among adolescents have been tested cross-sectionally on a cohort of 1598 grade 6 students in Scarborough, Canada. The purpose of this study was to examine the utility of these cross-sectional models in accounting for current smoking as compared to never smoking when this cohort was in grades 8 and 11. Methods. Current smoking was defined as reported regular or occasional smoking. Logistic regression and multiple regression models were tested separately for each gender and grade with variables entered in prespecified steps. Results. Current smoking is more strongly related to psychosocial variables and environmental variables among older male adolescents as compared to younger ones. In older female adolescents, current smoking appears to be more strongly related to attitude variables and less strongly related to psychosocial variables than among younger female adolescents. There is some evidence that grade 11 males may use cigarettes as a coping strategy for depression. Conclusions. Male and female students differ in how stress and a range of psychosocial factors are interrelated with regards to current smoking and these relationships appear to change over time.

Krainuwat K. Smoking initiation prevention among youths: Implications for community health nursing practice. Journal of Community Health Nursing 22(4): 195-204, 2005. (69 refs.)

Cigarette smoking among youths has long been documented as a national problem affecting health and economic status in the United States. A number of studies have documented that cigarette-smoking initiation occurs primarily between late childhood and young adolescence. This evidence has brought about the need for awareness among community health nurses to find and deliver effective antismoking programs to reduce the prevalence of youth smoking initiation. Generally, community health nurses are in an excellent position to help the nation achieve its goals in terms of reducing the incidence of youth smoking initiation. However, current knowledge about community health nursing practice and smoking initiation interventions is limited. This article raises awareness about smoking initiation prevention in youth and the need to implement effective smoking prevention programs in practice settings and encourages community health nurses to increase their involvement in antismoking initiation research and interventions.

Kremers SPJ; de Vries H; Mudde AN; Candel M. Motivational stages of adolescent smoking initiation: Predictive validity and predictors of transitions [rapid communication]. Addictive Behaviors 29(4): 781-789, 2004. (10 refs.)

The present study tested the use and validity of a stage model of adolescent smoking initiation. The model aims to identify adolescents who are currently not smoking, but who are cognitively predisposed to start smoking in the future. Research on subtypes within the precontemplation stage of adolescent smoking initiation and the concept of susceptibility to smoking led to the construction of a motivational stage model of four distinct stages: committer, immotive, progressive, and contemplator. Using longitudinal data on a large international sample of European adolescents (n=7117), the model proved to have value in predicting smoking initiation at 12 months follow up. The odds ratio to take up regular smoking behavior appeared to double with each forward stage transition. Although effect sizes were small to moderate, unique predictors of transitions from the various stages were identified. Implications of the findings are discussed

Lillehoj CJ; Trudeau L; Spoth R; Madon S. Externalizing behaviors as predictors of substance initiation trajectories among rural adolescents. Journal of Adolescent Health 37(6): 493-501, 2005. (40 refs.)

Purpose: The purpose of the current study was to investigate the influence of externalizing behaviors on substance initiation trajectories arnong rural adolescents over a 42-month period. Methods: Data were obtained from 198 rural adolescents (105 boys, 93 girls) who were participating in a longitudinal study. At the baseline assessment, Subjects were on average 12.3 years of age. Results: Controlling for gender, higher baseline levels of externalizing were associated with a greater number of substances initiated over time. The initiation trajectory was curvilinear girls, compared with boys, reported a lower number of substances initiated at baseline, a greater linear growth trajectory, and a deceleration of growth over time. Conclusions: The influence of adolescent externalizing behaviors on baseline levels and growth trajectories of substance initiation and the utility of latent growth curve modeling in the study of longitudinal change are discussed.

Lillehoj C; Trudeau L; Spoth R. Longitudinal modeling of adolescent normative beliefs and substance initiation. Journal of Alcohol and Drug Education 49(2): 7-41, 2005. (70 refs.)

The current study investigated the effects of baseline levels of academic achievement and longitudinal trends in normative beliefs on adolescent substance initiation across a 42-month time period. Participants were 272 rural adolescents who were an average of 12.3 years old at the baseline assessment. Academic achievement positively predicted the intercept and negatively predicted the growth-trajectory of normative beliefs regarding peer substance behavior. Further, baseline academic achievement negatively predicted initial levels, as well as the growth-trajectory, of substance initiation. The discussion addresses the influence of academic achievement and normative beliefs on substance initiation and the utility of latent growth curve modeling in studying longitudinal change. In addition, implications for prevention programming are discussed.

Lintonen TP; Konu AI. Adolescent alcohol beverage type choices reflect their substance use patterns and attitudes. Journal of Youth and Adolescence 32(4): 279-289, 2003. (40 refs.)

Alcoholic beverage type choices were studied in relation to adolescents' substance use patterns and attitudes towards substance use, utilizing the national 1999 Adolescent Health and Lifestyle Survey data (N = 4943) collected among Finns aged 14 and 16 years by mail. Frequencies of drinking, drunkenness and smoking, and chewing tobacco use as well as attitudes towards substance use and exposure to other drugs were all strongly related to beverage type choices. The amount of alcohol consumed was associated with the beverage choice. The relationships between beverage choices and substance use patterns were partly mediated through amounts drunk. Beverage type choices seemed to reflect substance use patterns and attitudes more generally. Wine and cider appeared beverages related to moderation and control in relation to substance use, but beer drinking may be interpreted as a sign of initiation into a substance use pattern favoring smoking and heavier use of alcohol and other drugs.

Maggs JL; Schulenberg JE. Initiation and course of alcohol consumption among adolescents and young adults. IN: Galanter M, ed. Recent Developments in Alcoholism. Volume 17: Alcohol Problems in Adolescents and Young Adults -- Epidemiology, Neurobiology, Prevention, Treatment. New York: Kluwer Academic, 2005. pp. 29-47. (88 refs.)

This chapter takes a normative developmental perspective on the etiology of alcohol use, focusing on the initiation and course of alcohol use (rather than alcohol use disorders) during adolescence and early adulthood. We review evidence regarding the sequelae and meaning of the age of initiation of alcohol use, consider variable- and pattern-centered approaches to modeling trajectories describing the course of alcohol use across adolescence and young adulthood, and offer developmental conceptualizations of risk and protective factors for alcohol use and related problems.

McAllister I; Makkai T. Antisocial behaviour among young Australians while under the influence of illicit drugs. Australian and New Zealand Journal of Criminology 36(2): 211-222, 2003. (32 refs.)

While the link between illicit drug use and criminal behaviour is frequently noted, comparatively little is known about which drugs are most likely to shape this behaviour, and about the role of early initiation into drug use. This study uses a large, national population survey to examine these relationships, focusing on adolescents and young adults who report illicit drug use. The results show that about one in 10 young Australians had engaged in some form of antisocial behaviour in the previous 12 months following drug use, and that such behaviour peaked at almost one in five males at the age of 19 years. Antisocial behaviour while under the influence of drugs is closely associated with the use of marijuana, amphetamines and inhalants. Age of initiation was relatively unimportant in predicting this antisocial behaviour, with the exception of the early use of marijuana. Overall, the results confirm the importance of delaying marijuana use for as long as possible in order to reduce these behaviours.

Mills KL; Teesson M; Darke S; Ross J; Lynskey M. Young people with heroin dependence: Findings from the Australian Treatment Outcome Study (ATOS). Journal of Substance Abuse Treatment 27(1): 67-73, 2004. (49 refs.)

This paper examines the patterns and correlates of heroin use in a cohort of 210 young Australians aged between 18 and 24, who were participants in the Australian Treatment Outcome Study, a longitudinal study of treatment outcomes for heroin dependence. Of major importance were the high rates of psychiatric comorbidity found among this group (37% lifetime Post Traumatic Stress Disorder, 23% current Major Depression, 75% Anti-Social Personality Disorder, and 51% Borderline Personality Disorder). Seventeen percent had attempted suicide in the preceding year. Although both the young (aged 18-24 years) heroin users and their older counterparts (aged 25-56 years) initiated drug use at the same age, young heroin users progressed to heroin use, regular heroin use, and treatment for heroin use, twice as quickly as older heroin users. These findings suggest that there is a limited window of opportunity in which early interventions may be applied before young heroin users progress to problematic use.

Novins DK; Baron AE. American Indian substance use: The hazards for substance use initiation and progression for adolescents aged 14 to 20 years. Journal of the American Academy of Child and Adolescent Psychiatry 43(3): 316-324, 2004. (44 refs.)

Objective: To describe the risks and risk factors for substance use initiation and progression among a large sample of American Indian (AI) adolescents. Method: Data came from surveys completed by 2,356 AI adolescents aged 14 to 20 years who participated in two or more consecutive waves of a longitudinal study between 1993 and 1996 (response rate 74%.). Discrete-time survival analysis was used to describe the risks and risk factors for substance use initiation and progression. Results: The risk for initiating use of any substance accelerated in early adolescence and peaked at age 18. The risk for progression from use of alcohol, marijuana, and/or inhalants to the use of other illicit drugs (e.g., cocaine) increased over the first 4.5 years after initiating substance use, then diminished in subsequent years. The risk of substance use initiation and progression varied across the four participating communities and by season of the year. Compared to adolescents who initiated substance use with alcohol only, adolescents who initiated substance use with marijuana or inhalants were more likely to progress to use other illicit drugs. Conclusions: Prevention programs for AI communities should be designed to address these community, age, and seasonal variations in the risks for substance use initiation and progression.

Ompad DC; Ikeda RM; Shah N; Fuller CM; Bailey S; Morse E; Collaborative Injection Drug User. Childhood sexual abuse and age at initiation of injection drug use. American Journal of Public Health 95(4): 703-709, 2005. (50 refs.)

Objectives. We examined the relation between childhood sexual abuse and injection drug use initiation among young adult injection drug users. Methods. We used mixed effect linear models to compare age at first injection among 2143 young injection drug users by first sexual abuse age categories. Results. The participants were predominantly male (63.3%) and White (52.8%). Mean age and age at first injection were 23.7 and 19.6 years, respectively; 307 participants (14.3%) reported childhood sexual abuse. After adjustment for gender, race/ethnicity, noninjection drug use before first injection drug use, and recruitment site, childhood sexual abuse was independently associated with younger age at first injection. Conclusions. Childhood sexual abuse was associated with earlier initiation of injection drug use. These data emphasize the need to integrate substance abuse prevention with post victimization services for children and adolescents.

Orlando M; Tucker JS; Ellickson PL; Klein DJ. Developmental trajectories of cigarette smoking and their correlates from early adolescence to young adulthood. Journal of Consulting and Clinical Psychology 72(3): 400-410, 2004. (47 refs.)

Smoking initiation typically occurs in adolescence and increases over time into emerging adulthood. Thus adolescence and emerging adulthood compose a critical time period for prevention and intervention efforts. To inform these efforts, this study used latent growth mixture modeling to identify 6 smoking trajectories from ages 13 to 23 among 5,9 14 individuals: nonsmokers (28%), stable highs (6%), early increasers (10%), late increasers (10%), decreasers (6%), and triers (40%). By age 23, the trajectories merged into 2 distinct groups of low- and high-frequency and their standing on age 23 outcomes reflected this grouping. Consideration of these results can help researchers identify at-risk individuals before their smoking becomes too problematic. providing an opportunity for intervention and possible prevention of nicotine dependence.

Patton GC; Coffey C; Carlin JB; Sawyer SM; Lynskey M. Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence. Addiction 100(10): 1518-1525, 2005. (37 refs.)

Aims: To examine the risk posed by cannabis use in young people for tobacco use disorders. Specifically we examined whether cannabis use in non-smokers predicted later initiation of tobacco use and whether cannabis use predicted later nicotine dependence in tobacco users. Design: A 10-year eight-wave cohort study. Setting: State of Victoria, Australia. Participants: A community sample of 1943 participants initially aged 14-15 years. Measuerments Self-report of tobacco and cannabis use was assessed in the teens using a computerized interview assessment and in young adulthood with a CATI assessment. The Fagerstrom Test for Nicotine Dependence was used to define nicotine dependence. Findings: For teen non-smokers, at least one report of weekly cannabis use in the teens predicted a more than eightfold increase in the odds of later initiation of tobacco use (OR 8.3; 95% CI 1.9-36). For 21-year-old smokers, not yet nicotine-dependent, daily cannabis use raised the odds of nicotine dependence at the age of 24 years more than threefold (OR 3.6, 1.2, 10) after controlling for possible confounders, including level of tobacco use and subsyndromal signs of nicotine dependence. Conclusions: Weekly or more cannabis use during the teens and young adulthood is associated with an increased risk of late initiation of tobacco use and progression to nicotine dependence. If this effect is causal, it may be that a heightened risk of nicotine dependence is the most important health consequence of early frequent cannabis use.

Peters RJ; Kelder SH; Prokhorov AV; Meshack A; Agurcia C; Yacoubian G et al. Beliefs and social norms about smoking onset and addictions among urban adolescent cigarette smokers. Journal of Psychoactive Drugs 37(4): 449-453, 2005. (23 refs.)

Cigarette smoking is a behavior which is most often developed during adolescence. The association between smoking onset and nicotine addiction has not been clearly established among ethic minorities. To better understand this relationship, this study used a qualitative approach to investigate relevant beliefs and norms associated with cigarette smoking initiation and development of nicotine addiction among 52 high school students who identified themselves as current smokers. In general, it was found that both boys and girls believed nicotine addiction starts during an individual's initial cigarette smoking event. The majority of both groups reported that their second smoking event was initiated during the same or next day after their first event. In addition, this research confirmed that friends and siblings who use tobacco are strong reinforcers in youth smoking initiation.

Pierce JP; Distefan JM; Kaplan RM; Gilpin EA. The role of curiosity in smoking initiation. Addictive Behaviors 30(4): 685-696, 2005. (31 refs.)

Context: Although advertising theories have long viewed curiosity as an intermediate goal to encouraging consumption of a product among previous nonusers, this variable is rarely discussed in psychological theories and its role in smoking uptake has not been addressed adequately. Design and setting: Using a longitudinal design, in 1999, we reinterviewed 12- to 15-year-old adolescent never smokers (N=2119; 970 committed never smokers, 1199 susceptible never smokers) 3 years after they responded to a population survey on tobacco use in California. Results: Logistic regression showed curiosity and susceptibility to smoke were independently associated with increased future smoking in all never smokers. Committed never smokers reporting curiosity were more likely to become susceptible by follow-up than those not curious. A multivariate analysis of committed never smokers from the cross-sectional survey identified best friends who smoke and receptivity to tobacco advertising and promotions as associated with curiosity. Conclusions: Curiosity may be a critical precursor to smoking. Future research on smoking initiation should examine curiosity and investigate factors influencing it.

Pokorny SB; Jason LA; Schoeny ME. The relation of retail tobacco availability to initiation and continued smoking. Journal of Clinical Child and Adolescent Psychology 32(2): 193-204, 2003. (55 refs.)

Used an ecological analysis employing multilevel random-effects regression analyses to model Level 1 (individual and social) and Level 2 (environmental) correlates of smoking initiation and continued smoking among 6th-, 7th-, and 8th-grade students. Data from 5,234 youth in 11 Midwestern communities were examined. Results indicate higher levels of retail tobacco availability (RTA) were associated with increased odds that a youth initiated smoking but not continued smoking. Among the Level 1 factors, youth who were older, male, had an adult tobacco user in the home, and had more peers who use tobacco had increased odds of initiating smoking. In contrast, only the presence of an adult tobacco user in the home and the number of peers who use tobacco were associated with increased odds that a youth continued smoking. Examining individual, social, and environmental factors simultaneously provides a clearer and more accurate model of these complex ecological influences.

Prinz RJ; Kerns SEU. Early substance use by juvenile offenders. Child Psychiatry & Human Development 33(4): 263-277, 2003. (20 refs.)

Although the interconnection between delinquency and substance use in adolescence is well documented, considerably less is known about substance-use initiation in childhood for juvenile delinquent populations. This descriptive study examined early substance initiation in childhood as reported by adolescents who were incarcerated for juvenile offenses (93 males, 96 females; 58% African American, 42% European American). Youth were individually interviewed using an adapted version of substance-related questions from the National Household Survey. Juvenile justice system records were reviewed to characterize offense histories. A majority of males and females reported using at least one substance (other than cigarettes) such as alcohol, marijuana, or inhalants by age 13. Alcohol use reportedly occurred by age 10 for 17% of the youth. For a substantial portion, early initiation turned into frequent early use. For example, 32% of the males and 39% of the females reported drinking alcoholic beverages at a frequency of several times per month or greater by age 13. Limited evidence related early substance initiation with subsequent substance abuse. Offense status was related to early substance initiation for females but not males. The study provided clear evidence that very early substance use is a significant problem among youth who end up in the juvenile justice system and that we need to find out more about the environmental and social variables affecting very early substance initiation.

Rhee SH; Hewitt JK; Young SE; Corley RP; Crowley TJ; Stallings MC. Genetic and environmental influences on substance initiation, use, and problem use in adolescents. Archives of General Psychiatry 60(12): 1256-1264, 2003. (43 refs.)

Background: We conducted a sibling/twin/adoption study of substance initiation, use, and problem use, estimating the relative contribution of genetic and environmental influences on these phenotypes in adolescents. Methods: The participants were 345 monozygotic twin pairs, 337 dizygotic twin pairs, 306 biological sibling pairs, and 74 adoptive sibling pairs assessed by the Colorado Center for the Genetics and Treatment of Antisocial Drug Dependence, Denver and Boulder. The initiation, use, and problem use of tobacco, alcohol, marijuana, and other illicit drugs were assessed. Tetrachoric correlations were computed for each group, and univariate model-fitting analyses were conducted. Results: There were moderate to substantial genetic influences, with the exception of alcohol use and any drug use, and modest to moderate shared environmental influences on substance initiation, use, and problem use. For alcohol and any drug, heritability was higher and the magnitude of shared environmental influences was lower for problem use than for initiation or use. Environmental influences shared only by twin pairs had a significant effect on tobacco initiation, alcohol use, and any drug use. For tobacco use, tobacco problem use, and marijuana initiation, heritability was higher and the magnitude of shared environmental influences was lower in female than in male adolescents. There was no evidence for sex-specific genetic or shared environmental influences on any variable. Conclusions: The moderate to substantial heritabilities found for adolescents in the present study are comparable to those found in twin studies of adult substance use and substance use disorders. The finding that problem use is more heritable than initiation and use is also consistent with the results of adult twin studies. The significance of environmental influences shared only by twin pairs on tobacco initiation, alcohol use, and any drug use suggests the influences of peers, accessibility of substances, and sibling interaction.

Robinson MQL; Berlin I; Moolchan ET. Tobacco smoking trajectory and associated ethnic differences among adolescent smokers seeking cessation treatment. Journal of Adolescent Health 35(3): 217-224, 2004. (61 refs.)

Purpose: To examine smoking trajectories in a clinical sample of adolescent smokers seeking cessation treatment, including: (a) smoking onset (initial, daily) and time intervals from initial to daily smoking and from daily smoking to treatment request, (b) associations between current level of tobacco dependence and smoking history, and (c) differences in smoking trajectory between African-American and non-African-American youth. Methods: Four hundred and thirty-two adolescent smokers (aged 13-17 years, 61.8% female, 32% African-American) responding to various media advertisement completed a telephone interview as part of pre-eligibility screening for a smoking cessation trial. Smoking trajectory data included age at onset of initial and daily smoking, intervals between those time points, and cigarettes smoked per day (CPD). Tobacco dependence was assessed using the Fagerstrom Test for Nicotine Dependence (FTND). Data were analyzed using regression models and multiple analyses of covariance. Results: Initial smoking occurred at a mean age of less than 12 years and daily smoking at age 13 years. Earlier onset of daily smoking was associated with higher FTND scores and longer duration from daily smoking to treatment request. For the entire sample, the time interval from initial to daily smoking was 1.14 years. When the sample was divided into early (before age 14 years) and later (at or after age 14 years) initiators, early initiators showed it slower progression from initial to daily smoking compared with late initiators (16 months vs. 6 months). Compared with non-African-American teen smokers, African-American youth reported a 1-year delay in onset of both initial and daily smoking. Conclusions: Early age of daily smoking and short time interval from initial to daily smoking highlight a brief window of opportunity to prevent the development of tobacco addiction and its consequences. Ethnic differences in smoking trajectory uncovered in this report call for ethnically tailored interventions to reduce youth smoking.

Sherman SG; Fuller CM; Shah N; Ompad DV; Vlahov D; Strathdee SA. Correlates of initiation of injection drug use among young drug users in Baltimore, Maryland: The need for early intervention. Journal of Psychoactive Drugs 37(4): 437-443, 2005. (23 refs.)

This article examines individual and social factors associated with initiation of illicit drug injection, with a focus on racial differences. Data were derived from across-sectional survey of young injection and noninjection drug users in Baltimore, Maryland. Participants were aged 15 to 30 and had initiated use of heroin, cocaine, and/or crack within the prior five years. Bivariate and multivariate logistic regression models were used to identify correlates of injection initiation. Of 579 drug users, 73% were injectors, 56% were male, and 41% were African American. In a multivariate model controlling for age, correlates of injection initiation were: being an African American male [Adjusted Odds Ratio (AOR): 0.08; 95% Confidence Interval (Cl): 0.04, 0.17] or female (AOR = 0.12; 95%CI: 0.06,0.27) compared to being a White male; younger age of first use of alcohol, marijuana, or inhalants (AOR=0.73; 95%CI: 0.65,0.82); shorter time between first use of alcohol, marijuana, or inhalants and first use of heroin, crack, or cocaine (per year decrease, AOR=0.63, 95%CI: 0.40, 0.87); parental drug use (AOR=0.54, 95%CI: 0.32, 0.92); seeing someone inject prior to injection, AOR=1.96, 95%CI: 1.01, 3.50); and crack smoking (AOR=1.77, 95%CI: 1.07, 2.99). Early drug use patterns and drug exposure factors are associated with initiation injection. Interventions are needed that target noninjection drug users to prevent transition to injection drug use.

Simons-Morton B. Prospective association of peer influence, school engagement, drinking expectancies, and parent expectations with drinking initiation among sixth graders. Addictive Behaviors 29(2): 299-309, 2004. (30 refs.)

Early initiation of drinking increases the lifetime risk for substance abuse and other serious health and social problems. An understanding of the predictors of early initiation is needed if successful preventive interventions are to be developed. Surveys were completed by 1009 sixth grade students at the beginning (Time 1) and end (Time 2) of the school year in four schools in one suburban school district. At Time 1, 55/1009 (5.5%) reported drinking in the past 30 days. From Time 1 to Time 2, the percentage of drinkers increase to 127/1009 (10.9%) of whom 101 were new drinkers. In multiple logistic regression analyses, school engagement was negatively associated and peer influence and drinking expectancies were positively associated with drinking initiation. A significant interaction was found between drinking expectancies and parental expectations. Among sixth graders with high drinking expectancies, those with low parental expectations for their behavior were 2.6 times more likely to start drinking than those with parents with high expectations for their behavior. Positive drinking expectancies were significantly associated with drinking initiation only among teens who believed their parents did not hold strong expectations for them not to drink. This finding held for boys and girls, Blacks and Whites and was particularly strong for Black youth. This finding provides new information about the moderating effect of parental expectations on drinking expectancies among early adolescents.

Spoth R; Redmond C; Shin C; Azevedo K. Brief family intervention effects on adolescent substance initiation: School-level growth curve analyses 6 years following baseline. Journal of Consulting and Clinical Psychology 72(3): 535-542, 2004. (32 refs.)

This study examines the effects of 2 brief family-focused interventions on the trajectories of substance initiation over a period of 6 years following a baseline assessment. The 2 interventions, designed for general-population families of adolescents, were the 7-session Iowa Strengthening Families Program (ISFP) (Molgaard & Spoth, 2001) and the 5-session Preparing for the Drug Free Years Program (PDFY) (Catalano, Kosterman, Haggerty, Hawkins, & Spoth, 1999). Thirty-three rural public schools were randomly assigned to the ISFP, the PDFY, or a minimal-contact control condition. The authors evaluated the curvilinear growth observed in school-level measures of initiation using a logistic growth curve analysis. Alcohol and tobacco composite use indices -- as well as lifetime use of alcohol, cigarettes, and marijuana-and lifetime drunkenness, were examined. Significant intervention-control differences were observed, indicating favorable delays in initiation in the intervention groups.

Stone AL; Storr CL; Anthony JC. Evidence for a hallucinogen dependence syndrome developing soon after onset of hallucinogen use during adolescence. International Journal of Offender Therapy and Comparative Criminology 15(3): 116-130, 2006. (32 refs.)

This study uses latent class methods and multiple regression to shed light on hypothesized hallucinogen dependence syndromes experienced by young people who have recently initiated hallucinogen use. It explores possible variation in risk. The study sample, identified within public-use data files of the 1999 National Household Survey on Drug Abuse (NHSDA), consists of 1186 recent-onset hallucinogen users, defined as having initiated hallucinogen use within 24 months of assessment (Median elapsed time since onset of use similar to 12 to 13 months). The recent-onset users in this sample were age 12 to 21 at the time of assessment and were between the ages of 10 and 21 at the time of their first hallucinogen use. The NHSDA included items to assess seven clinical features often associated with hallucinogen dependence, which were used in latent class modelling. Latent class analysis, in conjunction with prior theory, supports a three-class solution, with 2% Of recent-onset users in a class that resembles a hallucinogen dependence syndrome, whereas 88% expressed few or no clinical features of dependence. The remaining 10% may reflect users who are at risk for dependence or in an early stage of dependence. Results from latent class regressions indicate that susceptibility to rapid transition from first hallucinogen use to onset of this hallucinogen dependence syndrome might be influenced by hallucinogenic compounds taken (for example, estimated relative risk, RR = 2.4, 95% CI = 1.6, 76 for users of MDMA versus users of LSD). Excess risk of rapid transition did not appear to depend upon age, sex, or race/ethnicity.

Sun P; Unger JB; Sussman S. A new measure of smoking initiation and progression among adolescents. American Journal of Health Behavior 29(1): 3-11, 2005. (25 refs.)

Objective: To develop a new measure of smoking initiation and progression among adolescents. Method. This study used data from 2504 regular and alternative high school students to evaluate the psychometric properties of a new 3-item, 5-stage measure of smoking initiation and progression. Results: The categorization method showed good 4-week test-retest reliability (.83 among boys and.87 among girls). The demographic distribution of adolescents into stages was consistent with previous research. Conclusion: This 5-stage classification method could be a useful framework for describing variation along the smoking uptake and progression continuum.

Taylor CR; Bonner PG. Comment on "American media and the smoking-related behaviors of Asian adolescents." (editorial). Journal of Advertising Research 43(4): 419-430, 2003. (83 refs.)

In the March 2003 issue of the Journal of Advertising Research, Marvin Goldberg suggests that correlations found in his study correspond with findings of other studies and, hence, suggest a causal relationship between exposure to cigarette advertising (as well as promotional items and American movies) and the smoking-related behaviors of Hong Kong adolescents. In an earlier comment, Robert Reitter pointed out that the study provides no evidence of causality. We point out additional methodological flaws including inappropriate reclassification of data, the need to consider potential sources of bias, and lack of internal consistency of reported data. Additionally, the design of the study does not allow for a test of the proposed theories. We note that the study cites only literature that supports the author's views on the effects of cigarette advertising. The weight of the evidence from the academic literature suggests that (1) advertising does not play a significant role in smoking initiation; (2) advertising does not increase primary demand for cigarettes; and (3) advertising bans do not appear to reduce demand for cigarettes in mature markets.

van den Bree MBM; Pickworth WB. Risk factors predicting changes in marijuana involvement in teenagers. Archives of General Psychiatry 62(3): 311-319, 2005. (84 refs.)

Background: Marijuana use during adolescence has various adverse psychological and health outcomes. It is poorly understood whether the same risk factors influence different stages of marijuana involvement. Objective: To establish which risk factors best explain different stages of marijuana involvement. Design: Data were collected at 2 points using computer-assisted personal interview (wave I and wave 2 were separated by I year). Twenty-one well-established risk factors of adolescent substance use/abuse were used to predict 5 stages of marijuana involvement: (1) initiation of experimental use, (2) initiation of regular use, (3) progression to regular use, (4) failure to discontinue experimental use, and (5) failure to discontinue regular use. Data were analyzed- using logistic regression analysis. Participants: Middle school and high school students (N = 13 718, aged 11-21 years) participating in the National Longitudinal Study of Adolescent Health (Adol Health). Results: Three risk factors (own and peer involvement with substances, delinquency, and school problems) Were the strongest predictors of all stages. Their combined presence greatly increased risk of initiation of experimental (odds ratio, 20) and regular (odds ratio, 87) marijuana use over the next year. Personality, family, religious, and pastime factors exerted stage-specific, sex-specific, and age-specific influences. Conclusions: Assessment of substance, school, and delinquency factors is important in identifying individuals at high risk for continued involvement with marijuana. Prevention and/or intervention efforts should focus on these areas of risk.

Vaughn MG; Howard MO; Foster KA; Dayton MK; Zelner JL. Substance use in a state population of incarcerated juvenile offenders. IN: Hilarski C, ed. Addiction, Assessment, and Treatment with Adolescents, Adults, and Families. New York: Haworth Social Work Practice Press, 2005. pp. 155-174. (29 refs.)

This study examined the prevalence and patterns of illicit drug use among a state population of 723 incarcerated juvenile offenders. In addition to alcohol and marijuana, results indicated high rates of illicit substance use involving a wide range of substances, including amphetamines, opiate drugs, prescription drugs, and solvents. Further, significant gender and ethnic differences were observed with regard to alcohol and drug related problems, suicidal ideation, and age of substance use initiation.

Wagner FA; Velasco-Mondragon HE; Herrera-Vazquez M; Borges G; Lazcano-Ponce E. Early alcohol or tobacco onset and transition to other drug use among students in the State of Morelos, Mexico. Drug and Alcohol Dependence 77(1): 93-96, 2005. (24 refs.)

In this study, we explored if patterns in the transition from alcohol/tobacco in the Mexican State of Morelos, Mexico are similar to those observed in other countries. Methods: The data were from a representative sample of youth age 11-21 years (n = 13,105), who participated in a paper-and-pencil survey in middle schools, high schools, and colleges in the State of Morelos, Mexico. Drug use was assess-sed via the standardized instrument mostly used in Mexican student surveys. Cox's models for discrete time-survival analyses, stratified by school and age group were used to estimate the risk of drug use in relation to age of alcohol and tobacco use initiation by gender, while accommodating the complex survey design. Results: About 5% of the students were estimated to have used drugs in their life. Male early users of alcohol or tobacco were more likely to use other drugs, compared to students who did not have an early alcohol or tobacco onset. Comment: Further studies on social mechanisms might help to account for observed similarities in patterns of drug involvement in different countries. even in the context of important differences in rates of drug use.

Warner LA; White HR. Longitudinal effects of age at onset and first drinking situations on problem drinking. Substance Use & Misuse 38(14): 1983-2016, 2003. (91 refs.)

The purpose of this study was to describe aspects of the first alcohol-use experience, and examine the predictive relations among age of first use, context of alcohol use initiation, and problem drinking with and without controls for psychosocial risk factors. Data were from the Rutgers Health and Human Development Project, a five-wave, prospective study of substance-use behaviors in a community sample. Respondents, who were first interviewed at age 12 (1979-81) and most recently at age 30 or 31 (1999-2000) (N=371), reported on their first drinking experience, and on a range of known risk factors for alcohol abuse. Most alcohol initiation occurred during a family gathering. Regardless of initiation context, youth who drank at an early age were more likely than youth who initiated later to become problem drinkers, although the risk was relatively greater for the youth who first drank outside a family gathering. Based on multivariate logistic regressions, feeling drunk at initiation was the only onset-related variable significantly associated with problem drinking; other significant risks factors included male gender, delinquency, and family history of alcoholism. Further research focusing on the subjective effects experienced by youth when they first drink may be merited.

Yen CF; Yang YH; Ko CH; Yen JY. Substance initiation sequences among Taiwanese adolescents using methamphetamine. Psychiatry and Clinical Neurosciences 59(6): 683-689, 2005. (33 refs.)

The aim of this study was to examine substance initiation sequences in Taiwanese adolescent methamphetamine (MAMP) users. Three hundred adolescent MAMP users were questioned about their use of cigarettes, alcohol, areca quid, benzodiazepine, glue, marijuana, MAMP and heroin. The sequences of substance use before MAMP use were determined in every subject according to their age at substance initiation. The sequences of substance initiation were compared between genders and between early-onset and late-onset MAMP users. The results revealed that the adolescents had used cigarettes, alcohol and areca quid before MAMP, and very few (4%) adolescents had started using MAMP before using other substances. Female MAMP users were more likely to use MAMP as their first substance and were less likely to use areca quid than males. Male early-onset MAMP users were more likely to drink alcohol and chew areca quid before MAMP use than were late-onset users. This study found that the sequences of substance initiation were different between genders and between the early-onset and late-onset MAMP users. There are several findings that are different from those in Western studies on the sequence of substance initiation in the adolescent population.

Zimmerman DM; Sehnert SS; Epstein DH; Pickworth WB; Robinson ML; Moolchan ET. Smoking topography and trajectory of asthmatic adolescents requesting cessation treatment. Preventive Medicine 39(5): 940-942, 2004. (16 refs.)

Background. Teenage smokers cite health concerns as their primary motivators for tobacco smoking cessation. Smoke exposure aggravates the clinical course of asthma, yet few reports have examined the association between asthma and smoking topography and trajectory. Methods. Before their enrollment in a smoking cessation trial, we assessed the smoking topography (i.e., puff volume, maximum puff velocity, puff duration, and interpuff interval) and smoking trajectory (i.e., age of first cigarette, age of daily smoking, time to treatment request, and prior quit attempts) in 30 self-reported asthmatic and 92 nonasthmatic tobacco-dependent teenagers (mean age, 15.2 plus or minus 1.3 years, 28.7% African-American). Approximately one-half of asthmatics used prescribed medications for their asthma. Results. There was no significant difference in smoking topography or smoking trajectory variables between asthmatic and nonasthmatic adolescents, nor between medicated and nonmedicated asthma subgroups. Conclusions. Although tobacco smoking exacerbates asthmatic symptoms, these data suggest that age of smoking initiation, as well as smoking topography characteristics in asthmatic adolescents, does not differ from those of adolescents without asthma. These findings highlight the need for more effective health counseling of asthmatic youth regarding the physical and behavioral effects of smoking.