Early childhood misbehavior and the estimated risk of becoming tobacco-dependent

Latent classes of childhood trauma exposure predict the development of behavioral health outcomes in adolescence and young adulthood

BACKGROUND

To develop latent classes of exposure to traumatic experiences before the age of 13 years in an urban community sample and to use these latent classes to predict the development of negative behavioral outcomes in adolescence and young adulthood.

METHOD

A total of 1815 participants in an epidemiologically based, randomized field trial as children completed comprehensive psychiatric assessments as young adults. Reported experiences of nine traumatic experiences before age 13 years were used in a latent class analysis to create latent profiles of traumatic experiences. Latent classes were used to predict psychiatric outcomes at age ⩾13 years, criminal convictions, physical health problems and traumatic experiences reported in young adulthood.

RESULTS

Three latent classes of childhood traumatic experiences were supported by the data. One class (8% of sample), primarily female, was characterized by experiences of sexual assault and reported significantly higher rates of a range of psychiatric outcomes by young adulthood. Another class (8%), primarily male, was characterized by experiences of violence exposure and reported higher levels of antisocial personality disorder and post-traumatic stress. The final class (84%) reported low levels of childhood traumatic experiences. Parental psychopathology was related to membership in the sexual assault group.

CONCLUSIONS

Classes of childhood traumatic experiences predict specific psychiatric and behavioral outcomes in adolescence and young adulthood. The long-term adverse effects of childhood traumas are primarily concentrated in victims of sexual and non-sexual violence. Gender emerged as a key covariate in the classes of trauma exposure and outcomes.

The effect of two elementary school-based prevention interventions on being offered tobacco and the transition to smoking

AIMS

This study sought to more precisely delineate the mechanisms by which two early elementary school-based, universal (i.e., applied to the entire population regardless of risk status) preventive interventions increased survival to first tobacco cigarette smoked. Specifically, we examined whether the interventions' effect on survival to first use was via the reduction of offers to smoke and/or through preventing the transition from first offer to smoking.

METHODS

A total of 678 urban first-graders were assigned randomly to the classroom-centered (CC), or the family-school partnership (FSP), or a control classroom condition. Youth were followed annually until 1 year beyond their anticipated high school graduation (mean age ∼18 years). Discrete-time survival analyses on 628 youth evaluated the impact of the CC and FSP interventions on first tobacco offer and initial tobacco smoking once offered.

FINDINGS

The risk of being offered tobacco was reduced among both CC and FSP intervention groups relative to the control group, although the reduction was only statistically significant for the CC intervention. Neither intervention condition reduced the transition to smoking once offered tobacco to smoke.

CONCLUSION

The CC intervention appeared to have its effect on survival to first cigarette smoked by delaying the first offer to smoke. Preventive interventions focused on refusal skills during the middle school years may be necessary to reduce the likelihood of the transition to smoking once offered.

Childhood predictors of first chance to use and use of cannabis by young adulthood

AIMS

To prospectively examine the linkage between childhood antecedents and progression to early cannabis involvement as manifest in first chance to try it and then first onset of cannabis use.

METHODS

Two consecutive cohorts of children entering first grade of a public school system of a large mid-Atlantic city in the mid 1980s (n=2311) were assessed (mean age 6.5 years) and then followed into young adulthood (15 years later, mean age 21) when first chance to try and first use were assessed for 75% (n=1698) of the original sample. Assessments obtained at school included standardized readiness scores (reading; math) and teacher ratings of behavioral problems. Regression and time to event models included covariates for sex, race, and family disadvantage.

RESULTS

Early classroom misconduct, better reading readiness, and better math readiness predicted either occurrence or timing of first chance to try cannabis, first use, or both. Higher levels of childhood concentration problems and lower social connectedness were not predictive.

CONCLUSIONS

Childhood school readiness and behavioral problems may influence the risk for cannabis smoking indirectly via an increased likelihood of first chance to use. Prevention efforts that seek to shield youths from having a chance to try cannabis might benefit from attention to early predictive behavioral and school readiness characteristics. When a youth's chance to try cannabis is discovered, there are new windows of opportunity for prevention and intervention.

Comorbid psychiatric disorders and nicotine dependence in adolescence

AIMS

To examine bidirectional influences of onset of psychiatric disorders and nicotine dependence among adolescent smokers.

DESIGN

A prospective longitudinal cohort of adolescents and mothers drawn from a large city school system. Adolescents were interviewed five times and mothers three times over 2 years.

SETTING

Chicago, Illinois.

PARTICIPANTS

Subsample of adolescent smokers (n = 814).

MEASUREMENTS

Selected DSM-IV psychiatric disorders, nicotine dependence and selected risk factors were ascertained.

FINDINGS

Among lifetime smokers, 53.7% experienced at least one nicotine dependence criterion; 26.1% full dependence; 14.1% experienced an anxiety disorder, 18.8% a mood disorder and 29.5% a disruptive disorder. Nicotine dependence and psychiatric disorders were comorbid: nicotine-dependent youths had higher rates of individual and multiple disorders than those not dependent. Controlling for other covariates, mood disorder and nicotine dependence did not predict each other; anxiety disorder predicted nicotine dependence. Bidirectional influences were observed for disruptive disorder and nicotine dependence. Predictors of onset of full nicotine dependence included earlier onset age of tobacco use, high initial pleasant sensitivity to tobacco, alcohol and illicit drug use, abuse and dependence and parental nicotine dependence. Predictors of psychiatric disorder onset included gender, race/ethnicity, other psychiatric disorders, illicit drug abuse or dependence and parental depression and delinquency.

CONCLUSIONS

Initial pleasant experiences of smoking are predictive of later development of nicotine dependence. There may be reciprocal influences between disruptive disorder and development of nicotine dependence in adolescence, and intergenerational transmission of parental nicotine dependence and psychopathology.

Gender differences in the association between pre-adolescent smoking initiation and emotional or behavioural problems

BACKGROUND

Emotional and behavioural problems are a risk factor for the initiation of smoking. In this study, we aimed to assess this relationship beyond clinical cut-off values of problem behaviour.

METHODS

Cross-sectional national survey among 9-13 year old children with data on smoking and Childhood Behaviour Checklist (CBCL) (N = 960). Relationships between smoking and tertiles of CBCL-scores were assessed.

RESULTS

Smoking was reported by 5.9% of the children (7.1% boys and 5.0% girls, P > 0.100). Relationships between smoking and problem behaviour were present in girls, but ot in boys. Among girls, smoking was associated with attention problems, thought problems, and delinquent behaviour. For attention problems and delinquent behaviour the associations were limited to the CBCL-scores in the uppermost 16% which agrees with the subclinical cut-off value.

CONCLUSION

Pre-adolescent girls more frequently smoke if having attention problems, delinquent behaviour, or thought problems.

Substance use and common child mental health problems: examining longitudinal associations in a British sample

AIMS

To examine the longitudinal associations in both directions between mental health and substance use in adolescence.

DESIGN

Three-year longitudinal cohort.

SETTING

Britain (nationally representative sample).

PARTICIPANTS

3607 youths aged 11-16 years at baseline.

MEASUREMENTS

Externalizing and internalizing mental health problems were measured using brief questionnaires (parent-reported Strengths and Difficulties Questionnaire) and diagnostic interviews, including clinician-rated diagnoses of mental disorder. Substance use was measured by youth self-report, and included regular smoking, frequent alcohol consumption, regular cannabis use and ever taking other illicit drugs.

FINDINGS

Externalizing (specifically behavioural) problems at baseline independently predicted all forms of substance use, with a particularly strong effect on smoking. In all cases this association showed a dose-response relationship. In contrast, although internalizing problems had a strong univariable association with smoking, this disappeared after adjusting for comorbid externalizing problems. There was little or no evidence that baseline substance use predicted mental health at follow-up.

CONCLUSIONS

Externalizing problems predict adolescent substance use, and adjusting for comorbid externalizing problems is vital when investigating the effects of internalizing problems. A dose-response effect of externalizing problems is seen across the full range. Programmes seeking to prevent adolescent substance use by reducing externalizing problems may therefore wish to consider population-wide interventions rather than targeting individuals only at the negative extreme.

Epidemiological evidence on count processes in the formation of tobacco dependence

INTRODUCTION

Large-sample epidemiological studies of tobacco cigarette smoking routinely assess so-called "lifetime prevalence" of tobacco dependence. This work delves into the earliest stages of smoking involvement, focusing on newly incident tobacco cigarette smokers in the very recent past, and examines hypothesized subgroup variation in count processes that become engaged once smoking starts. Here, the term "count process" has two components: (a) whether smoking will be persistent and (b) the rate of smoking, conditional upon membership in a latent class of smokers who will persist, as estimated under the zero-inflated Poisson (ZIP) model for complex survey data.

METHODS

We estimate these ZIP parameters for nationally representative samples of newly incident smokers in the United States (all with smoking initiation within 24 months of assessment). Data are from the 2004-2007 National Surveys on Drug Use and Health.

RESULTS

Once cigarette smoking started, roughly 40%-45% persisted, and the estimated median rate was five smoking days/30 days, conditional on membership in the latent class of persistent smokers. Among non-Hispanic recent-onset cigarette smokers, Whites, Black/African Americans, Asians, and Native American/Alaskan Natives did not differ, but recent-onset smokers of Hispanic origin and those of Pacific Islander background had comparatively less cigarette involvement.

DISCUSSION

Tobacco prevention and control initiatives may require elaboration in the form of brief interventions, including interpersonal and social transactions that might constrain a mounting frequency of days of smoking before daily smoking starts, and until conventional smoking cessation medication aids become indicated. These very-early stage interventions (VESI) might be mounted within family or peer groups or in the primary care or school settings, but randomized trials to evaluate VESI interventions will be required.

Suspected causal association between cocaine use and occurrence of panic

AIM

To estimate a suspected causal association between cocaine use and the occurrence of panic.

METHODS

Data are from an epidemiologic sample of school-attending youths enrolled in primary school who were traced, rerecruited, and assessed via standardized interviews in young adulthood during 2000-2002. A total of 1,692 young adults comprised the analysis sample. Occurrences of panic and cocaine use were assessed in young adulthood, via standardized item sets from the Diagnostic Interview Schedule. A brief assessment of panic experiences had also been made when the youths were in early adolescence.

RESULTS

With statistical adjustment for important covariates, we found a modestly excess occurrence of panic attack-like experiences among those who had used cocaine at least once, relative to occurrence among young people who never had used cocaine (estimated odds ratio, OR = 1.9; p = .014 before exclusion of 288 with early onset panic attack-like experiences; p = .005 after this exclusion).

DISCUSSION

The main finding of this study was an association linking cocaine use and panic attack-like experiences, which was more modest than was observed in study samples that included older adults.

Educational attainment and smoking among women: risk factors and consequences for offspring

We examine the association between education and smoking by women in the population, including smoking during pregnancy, and identify risk factors for smoking and the consequences of smoking in pregnancy for children's smoking and behavioral problems. Secondary analyses of four national data sets were implemented: The National Survey of Drug Use and Health (2006), the National Longitudinal Survey of Youth (1979-2004); the National Longitudinal Survey of Adolescent Health (Wave III); National Health and Nutrition Examination Survey (2005-2006). The lower the level of education, the greater the risk of being a current smoker, smoking daily, smoking heavily, being nicotine dependent, starting to smoke at an early age, having higher levels of circulating cotinine per cigarettes smoked, and continuing to smoke in pregnancy. The educational gradient is especially strong in pregnancy. Educational level and smoking in pregnancy independently increase the risk of offspring smoking and antisocial and anxious/depressed behavior problems. These effects persist with control for other covariates, except maternal age at child's birth, which accounts for the impact of education on offspring smoking and anxious/depressed behavior problems. Women with low education should be the target of public health efforts toward reducing tobacco use. These efforts need to focus as much on social conditions that affect women's lives as on individual level interventions. These interventions would have beneficial effects not only for the women themselves but also for their offspring.

Association of major depression with subtypes of nicotine dependence found among adult daily smokers: a latent class analysis

Nicotine dependence (ND) and major depression (MD) are highly prevalent disorders that frequently co-occur. Less is known about which aspects of ND are most strongly associated with MD. The present study was designed to determine if subtypes of smokers exist and differ in their risk of MD and lifetime MD symptoms. Latent class analysis was used to identify profiles of DSM-IV ND criteria for 8,842 daily smokers drawn from the larger 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We found evidence for 4 distinct subtypes of smokers mainly characterized by increasing levels of ND severity, by number of criteria endorsed. We found a dose-response relationship between classes by increasing ND severity and odds of past-year MD and lifetime depression criteria. Class 2 was characterized by higher symptom endorsement probabilities (SEPs) for wider range of ND criteria and a higher odds of MD (OR=3.66) compared to class 3, which was characterized by higher SEPs for physiological ND criteria, higher prevalence of ND (class 2, 71.50% vs. class 3, 81.57%), and a lower odds of MD (OR=2.15). A post hoc contrast showed these two distinct classes of respondents with mild to moderate ND significantly differed in their likelihood of MD comorbidity (F=12.25, 1 df, p=0.0008). ND severity mainly characterized the classes, but unique differences may exist between smokers with mild to moderate ND. Individuals with symptom profiles not characterized by physiological dependence endorse wider range of ND criteria and have a higher likelihood of MD.

Opportunities to use drugs and stages of drug involvement outside the United States: Evidence from the Republic of Chile

BACKGROUND

Studying youthful drug involvement in the Republic of Chile, we sought to replicate North American research findings about the earliest stages of drug involvement (e.g., initial opportunities to use tobacco and alcohol, and transitions leading toward illegal drug use).

METHODS

A nationally representative multistage probability sample of middle and high school students was drawn; 30,490 youths completed surveys that assessed age at first drug exposure opportunities and first actual drug use. Cox discrete-time survival models accommodate the complex sample design and provide transition probability estimates.

RESULTS

An estimated 39% of the students had an opportunity to use cannabis, and 70% of these transitioned to actual cannabis use. The probability of cannabis use and the conditional probability of cannabis use (given opportunity) are greater for users of alcohol only, tobacco only, and alcohol plus tobacco, as compared to non-users of alcohol and tobacco. Male-female differences in cannabis use were traced back to male-female differences in drug exposure opportunities.

CONCLUSION

In Chile as in North America, when cannabis use follows alcohol and tobacco use, the mechanism may be understood in two parts: users of alcohol and tobacco are more likely to have opportunities to try cannabis, and once the opportunity occurs, they are more likely to use cannabis. Male-female differences do not seem to be operative within the mechanism that governs transition to use, once the chance to use cannabis has occurred.

Impulsiveness and cigarette smoking

OBJECTIVE

Varying aspects of impulsive personality have been associated with tobacco use in cross-sectional and prospective studies, including novelty seeking and (low) constraint but most studies have not examined more than one tobacco use phenotype (e.g., any tobacco use versus dependence) or considered more than one variety of impulsiveness simultaneously.

METHODS

The current study was conducted to evaluate the association of impulsive personality features with multiple tobacco use phenotypes including smoking status, lifetime tobacco consumption, and dependence in a sample of 1284 adults between the ages of 30 and 54. Participants completed multiple self-report measures of impulsive personality and were interviewed regarding lifetime tobacco use.

RESULTS

Results revealed that reward seeking and disinhibitory traits were both associated with smoking status but only disinhibition was associated with tobacco dependence, after controlling for reward seeking.

CONCLUSIONS

The results reported here may aid investigations aimed at identifying neurobiological, including genetic, correlates of tobacco use and dependence by providing potential behavioral correlates of the diversity of tobacco use phenotypes. Moreover, successful efforts to prevent tobacco-related disease through prevention or cessation programs will be facilitated by the identification of factors that are differentially associated with different smoking phenotypes.

Posttraumatic stress disorder and suicide attempts in a community sample of urban american young adults

CONTEXT

Previous research has shown that exposure to traumatic events, especially sexual trauma during childhood, is associated with an increased risk of attempted suicide. However, no information is available as to whether the increased risk of attempted suicide is related primarily to posttraumatic stress disorder (PTSD) following traumatic experiences or applies also to persons who experienced trauma but did not develop PTSD.

OBJECTIVE

We examine the association between exposure to traumatic events with and without resulting PTSD and the risk of a subsequent suicide attempt in a community sample of urban young adults.

DESIGN

A cohort study followed young adults who had participated in a randomized trial of all first-grade students entering 19 public schools.

SETTING

Baltimore, Maryland, an urban setting.

PARTICIPANTS

A total of 1698 young adults (mean age, 21; 47% male; 71% African American) who represented 75% of the original cohort of 2311 persons.

MAIN OUTCOME MEASURE

Relative risk of a subsequent suicide attempt associated with PTSD and with exposure to assaultive and non-assaultive traumas (no PTSD), as estimated using discrete time survival analysis.

RESULTS

Posttraumatic stress disorder was associated with increased risk of a subsequent suicide attempt. The PTSD-suicide attempt association was robust, even after adjustment for a prior major depressive episode, alcohol abuse or dependence, and drug abuse or dependence (adjusted relative risk, 2.7; 95% confidence interval, 1.3-5.5; P < .01). In contrast, exposure to traumatic events without PTSD was not associated with an increased risk of attempted suicide.

CONCLUSIONS

Posttraumatic stress disorder is an independent predictor of attempted suicide. Exposure to traumatic events without PTSD is not associated with a later suicide attempt.

Smoking status and levels of knowledge regarding cigarettes among primary school teachers

OBJECTIVES

Teachers are believed to be important role models for their students. This study's objective was to determine primary school teachers' smoking status, their level of knowledge regarding cigarettes and their attitude towards prohibition; and to obtain preliminary data that may contribute to the development of antismoking campaigns in schools.

METHODS

In total, 468 teachers were recruited and given a questionnaire.

RESULTS

The answers revealed that among respondents, 58.1% were current smokers, 36.1% were ex-smokers, and 5.8% had never smoked. The percentage of current smokers among females (71.7%) was significantly higher than among males (50.7%). The percentage of those who had begun smoking at age 15 or earlier was 32.0% in smoking males and 19.3% in females; this difference was also statistically significant. No significant difference regarding ideas about smoking and prohibitions on cigarettes was found among current smokers, ex-smokers, and nonsmokers.

CONCLUSIONS

Due to the high number of smoking teachers and their role model status, students may also be at risk of starting smoking. It was concluded that it would be beneficial to deliver educational programs and seminars encouraging smoking cessation to this professional group.

Comorbidity of psychiatric disorders and nicotine dependence among adolescents: findings from a prospective, longitudinal study

OBJECTIVE

To examine prospectively the comorbidity of DSM-IV psychiatric disorders and nicotine dependence in adolescence.

METHOD

A multiethnic sample (N = 1,039) of adolescents from grades 6 to 10 in the Chicago public schools (mean age 14.1 years) was interviewed at home five times, and mothers were interviewed three times over a 2-year period (2003-2005). Completion rates at each wave were 96% of the initial sample. Selected DSM-IV psychiatric disorders were ascertained from youths and mothers about youths at two annual waves with the NIMH Diagnostic Interview Schedule for Children, Version IV-Y and IV-P; DSM-IV symptoms of nicotine dependence were ascertained from youths at every wave using a measure developed for adolescents.

RESULTS

Psychiatric disorders most often preceded the onset of the first criterion of nicotine dependence. Prospective associations between psychiatric disorders and nicotine dependence were examined through logistic regressions. After controlling for comorbid disorders, it was found that lifetime disruptive disorder significantly predicted the onset of a nicotine dependence criterion (adjusted odds ratio 2.1). Early onset of any psychiatric disorder increased this risk. Other predictors included novelty seeking and extensiveness of smoking. By contrast, nicotine dependence did not predict the onset of a psychiatric disorder; significant predictors included the youths' prior other psychiatric disorders, novelty seeking, and parental depression and antisocial behavior.

CONCLUSIONS

Nicotine dependence does not seem to contribute to the onset of psychiatric disorders, whereas disruptive disorder is an important etiologic factor for nicotine dependence in adolescence.

Developmental trajectories of criteria of nicotine dependence in adolescence

We describe the nature and predictors of developmental trajectories of symptoms of DSM-IV nicotine dependence in adolescence following smoking initiation. Data are from a longitudinal cohort of 324 new smokers from grades 6-10 in the Chicago Public Schools, interviewed 5 times at 6-month intervals. Monthly data on DSM-IV symptoms of nicotine dependence were available for 36 months. Growth mixture modeling was applied to the monthly histories to identify trajectories of DSM-IV criteria of nicotine dependence. A four-class solution best fitted the data: no DSM criterion (47.7%); early onset/chronic course (19.8%); early onset/remission (17.3%); late onset (15.2%). Blunt use prior to cigarette use was associated with the three symptomatic trajectories. Conduct disorder and prior heavy smoking were associated with Class 2 (chronic). Conduct disorder differentiated Class 2 from Class 4 (late onset), while pleasant initial sensitivity to the first tobacco experience was associated with Classes 2 and 3 (remit) and differentiated Class 2 from Class 4. Novelty seeking characterized Class 3. Parental dependence differentiated chronicity (Class 2) from remission (Class 3) among those who developed symptoms early. Being Hispanic reduced membership in Classes 3 and 4, and being male for Class 3. The data highlight the importance of parental nicotine dependence as a risk factor for early and sustained nicotine dependence by the offspring, pleasant initial sensitivity and conduct disorder for early onset of dependence, and blunt use prior to smoking for all trajectories. The factors important for onset of dependence are not necessarily the same as those for sustained course.

Locally dependent latent class models with covariates: an application to under-age drinking in the USA

Under-age drinking is a long-standing public health problem in the USA and the identification of underage drinkers suffering alcohol-related problems has been difficult by using diagnostic criteria that were developed in adult populations. For this reason, it is important to characterize patterns of drinking in adolescents that are associated with alcohol-related problems. Latent class analysis is a statistical technique for explaining heterogeneity in individual response patterns in terms of a smaller number of classes. However, the latent class analysis assumption of local independence may not be appropriate when examining behavioural profiles and could have implications for statistical inference. In addition, if covariates are included in the model, non-differential measurement is also assumed. We propose a flexible set of models for local dependence and differential measurement that use easily interpretable odds ratio parameterizations while simultaneously fitting a marginal regression model for the latent class prevalences. Estimation is based on solving a set of second-order estimating equations. This approach requires only specification of the first two moments and allows for the choice of simple 'working' covariance structures. The method is illustrated by using data from a large-scale survey of under-age drinking. This new approach indicates the effectiveness of introducing local dependence and differential measurement into latent class models for selecting substantively interpretable models over more complex models that are deemed empirically superior.

Adolescent cannabis problems and young adult depression: male-female stratified propensity score analyses

Cannabis use and depression are two of the most prevalent conditions worldwide. Adolescent cannabis use is linked to depression in many studies, but the effects of adolescent cannabis involvement on young adult depression remain unclear and may differ for males versus females. In this cohort study of youth from a mid-Atlantic metropolitan area of the United States, repeated assessments from 1985 (at age 6 years) through 2002 (at age 21 years) were made for 1,494 individuals (55% female). Measured covariate differences between individuals with and without cannabis problems were controlled via propensity score techniques. The estimated risk of young adult depression for adolescents with cannabis problems was not significantly different from that for comparison adolescents for either females (odds ratio = 0.7, 95% confidence interval: 0.2, 2.3) or males (odds ratio = 1.7, 95% confidence interval: 0.8, 3.6). The evidence does not support a causal association linking adolescent-onset cannabis problems with young adult depression.

Children taking risks: the association with cocaine and other drug use by young adulthood

In this report from a longitudinal study, the main aim was to evaluate the long-term predictive strength of a novel cartoon-based risk-taking trait assessment, which might prove to have utility in future research on mechanisms leading toward illegal drug involvement. The study population originated as 2311 first-graders entering 19 elementary schools during two successive school years. The assessments started soon after the children entered primary school. The key response variable was participants' use of cocaine by the time of a young adult assessment. We found that for each standard deviation increase in the risk-taking scale there was a two-fold increase in the risk of becoming a cocaine user by young adulthood (estimated relative risk, RR=1.9; 95% confidence interval, CI=1.3, 2.7). Independently, onset of cannabis use by young adulthood was also predicted by risk-taking scale values, but use of legal drugs (alcohol and tobacco) was not. These long-span associations provide support for new research on very early risk-taking mechanisms that lead toward illegal drug involvement.

Depressed mood in childhood and subsequent alcohol use through adolescence and young adulthood

CONTEXT

Despite prior evidence supporting cross-sectional associations of depression and alcohol use disorders, there is relatively little prospective data on the temporal association between depressed mood and maladaptive drinking, particularly across extended intervals.

OBJECTIVE

To assess the association between depressed mood in childhood and alcohol use during adolescence and young adulthood by mood level and sex and race/ethnicity subgroups.

DESIGN

Cohort study of individuals observed during late childhood, early adolescence, and young adulthood.

SETTING

Urban mid-Atlantic region of the United States.

PARTICIPANTS

Two successive cohorts of students from 19 elementary schools have been followed up since entry into first grade (1985, cohort I [n = 1196]; 1986, cohort II [n = 1115]). The students were roughly equally divided by sex (48% female) and were predominantly African American (70%). Between 1989 and 1994, annual assessments were performed on students remaining in the public school system, and between 2000 and 2001, approximately 75% participated in an interview at young adulthood (n = 1692).

MAIN OUTCOME MEASURES

Among participants who reported having used alcohol, Cox and multinomial regression analyses were used to assess the association of childhood mood level, as measured by a depression symptom screener, with each alcohol outcome (incident alcohol intoxication, incident alcohol-related problems, and DSM-IV alcohol abuse and dependence).

RESULTS

In adjusted regression analyses among those who drank alcohol, a high level of childhood depressed mood was associated with an earlier onset and increased risk of alcohol intoxication, alcohol-related problems during late childhood and early adolescence, and development of DSM-IV alcohol dependence in young adulthood.

CONCLUSIONS

Early manifestations associated with possible depressive conditions in childhood helped predict and account for subsequent alcohol involvement extending across life stages from childhood through young adulthood.

Impacts of age of onset of substance use disorders on risk of adult incarceration among disadvantaged urban youth: a propensity score matching approach

BACKGROUND

Age of onset of substance use disorders in adolescence and early adulthood could be associated with higher rates of adult criminal incarceration in the U.S., but evidence of these associations is scarce.

METHODS

Propensity score matching was used to estimate the association between adolescent-onset substance use disorders and the rate of incarceration, as well as incarceration costs and self-reported criminal arrests and convictions, of young men predominantly from African American, lower income, urban households. Age of onset was differentiated by whether onset of the first disorder occurred by age 16.

RESULTS

Onset of a substance use disorder by age 16, but not later onset, was associated with a fourfold greater risk of adult incarceration for substance related offenses as compared to no disorder (0.35 vs. 0.09, P=0.044). Onset by age 16 and later onset were both positively associated with incarceration costs and risk of arrest and conviction, though associations with crime outcomes were more consistent with respect to onset by age 16. Results were robust to propensity score adjustment for observable predictors of substance use in adolescence and involvement in crime as an adult.

CONCLUSION

Among young men in this high risk minority sample, having a substance use disorder by age 16 was associated with higher risk of incarceration for substance related offenses in early adulthood and with more extensive criminal justice system involvement as compared to having no disorder or having a disorder beginning at a later age.

The latent structure of post-traumatic stress disorder: tests of invariance by gender and trauma type

BACKGROUND

Measurement invariance of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) criterion symptoms was tested by gender and trauma type, assaultive and non-assaultive.

METHOD

Analysis was conducted using latent class analysis (LCA), based on findings that the three-class LCA model from Breslau et al. (Archives of General Psychiatry 2005, 62, 1343-1351) fits the data across the four groups best. The classes represent three levels of PTSD-related disturbance: no disturbance, intermediate disturbance and pervasive disturbance, with the last one approximating the DSM-IV PTSD diagnosis.

RESULTS

Analysis of measurement invariance showed that, with respect to gender, there was no evidence of differential symptom reporting within the same disturbance class. DSM-IV symptom indicators represent the latent structure of PTSD equally in males and females. We found that more female than male victims of assaultive violence experienced pervasive disturbance. In the absence of measurement variability associated with gender, the finding is likely to reflect a gender difference in susceptibility. The analysis of measurement invariance detected evidence of variability associated with trauma type. Victims of assaultive violence in the pervasive disturbance class report more severe distress (especially emotional numbing) than do victims of non-assaultive violence in the same class.

CONCLUSIONS

The finding of measurement bias associated with type of trauma raises questions about the applicability of a single definition for PTSD associated with assaultive violence and PTSD associated with traumatic events of lesser magnitude.

On the development of nicotine dependence in adolescence

Little is known about the natural history of drug dependence. This article describes the development and predictors of DSM-IV nicotine dependence in adolescence when tobacco use is initiated. In a two-stage design, a survey was administered to 6th-10th graders in the Chicago Public Schools to select a cohort of adolescents. Household interviews were conducted with adolescents five times and with one parent (predominantly mothers) three times over 2 years. The analytical sample includes 353 youths, who started using tobacco within 12 months preceding Wave 1 or between Waves 1-5. Survival analysis estimated latency to individual DSM-IV nicotine dependence criteria and the full dependence syndrome. Twenty-five percent of youths experienced the syndrome within 23 months of tobacco use onset. Tolerance, impaired control and withdrawal were experienced most frequently. Youths who developed full dependence experienced their first symptom faster after tobacco use onset than those who experienced only one criterion through the end of the observation period. Cox proportional hazards models estimated the importance of time-constant and time-varying sociodemographic, tobacco and other drug use, parental and peer smoking, social psychological and biological risk factors for experiencing the first criterion and the full syndrome. Pleasant initial sensitivity to tobacco and number of cigarettes smoked the prior month predicted both outcomes. Parental dependence predicted the full syndrome. Significant covariates were generally the same across gender and racial/ethnic subgroups. The predictive significance of the initial smoking experience and parental dependence highlight the potential importance of genetic factors in the etiology of nicotine dependence.

Nicotine dependence subtypes: association with smoking history, diagnostic criteria and psychiatric disorders in 5440 regular smokers from the Vietnam Era Twin Registry

Studies suggest empirically derived subtypes of nicotine dependence exist in young adult populations with short smoking careers. It is not known if classes of dependence exist in middle aged smokers with longer smoking careers and whether these classes reflect quantitative or qualitative differences. It is not known if psychiatric disorders are associated with classes of nicotine dependence. Nicotine dependence symptoms were obtained from a 1992 administration of the Diagnostic Interview Schedule. Latent Class Analyses (LCA) was computed using data from 5440 members of the Vietnam Era Twin Registry. LCA was used to derive significantly different classes of nicotine dependence, which were assessed for their association with smoking history, nicotine dependence, and other psychiatric disorders. The LCA model which best fit the data was a 4 class solution characterized by severity. Age onset of regular smoking decreased with more severe classes. Cigarette consumption, failed cessation and psychiatric disorders were associated with more severe classes. Empirically derived subtypes of nicotine dependence are mostly characterized by increasing severity. Suggestions for refinement of nicotine dependence diagnostic criteria are discussed.

Drug dependence enviromics: job strain in the work environment and risk of becoming drug-dependent

In a prospective epidemiologic study of a sample of young adults, the authors estimated the risks of being drug-dependent and becoming drug-dependent in relation to the psychosocial work environment encountered during young adulthood. Data were obtained from two young adult assessments of 2,311 children who entered the first grade of primary school in 1985-1986. A total of 1,692 participants completed the first young adult assessment (YAT0) in 2000-2002, and a follow-up young adult assessment (YAT1) was completed approximately 1 year later. Work environments characterized by high job strain (low job control combined with high job demands assessed at YAT0) signaled a 2- to 3-fold excess risk of being drug-dependent (adjusted prevalence ratio = 2.3, 95% confidence interval: 1.4, 4.0). In reestimation for 861 young adults (61% female) with no drug dependence at YAT0, low job control alone was associated with a 2- to 3-fold excess risk of developing drug dependence (adjusted relative risk = 2.6, 95% confidence interval: 1.1, 6.5) between YAT0 and YAT1. The relative risk estimates did not change appreciably with statistical adjustment for demographic covariates, individual drugs used, childhood predispositional traits, job characteristics, and measurements of socioeconomic status at three time points (first grade, adolescence, and young adulthood).

The Fagerström test for nicotine dependence: a comparison of standard scoring and latent class analysis approaches

The classification of being tobacco dependent obtained via the established scoring method of the Fagerström test for nicotine dependence (FTND) is compared to a method that bases classification on the pattern of item responses. Young adults participating in a longitudinal study, who indicated they had ever smoked, were asked six standardized items (n = 962; mean age 21 years). By standard scoring, the mean FTND score was 1.9 (S.E.= 2.3): 66% of the smokers qualified for a very low level of dependence, 17% low, 9% moderate, and 9% a high level of dependence. Response patterns detected by latent class analysis (LCA) indicated class differences based on severity gradations and of qualitative content. Three profiles of tobacco dependence were found: a non-dependent class (50%), a class manifesting a moderate number of dependence features (31%), and more severely affected class (19%). The vast majority of smokers (three-fourth) were classified congruently by these two methods. Discrepancies involved LCA classifying smokers into a higher level of dependence when compared to the conventional scoring classification. Patterns of dependence features obtained from population samples that include a wide range of smokers may provide insight into possible phenotypic differences among tobacco smokers, particularly when LCA methods are used to complement standard scoring methods.

Correlates of regular cigarette smoking in a population-based sample of Australian twins

AIMS

To investigate the role of measured risk factors and the influence of genetic and environmental factors on regular cigarette smoking. Design Members of monozygotic and dizygotic, including unlike-sex twin pairs (n = 6257) from a young adult cohort from the Australian Twin Registry.

METHODS

Cox proportional hazards models were used to determine whether putative risk factors were significantly associated with regular cigarette smoking. Risk factors were classified into four tiers: tier 1 (parental history, including parental education, alcoholism and cigarette smoking), tier 2 (early home and family influences), tier 3 (early life events, e.g. trauma) and tier 4 (psychiatric symptoms/disorders with onset prior to 14 years), after controlling for gender, zygosity and their interactions. Genetic models were fitted to examine the heritability of smoking behavior before and after controlling for significant covariates from the four tiers.

FINDINGS

Parental history of cigarette smoking and alcoholism, parental closeness and home environment, as well as incidence of childhood sexual abuse or other trauma, a history of early onset panic attacks and conduct problems were associated with regular cigarette smoking. Important age interactions were found, particularly for family background risk factors. Regular cigarette smoking was moderately heritable, even after accounting for significant covariates.

CONCLUSIONS

Several measured risk factors are associated with regular smoking. While some of the genetic influences on regular smoking may be shared with these risk factors, a significant proportion of the genetic vulnerability to regular smoking is phenotype-specific.

Is prenatal tobacco exposure a risk factor for early adolescent smoking? A follow-up study

Recent reports indicate a relation between prenatal tobacco exposure (PTE) and offspring smoking. Many of these reports have been retrospective or have not included important variables such as other prenatal substance exposures, maternal and child psycho-social characteristics, mother's current smoking, and friends' smoking. No prior study has examined the timing of PTE. In this prospective study of a birth cohort of 567 14-year-olds, we examined the relation between trimester-specific PTE, offspring smoking, and other correlates of adolescent smoking. Average age of the adolescents was 14.8 years (range: 13.9-16.6 years), 51% were female, 54% were African-American. Data on maternal tobacco and other substance use were collected both prenatally and postnatally, 51% of the mothers were prenatal smokers and 53% smoked when their children were 14 years. PTE in the third trimester significantly predicted offspring smoking (ever/never, smoking level, age of onset) when demographic and other prenatal substances were included in the analyses. PTE remained a significant predictor of the level of adolescent smoking when maternal and child psychological characteristics were added to the model. When more proximal measures of the child's smoking were included in the model, including mother's current smoking and friends' smoking, PTE was no longer significant. Significant predictors of adolescent smoking at age 14 were female gender, Caucasian race, child externalizing behavior, maternal anxiety, and child depressive symptoms. Although direct effects of PTE on offspring smoking behavior have previously been reported from this study and by others, by early-adolescence, this association is not significant after controlling for the more proximal covariates of adolescent smoking such as mother's current smoking and peer smoking.

Smoking and young people's mental health

PURPOSE OF REVIEW

This review addresses the evidence on smoking and young people's mental health, reported during 2004.

RECENT FINDINGS

Research studies have confirmed the previously reported epidemiological associations of smoking with gender, race and social class, as well as suspected risk factors and antecedents. Among youths, the prevalence of smoking varies across subgroups of the population, classified by race/ethnicity and social class. Gender differences in smoking vary cross-nationally. Smoking among youths is higher when parents, siblings, or peers smoke. Smoking is also higher in youths with histories of early conduct problems, drinking and illegal drug use, depression, and suicidal behaviors. The protective role of youth involvement in sports and the lesser opportunity to smoke among youths involved in religious practice were also confirmed. Among young people, early conduct problems and associated early onset of daily smoking predict a greater likelihood of becoming nicotine dependent. The interpretation of the high smoking rate among schizophrenic patients as self-medication has been challenged by a recent study that reported that smoking predicted subsequent first hospitalization for schizophrenia. New findings suggest that young persons who experienced their first exposure to nicotine as relaxing are at elevated risk for becoming nicotine dependent.

SUMMARY

Longitudinal cohort studies and cross-sectional studies have been published on smoking and young people's mental health. These studies describe smoking correlates and identify predictors of negative outcomes of smoking, as well as predictors of nicotine dependence, smoking initiation, and smoking cessation.

The development of suicide ideation and attempts: an epidemiologic study of first graders followed into young adulthood

Studying community residing youths originally recruited for an intervention trial upon entry into first grade, this project sought to estimate risk of suicide ideation and attempts to young adulthood, with focus on those who used drugs before age 16, as compared to youths who used later in development or not at all. Standardized interview assessments in 1989-1994 were completed with 2311 youths age 8-15. Roughly 15 years after recruitment, our study team reassessed 1695, nearly 75% of the survivors (mean age = 21), finding 155 to have made suicide attempts (SA) and 218 with onset of depression-related suicide ideation (SI). We estimate relative risk (RR), from survival analysis and logistic regression models, to study early use of tobacco, alcohol, cannabis, and inhalants, with covariate adjustments for age, sex, race-ethnicity, and other pertinent covariates. Early-onset of cannabis use and inhalant use for females, but not for males, signaled modestly excess risk of suicide attempt (cannabis-associated RR = 1.9; p = 0.04; inhalant-associated RR = 2.2; p = 0.05). Early-onset of cannabis use by females (but not for males) signaled excess risk for suicide ideation (RR = 2.9; p = 0.006). Early-onset alcohol and tobacco use were not associated with later risk of SA or SI. In light of the relatively modest strength of association, the evidence may well reflect an underlying common diathesis or unmeasured prior confounding influences that link early-onset illegal drug use with later risk of these suicide-related events, rather than an influence of early-onset drug use per se.

Trauma exposure and posttraumatic stress disorder: a study of youths in urban America

We estimate the cumulative occurrence of traumatic events and posttraumatic stress disorder (PTSD), using Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria, in a high-risk sample of young people in urban United States. The epidemiological sample (n = 2,311) was recruited in 1985-1986 at entry into first grade of a public school system of a large mid-Atlantic city. Participants were interviewed about history of trauma and PTSD in 2000-2002 when their mean age was 21 years (n = 1,698). We found that the lifetime occurrence of assaultive violence was 62.6% in males and 33.7% in females. The risk of assaultive violence in males (but not females) varied by childhood area of residence within the city; the occurrence of other traumas did not vary by area of childhood residence. Females had a higher risk of PTSD than males following assaultive violence (odds ratio = 4.0, 95% confidence interval 2.0-8.3), but not following other traumas. A comparison of the results from this largely inner-city sample with the results from a recent study of a largely suburban sample in another region of the United States in which the same criteria and measures of trauma and PTSD were used suggested the possibility that males' risk for assaultive violence and females' risk for PTSD following exposure to assaultive violence might vary by characteristics of the social environment.