Early Initiation of Substance Use as an Indicator of Problematic Substance Use Among Young Men Who Have Sex with Men (YMSM)

Impact of Pre-Adolescent Substance Familiarity on Subsequent Use: Longitudinal Analysis of Risk by Latent Classes in the Adolescent Brain Cognitive Development Sample

BACKGROUND

Predicting substance use in adolescence is a difficult yet important task in developing effective prevention. We aim to extend previous findings on the linear associations between familiarity with (knowledge of) substances in childhood and subsequent substance use in adolescence through a latent class analysis (LCA) to create risk profiles based on substance familiarity.

METHOD

Using the ABCD Study® sample, we conducted an LCA using 18 binary substance familiarity variables (n = 11,694 substance-naïve youth). Complementary analyses investigated the relationship between LCA groups and (1) longitudinal use, (2) use initiation, and (3) early use.

RESULTS

The optimal LCA resulted in a four-class solution: Naïve, Common, Uncommon, and Rare, with each group increasing in both the number and rarity of known substances. Analysis 1 revealed an increased risk in use over time among both the Uncommon and Rare groups (ORs = 2.08 and 5.55, respectively, p's < 0.001) compared to the Common group. Analysis 2 observed a decreased risk for initiation between the Naïve and Common groups (OR = 0.61, p = 0.009); however, the Uncommon and Rare groups were at an increased risk compared to the Common group (ORs = 2.08 and 3.42, respectively, p's < 0.001). Analysis 3 found an increased risk of early use between the Common and Uncommon groups (OR = 1.92, p < 0.001) with a similar trend between the Common and Rare groups (OR = 1.90, p = 0.06).

CONCLUSION

These results highlight distinct risk profiles for adolescent substance use based on substance familiarity in middle childhood. Current work could be applied as an early screening tool for clinicians to identify those at risk for adolescent substance use.

Transitions to polysubstance use: Prospective cohort study of adolescents in Australia

BACKGROUND AND AIMS

Adolescent polysubstance use has been associated with adverse social and health outcomes. Our aim was to measure rates and transitions to polysubstance use during adolescence and identify factors associated with initiation and discontinuation of polysubstance use.

DESIGN

Prospective cohort study. Multistate Markov modelling was used to estimate rates and identify correlates of transitions between substance use states.

SETTING AND PARTICIPANTS

Adolescent-parent dyads (n = 1927; adolescents in grade 7, age ≈13 years) were recruited from Australian schools during 2010/11 (Wave 1). Adolescents were surveyed annually until 2016/17 (n = 1503; age ≈19 years; Wave 7) and parents were surveyed annually until 2014/15 (Wave 5).

MEASUREMENTS

Alcohol, tobacco, cannabis and 3,4-methylenedioxymethamphetamine (MDMA) use outcomes were collected at Waves 3-7. Potential confounders were collected at Waves 1-6 and consisted of sex, anxiety and depression symptoms and externalizing problems, parental monitoring, family conflict and cohesion, parental substance use and peer substance use. Covariates were age and family socioeconomic status.

FINDINGS

Few adolescents engaged in polysubstance use at earlier waves (Wave 3: 5%; Wave 4: 8%), but proportions increased sharply across adolescence (Waves 5-7: 17%, 24%, 36%). Rates of transitioning to polysubstance use increased with age, with few (<9%) adolescents transitioning out. More externalizing problems (odds ratio [OR] = 1.10; 99.6% confidence interval [CI] = 1.07-1.14), parental heavy episodic drinking (OR = 1.22; 99.6% CI = 1.07-1.40), parental illicit substance use (OR = 3.56; 99.6% CI = 1.43-8.86), peer alcohol use (OR = 5.68; 99.6% CI = 1.59-20.50) and peer smoking (OR = 4.18; 99.6% CI = 1.95-8.81) were associated with transitioning to polysubstance use.

CONCLUSIONS

Polysubstance use in Australia appears to be rare during early adolescence but more common in later adolescence with low rates of transitioning out. Externalizing problems and greater parental and peer substance use are risk factors for adolescent polysubstance use that may be suitable intervention targets.

Substance Use and Sexual Risk Behavior Among Black Men Who Have Sex With Men in New York City: Evidence for Increased Risk During Young Adulthood

This study evaluated whether the association between substance use and sexual risk behavior varies as a function of age among 1,009 Black men who have sex with men (BMSM) in New York City. Hierarchical linear regression was used to examine the relationship between age (18-26 vs. 27+), substance use, and number of sexual partners and acts of condomless anal sex (CAS) in the past 90 days. Age moderated the relationship between substance use and sexual risk behavior, such that positive associations among binge drinking, marijuana, cocaine, and party drug use and number of male sexual partners and cocaine use and acts of CAS were significantly stronger among young adults than adults. BMSM may engage in more sexual risk behavior during young adulthood, and those who use substances may be at increased risk for HIV transmission-particularly through multiple sex partners. HIV prevention interventions targeting BMSM may benefit from being tailored to age and addressing sexual risk behavior and substance use concurrently.

Does Religiosity Delay Adolescent Alcohol Initiation? A Long-Term Analysis (2008-2015) of Nationally Representatives Sample of 12th Graders

Objective: Underage alcohol consumption is associated with deleterious consequences, with earlier initiation leading to increased likelihood of alcohol misuse and dependence later in life. Religiosity represents a protective factor, such that those with increased religiosity delay alcohol initiation. Herein, we test the association between religiosity and alcohol initiation across several distinct national samples of high school seniors in the United States. Method: To assess long-term associations between alcohol initiation and religiosity, we utilized latent growth curve modeling and simple mean plots to conduct a secondary data analysis on 8 years (2008-2015) of the Monitoring the Future Survey (n = 20,099). Results: When compared with the baseline model, which posited a consistent age of initiation of approximately 9th grade χ² (n = 18,224, df = 31) = 33.70, p <.34, CFI = .000, TLI = 1.00, RMSEA = .006 (90% CI: .00, .017), religiosity plays an equally consistent role in delaying age of initiation by two grade levels, or three calendar years χ² (n = 17,978, df = 159.116) = 159.17, p<.0001, CFI = .848, TLI = .834, RMSEA = .017 (90% CI: .00, .03). When means were parsed out by religiosity level and gender, religion was a stronger protector against alcohol age of initiation for females than males. These associations were constant over the 8-year period and across multiple nationally representative samples of adolescents. Conclusions: Religiosity delays alcohol initiation for adolescents. Prevention programs should seek to identify which components of religiosity are most impactful, and subsequently develop and incorporate programmatic aspects that leverage these factors.

Age-related prevalence and twelve-month incidence of illicit drug use in a cohort of Australian gay and bisexual men: Results from the Flux Study

BACKGROUND

We report prevalence and incidence of drug use initiation in Australian gay and bisexual men (GBM) participating in an online cohort study.

METHODS

Between September 2014 and June 2015, 1,710 GBM were enrolled in the Following Lives Undergoing Change Study and followed-up six monthly. Participants were asked about measures of lifetime use at baseline and recent use (last six months) at all visits. Drug use initiation was defined as men who reported having never used a specific drug prior to baseline and reported recent use at follow-up.

RESULTS

Participants' median age was 31 years (range: 16-81). Prevalence of lifetime use was significantly associated with older age for all individual drugs (p trend<0.001), and 84.1% reported lifetime use of any drugs. Just above half (51.9%) reported recent use at baseline, with the majority reporting occasional use (once or twice in the previous six-months). Among men who reported no history of drug use at baseline, drug initiation was highest for amyl nitrite, with an incidence of 10.5 per 100 person-years (95% CI 7.9-13.9), followed by cannabis (7.3 per 100 person-years, 95% CI 5.0-10.6) and ecstasy (5.0 per 100 person-years, 95% CI 3.6-7.0). Younger age was significantly associated with higher incidence of initiation of amyl nitrite, ecstasy, cocaine, ketamine, GHB, and LSD (p trend <0.05 for all).

CONCLUSION

Prevalence of lifetime illicit drug use is lower in younger GBM than in their older counterparts. However, incidence of drug use initiation is high among younger men, providing an opportunity for early intervention.