Epidemiology of Youth Drug Abuse

Research Findings from May, 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.

How Academic Achievement, Attitudes, and Behaviors Relate to the Course of Substance Use During Adolescence: A 6-Year, Multiwave National Longitudinal Study

Self-report data regarding alcohol, cigarette, and marijuana use were collected biennially from ages 14 to 20 in a nationally representative panel sample of adolescents (N = 1,897) from the Monitoring the Future study. Growth curve analyses were performed using hierarchical linear modeling to consider psychosocial background, motivation and school attitudes, and parental and peer influences at age 14 as predictors of concurrent substance use and change in substance use. Results indicate that school misbehavior and peer encouragement of misbehavior were positively associated with substance use at age 14 and with increased use over time; school bonding, school interest, school effort, academic achievement, and parental help with school were negatively associated. The protective effects of positive school attitudes and perceptions of high status connected to academics were stronger for low-achieving compared with high-achieving youth. Implications for a developmental perspective on substance use etiology and prevention are discussed. Bryant A.L., Schulenberg J.E., O'Malley P.M., Bachman J.G., and Johnston L.D. How Academic Achievement, Attitudes, and Behaviors Relate to the Course of Substance Use During Adolescence: A 6-Year, Multiwave National Longitudinal Study. Journal of Research on Adolescence, 13(3), pp. 361-397, 2003.

Patterns of Sexual Risk Behaviors and Psychiatric Disorders in a Community Sample of Young Adults

This cross-sectional study documents significant associations between patterns of sexual risk behaviors and psychiatric diagnoses in a multiethnic community sample of young adults (N =1803) in South Florida. Self-report data regarding sexual behavior and psychiatric symptoms were collected in structured interviews in a follow-up of an earlier school-based study. Cluster analysis was used to group participants with regard to levels of sexual risk behaviors during the past year. Chi-square analysis and ANOVA identified significant associations between cluster membership and (a) lifetime and (b) past year diagnoses for affective disorders, conduct disorder, antisocial personality disorder, alcohol abuse/dependence, marijuana abuse/dependence, and other drug abuse/dependence. In addition, higher levels of sexual risk behaviors were associated with higher levels of cumulative lifetime psychiatric disorders. Implications for selected prevention of sexually transmitted diseases (STDs) and the treatment of psychiatric disorders in young adulthood are discussed. Tubman, J.G., Gil, A.G., Wagner, E. F., and Artigues, H. Patterns of Sexual Risk Behaviors and Psychiatric Disorders in a Community Sample of Young Adults. Journal of Behavioral Medicine, 26, pp. 473-500, 2003.

The Deterrence Hypothesis Reexamined: Sports Participation and Substance Use Among Young Adults

The widely held notion that sports participation reduces subsequent risk of substance use is evaluated with longitudinal survey data of a representative sample of 1,172 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, such as family structure and stress exposure. 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. These findings cast doubt about the contention that playing high school sports is protective against alcohol and illegal substance use. Eitle, D., Turner, R.J. and Eitle, T.M. The Deterrence Hypothesis Reexamined: Sports Participation and Substance Use Among Young Adults. Journal of Drug Issues, 33, pp. 193-222, 2003.

Cumulative Adversity and Drug Dependence in Young Adults: Racial/Ethnic Contrasts

This study assesses the effects of cumulative exposure to stressors as a risk factor for drug dependence, and evaluates whether race/ethnic differences in exposure to stressful events contributes to race/ethnic differences in prevalence of drug dependence. Data were analyzed cross-sectionally from a community survey of lifetime adverse experiences and substance and psychiatric disorders among young adults. Data were collected between 1997-2000 in Miami-Dade County, Florida. The sample size is 1,803 former Miami-Dade Public School students, 93% of whom were between ages 19 and 21 when interviewed. Males and females of Cuban origin, other Caribbean basin Hispanics, African-Americans, and non-Hispanic Whites are equally represented. Drug dependence disorder was assessed by DSM-IV criteria using the Composite International Diagnostic Interview, and a 41-item checklist of lifetime exposure to major and potentially traumatic experiences was used to measure cumulative adversity. Both measures include age at time of first occurrence. The lifetime rate of drug dependence disorder (total 14.3%) did not vary significantly (p>.05) by socioeconomic group. The rate for males (17.6%) was significantly greater than female rate (10.9%). The African-American rate (6.5%) was dramatically lower than non-Hispanic White (17.0%), Cuban (18.1%) and non-Cuban Hispanic (16.0%) rates despite their dramatically higher exposure to adversity. Twenty eight of 33 individual adversities were associated with the subsequent onset of drug dependence (p<.05). Cumulative lifetime exposure was greatest for males and for African-Americans, and was inversely associated with socioeconomic level. Multivariate discrete-time event history analysis revealed significant independent effects of distal (>1 year earlier) and proximal (previous year) exposure to adverse events (p<.05), controlling for childhood conduct disorder, ADHD, and prior psychiatric disorder. Lifetime cumulative exposure to distant as well as more recent adversity predicts risk of subsequent drug dependence, though it does not explain ethnic group differences in risk. Implications are that distal and proximal stressful events should both be included when measuring stress exposure. Turner, R.J., and Lloyd, D. Cumulative Adversity and Drug Dependence in Young Adults: Racial/Ethnic Contrasts. Addiction, 98, pp. 305-315, 2003.

Substance Use References in the Lyrics of Favorite Songs of African-American Adolescents

Concerns have been raised regarding the effect of media messages on health risk behaviors, particularly given that media with explicit content are often marketed toward adolescents under the age of 18 (Federal Trade Commission 2000). The goal of this study was to investigate the extent to which drug-related references were present in popular songs nominated by a sample of African-American adolescents. To address this issue, secondary data analyses were performed using data originally collected by the Reaching Adolescents, Parents, and Peers project (Project RAPP). In the spring of 1997, participants reported their five favorite songs. Songs that were nominated five or more times by the sample (popular songs) were coded for genre and drug-related content. Of the 93 popular songs, the most popular genres were R&B (34%), gangsta rap (32%), and non-gangsta rap (27%). The majority of rap (68%) and gangsta rap (80%) songs contained at least one reference to illicit drugs, whereas few R & B songs did (6%). Marijuana and stimulants were the most commonly referred to drugs. These findings substantiate the need for more research on the potential relationship between exposure to media messages and drug use among adolescents. Brookshire, C.D., Stevens, E., Bryant, S., Browne, D.C., and Clubb, P. Substance Use References in the Lyrics of Favorite Songs of African-American Adolescents. Journal of Young Investigators, 1(1), pp 1-7, 2003.

Childhood Compelled Sex and Its Relationship to Structural Disadvantage, Subcultural Norms, Violence, and Illicit Drug Use in Inner City Households

There are a number of studies that have linked child sexual abuse to various adverse outcomes, including substance abuse. This study is a retrospective, qualitative study that seeks to understand the etiology, significance, and response to early compelled sex within the social context of poor, inner-city, predominantly African-American households (approximately 72 households) in New York City. Adult sexual contact with girls was widespread, even the norm in many impoverished households, although it is not accepted behavior by everyone living in the inner city. 61% of female subjects reported having compelled sex by age 13. Typically this activity took place regularly over time and fit within the young girl's sexual development pathway leading to independent sexuality. Many adults do not regard compelled sex as a major problem, and compelled sex is consistent with other subcultural behaviors, including violence and the ever-present threat of violence. The primacy of drug use in the lives of many inner-city residents also supports the acceptance of these subcultural norms and the commodification of sexual behavior (exchange of sex for food, rent money, drugs). Dunlap, E., Golub, A. and Johnson, B. Girls' Sexual Development in the Inner City: From Compelled Childhood Sexual Contact to Sex-for-Things Exchanges. Journal of Child Sexual Abuse, 12(2), pp. 73-96, 2003.

Drug Use by Juvenile Detainees: Comparison of Self-Report and Urinalysis Data

1,829 youth in the Cook County Juvenile Temporary Detention Center were interviewed using the Diagnostic Interview Schedule for Children (DISC 2.3) to gather information on substance use, and 1,745 of these subjects provided urine samples for drug analysis using Enzyme-Multiplied Immunoassay Tests (EMIT-10 panel). Most subjects knew they would be urine tested when they were interviewed. 77.3% reported cannabis use in the past 6 months, 90.1% reported lifetime use. Self-report of other substances was less common, 8.0% reported use of other substances in the past 6 months, 13.0% lifetime. Two-thirds of detainees' urines tested positive for any drug; 65.9% tested positive for cannabis, 4.8% for cocaine, and 1.1% for hallucinogens. Overall, the veracity of self-report was high; among those who tested positive for any substance, 87.7 had reported use in the past 6 months and 94.1% had reported lifetime use. The veracity figures for cannabis were quite similar, 87.6% past 6 months, 94.1% lifetime; and these numbers account for the high veracity seen overall. Veracity figures for drugs other than cannabis were 27.5% for past 6 months and 37.8% lifetime. In general, younger detainees, African-American detainees, and detainees with recent drug arrests lacked veracity in self-reporting drug use. The authors suggest that self-report and urinalysis should be used together along with other data such as information about substance abuse treatment, records of drug-related arrests and charges, and information from families and schools to identify those youth in greatest need of intervention. McClleland, G.M., Teplin, L.A., and Abram, K.M. Detection and Prevalence of Substance Use Among Juvenile Detainees. OJJDP Juvenile Justice Bulletin, March, pp. 1-14, 2004.

Alcohol, Tobacco, and Other Drug Use among Asian American and Pacific Islander Adolescents in California and Hawaii

Prior research suggests that the lowest rates of alcohol, tobacco, and other drug (ATOD) use are often reported for Asian Americans/Pacific Islanders (AAPIs), compared to other Whites. These low rates are, however, often based upon samples with small representations of AAPIs, or represented by only one or two AAPI groups. This study investigates drug use among specific AAPI subgroups (Chinese, Filipino, Japanese, and Pacific Islander/Native Hawaiian) using data from school surveys collected from nearly 82,000 9th grade students in California and nearly 5,000 10th grade students in Hawaii. Results showed that ATOD rates were lowest for the Chinese adolescents and highest among the White and Pacific Islanders/Native Hawaiians reported among the highest. Similar variation was found for need for alcohol and other drug treatment for these groups. In summary, AAPIs clearly constitute heterogeneous groups characterized by a wide range of ATOD behaviors and treatment needs. Wong, M.M., Klingle, R.S., and Price, R.K. Alcohol, Tobacco, and Other Drug Use among Asian American and Pacific Islander Adolescents in California and Hawaii. Addictive Behaviors, 29, pp.127-141, 2004.

Reasons for Teachers' Adaptation of Prevention Curricula for Non-White Students

There is increasing evidence to suggest that the adaptation of classroom-based prevention curricula in the nation's middle schools is widespread. This study investigated the reasons for teachers' adaptation of prevention curricula. A randomly selected sample of nationally representative lead middle school substance abuse prevention teachers from 50 states and the District of Columbia answered questions concerning eight student problems or needs (i.e., poverty; violence; gang activity; discipline problems; sexual activity; various racial/cultural groups; special needs/disabilities; student and parent substance use) that were hypothesized to constitute reasons for curriculum adaptation. Controlling for a variety of school and teacher characteristics, teachers in high minority schools were more likely to adapt curricula in response to three of the eight characteristics presented (i.e., youth violence; limited English proficiency; and various racial/ethnic or cultural groups within classroom). It is suggested that curriculum developers make a systematic effort to understand how teachers are adapting their curricula in high minority schools and incorporate these modifications, if found effective, into their curricula. Ringwalt, C.L., Vincus, A., Ennett, S., Johnson, R., and Rohrbach, L.A. Reasons for Teachers' Adaptation of Substance Use Prevention Curricula in Schools With Non-While Student Populations. Prevention Science, 5(1), pp. 61-67, 2004.

Drug Abuse Prevention Program Development - Results Among Latino and Non-Latino White Adolescents

Five program development studies from Project Towards No Drug Abuse (TND) were reanalyzed to discern Latino versus non-Latino Whites similarities and differences in receptivity to a wide variety of high school-based drug abuse prevention activities. In most of the program development studies, these youth attended alternative (continuation) high schools in Southern California. Although there were a total of 46% Latino students in these schools, 99% of the students indicated English as the main language spoken at school and home. Thus, taken together, almost all Latino youth in the various studies analyzed preferred to respond to survey questions in English. Latinos were relatively low in socioeconomic status (SES) and used drugs less frequently than non-Latino whites. Still, this group of highly acculturated Latinos and non-Latino Whites (37% of the school population) perceived that they were attending alternative schools for the same reasons (e.g., lack of credits, truancy). Very few differences in receptivity ratings of proposed TND activities were found as a function of ethnicity. In other words, the data suggest that the same types of lessons are applicable to older teens in both ethnic groups. Sussman, S., Yang, D.Y., Baezconde-Garbanati, L., and Dent, C.W. Drug Abuse Prevention Program Development - Results Among Latino and Non-Latino White Adolescents. Evaluation & The Health Professions, 26(4), pp. 355-379, 2003.

Familism, Parental Monitoring & Knowledge as Predictors of Adolescent Drug Use

The authors investigated relationships between marijuana and inhalant use and measures of familism, parental monitoring, drug use knowledge and acculturation as well as demographic factors in 1,094 Anglo and Hispanic youth from 5 school districts in southwest Arizona. Outcome measures addressed lifetime and 30-day marijuana and inhalant use. Hispanics exhibited higher use across all measures. Among Hispanic youth, high acculturation was associated with low marijuana but high inhalant use. In both Hispanics and Anglos positive family relations and parental monitoring were strongly associated with reduced marijuana use but only among youth most knowledgeable about drugs. Familism and monitoring were not associated with diminished use among the less knowledgeable. For inhalants, monitoring combined with high knowledge or with high familism was associated with attenuated use. The role of knowledge in reducing drug use suggests continuing to disseminate factual material. Prevention strategies also should incorporate a family component to inform parents and open lines of communication. Ramirez, J.R., Crano, W.D., Quist, R. Burgoon, M., Alvaro, E.M. and Grandpre, J. Acculturation, Familism, Parental Monitoring, and Knowledge as Predictors of Marijuana and Inhalant Use in Adolescents. Psychology of Addictive Behaviors. 18(1), pp. 3-11, March 2004.

Comparing African American and Caucasian Marijuana Use from Early Adolescence Through Young Adulthood

Although epidemiological studies have consistently reported that African American adolescents are less likely to use drugs than their Caucasian counterparts, few researchers have examined the developmental trajectories of drug use to identify whether and when differences in marijuana use appear and the nature of these differences. This study compared marijuana use patterns for African American and Caucasian youth across 7 waves of data using a community based dataset collected as part of the evaluation of Project DARE. Because the DARE intervention was found to have no effects on any program targets, this dataset provides an appropriate community sample for investigating developmental changes in drug use over time. 1,354 students (49.7% male, 77.4% Caucasian) were interviewed once a year in the sixth through tenth grades and again at age 20. Consistent with prior research, early onset of substance use was associated with low church involvement, low peer pressure resistance, high sensation seeking, and high positive and low negative expectancies about the effects of marijuana. These relationships held true for both African American and Caucasian adolescents. Relationships between marijuana use patterns and other outcomes including psychological problems, aggression and arrests were also examined. Among Caucasian adolescents, those with the earliest onsets reported more negative outcomes, whereas adolescents with the latest onsets reported fewer. However, the pattern was different for African American adolescents. The early-onset and late-onset African American groups were similar on outcome variables and, by age 20, these groups were using marijuana at rates that were low and indistinguishable from each other. By contrast, African American adolescents who began using marijuana around the ninth grade were significantly higher on these outcomes than were any of the other groups. Thus, initiation of marijuana use in mid-adolescence among African Americans poses the greatest risk for continued use. Brown, T.L., Flory, K., Lynam, D.R., Leukefeld, C., and Clayton, R.R. Comparing the Developmental Trajectories of Marijuana Use of African American and Caucasian Adolescents: Patterns, Antecedents, and Consequences. Experimental and Clinical Psychopharmacology, 12, pp. 47-56, 2004.

Maternal Influences on Urban Adolescent Girls' Smoking Intentions

Prior research has shown that parents who smoke are more likely to have children who smoke. Moreover, adolescents have been found to overestimate the number of adults and teenagers who smoke. This overestimation produces an expectation of smoking as normative and has been associated with an increase use of cigarettes among adolescents. This study examined maternal social influences on cigarette usage among urban minority girls with interview data from 450 mother-daughter dyads recruited from 30 New York City public and parochial middle schools. Girls in this sample ranged in age from 11 to 15 years and reported smoking rates of about 18% and smoking intention rates of 24%. Most of the sample was either Black or Latina, with smaller percentages of other groups (White, Native American, Asian). Neither mothers' reports of their own smoking nor maternal attitudes toward children's smoking were predictive of girls' experimental smoking and intentions to smoke in the next year. However, girls who perceived their mothers to be smokers were more likely to have tried smoking and to say that they intend to try smoking compared to girls who perceived their mothers to be nonsmokers. Compared to girls with low normative expectations of adult smoking, girls with high normative expectations were 2.89 times more likely to have tried cigarettes and 2.32 times more likely to intend to smoke. These findings suggest that preventive interventions aimed at correcting normative expectations of smoking among parents and youth may be helpful in deterring smoking among children. Nichols, T.R., Graber, J.A., Brooks-Gunn, J., and Botvin, G.J. Maternal Influences on Smoking Initiation Among Urban Adolescent Girls. Journal of Research on Adolescence, 14, pp. 73-97, 2004.

Runaway Youth's Use of Federally-Funded Crisis Services Differs by Region

This study examined national and regional differences between runaway shelter users and national census norms on demographic and high-risk characteristics. Data collected from federally-funded youth shelters nationwide (n = 16,652) were compared with U.S. adolescent populations (n = 26,735,028). Runaway youth were more likely to be female, minority and older than respective national figures; ethnicity varied greatly from one region of the U.S. to another. Proportions of youth with high-risk characteristics, such as illicit drug use and selling, suicidal behaviors, and physical and sexual abuse were strikingly different across regions. Development of policies and services that target particular issues of youth in specific regions is needed. Thompson, S., Maguin, E., and Pollio, D. National and Regional Differences Among Runaway Youth Using Federally-Funded Crisis Services. Journal of Social Services Research, 30(1), pp. 1-17, 2003.