Rebecca J. Evans-Polce

Changes in gender and racial/ethnic disparities in rates of cigarette use, regular heavy episodic drinking, and marijuana use: ages 14 to 32.

BACKGROUND The purpose of this study is to investigate disparities in substance use behaviors across gender and race/ethnicity as a flexible function of age from mid-adolescence through young adulthood. METHODS Using data from the National Longitudinal Study of Adolescent Health, the time-varying effect model (TVEM) was used to examine gender and racial/ethnic differences in the prevalence of cigarette use, regular heavy episodic drinking (HED), and marijuana use as a smooth function of developmental age. RESULTS Prevalence of cigarette use, regular HED, and marijuana use was higher for males than females overall, although gender differences varied with age. With regard to race, prevalence of each substance was higher for White than Hispanic or Black individuals; these differences increased considerably from ages 16 to 20, particularly for cigarette use. Differences in cigarette use by race/ethnicity were found across age, but were largest at age 18, when cigarette use peaks for White individuals, but continues to climb throughout the 20s among Hispanic and Black individuals. CONCLUSIONS These results suggest that substance use, particularly for certain population subgroups, increases past early adolescence. Disparities in substance use behaviors fluctuate considerably throughout adolescence and young adulthood, suggesting that targeted intervention programs are more critical at particular ages. These findings also demonstrate that TVEM can advance our understanding of health risk behaviors and their correlates across developmental time.

The downside of tobacco control? Smoking and self-stigma: A systematic review.

OBJECTIVE Little is known about the consequences of tobacco smoking stigma on smokers and how smokers may internalize smoking-related stigma. This review summarizes existing literature on tobacco smoking self-stigma, investigating to what extent smokers are aware of negative stereotypes, agree with them and apply them to themselves. METHODS We carried out a systematic search of Pubmed/Web of Science/PsycInfo databases for articles related to smoking self-stigma through June 2013. Reference lists and citations of included studies were also checked and experts were contacted. After screening articles for inclusion/exclusion criteria we performed a quality assessment and summarized findings according to the stages of self-stigma as conceptualized in Corrigans progressive model of self-stigma (aware, agree, apply and harm). Initial searches yielded 570 articles. RESULTS Thirty of these articles (18 qualitative and 12 quantitative studies) met criteria for our review. Awareness of smoking stigma was virtually universal across studies. Coping strategies for smoking stigma and the degree to which individuals who smoke internalized this stigma varied both within and across studies. There was considerable variation in positive, negative, and non-significant consequences associated with smoking self-stigma. Limited evidence was found for subgroup differences in smoking-related stigma. CONCLUSION While there is some evidence that smoking self-stigma leads to reductions in smoking, this review also identified significant negative consequences of smoking self-stigma. Future research should assess the factors related to differences in how individuals respond to smoking stigma. Public health strategies which limit the stigmatization of smokers may be warranted.

Review articleThe downside of tobacco control? Smoking and self-stigma: A systematic review

OBJECTIVE Little is known about the consequences of tobacco smoking stigma on smokers and how smokers may internalize smoking-related stigma. This review summarizes existing literature on tobacco smoking self-stigma, investigating to what extent smokers are aware of negative stereotypes, agree with them and apply them to themselves. METHODS We carried out a systematic search of Pubmed/Web of Science/PsycInfo databases for articles related to smoking self-stigma through June 2013. Reference lists and citations of included studies were also checked and experts were contacted. After screening articles for inclusion/exclusion criteria we performed a quality assessment and summarized findings according to the stages of self-stigma as conceptualized in Corrigans progressive model of self-stigma (aware, agree, apply and harm). Initial searches yielded 570 articles. RESULTS Thirty of these articles (18 qualitative and 12 quantitative studies) met criteria for our review. Awareness of smoking stigma was virtually universal across studies. Coping strategies for smoking stigma and the degree to which individuals who smoke internalized this stigma varied both within and across studies. There was considerable variation in positive, negative, and non-significant consequences associated with smoking self-stigma. Limited evidence was found for subgroup differences in smoking-related stigma. CONCLUSION While there is some evidence that smoking self-stigma leads to reductions in smoking, this review also identified significant negative consequences of smoking self-stigma. Future research should assess the factors related to differences in how individuals respond to smoking stigma. Public health strategies which limit the stigmatization of smokers may be warranted.

Heterogeneity of alcohol, tobacco, and other substance use behaviors in U.S. college students: A latent class analysis.

PURPOSE To identify subgroups of college students with distinct profiles of traditional and alternative types of tobacco, alcohol, and other substance use and to examine how demographic characteristics and academic and social activities are associated with subgroup membership. METHODS We used latent class analysis to characterize subgroups of individuals in their fourth-year of college based on their patterns of seven substance use behaviors: extreme heavy episodic drinking (HED), cigarette use, cigar/cigarillo/little cigar use, smokeless tobacco use, hookah use, marijuana use, and non-medical prescription drug use. Demographic characteristics and academic and social activities were then incorporated as predictors of these latent classes. RESULTS We identified five classes defined by unique behavior patterns: (1) Non/Low Users, (2) Non-Hookah Tobacco Users, (3) Extreme HED & Marijuana Users, (4) Hookah and Marijuana Users, and (5) Poly-Substance Users. Being male, older, and involved in sports were associated with greater odds of being in the Poly-Substance User class compared to the Low/No User class, and participating in an honors society and reporting more positive peer relationships were associated with being in the Hookah and Marijuana User class compared to the Low/No User class. CONCLUSION Our findings of unique characteristics in the subgroups identified suggest that college substance users are a heterogeneous population requiring different targeted interventions. Of particular concern are subgroups with high rates of alternative tobacco products, as perceived risks of use may be inaccurate and this is not currently a focus of college substance use prevention interventions.

Age trends in rates of substance use disorders across ages 18–90: Differences by gender and race/ethnicity

BACKGROUND Although research has documented age differences in substance use, less is known about how prevalence of substance use disorders (SUDs) vary across age and differ by gender and race/ethnicity. METHODS Time-varying effect models (TVEMs) were estimated on data from the National Epidemiologic Survey of Alcohol and Related Conditions-III (NESARC III; N=36,309), a nationally representative survey of the adult population. The sample was 44% male; 53% White, 21% Black, 19% Hispanic/Latino, 6% other race/ethnicity. Prevalence of four SUDs (alcohol, tobacco, cannabis and opioid use disorders) were flexibly estimated across ages 18-90 by gender and race/ethnicity. RESULTS Estimated SUD prevalences were generally higher for men compared to women at most ages until the 70s. However, disparities by race/ethnicity varied with age, such that for most SUDs, estimated prevalences were higher for White participants at younger ages and Black participants at older ages. DISCUSSION Results suggest relatively constant disparities by gender across age, and a crossover effect for Black and White participants. Findings demonstrate that Black individuals in midlife may be an important target of intervention programs for some substances.

Taking a life course approach to studying substance use treatment among a community cohort of African American substance users

BACKGROUND Life course theory emphasizes the need to examine a wide variety of distal factors along with proximal factors, longitudinally. Yet research on who obtains substance use treatment is generally cross-sectional and limited to examining developmentally proximal factors (e.g., substance use severity) and demographic factors. METHODS To investigate treatment within a life-course framework, we studied 522 drug and/or alcohol users from a community cohort of African Americans followed prospectively from age 6. Developmentally distal factors of childhood and adolescent social behavior, family environment, academic achievement, mental health, and substance use along with the key proximal factors of substance use severity and socioeconomic status were examined using regression analyses to assess their impact on obtaining adult substance use treatment. RESULTS One-fifth of the study population obtained treatment for substance use by age 32 (20.5%). Although adult socioeconomic status was not associated with substance use treatment in adulthood in the multivariable model, the proximal factor of substance use severity was a strong predictor of obtaining substance use treatment, as expected. After including several developmentally distal factors in the model, childhood aggression also had an independent effect on adult substance use treatment, above and beyond substance use severity. CONCLUSIONS These findings emphasize the importance of using a life course framework when exploring predictors of treatment; early life characteristics are important influences beyond the more proximal factors in adulthood. Research should continue to take a life course approach to better understand pathways to substance use treatment.

Childhood cigarette and alcohol use: Negative links with adjustment

Children who initiate cigarette or alcohol use early-during childhood or early adolescence-experience a heightened risk of nicotine and alcohol dependence in later life as well as school failure, crime, injury, and mortality. Using prospective intergenerational data from the Millennium Cohort Study (MCS), we investigate the association between early substance use initiation (cigarettes or alcohol) and age 11 school engagement, academic achievement, and wellbeing. The ongoing MCS tracks the development of a nationally representative sample of children in the United Kingdom (born 2000-2002) from infancy through adolescence. At age 11, MCS children (n=13,221) indicated whether they had ever used cigarettes or alcohol; at age 7 and 11 they reported on school engagement and wellbeing and completed investigator-assessed tests of academic achievement. Using propensity score methods, children who had initiated cigarette or alcohol use by age 11 were matched to abstaining children with similar risks (or propensities) of early substance use, based on numerous early life risk and protective factors assessed from infancy to age 7. We then examined whether early initiators differed from non-initiators in age 11 adjustment and achievement. Results show that substance use by age 11 was uncommon (3% cigarettes; 13% alcohol). After matching for propensity for early initiation, school engagement and wellbeing were significantly lower among initiators compared to non-initiators. Academic achievement was not consistently related to early initiation. We conclude that initiation of smoking and drinking in childhood is associated with poorer adjustment.

Disparities in substance use behaviors and disorders among adult sexual minorities by age, gender, and sexual identity

BACKGROUND Sexual minorities (SMs) experience elevated rates of substance use behaviors and disorders relative to heterosexuals; minority stress is theorized to contribute to these disparities. As SMs are not a homogenous group, analyses that aggregate SMs across sexual identity, age, or gender obscure important variation among this population. To date, age- and gender-specific disparities have not been rigorously examined using a large national sample. METHODS Using data on 67,354 adults (ages 18-49) from the 2015 and 2016 National Survey of Drug Use and Health we examined age- and gender-specific disparities in smoking, heavy episodic drinking, marijuana use, illicit drug use, and alcohol/substance use disorder. Age groups were ages 18-25, 26-34, and 35-49. Using logistic regression, we estimated age- and gender-specific odds ratios for gay/lesbian and bisexual individuals, relative to heterosexuals; analyses adjusted for demographic characteristics. RESULTS Bisexual women had significantly elevated odds of all outcomes at all ages, relative to heterosexual women. Gay/lesbian individuals had significantly elevated odds for nearly all outcomes compared to same-gender heterosexuals at ages 18-25, but not consistently at older ages. For bisexual men, significant disparities compared to heterosexual men were only observed at ages 35-49 for marijuana use and alcohol/substance use disorder. CONCLUSIONS We found notable within-group differences regarding SM disparities. While disparities were most pronounced in young adulthood for gay/lesbian individuals and mid-adulthood for bisexual men, bisexual women uniquely experienced disparities across all ages. Minority stress experiences may vary with respect to gender, age/cohort, and sexual identity, resulting in differential risk for substance use.

Prospective Associations of 12th-Grade Drinking Intensity and Age 19/20 Driving-Related Consequences

PURPOSE The purpose of this study is to examine driving-related consequences associated with levels of drinking intensity among a national sample of young adult drinkers. METHODS Data come from a nationally representative sample of 12th graders sampled annually in 2005-2014 with subsamples surveyed at age 19/20 years. Multivariable logistic regressions examined associations of 12th-grade drinking intensity (0-4, 5-9, 10-14, and 15+ drinks in a row) with driving consequences at age 19/20 years. RESULTS Twelfth-grade binge drinkers (compared with nonbinge drinkers) were more likely to experience negative driving consequences at age 19/20 years. Among binge drinkers, 15+ drinkers (compared with 5-9 drinkers) in 12th grade had increased the risk of negative drinking consequences at age 19/20 years. CONCLUSIONS These results suggest that while underage binge drinkers are at an increased risk for having driving consequences, those who engage in higher intensity drinking are at even greater risk for these consequences. High-intensity drinkers may require additional screening or intervention to reduce future driving-related consequences.

Gender- and age-varying associations of sensation seeking and substance use across young adulthood

INTRODUCTION Sensation seeking is associated with elevated risk for substance use among adolescents and young adults. However, whether these associations vary across age for young men and women is not well characterized. METHODS Using data from the Monitoring the Future (MTF) panel study, we examine the age-varying associations of sensation seeking and three types of substance use behavior (binge drinking, cigarette use, and marijuana use) across ages 18 to 30 using time-varying effect modeling. Analyses include participants in the eleven most recent MTF cohorts (12th-graders in 1994-2004), who are eligible to respond through age 29/30 (N = 6338 people; 30,237 observations). RESULTS While sensation seeking levels and substance use are lower among women, the magnitude of the association of sensation seeking with binge drinking and with marijuana use among women exceeds that of men in the later 20s. Differential age trends were observed; among men, the associations generally decreased or remained constant with age. Yet among women, the associations decayed more slowly or even increased with age. Specifically, the association of sensation seeking with marijuana use among women increased during the late 20s, such that the association at age 30 exceeded that in the early 20s. CONCLUSIONS The significantly stronger associations of sensation seeking with binge drinking and marijuana use observed among women compared to men during the mid- to late-20s suggests divergent risk factors across genders for substance use during young adulthood, with sensation seeking remaining a strong risk factor for women but not men.