Epidemiology of Youth Drug Abuse

Research Findings from May, 1998 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.

Early Stages of Drug Use: Transitions from Opportunity to Use

In research at Johns Hopkins University focusing on the earliest stages of drug involvement investigators studied the transition from an initial opportunity to try marijuana to the subsequent use of this drug through secondary analysis of self-report interview data gathered from nationally representative samples of the United States National Household Surveys on Drug Abuse, 1979-1994. The evidence indicates that the estimated prevalence of an opportunity to try marijuana has been rather stable for 15 years. However, there are recent increases in the probability of rapidly progressing from first marijuana opportunity to first marijuana use, among persons given an opportunity to use. In addition, the transition from first marijuana opportunity to eventual marijuana use seems to depend upon age at first opportunity. This epidemiological evidence on the transition from marijuana opportunity to marijuana use, the first to be published based on a nationally representative US sample, highlights directions for future research and a focus for prevention efforts. Van Etten, M.L., Neumark, Y.D., Anthony, J.C. Drug and Alcohol Dependence., 49(1), pp. 1-7, 1997.

Adolescent Versus Adult Onset and the Development of Substance Use Disorders in Males

While the adolescent onset of substance use disorders has been thought to be characterized by specific features, previous studies on the importance of age of onset have not distinguished adolescent from early-adult onset. Drs. Clark, Kirisci and Tarter of CEDAR examined the influence of adolescent age of onset on the development of substance use disorders by comparing adolescents with substance use disorders and adults divided into three groups by age of onset: adolescent, early-adult and late-adult. Adolescent-onset groups, compared with adult-onset groups, had higher lifetime rates of cannabis and hallucinogen use disorders, shorter times from first exposure to dependence, shorter times between the development of their first and second substance dependence, and higher psychopathology rates, including conduct disorder and major depression. The results suggest that adolescent-onset SUD is a distinct subtype involving different substances and more rapid development than adult-onset SUD. Clark, D.B., Kirisci, L., and Tarter, R.E. Drug and Alcohol Dependence, 49, pp. 115-121, 1998.

School Differences in Rates of Substance Use

Previous research has noted that schools vary in substance use prevalence rates, but explanations for school differences have received little empirical attention. This article assesses variability across elementary schools (N=36) in rates of early adolescent alcohol, cigarette, and marijuana use. Characteristics of neighborhoods and schools were measured using student, parent, and archival data. Findings show substantial variation across schools in substance use. Attributes of neighborhoods and schools are statistically significant related to school rates of lifetime alcohol use, lifetime cigarette use, and current cigarette use. Contrary to expectations, lifetime alcohol and cigarette use rates are higher in schools located in neighborhoods having greater social advantages as indicated by the perceptions of residents and archival data. Neighborhood effects are expressed both directly and indirectly through school characteristics. Ennett, S.T., Flewelling, R.L., Lindrooth, R.C. & Norton, E.C. School and Neighborhood Characteristics Associated With School Rates of Alcohol, Cigarette, and Marijuana Use. Journal of Health and Social Behavior, 38, pp. 55-71, 1997.

African-American and Puerto Rican Drug Use: A Longitudinal Study

The objective of this study was to examine the interrelationship of acculturation, family, personality, ecology, and peer domains measured in adolescence as they impact drug use 5 years later and to assess the role of family variables as buffers against personality risks. Youths completed questionnaires in classrooms at T1 and were individually interviewed at T2 (mean age = 20 years). Data were analyzed separately for African-American and Puerto Ricans using correlations, hierarchical multiple regressions, and two-way interactions. Most results were similar or both ethnic groups. Eighty percent of the T1 variables significantly related to T2 stage of drug use. A mediational model of the path to drug use was supported. Acculturative influences were associated with family relations, which in turn were related to personality attributes. A reciprocal relationship emerged between the personality and peer domains in their impact on drug use. Family variables primarily enhanced the effect of protective personality traits on drug use. Results suggest that the stability of drug use alone cannot explain the relationship between the earlier domains and later drug use. Specific adolescent risks have long-lasting effects. The personality domain has a direct effect on later drug use despite a benign picture in the acculturation, family, and peer domains. Brook, J S., Whitemans, M., Balka, E.B., Win, P.T., and Gursen, M.D. Journal of American Academy of Child Adolescent Psychiatry, 36(9), pp. 1260-1268, 1997.

Association between Attention Deficit Hyperactivity Disorder (ADHD) and Cigarette Smoking

In a follow-up study of siblings of ADHD and control probands, it was found that found that ADHD in probands increased the risk for cigarette smoking in siblings regardless of the sibling's own ADHD status or the presence of other psychiatric conditions. Moreover, ADHD in the siblings was associated with higher rates of cigarette smoking along with a significantly younger age at onset. In like manner, conduct disorder, major depression and drug abuse were associated with high rates of cigarette smoking. In addition, cigarette smoking appeared to be familial among the ADHD families but not the control families. Finally, male gender did not appear to be a risk factor for cigarette smoking in the sample. Using DSM-III-R structured diagnostic interviews and blind raters, we conducted a four-year follow-up of siblings from ADHD (N=149) and control families (N=117). The mean age of the siblings was 17.2 (range 9 to 41) and roughly half were males. First we analyzed the data using univariate methods (i.e., Chi-square tests) which were followed by multivariate logistic regression models which simultaneously controlled for confounding variables such as high risk status (i.e., whether a sibling of an ADHD or normal control proband), socioeconomic status, age, IQ, gender and psychiatric disorders. Since ADHD is a prevalent, childhood onset disorder that is often characterized by impulsive behavior, it could represent a large group of youth at high risk for smoking, illicit drug use, medical morbidity and premature mortality. Since ADHD children and their siblings comprise a large portion of the population at high risk for smoking, they may represent an excellent group to be targeted for prevention programs. Further Evidence of an Association between Attention Deficit Hyperactivity Disorder (ADHD) and Cigarette Smoking: Findings from a High Risk Sample of Siblings. Milberger, S., Biederman, J., Faraone, S.V., Chen, L., and Jones J. American Journal on Addictions, 6, pp. 205-217, 1997.

Tobacco Use Among Mexican American Youth

Increases in smoking/tobacco-related diseases among the Hispanic population call for an examination of tobacco use among this population. This study examined the relationship between gender, level of cultural identification, migrant status, grade level, tobacco use, and perception of harm among Mexican American youth. Results showed males were more likely to use cigarettes (occasional and daily) and smokeless tobacco than females when grade, cultural identification, and migrant status of parent are held constant. No gender effect was found for lifetime cigarette use. The odds of using cigarettes and smokeless tobacco were found to increase substantially across grades. Effects were found for Mexican American/Spanish and Anglo/White American cultural identification and daily cigarette use. Youths who belonged to nonmigrant families or who identified with a traditional Mexican American/Spanish culture were more likely to consider the regular use of tobacco harmful. Casas, M.J., Bimbela, A., et. al. Cigarette and Smokeless Tobacco Use Among Migrant and Nonmigrant Mexican American Youth. Hispanic Journal of Behavioral Sciences, 20(1), pp. 102-121, 1998.

A Regression Analysis Estimating the Number of Drug-using Arrestees in 185 U.S. Cities.

A prevalence model for drug-using arrestees was developed by relating selected social indicators from 1990 Census data and drug use rates from Drug Use Forecasting data using logistic regression analysis. An estimation of the total arrestee population was based upon the FBI's Uniform Crime Reports (UCR). Of the originally selected 200 largest cities (indicated by total population size), 16 did not report to UCR; arrest data for Chicago were obtained separately from local officials. Thus, 185 cities were included in the present analysis. A separate logistic regression was conducted for each of the following dependent variables: the urine positive rates for cocaine, opiates, amphetamines, intravenous drug users, and any drug, for each of the eight subgroups defined by the cross-combination of gender and offense type (violent, drug-related, income-generating, and others). Predictors were five social indicators from Census data hypothesized to be associated with drug use levels in different cities: Census population, and percentages of unemployment, poverty, high school graduates, and youths. It was estimated that in 1990, about 925,000 arrestees used cocaine; 317,000 used opiates; 213,000 used amphetamines; 389,000 were drug injectors; and 1,296,000 used some illicit drug. This approach represents a cost-efficient method for prevalence estimation that is based on empirically demonstrable relationships between social indicators and drug use rates. Hser, Y.I., Prendergast, M.L., Anglin, M.D., Chen, J., and Hsieh, S. American Journal of Public Health, 88(3), pp. 487-490, 1998.

Ethnicity and Gender in Adolescent Drug Resistance

While ethnic and gender differences have been reported in the amount and type of drug use, little is known about how drugs get offered to adolescents and how members of different cultural groups respond to those offers. Interviews (30-40 minutes) were conducted with 158 middle school students. Adolescent "near-peer" interviewers were trained for this project and matched to participants by ethnicity and gender. Data were content analyzed and results showed that for all groups, simple offers were more likely than complex, pressure-filled strategies, and these offers were typically resisted through simple refusals (i.e., "no") rather than more complex techniques (e.g., explanations). Drugs tended to be most frequently offered to all groups at home or in public rather than at school or parties. Gender and ethnic differences were observed in other areas. Latinos/Latinas were significantly more likely to experience drug offers than other males and females. Hecht, M., Trost, M., Bator, R., & MacKinnon, D. Ethnicity and Gender Similarities and Differences in Drug Resistance. Journal of Applied Communication Research, 25, pp. 1-23, 1997.

Self-Reported Drug Use: Results of Selected Empirical Investigations of Validity

This article reviews the literature and discusses two series of empirical studies. The literature shows some evidence that drug abusers self-reports are generally reliable and accurate, but the studies are more strikingly marked by findings of wide variations in accuracy and in the samples and procedures used to obtain them. In the authors first study, data from 323 narcotics addicts were collected through two interviews held 10 years apart. This set of analyses examined the quality of the longitudinal retrospective self-report from narcotics addicts, including validity of recent narcotics use, reliability of various measures, stability of relationships among these measures, and pattern reliability among latent constructs. Results contribute strongly to confidence in the validity of the relationships among these data derived from addicts self-report. The second set of analyses focused on validity of self-reported drug use among 3,493 clients from Los Angeles County sexually transmitted disease clinics, hospital emergency rooms, and jails. Results suggest that the accuracy of self-report of recent drug use varies by the sample sources, drug types, and subject characteristics. Targeting these high-risk groups may improve prevalence estimation. The article concludes that empirical validation of self-report is always necessary to enhance the utility of collected self-report data and provide means of controlling for potential biases. Hser, Y.I. Self-Reported Drug Use: Results of Selected Empirical Investigations of Validity. In L. Harrison and A. Hughes (Eds.), The Validity of Self-Reported Drug Use: Improving the Accuracy of Survey Estimates (NIDA Research Monograph 167, pp. 320-343). Washington, DC: U.S. Government Printing Office, 1997.

Factors Associated with Early Sexual Activity among Urban Adolescents

This study uses lifespan and ecological frameworks to investigate the factors associated with early adolescent sexual activity. Data from a longitudinal study of urban teenagers of color address three issues: (1) the prevalence and pattern of sexual activity among boys and girls ages 15 and younger, (2) the link between early sexual activity and high-risk sexual behavior, and (3) the life contexts linked with early sexual activity. Results from 803 African American and Hispanic adolescents suggest a high prevalence of early sexual activity, which is associated with higher rates of childbearing and risky sexual behavior than sexual activity initiated in later adolescence. Somewhat different factors are associated with early sexual activity for boys and girls, although family composition, parent attachment, and substance use are important for both genders. Implications for intervention are discussed. Smith, C.A. Social Work, 42, pp. 334-346, 1997.

Interrelationships Between Adolescent Drug Use and Drug Use 5 Years Later

In 1990 (T1), African American (n=695) and Puerto Rican (n=637) youths in East Harlem schools completed questionnaires on six domains: personality attributes, family relationships, peer factors, ecological variables, acculturation measures, and stage of drug use. Five years later (T2), 459 of the African American youth and 423 of the Puerto Rican youth were re-contacted to complete a follow-up questionnaire on the same domains. At T1, there were no significant differences in self-reported drug use between the African American and Puerto Rican youths but at T2, significantly more Puerto Ricans used drugs than did African Americans. The variables within the different domains were analyzed to determine those in T1 which were related to T2 drug use. Acculturation, family, personality, and peer domains were found to be related to stage of drug use in young adulthood, with control for stage of drug use in adolescence. The study suggests that stability of drug use alone cannot explain the relationship between earlier domains and later drug use, and that specific adolescent risk factors have long-lasting effects into young adulthood. Targeting risk factors related to adolescent drug use during adolescence is likely to reduce contemporaneous and later drug use. Brook, J.S., et al. African-American and Puerto Rican Drug Use: A Longitudinal Study, J. Am. Acad. Child Adolesc. Psychiatry, 36 (9), pp. 1260-1268, 1997.

Patterns by Gender and Ethnicity Among School Attenders and Dropouts

Differences in patterns of volatile solvent use were explored with special emphasis on use as related to school enrollment status. The sample included American Indian, Mexican-American and White American youth. Three enrollment status categories were identified: dropout, academically at-risk (enrolled), and control. A self report survey was used to assess both level and intensity of volatile solvent use. Findings indicated that a higher proportion of the dropout cohort have used volatile solvents, used volatile solvents regularly, and used volatile solvents with more intensity than either the academically at-risk group or the control group. An interaction between gender and ethnicity was also revealed; American Indian females reported higher lifetime prevalence and thirty-day prevalence than did American Indian males, whereas for both the Mexican-American and White American samples, males report higher rates than females. Findings are discussed in terms of the influence of volatile solvent abuse and school success as well as previous findings. Bates, S.C., Plemons, B.W., Jumper-Thurman, P. Beauvais, F. Patterns by Gender and Ethnicity Among School Attenders and Dropouts. Drugs and Society, 10, pp. 67-78, 1997.

Childhood, Adolescent, Familial, and Peer Antecedents of Cigarette Smoking in Young Adults

This study examined the interrelation of personality, family, and peer determinants and their effects on tobacco use by young adults. Mothers were first interviewed about their children when they were between the ages of 1 and 10 years old. Three subsequent interviews were conducted with the children when they reached adolescence and young adulthood. Results show support for the mediational model, which is derived from the family interactional theory framework to examine pathways that may lead to adolescent legal and illegal drug use and other problem behavior. There was a sequence in patterning: from parenting during early adolescence, to personality and peer factors, extending to smoking in late adolescence and culminating in smoking in adulthood. With a developmental approach, a number of psychosocial measures appear related in both younger and older children. Developmental differences also emerged, suggesting four possible targets for therapeutic or preventive intervention: the parent, the child, the adolescent, and the peer group. Brook, J.S., et al. Cigarette Smoking in Young Adults: Childhood and Adolescent Personality, Familial, and Peer Antecedents, J. Genetic Psychology, 158(2), pp. 172-188, 1997.

Implementation Issues in Drug Abuse Prevention Research

Methodological issues evaluating quality of implementation of drug use prevention programs are reviewed: definition (adherence, exposure, reinvention), measurement (self-report, other's report, behavioral observation), and parameters of influence (person, situation, environment). When implementation is defined as the interaction of person, situation, and environment, the "true" drug use prevention program effect is established as the average of effect generated from experimental assignment and program implementation. Differences between researcher and programmer standards of implementation quality are interpreted in terms of an efficacy/effectiveness continuum. Pentz, M.A. & Trebow, E. Implementation Issues in Drug Abuse Prevention Research. Substance Use and Misuse, 32, pp. 1655-1660, 1997.

General Deviance and Psychological Distress: Impact of Family Support/Bonding over 12 Years from Adolescence to Adulthood

Comorbidity occurs within and across various domains of human pathology and may be diverse manifestations of a single, general dysfunction in early family support and bonding. Family socialization, pseudo maturity, and self-derogation theories were tested using cross-sectional and 12-year prospective data from a community sample assessed in late adolescence (age 18) and again in adulthood (age 30). All of the hypotheses and expected findings received some support in the data analyses these confirmed that: general deviance and psychological distress were significantly correlated for both men and women and therefore are overlapping and comorbid disorders; both general distress and psychological distress were significantly predicted by family support/bonding fully accounted for the cross-sectional association between general deviance and psychological distress for the women and general deviance for the men: both theories of pseudo maturity and self-derogation explained many of the prospective effects from late adolescence into adulthood: sexual involvement, although an indicator of general deviance, related negatively with indicators of psychological distress; different patterns were evident for the development periods of adolescence compared with adulthood; and many of the processes differed by sex. Newcomb, M.D. Criminal Behavior and Mental Health, 7, pp. 369-400, 1997.

Delinquency and Antisocial Behavior: A Review of Family Processes and Intervention Research

Recent longitudinal research employing complex measurement and analytic strategies has generated new, more intricate conceptualizations of the relationship between family life and delinquency, all of which have important implications for intervention with delinquents and their families. This critical review of the current research on the role of the family, its implications for family-based interventions with delinquents, and the existing treatment outcome research highlights four areas: the link between different family processes and delinquency, reciprocal relationships between parenting and delinquency, the effects of family context on parenting and delinquency, and the family as one cause of delinquency among many. Smith, C.A., and Stern, S.B. Social Service Review, 71, pp. 382-420, 1997.

Survey Finds Parenting Differences Between Narcotic Addicts and Their Parents

A 2-part survey was administered to male and female narcotic addicts receiving methadone maintenance to examine their retrospective self-reports about how they were parented and compare them with their views about their own parenting practices of their adolescent children. The sample of 313 adult addicts included 248 females (79%) and 65 males (21%). The average age was 37.6 years. There were 250 African Americans (80%) and 63 Whites (20%) in the sample. The mean age of addiction (narcotic use 4 days a week for a month or more) was 22.5 years, and the average period of continuous use was 5.4 years. Since the age of addiction, the subjects had spent an average of 10.7 months in prison. The addicts viewed their mothers as significantly more effective at parenting than their fathers, especially in terms of interaction, communication, and affection. Fathers were generally perceived as unavailable and distant. In terms of their own parent practices, the addicts reported being significantly more involved, more responsible, and more closely attached to their children than their parents were to them. They also reported that they were more active disciplinarians and utilized significantly fewer punitive behaviors with their children. Nurco, D.N.,et al., The Family Experiences of Narcotic Addicts and Their Subsequent Parenting Practices. Am. J. Drug Alcohol Abuse, 24(1), pp. 37-59, 1998.