Deborah D. Kloska

State Tobacco Control Spending and Youth Smoking

OBJECTIVE We examined the relationship between state-level tobacco control expenditures and youth smoking prevalence and cigarette consumption. METHODS We estimated a 2-part model of cigarette demand using data from the 1991 through 2000 nationally representative surveys of 8th-, 10th-, and 12th-grade students as part of the Monitoring the Future project. RESULTS We found that real per capita expenditures on tobacco control had a negative and significant impact on youth smoking prevalence and on the average number of cigarettes smoked by smokers. CONCLUSIONS Had states represented by the Monitoring the Future sample and the District of Columbia spent the minimum amount of money recommended by the Centers for Disease Control and Prevention, the prevalence of smoking among youths would have been between 3.3% and 13.5% lower than the rate we observed over this period.

RELATIONSHIP BETWEEN NICOTINE TOLERANCE QUESTIONNAIRE SCORES AND PLASMA COTININE

The Fagerström Tolerance Questionnaire (TQ) is often used in both research and treatment contexts to evaluate nicotine tolerance and physiological dependence in cigarette smokers. Recently, however, questions about its validity and its usefulness in comparison to other easily collected measures have been raised. In the present study, 100 male subjects reporting for experimental sessions (Sample I) and 50 male and female subjects entering a smoking cessation clinic program (Sample II) were administered the TQ and determinations of plasma cotinine during ad libitum smoking were made. TQ scores were found to be correlated with cotinine levels in both samples, and several of the individual items proved to have statistically significant discriminatory value. Other schemes for determining degree of dependence were considered and found not to be superior to the TQ. Suggestions for further refining the TQ are reviewed.

Predicting risk-taking with and without substance use: the effects of parental monitoring, school bonding, and sports participation.

Risk-taking is statistically normative during adolescence, yet is associated with adverse outcomes including substance use. The present study draws the distinction between protective factors (effective for those identified as high risk takers) and promotive factors (effective for all) against substance use, focusing on parental monitoring, school bonding, and sports participation. A total of 36,514 8th and 10th grade participants in the national Monitoring the Future study were included. Although parental monitoring was associated with lower alcohol and marijuana use among all adolescents (i.e., promotive effect), these effects were strongest among the highest risk takers (i.e., protective effect) and females. School bonding was associated with lower levels of both alcohol and marijuana use among all groups of adolescents, but these promotive effects were weak. Sports participation was associated with higher levels of alcohol use among all males and among 8th grade females who did not identify as high risk takers. Despite being a risk factor for alcohol use, sports participation did demonstrate a promotive effect against marijuana use among 10th grade females only, and especially so for high risk-taking females (i.e., protective effect). Overall, these findings suggest that of the three mechanisms studied, parental monitoring emerged as the most promising entry point for substance use prevention and intervention across groups, particularly for females and high risk-taking adolescents.

Age-related changes in reasons for using alcohol and marijuana from ages 18 to 30 in a national sample

This study used up to seven waves of data from 32 consecutive cohorts of participants in the national longitudinal Monitoring the Future study to model changes in self-reported reasons for using alcohol and marijuana by age (18 to 30), gender, and recent substance use. The majority of stated reasons for use decreased in prevalence across young adulthood (e.g., social/recreational and coping with negative affect reasons); exceptions included age-related increases in using to relax (alcohol and marijuana), to sleep (alcohol), because it tastes good (alcohol), and to get high (marijuana). Women were more likely than men to report drinking for reasons involving distress (i.e., to get away from problems), while men were more likely than women to endorse all other reasons. Greater substance use at age 18 was associated with greater likelihood of all reasons except to experiment and to fit in. A better understanding of developmental changes in reasons for use is important for understanding normative changes in substance use behaviors and for informing intervention efforts involving underlying reasons for use.

Non-medical use of prescription opioids during the transition to adulthood: a multi-cohort national longitudinal study

AIMS To examine non-medical use of prescription opioids (NMUPO) patterns during the transition from adolescence to adulthood, and assess individual characteristics and other substance use behaviors associated with longitudinal patterns of NMUPO. DESIGN Nationally representative samples of high school seniors in the United States (wave 1: modal age 18 years) were followed longitudinally across three biennial follow-up waves (waves 2, 3 and 4: modal ages 19/20, 21/22 and 23/24 years). SETTING Data were collected via self-administered questionnaires to high school seniors and young adults. PARTICIPANTS The longitudinal sample consisted of 27 268 individuals in 30 cohorts (high school senior years 1976-2005) who participated in all four waves. MEASUREMENTS Self-reports of NMUPO and other substance use behaviors. FINDINGS Approximately 11.6% [95% confidence interval (CI) = 11.2%, 12.0%] of the sample reported past-year NMUPO in at least one of the four waves. Among those who reported past-year NMUPO in at least one wave, 69.0% (67.6%, 70.4%), 20.5% (19.3%, 21.7%), 7.8% (7.1%, 8.6%) and 2.7% (2.3%, 3.1%) reported NMUPO at one, two, three and four waves, respectively. Several wave 1 variables were associated with greater odds of multiple waves of NMUPO and individuals who reported more waves of NMUPO had greater odds of other substance use behaviors. CONCLUSIONS Although most non-medical use of prescription opioids among 18-year-olds in the United States appears to be non-continuing, approximately one-third of the sample reporting non-medical use of prescription opioids appear to continue use beyond age 18 and have elevated odds of other substance use behaviors at ages 23/24.

Prevalence and characteristics of substance abuse treatment utilization by US adolescents: National data from 1987 to 2008

OBJECTIVE Although many adolescents use and abuse illicit drugs, few of those who could benefit from substance abuse treatment ever receive these services. The present study examines the prevalence of utilization of substance abuse treatment in national samples of adolescents over the past 22 years and identifies characteristics associated with receipt of these services. METHOD Monitoring the Future data on lifetime utilization of substance abuse treatment was available for 12th grade students who reported any lifetime illicit drug use from 1987 to 2008 (N=25,537). After describing the prevalence of treatment utilization over this time period, logistic regression was used to examine potential predictors of treatment utilization. RESULTS The overall prevalence of treatment utilization has remained relatively unchanged over the past 22 years. In multivariable models, adolescents reporting a greater frequency of lifetime use of marijuana or cocaine were more likely to receive substance abuse treatment. Additionally, substance abuse treatment utilization was more likely in those who received other mental health services. CONCLUSION Despite increased evidence for the effectiveness of substance abuse treatment, utilization of these services by adolescents has remained low and relatively stable over the past 22 years. Attempts to increase utilization of substance abuse treatment services would likely benefit from building on existing connections with mental health treatment.

Substance Use Disorder in Early Midlife: A National Prospective Study on Health and Well-Being Correlates and Long-Term Predictors

This study used national multicohort panel data from the Monitoring the Future study (N = 25,536 from senior year classes 1977–1997 followed up to the age of 35 years in 1994–2014) to examine how early midlife (age 35 years) alcohol use disorder (AUD) and cannabis use disorder (CUD) are associated with adolescent and adult sociodemographics and health and well-being risk factors. Survey items adapted from DSM-5 diagnostic criteria were used to identify individuals who (a) showed symptoms consistent with criteria for AUD or CUD at age 35 years, (b) used the substance without qualifying for a disorder (nondisordered users), and (c) abstained from using alcohol or marijuana during the past five years. At age 35 years, the estimated prevalence of past five-year AUD was 28.0%, and that of CUD was 6.1%. Multinomial logistic regressions were used to identify variations in the relative risk of disorder symptoms as a function of sociodemographic characteristics, age 18 educational and social indices and substance use, and age 35 health and satisfaction indices and substance use. In the full models, age 18 binge drinking and marijuana use were found to be among the strongest predictors of age 35 AUD and CUD, respectively. Among age 35 health and well-being indicators, lower overall health, more frequent cognitive difficulties, and lower satisfaction with spouse/partner were consistently associated with greater risks of AUD and CUD. Some evidence was found for a J-shaped association between age 35 AUD or CUD status and health and well-being indices, such that nondisordered users were sometimes better off than both abstainers and those experiencing disorder. Finally, nondisordered cannabis use, but not CUD, was found to be more common in more recent cohorts. Implications are discussed regarding the importance of placing early midlife substance use disorder within the context of both adolescent substance use and adult health and well-being.

Competitive sports participation in high school and subsequent substance use in young adulthood: Assessing differences based on level of contact

The objective of this study is to examine how participation in different types of competitive sports (based on level of contact) during high school is associated with substance use 1 to 4 years after the 12th grade. The analysis uses nationally representative samples of 12th graders from the Monitoring the Future Study, who were followed 1 to 4 years after the 12th grade. The longitudinal sample consisted of 970 12th graders from six recent cohorts (2006–2011). The analyses, which controlled for 12th grade substance use, school difficulties, time with friends, and socio-demographic characteristics, found that respondents who participated in at least one competitive sport during the 12th grade had greater odds of binge drinking during the past two weeks (AOR = 2.04; 95% CI = 1.43, 2.90) 1 to 4 years after the 12th grade, when compared to their peers who did not participate in sports during their 12th grade year. Moreover, respondents who participated in high-contact sports (i.e. football, ice hockey, lacrosse, and wrestling) had greater odds of binge drinking (AOR = 1.80; 95% CI = 1.18, 2.72), and engaging in marijuana use during the past 30 days (AOR = 1.81; 95% CI = 1.12, 2.93) 1 to 4 years after the 12th grade when compared to their peers who did not participate in these types of sports during their 12th grade year. Accordingly, the findings indicate important distinctions in sport participation experiences on long-term substance use risk that can help inform potential interventions among young athletes.

Patterns of simultaneous and concurrent alcohol and marijuana use among adolescents

ABSTRACT Background: Alcohol and marijuana are the most commonly used substances among adolescents but little is known about patterns of co-use. Objectives: This study examined patterns of concurrent (not overlapping) and simultaneous (overlapping) use of alcohol and marijuana among adolescents. Methods: Data from US-national samples of 12th graders (N = 84,805, 48.4% female) who participated in the Monitoring the Future study from 1976 to 2016 and who used alcohol and/or marijuana in the past 12 months were used to identify latent classes of alcohol use, marijuana use, and simultaneous alcohol and marijuana (SAM) use. Results: A four-class solution indicated four patterns of use among adolescents: (1) Simultaneous alcohol and marijuana (SAM) use with binge drinking and recent marijuana use (SAM-Heavier Use; 11.2%); (2) SAM use without binge drinking and with recent marijuana use (SAM-Lighter Use; 21.6%); (3) Marijuana use and alcohol use but no SAM use (Concurrent Use; 10.7%); and (4) Alcohol use but no marijuana or SAM use (Alcohol-Only Use; 56.4%). Membership in either SAM use class was associated with a higher likelihood of truancy, evenings out, and use of illicit drugs other than marijuana. SAM-Heavier Use, compared to SAM-Lighter Use, class members were more likely to report these behaviors and be male, and less likely to have college plans. Conclusions: Among 12th graders who use both alcohol and marijuana, the majority use simultaneously, although not all use heavily. Given the recognized increased public health risks associated with simultaneous use, adolescent prevention programming should include focus on particular risks of simultaneous use.

“I Am So Bored!”: Prevalence Rates and Sociodemographic and Contextual Correlates of High Boredom Among American Adolescents:

Adolescent boredom is associated with maladaptation and negative developmental outcomes, yet little is known about the prevalence and correlates of high boredom. Drawing from a broad psychosocial framework, the present study examined rates of high boredom and sociodemographic and contextual correlates among nationally representative samples of 8th and 10th graders (N = 21,173; 51.8% female) from the Monitoring the Future survey. Results indicate that approximately 20% of adolescents reported high levels of boredom. Those who were more likely to report high boredom were eighth graders; females; youth who identified as Black, Biracial, or Native American/Native Hawaiian/Pacific Islander; rural youth; and youth of lower socioeconomic status. Results of multivariable logistic regression analyses show significant associations between high boredom and many elements of school, parent, peer, and extracurricular contexts, controlling for sociodemographic characteristics. Findings highlight the pervasiveness of high boredom among American youth and may benefit prevention and intervention efforts by identifying multiple contextual associations with adolescent boredom.