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Stevely AK, Gray LA, Fairbrother H, Fenton L, Henney M, Kersbergen I, Holmes J. A latent class analysis of international change and continuity in adolescent health and wellbeing: A repeat cross-sectional study. PLoS One 2024; 19:e0305124. [PMID: 38861509 PMCID: PMC11166295 DOI: 10.1371/journal.pone.0305124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/24/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Since the early 2000s, there have been marked trends in adolescent health and wellbeing indicators across Europe, North America and Australia. In particular, there have been substantial declines in youth drinking. We know little about how these trends are underpinned by co-occurring indicators within individuals. This paper aims to analyse change over time in how indicators cluster within individuals and differences in these patterns between five countries with different trends in youth drinking. METHODS We analysed four waves of repeat cross-sectional survey data from 15-year-olds in England (n = 5942), Italy (n = 5234), the Netherlands (n = 5408), Hungary (n = 5274), and Finland (n = 7446), which were included in the Health Behaviours in School-aged Children (HBSC) study between 2001/02 and 2013/14. We defined clusters of individuals using multigroup latent class analyses which accounts for change over time. The class indicators included health behaviours, attitudes, wellbeing and relationships. We modelled associations between class membership, sex, and family affluence over time. RESULTS We identified four classes in all countries: Overall unhealthy, Overall healthy, Moderately healthy and Substance abstainers with behaviour risk indicators. The proportion of adolescents in the Overall unhealthy class declined between 2001/02 and 2013/14 by between 22.8 percentage points (pp) in England and 3.2pp in Italy. The extent to which indicators of health and wellbeing changed as linked clusters differed across countries, but changes in alcohol consumption, smoking, drug use and sexual activity were typically concurrent. Adolescents with low family affluence were more likely to be in the Overall unhealthy class in all years. CONCLUSIONS Improvements in indicators of adolescent health and well-being are due mainly to concurrent declines in drinking, smoking, sexual activity, and cannabis use, but these declines are not consistently associated with improvements in other domains. They have also not led to reductions in inequalities in indicators of health and well-being.
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Affiliation(s)
- Abigail K. Stevely
- Sheffield Addictions Research Group (SARG), Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
| | - Laura A. Gray
- Health Economics and Decision Science, Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
- Healthy Lifespan Institute, University of Sheffield, Sheffield, United Kingdom
| | | | - Laura Fenton
- Sheffield Addictions Research Group (SARG), Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
| | - Madeleine Henney
- Sheffield Addictions Research Group (SARG), Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
| | - Inge Kersbergen
- Sheffield Addictions Research Group (SARG), Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
| | - John Holmes
- Sheffield Addictions Research Group (SARG), Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
- Healthy Lifespan Institute, University of Sheffield, Sheffield, United Kingdom
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Halladay J, MacKillop J, Acuff S, Amlung M, Munn C, Georgiades K. Early substance use and the school environment: A multilevel latent class analysis. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2024; 33:33-56. [PMID: 38449719 PMCID: PMC10914148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Background Early substance use is associated with increased risks for mental health and substance use problems which are compounded when using several substances (i.e., polysubstance use). A notable increase in substance use occurs when adolescents transition from elementary to secondary schooling. Objective This study seeks to characterize student and school classes of substance use. Methods A cross-sectional multilevel latent class analysis and regression was conducted on a representative sample of 19,130 grade 6-8 students from 180 elementary schools in Ontario, Canada to: 1) identify distinct classes of student substance use; 2) identify classes of schools based on student classes; and 3) explore correlates of these classes, including mental health, school climate, belonging, safety, and extracurricular participation. Results Two student and two school classes were identified. 4.1% of students were assigned to the high probability of early polysubstance use class while the remaining 95.9% were in the low probability class. Students experiencing depressive and externalizing symptoms had higher odds of being in the early polysubstance use class (Odds Ratio [OR]s=1.1-1.25). At the school level, 19% of schools had higher proportions of students endorsing polysubstance use. Perceptions of positive school climate, belonging, and safety increased the odds of students being in the low probability of early polysubstance use student-level class (ORs=0.85-0.93) and lower probability of early polysubstance use school-level class. Associations related to extracurricular participation were largely not statistically significant. Conclusions Student and school substance use classes may serve as targets for tailored prevention and early interventions. Results support examining school-based interventions targeting school climate, belonging, and safety.
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Affiliation(s)
- Jillian Halladay
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Camperdown NSW, Australia
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Samuel Acuff
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Michael Amlung
- Cofrin Logan Center for Addiction Research and Treatment, The University of Kansas, Lawrence, Kansas, United States
| | - Catharine Munn
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario
- Offord Centre for Child Studies, McMaster University, Ron Joyce Children's Health Centre, Hamilton, Ontario
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Vrinten C, Parnham JC, Radó MK, Filippidis FT, Creese H, Hopkinson NS, Laverty AA. Patterns of cigarette and e-cigarette use among UK adolescents: a latent class analysis of the Millennium Cohort Study. Eur J Public Health 2023; 33:857-863. [PMID: 37573139 PMCID: PMC10567249 DOI: 10.1093/eurpub/ckad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Patterning of cigarette and e-cigarette use among young people remains poorly characterized. We aimed to describe these patterns in the UK Millennium Cohort Study at age 14 and 17 years. METHODS Data on cigarette and e-cigarette use come from 9731 adolescents. Latent class analysis assigned participants to membership of classes of product use and multinomial logistic regression analyses assessed differences in the likelihood of belonging to classes by sociodemographic (age, gender, ethnicity, household income, maternal education and country of residence) and smoking-related social factors (caregiver tobacco use, caregiver e-cigarette use and peer smoking). RESULTS We identified four classes of use: 45.8% of adolescents 'continued to abstain' from cigarettes or e-cigarettes; 21.3% 'experimented' (used once or in the past but not currently) with cigarettes and/or e-cigarettes by age 17 but were not current users; 19.0% were 'late adopters', characterized by low levels of use at age 14 but high levels of experimentation and current use at age 17; and 13.9% were 'early adopters', characterized by high levels of experimentation and current use at ages 14 and 17. At age 17, 70.4% of 'early adopters' smoked cigarettes regularly plus an additional 27.3% experimented with cigarettes. Corresponding percentages for e-cigarettes were 37.9% and 58.9%. Tobacco and e-cigarette use by caregivers, and cigarette use by peers, were associated with being both 'late adopters' and 'early adopters'. CONCLUSIONS Approximately one in seven adolescents in the UK are 'early adopters' of nicotine products. This highlights the need to develop and implement effective policies to prevent nicotine use uptake.
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Affiliation(s)
- Charlotte Vrinten
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Jennie C Parnham
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Márta K Radó
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Hanna Creese
- Child Health Unit, School of Public Health, Imperial College London, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital Campus, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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The association between early onset of alcohol, smokeless tobacco and marijuana use with adult binge drinking in United States. Sci Rep 2023; 13:187. [PMID: 36604596 PMCID: PMC9814633 DOI: 10.1038/s41598-023-27571-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Binge drinking is a deadly pattern of excessive alcohol use that is associated with multiple diseases in the United States. To date, little is known about the associations between the early onset of substance use and other factors with the severity of adult binge drinking. The 2018 National Survey on Drug Use and Health data was used to identify binge drinking (binary and in number of days in the past month). Age at onset was categorized into four groups as 1-12, 13-14, 15-17, or beyond 18. Weighted multivariate logistic regression and Poisson regression analyses were performed to examine the associations between early onset of alcohol, smokeless tobacco, and marijuana use with binge drinking. The severity of binge drinking was statistically significantly associated with substance use (4.15 days in a month), early onset of alcohol, smokeless tobacco, and marijuana use (2.15-4.93 days, all p-values < 0.0001), after accounting for the covariates. Past year substance use disorder is strongly associated with binge drinking. The severity of adult binge drinking is significantly associated with early onset of substance use including alcohol, smokeless tobacco, and marijuana. Continued efforts are warranted to improve substance use prevention and treatment tailored for adolescents and youths to prevent development of adult binge drinking.
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Romm KF, Childers MG, Douglas AE, Bray BC, Dino G, Blank MD. Transitions in tobacco use profiles among adolescents: Results from the Population Assessment of Tobacco and Health (PATH) study waves 3 and 4. Drug Alcohol Depend 2022; 232:109272. [PMID: 35033957 PMCID: PMC8885853 DOI: 10.1016/j.drugalcdep.2022.109272] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Despite increases in adolescents' polytobacco use, little work has utilized recent national data to examine transitions in polytobacco use over time or predictors of such transitions. METHODS Data derived from the Population Assessment of Tobacco and Health (PATH) study. Participants used at least one tobacco product (cigarettes, electronic cigarettes [ECIGs], traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco [SLT], hookah) at Wave 3 (W3; 2015-2016) or 4 (W4; 2016-2018) and had Wave 1 (W1) data (N = 1072; Mage= 13.71, SD =1.71, 46.4% female; 56.6% White, 23.2% Hispanic). Latent transition analysis (LTA) examined probabilities of transitioning between classes across waves and sociodemographic correlates of transitions. RESULTS Five latent classes were identified: Low Users (n = 372, 34.7% W3; n = 249, 23.3% W4), ECIG Users (n = 256, 23.8% W3; n = 286, 26.7% W4), Cigarette Users (n = 215, 20.1% W3; n = 293, 27.3% W4), SLT Users (n = 91, 8.5% W3; n = 92, 8.6% W4), and Polytobacco Users (n = 138, 12.9% W3; n = 152, 14.1% W4). Cigarette Users and SLT Users displayed the highest probabilities for class stability. Low Users were most likely to transition to ECIG Users or Cigarette Users, whereas Polytobacco Users were most likely to transition to Low Users. ECIG Users were likely to transition to Low Users or Cigarette Users. Older and White adolescents were more likely to display riskier transitions. CONCLUSIONS Although Cigarette Users and SLT Users remained largely stable in membership, findings demonstrate greater movement across polytobacco use classes relative to previous research and suggest that ECIGs may be the most common entry point to tobacco use.
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Affiliation(s)
- Katelyn F Romm
- George Washington University, Washington, DC 20052, USA.
| | - Margaret G Childers
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA.
| | - Ashley E Douglas
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA.
| | - Bethany C Bray
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60608, USA.
| | - Geri Dino
- West Virginia Prevention Research Center, Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA.
| | - Melissa D Blank
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA; West Virginia Prevention Research Center, Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506, USA.
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Chae M, Han K. Differences in Health Behavior Profiles of Adolescents in Urban and Rural Areas in a Korean City. Healthcare (Basel) 2021; 9:282. [PMID: 33806690 PMCID: PMC7998240 DOI: 10.3390/healthcare9030282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 11/22/2022] Open
Abstract
Through a latent class analysis approach, we can classify individuals and identify subgroups according to health behavior patterns, and find evidence for the development of customized intervention programs to target high-risk groups. Our study aimed to explore differences in latent classes of health behaviors in adolescents by region (urban vs. rural areas) in a Korean city. This cross-sectional secondary analysis utilized data collected from all first graders' student health checkups in middle school and high school in a city of the largest island in Korea in 2016 (n = 1807). Health behavior indicators included both healthy (consuming breakfast regularly, consuming vegetables daily, consuming milk daily, consuming fast food on a limited basis, engaging in vigorous physical activities, brushing teeth, and practicing hand hygiene) and unhealthy (drinking, smoking, and overusing the internet) behaviors. Nutritional and diet behaviors were important factors for classifying healthy and unhealthy adolescents in both regions. Approximately 11% of rural students belonged to the risky group, which was characterized by a high level of drinking alcohol and smoking. These results suggest that when developing health policies for adolescents, customized policy-making and education based on the targeted groups' behavioral patterns could be more effective than a uniform approach.
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Affiliation(s)
| | - Kihye Han
- College of Nursing, Chung-Ang University, Seoul 06974, Korea;
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Lozano A, Liu F, Lee TK, Prado G, Schwartz SJ, Leventhal AM, Kelleghan AR, Unger JB, Barrington-Trimis JL. Bidirectional associations between e-cigarette use and alcohol use across adolescence. Drug Alcohol Depend 2021; 220:108496. [PMID: 33461153 PMCID: PMC8320369 DOI: 10.1016/j.drugalcdep.2020.108496] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Evidence on prospective bidirectional associations between e-cigarette and alcohol use among adolescents can inform prevention and policy but is largely absent from the literature. METHODS Data were drawn from a prospective cohort of students attending 10 Los Angeles high schools (N = 3396; baseline mean age = 14.1, SD = 0.4). Students completed surveys every 6-months from 2013 to 2017; 8 total waves. Analyses were restricted to (a) individuals who were never users of alcohol (N = 2394) or (b) individuals who were never users of e-cigarettes (N = 2704) at baseline. Repeated-measures, generalized linear mixed models were used to estimate the adjusted odds of past 6-month alcohol and e-cigarette initiation, in separate models. RESULTS Among alcohol never-users at baseline, 15.7 % (N = 375) initiated alcohol use over the study period. Compared to never-users of e-cigarettes, those who reported use of e-cigarettes had 3.5 times the odds of subsequently initiating alcohol use in the following wave (OR = 3.54; 95 % CI: 2.81, 4.47). Stronger associations were observed for males (OR = 4.94; 95 % CI: 3.78, 6.45) than for females (OR = 3.21; 95 % CI: 2.33, 4.41; pinteraction = 0.04). Among e-cigarette never-users at baseline, 26.3 % (N = 709) initiated e-cigarette use over the study period. Compared to never-users of alcohol, those who reported use of alcohol had 3.2 times the odds of subsequently initiating e-cigarette use in the following wave (OR = 3.23; 95 % CI: 2.68, 3.89). This association did not differ by gender. CONCLUSIONS E-cigarette and alcohol use can be markers to identify youth at risk for future alcohol and e-cigarette use, respectively. Research examining mechanisms underlying these associations is needed to infer causality.
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Affiliation(s)
- Alyssa Lozano
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Feifei Liu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
| | - Tae Kyoung Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, 33143, USA
| | - Seth J Schwartz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, USA; Departments of Kinesiology, Health Education, and Counseling Psychology, College of Education, University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA
| | - Adam M Leventhal
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
| | - Annemarie R Kelleghan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA; Department of Psychology, University of Southern California, 3620 S. McClintock Ave. SGM 501, Los Angeles, CA, 90089, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA, 90089, USA.
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Whitaker V, Oldham M, Boyd J, Fairbrother H, Curtis P, Meier P, Holmes J. Clustering of health-related behaviours within children aged 11-16: a systematic review. BMC Public Health 2021; 21:137. [PMID: 33446174 PMCID: PMC7807795 DOI: 10.1186/s12889-020-10140-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 12/28/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE We aimed to systematically review and synthesise evidence on the clustering of a broad range of health-related behaviours amongst 11-16 year olds. METHOD A literature search was conducted in September 2019. Studies were included if they used cluster analysis, latent class analysis, prevalence odds ratios, principal component analysis or factor analysis, and considered at least three health-related behaviours of interest among 11-16 year olds in high-income countries. Health-related behaviours of interest were substance use (alcohol, cigarettes and other drug use) and other behavioural risk indicators (diet, physical activity, gambling and sexual activity). RESULTS The review identified 41 studies, which reported 198 clusters of health-related behaviours of interest. The behaviours of interest reported within clusters were used to define eight behavioural archetypes. Some included studies only explored substance use, while others considered substance use and/or other health-related behaviours. Consequently, three archetypes were comprised by clusters reporting substance use behaviours alone. The archetypes were: (1) Poly-Substance Users, (2) Single Substance Users, (3) Substance Abstainers, (4) Substance Users with No/Low Behavioural Risk Indicators, (5) Substance Abstainers with Behavioural Risk Indicators, (6) Complex Configurations, (7) Overall Unhealthy and (8) Overall Healthy. CONCLUSION Studies of youth health behavioural clustering typically find both a 'healthy' cluster and an 'unhealthy' cluster. Unhealthy clusters are often characterised by poly-substance use. Our approach to synthesising cluster analyses may offer a means of navigating the heterogeneity of method, measures and behaviours of interest in this literature.
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Affiliation(s)
| | - Melissa Oldham
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jennifer Boyd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Penny Curtis
- Health Sciences School, University of Sheffield, Sheffield, UK
| | - Petra Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Halladay J, Woock R, El-Khechen H, Munn C, MacKillop J, Amlung M, Ogrodnik M, Favotto L, Aryal K, Noori A, Kiflen M, Georgiades K. Patterns of substance use among adolescents: A systematic review. Drug Alcohol Depend 2020; 216:108222. [PMID: 32971420 DOI: 10.1016/j.drugalcdep.2020.108222] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/10/2020] [Accepted: 07/28/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This review characterizes empirically derived patterns of multiple (multi-) substance use among adolescents. A secondary objective was to examine the extent to which mental health symptomatology was included in the empirical analyses examining substance use patterns. METHODS Eligible studies included those that used cluster-based approaches, included the assessment of at least two different substances, and were based on study samples with mean ages between 11 and 18 years. 4665 records were screened including 461 studies for full-text screening. RESULTS 70 studies were included with common clusters being: low use, single or dual substance use, moderate general multi-use, and high multi-use. The most common patterns of single or multi-substance use were: alcohol only, alcohol with cannabis and/or tobacco, and use of alcohol, tobacco, and cannabis with and without other drugs. Lower socioeconomic status, older age, and male gender were consistent predictors of multi-use clusters. Only 37 % of studies compared differences in levels of mental health across clusters with symptoms consistently associated with a greater likelihood of multi-use. Only 29 % of studies included mental health indicators in cluster-based analyses, with over half identifying distinct mental health and substance use clusters. Fit indices in cluster analyses and measurement properties of substance use were heterogeneous and inconsistently reported across studies. CONCLUSIONS Distinct patterns of substance use were derived but methodological differences prevented direct comparison and reduced capacity to generalize across studies. There is a need to establish standardized methodological approaches to identify robust patterns of substance use to enhance etiological, prognostic, and intervention research.
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Affiliation(s)
- Jillian Halladay
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - R Woock
- Department of Social Sciences, McMaster University, Canada.
| | - H El-Khechen
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - C Munn
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada; Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Canada.
| | - J MacKillop
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Canada.
| | - M Amlung
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Canada.
| | - M Ogrodnik
- NeuroFit Lab, Department of Kinesiology, McMaster University, Canada.
| | - L Favotto
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - K Aryal
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - A Noori
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada.
| | - M Kiflen
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada; Population Health Research Institute, Hamilton, ON, Canada.
| | - K Georgiades
- Department of Health Research, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton ON L8S 4S4, Canada; Department of Psychiatry & Behavioral Neurosciences, McMaster University, Canada; Offord Centre for Child Studies, McMaster University, Canada.
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Boyd CJ, Veliz P, Evans-Polce R, Eisman AB, Esteban McCabe S. Latent class trajectories: U.S. adolescents' nicotine use and its association with nicotine dependence. Addict Behav Rep 2020; 12:100303. [PMID: 33364312 PMCID: PMC7752718 DOI: 10.1016/j.abrep.2020.100303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 01/21/2023] Open
Abstract
Youth’s 30-day nicotine/tobacco use increased across three waves of PATH: 2013–2017. Cigarette use associated with greater nicotine/tobacco dependence than e-cigarettes. LCA revealed variability in youths’ nicotine/tobacco use & dependence trajectories. Findings have relevance for prevention messages with high-risk youth.
Introduction Twenty-seven percent of adolescents used a nicotine/tobacco product in 2018. Our study analyzed three waves from the Population Assessment of Tobacco and Health (PATH) Study and examined adolescent nicotine/tobacco use trajectories over time to determine which latent classes were associated with symptoms of nicotine dependence. Methods The PATH Study used a four-stage, stratified area probability sample and annual household interviews with adolescents (12–17 years). Adolescents who indicated past 30-day nicotine/tobacco use at least once were included (n = 1101). We used latent class analysis (LCA) to identify nicotine/tobacco trajectories across three waves of PATH data and their association with six symptoms consistent with nicotine dependence from the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68). Results All types of past 30-day nicotine/tobacco use increased across the three waves. An LCA model fit was assessed using both the CIV and entropy measures in conjunction with the Vuong-Lo-Mendell-Rubin LRT. A five latent class solution had the lowest BIC value (BIC = 9784.272), and resulted in: (1) “Stable/consistent multiproduct use trajectory”, (2) “Increasing cigarette use trajectory”, (3) “Increasing e-cigarette use trajectory”, (4) “Experimental (poly-nicotine/tobacco) use trajectory”, and (5) “Increasing other nicotine/tobacco use trajectory”. The most prevalent was the “Experimental (poly-nicotine/tobacco) use trajectory” (33.8%) although sex, race, and social class were associated with different trajectories. Those represented by the “Increasing cigarette use trajectory” (19.4%) reported significantly more past-year nicotine dependence symptoms (b = 1.73, p < 0.001) compared to the “Increasing e-cigarette use trajectory”. Findings varied by sex and race. Conclusions Results indicate that the relationship between e-cigarette use and other forms of nicotine/tobacco and substance use is complex and that adolescent nicotine/tobacco users are a heterogenous group with different risks for nicotine dependence. Findings can inform tailored prevention education and messaging for different groups of youth.
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Affiliation(s)
- Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI 48109, USA.,School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI 48109, USA.,Addiction Center, Department of Psychiatry, Rachel Upjohn Bldg, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, USA
| | - Philip Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI 48109, USA.,School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI 48109, USA
| | - Rebecca Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI 48109, USA.,School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI 48109, USA
| | - Andria B Eisman
- Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, 656 West Kirby, Detroit, MI 48202, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI 48109, USA.,School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, MI 48109, USA.,Institute for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI 48104, USA
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11
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Scheier LM, Komarc M. Are E-cigarette Users a Unique Group of Smokers? Latent Class Analysis of the National Youth Tobacco Survey. JOURNAL OF DRUG EDUCATION 2020; 49:87-114. [PMID: 33307768 DOI: 10.1177/0047237920980483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We used data from the 2014 National Youth Tobacco Survey to examine patterns of cigarette smoking behavior and tobacco use. In light of the recent upsurge in e-cigarette use, we modeled current use and future intentions to use vape products along with combustible cigarette smoking and other tobacco products (i.e., cigars, cigarillos, chew, snuff, and dip). Latent class analyses indicated four discrete classes of smokers including a nominally involved class with very modest levels of tobacco product use, a class blending e-cigarette and cigars, a class of youth who predominantly use combustible cigarettes, and a group reporting indiscriminate use of almost all tobacco products excluding chew. Tests of invariance in item response probabilities and latent class proportions showed little variation across race and gender, albeit a new class of combustible cigarette and e-cigarette users emerged when examined by grade. Members of the heavy smoking and tobacco use class were more likely to be male, White, and older. Predictors of class membership included expectancies (perceived benefits of use), perceived harm (risk), media exposure, tobacco dependence, and the desire to quit. Findings are discussed in terms of characterizing risk among already smoking youth and how actionable prevention measures can be incorporated into existing universal and indicated programs that target reducing tobacco use and smoking behaviors.
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Affiliation(s)
| | - Martin Komarc
- Department of Kinanthropology and Humanities, Faculty of Physical Education and Sport, Charles University in Prague, Prague, Czech Republic
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12
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Ozga-Hess JE, Romm KF, Felicione NJ, Dino G, Blank MD, Turiano NA. Personality and impulsivity as predictors of tobacco use among emerging adults: A latent class analysis. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020; 163:110076. [PMID: 34321706 PMCID: PMC8313022 DOI: 10.1016/j.paid.2020.110076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The tobacco industry markets their products toward emerging adults (18-29), with the goal of increasing use among this age group. To inform prevention efforts, researchers are investigating how specific demographic and psychological traits may predict tobacco initiation and continuation. Participants were 578 incoming university freshmen from the Appalachian region. Participants provided information on demographics, personality traits, impulsivity characteristics, lifetime use of cigarettes and electronic cigarettes (ECIGs), and current use of cigarettes, ECIGs, small cigars/cigarillos, large cigars, smokeless tobacco, and waterpipe. Latent class analysis identified tobacco-use classes and regressions identified psychological predictors of class membership. Participants were Nonusers, Experimenters, and Polytobacco Users. Lower agreeableness and conscientiousness as well as higher extraversion and neuroticism were associated with being Experimenters or Polytobacco Users. Lower impulsivity was associated with being Nonusers. Distinct types of emerging adults belong to each tobacco use class, suggesting that individual differences be incorporated in prevention efforts.
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Affiliation(s)
| | - Katelyn F. Romm
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | | | - Geri Dino
- WV Prevention Research Center, West Virginia University, Morgantown, WV, USA
- WV Clinical and Translational Sciences Institute, West Virginia University, Morgantown, WV, USA
| | - Melissa D. Blank
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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13
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Schneider KE, Brighthaupt SC, Winiker AK, Johnson RM, Musci RJ, Linton SL. Characterizing profiles of polysubstance use among high school students in Baltimore, Maryland: A latent class analysis. Drug Alcohol Depend 2020; 211:108019. [PMID: 32354578 PMCID: PMC7236476 DOI: 10.1016/j.drugalcdep.2020.108019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Adolescent drug use has long term health consequences, like substance use disorders and psychiatric illnesses. Proximal health risks, especially for overdose, are amplified when multiple substances are combined. Existing literature on polysubstance use among adolescents has largely focused on alcohol, tobacco, and marijuana, but has largely excluded other drugs like opioids. Understanding how adolescents combine illicit drugs is essential for intervening to prevent poor health outcomes. METHODS We aimed to explore patterns of lifetime polysubstance use among adolescents in Baltimore City. We used data on 9th-12th graders recruited to participate in the 2017 local Baltimore Youth Risk Behavior Survey who reported any lifetime drug use (n = 387; 60 % female, 77 % non-Hispanic Black). We then conducted a latent class analysis using 10 indicators of lifetime drug and alcohol use. After selecting the class model, we tested for associations between the class profiles and race, sex, school grade, and lifetime injection drug use. RESULTS We identified three profiles of lifetime polysubstance use in our sample: alcohol and marijuana (68.6 % of sample), polysubstance (22.0 %), and alcohol/pain medication/inhalant use (9.4 %). Members of the polysubstance use class were more likely to be male and to report injection drug use. CONCLUSIONS Understanding broader patterns of drug use beyond alcohol, tobacco and marijuana among adolescents is a crucial step towards preventing adverse drug and health-related outcomes later in life. More research is needed to characterize the full health impact of youth polysubstance use patterns and related risk behaviors like injection drug use.
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Affiliation(s)
- Kristin E Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Sherri-Chanelle Brighthaupt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Abigail K Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Rashelle J Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
| | - Sabriya L Linton
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
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14
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Longitudinal Patterns of Multiple Tobacco and Nicotine Product Use Among Texas College Students: a Latent Transition Analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:1031-1042. [DOI: 10.1007/s11121-019-01031-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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