Emotional symptoms and sensation seeking: Implications for tobacco interventions for youth and young adults

Depressive symptoms and the age of initiation of tobacco and marijuana use among adolescents and young adults

BACKGROUND

Studies have demonstrated important associations between depressive symptoms and tobacco and marijuana use. However, to date, it is unknown if depressive symptoms predispose youth to tobacco and marijuana use at earlier ages over time.

METHODS

Data from the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) for the years 2019-2021 (Waves 9-14) were used. Eligible samples include individuals who had never used cigarette (n=1776), e-cigarette (n=1353), or marijuana (n=1505) at basline and had complete data on covariates. Interval-censoring survival analysis was used to examine the differences in the estimated age of first use of cigarettes, e-cigarettes, and marijuana by depressive symptoms.

RESULTS

10th-grade cohort participants with depressive symptoms had increased risk of earlier age of first use of cigarette [AHR=1.45; 95% CI=1.02-2.04)], e-cigarette [AHR=1.65(1.27-2.15)], and marijuana [AHR=1.56(1.20-2.01)]. 12th-grade cohort participants with depressive symptoms had increased risk of earlier age of first use of cigarette [AHR=1.41(1.11-1.82), e-cigarette [AHR=1.35(1.10-1.87)] and marijuana [AHR=1.25(1.01-1.55)]. However, among the two-year post-high school cohort, depressive symptoms predicted the age of first use of marijuana only [AHR=1.34(1.13-1.60)]. Between ages 18-to-20 years, the estimated cumulative incidence of initiation almost doubled for all three products among depressive participants in 10th and 12th-grade cohorts.

CONCLUSIONS

Among 10th-grade, 12th-grade, and 2-year post-HS students, those with depressive symptoms initiate tobacco and marijuana use at earlier ages than peers without depressive symptoms. Early screening and management of depressive symptoms among adolescents and young adults may be a promising target for preventing or delaying the age of first use of substance use.

The Association Between Tobacco and Cannabis Use and the Age of Onset of Depression and Anxiety Symptoms: Among Adolescents and Young Adults

INTRODUCTION

No studies have prospectively explored the association between the use of tobacco or cannabis use and the age of onset of depressive or anxiety symptoms, and no studies have identified the peak ages and ranges of onset of these symptoms among tobacco and/or cannabis users.

AIMS AND METHODS

This is a secondary analysis of Texas Adolescent Tobacco and Marketing Surveillance System data, waves 9-14 (2019-20121). Participants were in 10th grade, 12th grade, and 2 years post-high school (HS) at baseline (wave 9). Interval-censoring multivariable Cox proportional hazards models were fit to assess differences in the estimated age of onset of depression and anxiety by tobacco and cannabis use while adjusting for covariates.

RESULTS

We found that lifetime or ever cigarette, e-cigarette, and cannabis use had an increased risk of an earlier age of onset of depressive and anxiety symptoms across the three cohorts, and the youngest cohort was the most differentially impacted by substance use. Between ages 18 to 19 years in the 10th-grade cohort, between ages 20 to 21 years in the 12th-grade cohort, and between ages 22 to 23 years in the post-HS cohort, the estimated hazard function (or cumulative incidence) for reporting depressive and anxiety symptoms almost doubled among lifetime cigarette, e-cigarette, and cannabis users.

CONCLUSIONS

Tobacco and cannabis users should be screened for mental health problems at an earlier age, especially those aged 18 years and younger, and provided with age- and culturally appropriate resources to prevent or delay the onset of anxiety and/or depression symptoms.

IMPLICATIONS

The study's findings indicate that tobacco and cannabis use is directly linked to the early onset of depressive and anxiety symptoms among youth. This highlights the significance of early screening and substance use interventions, particularly for youth aged 18 years and younger, as they are disproportionately affected by both substance use and mental health problems. School-based interventions that are age- and culturally appropriate hold promise as they enable youth to seek professional help early, and in a supportive environment. Intervening early in substance shows promise in reducing the likelihood of developing mental health problems at a young age.

Emotional self-regulation, impulsivity, 5-HTTLPR and tobacco use behavior among psychiatric inpatients

BACKGROUND

While the serotonin transporter (SLC6A4) gene, 5-HTTLPR, interacts with the social environment to influence both emotional self-regulation and smoking behavior, less is known about interactions between emotional self-regulation and 5-HTTLPR or their joint influence on tobacco use. Here, we examined such interactions among psychiatric inpatients, the population with the highest rates of smoking.

METHODS

Participants (506 adults) were psychiatric inpatients at The Menninger Clinic in Houston TX between 2012 and 16. Most were white (89%), male (55%), with a mean age of 32.3 years. Participants completed the Difficulties in Emotional Regulation Scale (DERS) at admission. We examined interactions with smoking among three DERS subscales and 5-HTTLPR, controlling for sex, race and age.

RESULTS

Smoking rates were higher among those with the 5-HTTPLR L'L' genotype compared to peers carrying an S' allele (47.9% vs. 37.4%, respectively). Among S' allele carrying participants, impulse control difficulties (OR = 1.09; 95%CI: 1.03-1.14) and lack of emotion clarity (OR = 1.06; 95%CI: 1.00-1.11) increased risk for ever using tobacco, while accessing more ways to regulate emotion (OR = 0.95; 95%CI: 0.92-0.99) offered a protective effect against ever using tobacco. Neither demographic nor DERS covariates were associated with using tobacco among the L'L' group.

LIMITATIONS

This ethnically homogenous sample limits generalizability and using a binary outcome can over-estimate a gene environment interaction effect.

CONCLUSIONS

Emotional self-regulation exerts a stronger influence on using tobacco among carriers of an S' allele of 5-HTTLPR than peers with the L'L' genotype. Promoting emotional self-regulatory skills may have benefits for preventing tobacco use.

Brief Sensations Seeking Scale (BSSS): Validity Evidence in Mexican Adolescents

Sensation seeking is a construct associated with risky behaviors over a wide age range, but validation studies in Mexico are lacking. The aim of this study was to investigate the validity of two versions of the Brief Sensation Seeking Scale (the BSSS-8 and BSSS-4) in young Mexican individuals. The sample consisted of 2884 students (age: M = 16.6, SD = 1.5) from five preparatory schools in Morelos, Mexico. The internal structure of the BSSS was evaluated according to the structural equation modeling (SEM) parameterization, including measurement invariance (compared to the factor loadings obtained in the meta-analysis); conditional reliability; and equivalence between versions. The unidimensionality and measurement invariance (configurational, factor loadings, thresholds, intercepts, and residuals) across sex and age groups were satisfactory, and the factor loadings were highly congruent with those obtained in the meta-analysis. Reliability was suitably high (greater than 0.80), especially near the mean scores, but was lower for extreme scores. Thus, the instrument was concluded to be optimal for defining the construct of sensation seeking, consistent with the findings of previous studies.