Epidemiology of Youth Drug Abuse

Research Findings from February, 2004 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate the epidemiology, etiology, and prevention research. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

Nicotine-Dependence Symptoms In Adolescent Smokers

Although many factors have been identified as related to adolescent smoking, few studies have examined the role of nicotine-dependence (ND) symptoms. The purpose of this study was to investigate the association between ND symptoms and smoking status among adolescents in the early stages of the smoking onset process. The McGill University Study on the Natural History of Nicotine Dependence is an ongoing 6-year prospective investigation of the natural history of ND among 1267 grade 7 students in ten Montreal high schools. The baseline response was 55.4%. Subjects for this cross-sectional analysis of baseline data, collected in 1999, included 241 past 3-month smokers (mean age [SD] =13.0+/-0.7 years at baseline). ND symptoms were measured in five indicators, including a measure based on the criteria for tobacco dependence in the International Classification of Diseases-10th Revision (ICD-10), the Hooked on Nicotine Checklist, and three symptom clusters (withdrawal, self-medication, and ND/cravings symptoms). The association between ND symptom indicators and each of sporadic, monthly, weekly, and daily smoking relative to less frequent smoking was investigated in multiple logistic regression analysis. Dr. Difranza and colleagues found that low cigarette exposure, 16.6% of past 3-month smokers were tobacco dependent. The proportion increased from 0%, 3.1% and 4.6% among triers, sporadic smokers, and monthly smokers, respectively, to 19.4% and 65.9% among weekly and daily smokers, respectively. ND/cravings consistently distinguished each smoking category from less frequent smokers. These data challenge current smoking onset models, which suggest that ND develops only after several years of heavy or daily smoking. ND symptoms are associated, at least cross-sectionally, with increased smoking in adolescents. To increase the likelihood of being effective, tobacco-control programs for children and adolescents will need to take early ND symptoms into account. O'Loughlin, J., DiFranza, J., Tyndale, R.F., Meshefedjian, G., McMillan-Davey, E., Clarke, P.B.S., Hanley, J. and Paradis, G. Nicotine-Dependence Symptoms are Associated with Smoking Frequency in Adolescents. American Journal of Preventive Medicine, 25(3), pp. 219-225, 2003.

Cigarette Smoking and Smoking-Related Beliefs After 2 Decades in a Community Sample

Rates of cigarette smoking and smoking-related beliefs in 1980 and 2001 among 7th-11th graders in a midwestern community were compared. Smoking was less prevalent in 2001 than in 1980, with the greatest declines in experimental smoking and a smaller drop in regular smoking. Beliefs about smoking generally became more negative. Adolescents (particularly nonsmokers) viewed smoking as more addictive and as having more negative social consequences in 2001 than in 1980 and had more negative attitudes toward smoking in 2001. These results were replicated among parent-child pairs in which parents were measured when they were adolescents between 1980 and 1983 and their children were measured in 2001. These beliefs and attitudes partially mediated the effects of time on smoking. Chassin, L., Presson, C.C., Sherman, S.J. and Kim, K. Historical Changes In Cigarette Smoking And Smoking-Related Beliefs After 2 Decades In A Midwestern Community. Health Psychology, 22(4), pp. 347-353, 2003.

Prevalence of Alcohol and Drug Use in an Adolescent Training Facility

Dr. Lyn Stein and colleagues at the NIDA-funded Center for Alcohol and Addiction, Brown University, conducted a study of the substance use and crime histories of incarcerated male adolescents. Chart reviews of 186 adolescents indicated that drug use was highly prevalent, with 88.7% using alcohol and 95.7% using marijuana. Ethnic differences in drug use were found, with Caucasian, non-Hispanic adolescents significantly more likely to use cocaine, hallucinogens, and heroin than were adolescents of other ethnicities. Among the crimes committed, possession of a controlled substance was the most prevalent, with 31.8% of adolescents involved. These results provide important guidance for developing targeted behavioral treatments to reduce incarcerated adolescents' use of drugs and involvement in drug-related crimes. Lebeau-Craven, R., Stein, L., Barnett, N., Colby, S.M., Smith, J.L.and Canto, A.L. Substance Use & Misuse, 38(7), pp. 825-834, June 2003.

Boundary-Crossing and Drug Use Among Young Adults in a Low-Income, Minority, Urban Neighborhood

In this paper, researchers examined the relationship between boundary-crossing sexual partnerships (i.e., those between partners who are 5 or more years older, of a different race or ethnicity, or live in a different neighborhood or borough) and use of crack or injected drugs among young adults in Bushwick, Brooklyn. Women who smoked crack or injected drugs were more likely to have a sexual partner who was older, of a different race/ethnicity, or from a different borough than were women who did not use these drugs; men who used these drugs were more likely to have older sex partners than men who did not. Young people who use these drugs are known to be at higher risk of having HIV and a number of other sexually-transmittable infections such as hepatitis B, genital herpes, and syphilis. These results imply that this risk may be even higher for people who cross these boundaries. In addition, if these young people become infected, they may be particularly likely to serve as a gateway for spreading infection to other social groups. Flom, P., Friedman, S., Neaigus, A. and Sandoval, M. Boundary-Crossing and Drug Use Among Young Adults in a Low-Income, Minority, Urban Neighborhood. Connections, 25 (2), pp. 77-87, 2003.

Prevalence and Development of Psychiatric and Substance Use Disorders in Childhood and Adolescence

The authors used longitudinal data from a representative community sample of 1420 nine through sixteen year olds, to describe the prevalence and continuity of psychiatric disorders over time. Several significant findings were reported. By age 16, over a third (36.7%) of subjects met DSM-IV criteria for one or more disorders, and those with one disorder were 3 times more likely to have the same or another diagnosis at later waves. Rates of comorbidity were high, with one quarter (25.5%) diagnosed with 2 or more disorders at one time. Almost all disorders showed significant rates of continuity over time. Continuity from one diagnosis to another was significant between anxiety and depressive disorders, and from anxiety and conduct disorder to substance abuse, in girls. Substance use disorders increased with age and were more prevalent in boys than girls. The sample, while representative, does not represent the American population, but prevalence rates were comparable to those in several other studies. The notable points from this study relate particularly to the findings regarding continuity: that in a representative sample, only anxiety and conduct disorders predicted substance use disorders, and only in girls. This has important implications for improving our understanding of the etiology of adolescent drug abuse, for identifying those children at particular risk, and for developing and testing effective childhood interventions to prevent later drug abuse. Costello, E.J., Mustillo, S., Erkanli, A., Keeler, G., and Angold, A. Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence. Arch Gen Psychiatry, 60, pp. 837-844, 2003.

Comorbid Substance Use and Psychiatric Disorders Among Juvenile Detainees

To estimate the prevalence of comorbid psychiatric disorders in the past 6 months, the Diagnostic Interview Schedule for Children Version 2.3 was administered to 1,829 randomly selected detainees (1172 males, 657 females, aged 10-18) in the Cook County Juvenile Temporary Detention Center. Overall, more than 10 percent of males and almost 14 percent of females had a substance abuse disorder and a major mental disorder, such as psychosis, manic episode, or major depressive episode. Approximately 600 of these 1,829 young people had substance abuse disorders and behavioral disorders. In the subset of 305 youth with major mental disorders, more than 50 percent of females and nearly 75 percent of males also reported a substance abuse disorder. When the subset of 874 youth with substance abuse disorders was examined, 30 percent of the females and 21.4 percent of the males were found to also have a major mental disorder. About 25 percent of juvenile justice system detainees with major mental disorders reported that their psychiatric problem preceded their substance abuse disorder by more than 1 year. Almost 67 percent of females and more than 54 percent of males developed their mental and drug abuse disorders within the same year. Overall, these findings point to the need for assessment and treatment of juvenile detainees with comorbid substance abuse and mental health disorders. Abram, K.M., Teplin, L.A., McClelland, G.M. and Dulcan, M.K. Comorbid Psychiatric Disorders in Youth in Juvenile Detention. Arch Gen Psychiatry, 60(11), pp. 1097-1108, 2003.

Recanting of Substance Use Reports In a Longitudinal Prevention Study

This study analyzed recanting of substance use reports for lifetime use of alcohol, alcohol to get drunk, cigarettes, marijuana and cocaine in an 8-wave panel study designed to evaluate the Drug Abuse Resistance Education (DARE) program in the state of Illinois. Although this phenomenon has been identified elsewhere, the current analysis of recanting is a unique attempt to track this behavior over the entire course of adolescence. Overall, rates of recanting for specific drugs was extremely high, ranging from 45% for lifetime reports of alcohol use to 81% for lifetime reports of cocaine use. Most recanting occurred in the wave immediately following the wave of first disclosure. Paralleling results from other studies, race/ethnicity was an important correlate of recanting in both bivariate and multivariate analyses. African American respondents had higher rates of recanting than White subjects. Even after controlling for the number of follow-up waves, the later the wave of first disclosed lifetime drug use, the lower the probability that drug use would be recanted ever (for all substances) or in the wave immediately following first disclosure (for reports of ever having been drunk or for lifetime marijuana or cocaine use). One important limitation of this study is that it is focused on a sample attending schools in one particular state (Illinois) in the United States during one particular time period. Fendrich, M. and Rosenbaum D.P. Recanting of Substance Use Reports in a Longitudinal Prevention Study. Drug Alcohol Depend, 20, pp. 241-253, 2003.

Marijuana Use Affects Completion of High School

Cross-sectional research has shown a link between adolescent substance use and educational motivation. The purpose of the current study was to examine this link in a longitudinal sample of African American youth. The study examined the interrelationships between alcohol and both marijuana use and school motivation over the high school years and their effect on graduation in 681 African American adolescents (50.8% female). School motivation was shown to relate to subsequent alcohol use throughout high school and marijuana use early in high school. School motivation did not affect graduation status, but alcohol and marijuana use were related to a lower likelihood of graduating from high school. Some gender differences and differences among those who had tried alcohol or marijuana at the first wave as opposed to those who had not tried each substance were found. The findings support a systems model where school experiences can affect substance use, which, in turn, can affect the completion of high school. Zimmerman, M.A., Schmeelk-Cone, K.H. A Longitudinal Analysis of Adolescent Substance Use and School Motivation Among African American Youth. J Res Adolesc, 13(2), pp. 185-210, 2003.

Racial/Ethnic Differences in Smoking Accounted for, in Part, by Social Influence

Using data from a longitudinal panel of nearly 3000 adolescents to predict current smoking among young adults, this study tested whether considering variables that tap prior social bonds and influences eliminates race/ethnicity as a significant predictor of current smoking. At age 23, African Americans and Asians exhibited substantially lower rates of current smoking than Whites and Hispanics. Controlling for social influences during high school, particularly exposure to siblings and friends who smoked plus parental disapproval of smoking, accounted for these differences. Social bonding variables, in contrast, had a limited effect on these differences. Interventions aimed at decreasing adolescent vulnerability to prosmoking influences, reducing overall levels of peer cigarette use, and helping parents better convey their disapproval of smoking should help curb young adult smoking and diminish racial/ethnic differences in tobacco use. Ellickson, P.L., Perlman, M. and Klein, D.J. Explaining Racial/Ethnic Differences in Smoking During the Transition to Adulthood. Addict Behav., 28(5), pp. 915-931, 2003.

Role Models and Psychosocial Outcomes Among African American Adolescents

The authors examined who 679 African American ninth-graders (aged 14-17 yrs) from urban environments look up to and how their role model choices relate to substance use, delinquency, academic engagement, and psychological well-being. Male adolescents without male role models and females identifying brothers as role models reported the most problem behavior. Adolescents with paternal male role models had the most positive school outcomes, no differences were found in psychological well-being among adolescents in terms of their male role models. The presence of female role models, in contrast, was associated with psychological well-being such that adolescents with maternal role models reported the least distress. Adolescents without female role models had the lowest grades and most negative school attitudes. These findings remained when parental support, family conflict, and father presence in the household were controlled, suggesting role model effects are separate from parenting effects. Findings support and expand on the notion that having someone to look up to is critical for African American youths' development. Bryant, A.L. and Zimmerman, M.A. Role Models and Psychosocial Outcomes Among African American Adolescents. J Adolesc Res., 18(1), pp. 36-67, 2003.

Predictors of the Transition to Regular Smoking

This study identified predictors of the transition from experimentation to regular smoking in middle adolescence, late adolescence, and young adulthood. Students completed self-report surveys assessing the following potential predictors of the transition to regular smoking from grades 8 to 10, grades 10 to 12, and grades 12 to age 23 years: demographic characteristics, smoking-related attitudes, behaviors and environment, other problem behaviors; academic orientation; parental bonding; and mental health. Regression techniques which adjust for weighting and clustering of observations were used to determine the independent associations of the predictor variables on subsequent smoking status. Risk factors for the transition to regular smoking during middle adolescence included being white, prosmoking attitudes, friend smoking, weak academic orientation, and less parental support. During late adolescence, being African-American was protective, whereas risk factors included prosmoking attitude, drinking, non-intact nuclear family, and less parental support. Risk factors in young adulthood include younger age and prosmoking attitudes. Results point to several smoking-related attitudes, social influences, and behaviors that prevention efforts may target to curb the escalation of smoking. Tucker, J.S., Ellickson, P.L., and Klein, D.J. Predictors of the Transition to Regular Smoking During Adolescence and Young Adulthood, J Adolesc Health, 32(4), pp. 314-324, 2003.

Common Predictors of Cigarette Smoking, Alcohol Use, Aggression, and Delinquency Among Inner-City Minority Youth

The present study examined the prevalence rates and common predictors of substance use, aggression, and delinquency among inner-city minority youth entering middle school. A survey was administered to 6th grade students (N = 5423) from 42 New York City schools. Aggressive behaviors were reported most frequently, followed by delinquent behaviors, alcohol use, and cigarette smoking. Across all behavioral outcomes, social and environmental influences explained the largest proportion of variance, followed by individual characteristics and skills, bonding to conventional institutions, and demographic variables. For the majority of predictor variables there was substantial overlap in patterns of prediction across outcomes. These findings indicate that several factors that correspond to the predominant psychosocial theories of adolescent development explain variation across different problem behavior outcomes among inner-city minority youth. Griffin, K.W., Botvin, G.J., Scheier, L.M., Doyle, M.M. and Williams, C. Common Predictors of Cigarette Smoking, Alcohol Use, Aggression, and Delinquency Among Inner-City Minority Youth. Addictive Behaviors, 28, pp. 1141-1148, 2003.

Sports Participation and Substance Abuse In Young Adults

The widely held notion that sports participation reduces subsequent risk of substance use is evaluated with longitudinal data of a representative sample of youth when they were in their preteen and young adult years. Unlike previous inquiries into the deterrence hypothesis, the present study controls for other major factors previously found to be predictive of alcohol and drug use. Results of analyses revealed that contrary to the deterrence hypothesis, playing high school sports does not appear to be a protective factor that lowers one's involvement in young adult alcohol or drug use--with one exception. Subgroup analyses revealed that among blacks, the greater the extent of high school sports participation, the less the risk of substance use. In direct contradiction to the deterrence hypothesis, playing high school sports was found to be positively associated with alcohol use for whites, even in the context of other major predictors of alcohol use. Further analyses revealed that the positive association between sports participation and alcohol use appeared to exist only for white males. The implications of these results are discussed. Eitle, D., Turner, R.J. and Eitle, T.M. The Deterrence Hypothesis Reexamined: Sports Participation and Substance Abuse Young Adults. Journal of Drug Issues, 33, pp. 193-222, 2003.

Relevant Biological Background Knowledge Enables Children to Learn About the Mechanisms of Drug Action

To prevent early drug and alcohol experimentation, experts suggest that prevention efforts should be initiated in elementary school. However, there has been little systematic assessment of the knowledge that elementary school-aged children need in order to understand the risks associated with substance abuse. This study sought to determine whether children are better able to learn about the physiological mechanisms of drug action if they have relevant biological background knowledge than if they do not. The participants were 363 third- to sixth-grade students from 24 classrooms in four Catholic schools in an ethnically diverse metropolitan area who were enrolled in a study of the efficacy of a drug-education curriculum designed to teach a causally coherent explanation of how alcohol and cocaine effect behavior. All children took pre- and posttests designed to measure knowledge about alcohol and cocaine, attitudes and intentions toward their use, and knowledge of the brain and circulatory system. The children were randomly assigned to four small groups within same-grade groupings, and one researcher was randomly assigned to oversee each group. The groups received one of four curricula: (1) basic theory of drug action, (2) biologically enhanced version of the theory, (3) version confronting smoking myths, or (4) control group. Results indicated that biological knowledge was greater among older students, but on the whole, elementary school-aged children may not have sufficient grasp of general biological information to apply it to a specific case like the circulation of drugs. Nevertheless, biological knowledge, especially knowledge of the brain's controlling functions, was positively associated with greater endorsement of central theories of drug action. Most importantly, the hypothesis that relevant biological knowledge would be associated with both concurrent drug knowledge and gains in drug knowledge following exposure to a drug and alcohol education curriculum was supported. Sigelman, C.K., Bridges, L.J., Sorongon, A.G., Rinehart, C.S., Brewster, A.B., and Wirtz, P. Biological Background Knowledge and Learning From a Drug and Alcohol Education Program. The Journal of Genetic Psychology, 164(2), pp. 133-152, 2003.

Predictors of Smoking Among Rural Adolescents

This study investigated a model of social and cognitive cross-sectional predictors of smoking, with a focus on rural adolescents. Gender-specific differences in etiology were examined by testing the same model separately for boys and girls. Seventh graders (N=1,673) residing in northeastern Iowa self-reported smoking, peer smoking norms, adult smoking norms, drug refusal assertiveness, drug refusal techniques, life skills, prosmoking attitudes, risk-taking tendency, and family management practices. Data were collected during a class period in 36 junior high schools. Peer smoking norms, adult smoking norms, drug refusal assertiveness, drug refusal techniques, prosmoking attitudes, and risk-taking tendency were associated with smoking. Notably, family management skills and life skills were associated with current smoking for girls only. Based on the results of the present study and on previous research, smoking prevention programs for rural adolescents should incorporate normative education, drug refusal training, parent skills training, and competence enhancement skills training, strategies that have been successful with urban and suburban populations. Epstein, J.A., Botvin, G.J., and Spoth, R. Predicting Smoking among Rural Adolescents: Social and Cognitive Processes. Nicotine and Tobacco Research, 5, pp. 485-491, 2003.

Substance Abuse Among Very Young Juvenile Offenders

Although the relationship between delinquency and substance use in adolescence is well documented, less is known about substance-use initiation in childhood for juvenile delinquent populations. This 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 on Drug Abuse. 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 at least several times per month by age 13. Limited evidence related early substance initiation with subsequent substance abuse. Offense status is related to early substance initiation for females but not males. Early substance use is a significant problem among youth who end up in the juvenile justice system. Prinz, R.J., and Kerns, S.E.U. Early Substance Use by Juvenile Offenders. Child Psychiatry and Human Development, 33(4), pp. 263-277, 2003.

Comorbid Psychiatric Disorders in Youth in Juvenile Detention

This epidemiological study seeks to estimate 6-month prevalence of comorbid psychiatric disorders among juvenile detainees by demographic subgroups including gender, race/ethnicity, and age. Participants in this longitudinal study include 1,829 youth (age 10-18 years) initially arrested and detained between 1995 and 1998 at the Cook County Juvenile Temporary Detention Center in Chicago, IL. Subjects were randomly selected to participate in the study. Results indicate significantly more females (57%) than males (46%) met the criteria for 2 or more mental health disorders represented in the DSM-III-R. Nearly 14% of the girls and 11% of the boys had both a major mental disorder (psychosis, manic episode, or major depressive episode) and a substance use disorder. Nearly 30% of the girls and 20% of the boys with substance use disorders had major mental health disorders. Rates of comorbidity were higher among non-Hispanic whites and older adolescents. Abram, K.M., Teplin, L.A., McClelland, G.M., and Dulcan, M.K. Comorbid Psychiatric Disorders in Youth in Juvenile Detention. Archives of General Psychiatry, 60, pp. 1097-1108, 2003.

Sense of Belonging in School as a Protective Factor Against Drug Abuse Among Native American Urban Adolescents

This article presents the results of a study conducted with 243 Native American students who were part of a multi-ethnic sample of adolescents attending middle school in a large urban center in the Southwest region of the United States. Native adolescents who felt a stronger sense of belonging in their school were found to report a lower lifetime use of alcohol and cigarettes, lower cigarette and marijuana use in the previous month, lower frequency of current use of these substances, fewer substances ever used, and a later age of initiation into drug use than other Native students. Research implications are discussed in relationship to school environment, culturally-grounded prevention curricula, and school social work practice. Napoli, M., Marsiglia, F.F., and Kulis, S. Sense of Belonging in School as a Protective Factor Against Drug Abuse Among Native American Urban Adolescents. Journal of Social Work Practice in the Addictions, 3(2), pp. 25-41, 2003.

Posttreatment Victimization and Violence Among Adolescents Following Residential Drug Treatment

This article examines the relationships among experiences of childhood abuse, psychiatric disorders, self-reported victimization, and violent behavior, with a focus on gender differences. Data were obtained from interviews at treatment entry and 5-year post-treatment for 446 adolescent clients in therapeutic community (TC) drug treatment programs throughout the United States and Canada. Fifty-eight percent of the sample indicated that they engaged in serious violent behaviors (e.g., beatings, threatening or using weapons against other people, or violent crimes such as assaults, rapes, murders) in the 5 years following their separation from TC treatment. Multivariate logistic regression analyses revealed that victimization in the posttreatment period was the most significant factor associated with violent behavior, and pretreatment childhood abuse experiences and psychiatric disorders were not significantly related to the odds of violent behavior. There were significant gender differences in self-reported victimization and violent behavior. The findings suggest that violence in young adulthood for males is related to increasing involvement in violent lifestyles that include drug trafficking, while violence among females is associated with the social and psychological consequences of drug involvement and victimization. High rates of violent involvement and victimization among former adolescent clients suggests the utility of incorporating interventions such as safety-oriented strategies for females or interventions that address involvement in the drug use lifestyles (i.e., use and dealing) for both males and females into residential treatment to reduce the likelihood of future violence. Hawke, J.M., Jainchill, N. and De Leon, G. Posttreatment Victimization and Violence Among Adolescents Following Residential Drug Treatment. Child Maltreatment, 8(1), pp. 58-71, 2003.