Is Early Onset of Nonmedical Prescription Stimulant Use Associated With Cocaine Use During Adolescence? Results From a National Study

BACKGROUND

To examine the associations between early onset of nonmedical prescription stimulant use (NPSU) and cocaine use.

METHODS

Nationally representative samples of high school seniors were surveyed annually. Data were collected via self-administered questionnaires in nationally representative public and private schools in the United States (1976-2020) as part of the Monitoring the Future Study. The sample consisted of 45 cohorts of 12th grade students (N = 121 909). The main outcome was lifetime, past-year, and past-month cocaine use.

RESULTS

An estimated one in every 10 (10.1%) individuals reported lifetime NPSU while 8.5% reported any cocaine use. The vast majority of youth (87.2%) initiated NPSU before cocaine among those who reported both substances. Cocaine use was most prevalent among youth who reported early onset of NPSU in 8th grade or earlier (51.7%) followed by those who reported later onset of NPSU in 12th grade (24.7%), and those who never initiated NPSU (3.7%). Binary logistic regression analysis indicated that early onset of NPSU had greater adjusted odds of cocaine use compared to those with later onset of NPSU or those who never reported NPSU. Moreover, the adjusted odds of cocaine use were higher for adolescents who initiated NPSU before or after medical use of prescription stimulants compared to those with no history of medical use or NPSU. Similar results were found for lifetime, past-year, and past-month cocaine use as a function of NPSU onset; this association was stronger among more recent cohorts.

CONCLUSIONS

Early onset of NPSU appears to be a signal of increased risk of cocaine use among US adolescents. NPSU should be included in screening and early prevention strategies among secondary school students. Health professionals, school officials, and families are encouraged to monitor youth for NPSU based on the increased risk of later cocaine use and related consequences.

Attention-Deficit Hyperactivity Disorder Stimulant Therapy and Prescription Drug Misuse During Transition to Young Adulthood

OBJECTIVE

Limited prospective data exist about the impact of stimulant therapy for attention-deficit hyperactivity disorder (ADHD) during adolescence on the risk for later prescription drug misuse (PDM; i.e., of benzodiazepines, opioids, and stimulants).

METHODS

National longitudinal multicohort panels (baseline cohort years 2005-2017) of U.S. 12th grade students (N=11,066; ages 17 and 18 years) from the Monitoring the Future study were surveyed via self-administered questionnaires and followed up biennially during young adulthood (ages 19-24). A multivariable analysis was used to assess whether adolescents' lifetime history of stimulant therapy for ADHD was associated with subsequent PDM.

RESULTS

Overall, 9.9% of adolescents reported lifetime stimulant therapy for ADHD at ages 17 and 18. No significant differences were found in the adjusted odds of later incidence or prevalence of past-year PDM during young adulthood between adolescents with lifetime stimulant therapy and adolescents with no stimulant therapy. Over the 5-year follow-up, past-year PDM during young adulthood was most prevalent among adolescents who reported both stimulant therapy and prescription stimulant misuse (53.1%) and those who reported prescription stimulant misuse only (51.5%). Compared with adolescents in a control group without lifetime stimulant therapy or misuse, adolescents reporting prescription stimulant misuse had significantly higher adjusted odds of later incidence and prevalence of PDM during young adulthood.

CONCLUSIONS

Adolescents' stimulant therapy for ADHD was not significantly associated with increased risk for later PDM during young adulthood. In contrast, adolescents' misuse of prescription stimulants strongly predicted later PDM. Monitoring adolescents for prescription stimulant misuse may help identify and mitigate the risk for future PDM.

Is age of onset and duration of stimulant therapy for ADHD associated with cocaine, methamphetamine, and prescription stimulant misuse?

BACKGROUND

To assess whether age of onset and duration of stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) are associated with cocaine, methamphetamine, and prescription stimulant misuse during adolescence.

METHODS

Nationally representative samples of US 10th and 12th grade students (N = 150,395) from the Monitoring the Future study were surveyed via self-administered questionnaires from 16 annual surveys (2005-2020).

RESULTS

An estimated 8.2% of youth received stimulant therapy for ADHD during their lifetime (n = 10,937). More than one in 10 of all youth reported past-year prescription stimulant misuse (10.4%)-past-year cocaine (4.4%) and methamphetamine (2.0%) use were less prevalent. Youth who initiated early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years) did not have significantly increased adjusted odds of cocaine or methamphetamine use relative to population controls (ie, non-ADHD and unmedicated ADHD youth). Youth who initiated late stimulant therapy for ADHD (≥10 years old) and for short duration (<1 year) had significantly higher odds of past-year cocaine or prescription stimulant misuse in adolescence than those initiating early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years). Youth who initiated late stimulant therapy for ADHD (≥10 years) for short duration (<1 year) had significantly higher odds of past-year cocaine, methamphetamine, and prescription stimulant misuse versus population controls during adolescence. No differences in past-year cocaine, methamphetamine, and prescription stimulant misuse were found between individuals who only used non-stimulant therapy for ADHD relative to youth who initiated early stimulant therapy (≤9 years old) and for long duration (≥6 years).

CONCLUSIONS

An inverse relationship was found between years of stimulant therapy and illicit and prescription stimulant misuse. Adolescents with later initiation and/or shorter duration of stimulant treatment for ADHD should be monitored for potential illicit and prescription stimulant misuse.

Transitions in Prescription Benzodiazepine Use and Misuse and in Substance Use Disorder Symptoms Through Age 50

OBJECTIVE

Prescription benzodiazepines are among the most commonly used and misused controlled medications. The authors aimed to examine transitions from medical use of prescription benzodiazepines to prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms during adulthood.

METHODS

Eleven national cohorts of U.S. 12th graders (N=26,575) were followed up from ages 18 (1976-1986) to 50 (2008-2018). Prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms were examined with prevalence estimates and multivariable logistic regression.

RESULTS

By age 35, 70.9% of respondents had not used or misused prescription benzodiazepines, 11.3% reported medical use only, 9.8% indicated both medical use and misuse, and 14.1% reported misuse only. In analyses adjusted for demographic and other characteristics, adults reporting only medical use of prescription benzodiazepines by age 35 had higher odds of later prescription benzodiazepine misuse (adjusted OR [AOR]=2.17, 95% CI=1.72-2.75) and prescription opioid misuse (AOR=1.40, 95% CI=1.05-1.86) than respondents ages 35-50 who never used prescription benzodiazepines. More frequent medical use of prescription benzodiazepines by age 35 was associated with increased risk for substance use disorder symptoms at ages 40-50. Any history of prescription benzodiazepine misuse by age 35 was associated with higher odds of later prescription benzodiazepine misuse, prescription opioid misuse, and substance use disorder symptoms, compared with no misuse.

CONCLUSIONS

Prescription benzodiazepine use or misuse may signal later prescription drug misuse or substance use disorders. Medical use of prescription benzodiazepines by age 35 requires monitoring for prescription drug misuse, and any prescription benzodiazepine misuse warrants an assessment for substance use disorder.

Age 18-30 trajectories of binge drinking frequency and prevalence across the past 30 years for men and women: Delineating when and why historical trends reversed across age

Historical analyses based on US data indicate that recent cohorts engage in lower binge drinking at age 18 relative to past cohorts, but by the mid- to late-20s the reverse is true: recent cohorts engage in higher binge drinking relative to past cohorts. We pinpoint when - both developmentally and historically - this reversal manifested, examine possible reasons for this reversal, and examine sex convergence in these developmental and historical patterns. As part of the US national Monitoring the Future Study, over 75,000 youths from the high school classes of 1976-2006 were surveyed biennially between ages 18 and 30. We found that the reversal primarily manifested between ages 18 and 24 for men and 18 and 22 for women. We also found that the reversal emerged gradually across the last three decades, suggesting it is the result of a broad and durable historical shift. Our findings indicated that historical variation in social roles and minimum legal drinking age collectively accounted for only a modest amount of the reversal, although marriage was the most influential among the factors examined here. Finally, we found evidence that sex convergence in binge drinking was developmentally limited and far more pronounced at the beginning of the transition to adulthood.

Cocaine or Methamphetamine Use During Young Adulthood Following Stimulant Use for Attention-Deficit/Hyperactivity Disorder During Adolescence

Importance

The prescribing of stimulant medications for attention-deficit/hyperactivity disorder (ADHD) has increased in the US. Prescription stimulants are one of the most commonly misused controlled substances during adolescence. Despite a 10-fold increase in stimulant-related overdose deaths in the past decade, the transitions from prescription stimulants to illicit stimulants (eg, cocaine, methamphetamine) remain relatively unknown in longitudinal population-based studies.

Objective

To determine the longitudinal transitions from adolescents' prescription stimulant exposure (ie, stimulant therapy for ADHD and prescription stimulant misuse [PSM]) to later cocaine and methamphetamine use during young adulthood.

Design, Setting, and Participants

National longitudinal multicohort panels of US 12th grade public and private school students in the coterminous US were assessed annually (baseline cohort years 2005-2017 [between March and June]) and followed up across 3 waves over a 6-year period to 23 to 24 years of age (follow-up years 2011-2021 [between April and October]).

Exposure

History of self-reported stimulant therapy for ADHD at baseline.

Main Outcomes and Measures

Incidence and prevalence of past-year use of cocaine and methamphetamine during young adulthood (19-24 years of age).

Results

Among 5034 students enrolled at baseline (2589 [52.0%] female), 470 (10.2% [95% CI, 9.4%-11.2%]) reported use of stimulant therapy for ADHD, 671 (14.6% [95% CI, 13.5%-15.6%]) reported PSM only, and 3459 (75.2% [95% CI, 73.9%-76.4%]) reported neither (and served as population controls). In controlled analyses, there were no statistically significant differences between adolescents who reported stimulant therapy for ADHD at baseline compared with population controls in the adjusted odds of transitioning to later cocaine or methamphetamine initiation or use during young adulthood (19-24 years of age). In contrast, PSM during adolescence in those not treated with stimulants for ADHD had significantly higher odds of transitioning to later cocaine or methamphetamine initiation and use during young adulthood compared with population controls (adjusted odds ratio, 2.64 [95% CI, 1.54-4.55]).

Conclusions and Relevance

In this multicohort study, adolescents' stimulant therapy for ADHD was not associated with increased risk of later cocaine and methamphetamine use during young adulthood. Adolescents' prescription stimulant misuse offered a signal for subsequent cocaine or methamphetamine use and warrants monitoring and screening.

Prescription Stimulant Medical and Nonmedical Use Among US Secondary School Students, 2005 to 2020

Importance

Recent information on the prevalence of prescription stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) and nonmedical use of prescription stimulants (NUPS) at the school-level among US secondary school students is limited.

Objective

To investigate the school-level prevalence of and association between stimulant therapy for ADHD and NUPS among US secondary school students.

Design, Setting, and Participants

This cross-sectional study used survey data collected between 2005 and 2020 as part of the Monitoring the Future study (data collected annually via self-administered survey in schools from independent cohorts). Participants were from a nationally representative sample of 3284 US secondary schools. The mean (SD) response rates were 89.5% (1.3%) for 8th-grade students, 87.4% (1.1%) for 10th-grade students, and 81.5% (1.8%) for 12th-grade students. Statistical analysis was performed from July to September 2022.

Main Outcome and Measure

Past-year NUPS.

Results

The 3284 schools contained 231 141 US 8th-, 10th-, and 12th-grade students (111 864 [50.8%, weighted] female; 27 234 [11.8%, weighted] Black, 37 400 [16.2%, weighted] Hispanic, 122 661 [53.1%, weighted] White, 43 846 [19.0%, weighted] other race and ethnicity). Across US secondary schools, the past-year prevalence of NUPS ranged from 0% to more than 25%. The adjusted odds of an individual engaging in past-year NUPS were higher at secondary schools with higher proportions of students who reported stimulant therapy for ADHD, after controlling for other individual-level and school-level covariates. Students attending schools with the highest rates of prescription stimulant therapy for ADHD had approximately 36% increased odds of past-year NUPS compared with students attending schools with no medical use of prescription stimulants (adjusted odds ratio, 1.36; 95% CI, 1.20-1.55). Other significant school-level risk factors included schools in more recent cohorts (2015-2020), schools with higher proportions of parents with higher levels of education, schools located in non-Northeastern regions, schools located in suburban areas, schools with higher proportion of White students, and schools with medium levels of binge drinking.

Conclusions and Relevance

In this cross-sectional study of US secondary schools, the prevalence of past-year NUPS varied widely, highlighting the need for schools to assess their own students rather than relying solely on regional, state, or national results. The study offered new evidence of an association between a greater proportion of the student body that uses stimulant therapy and a greater risk for NUPS in schools. The association between greater school-level stimulant therapy for ADHD and other school-level risk factors suggests valuable targets for monitoring, risk-reduction strategies, and preventive efforts to reduce NUPS.

Type of medication therapy for ADHD and stimulant misuse during adolescence: a cross-sectional multi-cohort national study

Background

Attention-deficit/hyperactivity disorder (ADHD) is associated with higher substance use rates. Stimulant and non-stimulant pharmacotherapy improve adolescent ADHD, but their associations with prescription stimulant misuse (PSM), cocaine, and methamphetamine use are unclear. Using 2005-2020 US Monitoring the Future data, we investigated relationships between ADHD pharmacotherapy history and PSM, cocaine, or methamphetamine use.

Methods

Secondary students (13-19 years) provided data on pharmacotherapy history (N = 199,560; 86.3% of total sample) between January 1, 2005 and May 31, 2020 in a cross-sectional multi-cohort study; weights assured a nationally representative sample. Participants were grouped by ADHD pharmacotherapy history: none (88.7%; principally non-ADHD controls); stimulant-only (5.8%); non-stimulant-only (3.3%); both stimulant and non-stimulant (2.1%). Outcomes were past-year PSM, cocaine, and methamphetamine use. Logistic regressions examined relationships between pharmacotherapy history and outcomes, controlling for sociodemographics, recent substance use, and stimulant treatment cessation.

Findings

Past-year outcome rates were lowest in adolescents with no pharmacotherapy history: 4.7% for PSM [8310/174,561], 1.6% for cocaine [2858/174,688], and 0.7% for methamphetamine [1036/148,378]. A history of both stimulant and non-stimulant treatment was associated with the highest rates: 22.3% for PSM [940/4098], 10.4% for cocaine [450/4110], and 7.8% for methamphetamine [275/3427]. Adolescents who received monotherapy (stimulant- or non-stimulant-only) had intermediate rates, with no differences between monotherapy groups.

Interpretation

While elevated PSM and illicit stimulant use rates are likely influenced by ADHD, our findings suggested adolescents with a history of both stimulant and non-stimulant pharmacotherapy are at highest risk for these stimulant outcomes. Adolescents receiving ADHD pharmacotherapy should be monitored for PSM and illicit stimulant use.

Funding

National Institute on Drug Abuse/National Institutes of Health (USA) and Food and Drug Administration (USA).

The Initiation and Developmental Course of Prescription Drug Misuse Among High School Athletes During the Transition Through Young Adulthood

The objective of this study was to examine the extent to which involvement in high-contact, semicontact, or noncontact sports during the 12th grade is associated with the initiation and developmental course of prescription drug misuse (PDM) between ages 17/18 years and 27/28 years. Data were collected from a national multicohort panel sample of US 12th-graders (cohorts 2006-2017; n = 4,772) from the Monitoring the Future Study who were followed for a decade, through age 27/28 years. Approximately 31% of high school seniors indicated PDM at baseline (age 17/18 years). While past-year PDM remained relatively stable between ages 17/18 years and 27/28 years, participation in both noncontact (adjusted odds ratio = 1.40, 95% confidence interval: 1.02, 1.91) and contact (adjusted odds ratio = 1.57, 95% confidence interval: 1.08, 2.28) sports in the 12th grade increased the odds of initiating prescription stimulant misuse during the 10 years following high school as compared with respondents who did not participate in these types of sports in the 12th grade. To our knowledge, this is the first national study to have assessed how sports participation during high school is associated with the initiation and developmental course of PDM from adolescence to young adulthood. These findings reinforce the need for PDM screening during adolescence, as nearly 1 in 3 high school seniors engage in PDM. Increased prescription stimulant misuse following high school warrants ongoing monitoring during young adulthood, especially among athletes.

An empirical evaluation of alternative approaches to adjusting for attrition when analyzing longitudinal survey data on young adults' substance use trajectories

OBJECTIVES

Longitudinal survey data allow for the estimation of developmental trajectories of substance use from adolescence to young adulthood, but these estimates may be subject to attrition bias. Moreover, there is a lack of consensus regarding the most effective statistical methodology to adjust for sample selection and attrition bias when estimating these trajectories. Our objective is to develop specific recommendations regarding adjustment approaches for attrition in longitudinal surveys in practice.

METHODS

Analyzing data from the national U.S. Monitoring the Future panel study following four cohorts of individuals from modal ages 18 to 29/30, we systematically compare alternative approaches to analyzing longitudinal data with a wide range of substance use outcomes, and examine the sensitivity of inferences regarding substance use prevalence and trajectories as a function of college attendance to the approach used.

RESULTS

Our results show that analyzing all available observations in each wave, while simultaneously accounting for the correlations among repeated observations, sample selection, and attrition, is the most effective approach. The adjustment effects are pronounced in wave-specific descriptive estimates but generally modest in covariate-adjusted trajectory modeling.

CONCLUSIONS

The adjustments can refine the precision, and, to some extent, the implications of our findings regarding young adult substance use trajectories.

Alcohol use and the COVID-19 pandemic: Historical trends in drinking, contexts, and reasons for use among U.S. adults

Objective

The current study used U.S. national data to examine drinking trends prior to and during the COVID-19 pandemic in 2020, focusing on changes in U.S. young- and middle-adult alcohol prevalence, frequency, and drinking contexts and reasons, and whether they differed by age and college status.

Methods

Data from 2015 to 2020 from 16,987 young adults (ages 19–30) and 23,584 middle adults (ages 35–55) in the national Monitoring the Future study were used to model historical trends and potential 2020 shifts (data collection April 1 to November 30, 2020) in prevalence (30-day, daily, binge drinking) and frequency (30-day, binge drinking). For young adults, data on drinking contexts and negative affect reasons for drinking were examined. Moderation by age and college status was also tested.

Results

2020 was associated with (1) downward deviation in 30-day (young and middle adults) and binge drinking (young adults) prevalence; (2) upward deviation in daily drinking prevalence (middle adults); (3) among drinkers, upward deviation in frequency of 30-day (young and middle adults) and binge drinking (young adults); and (4) changes in drinking contexts and reasons among drinkers. Among college students, in particular, 2020 was associated with a downward deviation from expected historical trends in drinking prevalence. Upward deviations in daily prevalence and both binge and 30-day drinking frequency were stronger at ages 25–30 (vs. 19–24) and 35–45 (vs. 50–55).

Conclusions

Among U.S. young and middle adults, deviations from expected historical trends in population alcohol use that occurred during the pandemic included decreases in alcohol use prevalence, increases in alcohol use frequency, and increases in the use of alcohol to relax/relieve tension and because of boredom. These shifts were likely due, in part, to drinking while alone and at home—which increased during the pandemic.

Trajectories of prescription opioid and heroin use in adulthood

BACKGROUND AND OBJECTIVES

Due to a reduction in the availability of prescription opioids in the United States, the potential transition from prescription opioids to heroin is a public health concern. We assessed trajectories of both nonmedical prescription opioid (NMPO) and heroin use from adolescence (age 18) to adulthood (age 50) and how these trajectories were associated with substance use disorder (SUD) in adulthood (age 35-50).

METHODS

A national sample of 26,569 individuals from eleven cohorts of US high school seniors (1976-1986) who were followed until age 50 (2008-2018). The analysis focuses on respondents who engaged in past-year NMPO and heroin use. Outcomes included the endorsement of two or more SUD symptoms.

RESULTS

Among NMPO users, 7.5% had used heroin by the age of 50. The latent profile analyses assessing individuals who reported both NMPO and heroin use during the 32-year study period found four unique trajectory groups: (1) "age 18 concurrent use" (81.2%); (2) "mid-30s NMPO-to-heroin use transition" (10.7%); (3) age 19/20 NMPO-to-heroin use transition, followed by 40s heroin-to-NMPO use transition (4.3%); and (4) "mid-20s NMPO-to-heroin use transition" (3.7%). Respondents in the "mid-30s NMPO-to-heroin use transition" trajectory group had the highest odds of indicating two or more SUD symptoms between ages 35-50.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

This is the first study to assess NMPO and heroin use trajectories among a national probability-based sample followed from age 18 to 50. The findings suggest that prescription opioid misuse is a risk factor in the development of SUDs and has a long-term impact.

Longitudinal Analysis of Substance Use Disorder Symptom Severity at Age 18 Years and Substance Use Disorder in Adulthood

IMPORTANCE

Although more than 1 in every 3 US individuals will develop a substance use disorder (SUD) in their lifetime, relatively little is known about the long-term sequelae of SUD symptoms from adolescence through adulthood.

OBJECTIVE

To evaluate the longitudinal associations between adolescents' SUD symptom severity with later medical use of prescription drugs (ie, opioids, sedatives, and tranquilizers), prescription drug misuse (PDM), and SUD symptoms at ages 35 to 50 years.

DESIGN, SETTING, AND PARTICIPANTS

Eleven cohorts of US 12th grade students were followed longitudinally from age 18 years (1976-1986) to age 50 years (2008-2018) in the Monitoring the Future (MTF) study. Baseline surveys were self-administered in classrooms, and follow-ups were conducted by mail. Data were analyzed from June 2021 to February 2022.

EXPOSURE

Response to MTF study between 1976 and 2018.

MAIN OUTCOMES AND MEASURES

Sociodemographic variables were measured at baseline. All bivariate and multivariate analyses use attrition weights to adjust for attrition by age 50 years within the sample. SUD symptoms, prescription drug use, and PDM were measured at baseline and every follow-up.

RESULTS

The sample of 5317 individuals was 51.2% female (2685 participants; 95% CI, 49.6%-52.6%) and 77.9% White (4222 participants; 95% CI, 77.6%-79.1%). Participants were surveyed beginning at age 18 years and ending at age 50 years. The baseline response rate ranged from 77% to 84%, and the 32-year retention rate was 53%. Most adolescents with most severe SUD symptoms at age 18 years had 2 or more SUD symptoms in adulthood (316 participants [61.6%]; 95% CI, 55.7%-66.9%), and this association held for baseline alcohol, cannabis, and other drug use disorder symptoms. Adolescents with the highest SUD symptom severity at age 18 years had the highest adjusted odds of prescription drug use and PDM in adulthood (4-5 symptoms, adjusted odds ratio, 1.56; 95% CI, 1.06-2.32; ≥6 symptoms, adjusted odds ratio, 1.55; 95% CI, 1.11-2.16). The majority of adults using prescribed opioids, sedatives, or tranquilizers (568 participants [52.2%]; 95% CI, 48.4%-55.9%) in the past year had multiple SUD symptoms at age 18 years.

CONCLUSIONS AND RELEVANCE

These findings suggest that most adolescents with severe SUD symptoms do not transition out of symptomatic substance use, and the long-term sequelae for adolescents with more severe SUD symptoms are more deleterious than those for adolescents with no or low severity. Prescribers should be aware that many adults prescribed opioids, sedatives, or tranquilizers had multiple SUD symptoms during adolescence and require careful assessment and monitoring.

The destabilization and destandardization of social roles across the adult life course: Considering aggregate social role instability and its variability from a historical-developmental perspective

Existing research focused on social role destabilization (historical increases in role instability) and destandardization (historical increases in variability of role instability) has primarily focused on discrete social roles during discrete periods of development. Building on this work, we applied a macro approach to elucidate the extent to which historical trends toward destabilization and destandardization are occurring at the aggregate among a key set of social roles (union formation, education, residential independence, and employment) and across the whole of adulthood. Applying a historical-developmental approach, we also document how historical trends toward destabilization and destandardization vary by age. We used 3 historical, longitudinal data sets: the Monitoring the Future study (N = 69,464; 55.4% women; 75.5% white), the Panel Study of Income Dynamics (N = 45,001; 51.4% women; 54.3% white), and The Health and Retirement Study (N = 30,913; 53.6% women; 75.6% white) that collectively cover the entire adult life course and over a century of U.S. birth cohorts. We found that aggregate destabilization and destandardization have occurred across the entirety of adulthood, although trends appear more pronounced at either end of the adult life course and the specific roles driving both trends vary across the adult life course. Findings were robust for educational attainment, and destabilization and destandardization were more pronounced among women. Findings highlight the importance of considering social role changes at the aggregate and singularly, and the need to evaluate social role changes in any 1 period of adulthood in conjunction with those occurring in other periods of adulthood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Building on a Sequential Mixed-Mode Research Design in the Monitoring the Future Study

Given the promise of the web push plus e-mail survey design for providing cost-effective and high-quality data (Patrick et al. 2018, 2019) as an alternative to a paper-and-pencil mailed survey design for the longitudinal Monitoring the Future (MTF) study, the current study sought to further enhance the web push condition. The MTF sample is based on US nationally representative samples of 12th grade students surveyed annually. The MTF control group for the current study included participants who completed the in-school baseline survey in the 12th grade and were selected to participate in their first follow-up survey in 2017 via mailed surveys (N = 1,222). A supplementary sample (N = ∼2,450) was assigned to one of the two sequential mixed-mode conditions. Those in condition 1 (N = 1,198), or mail push, were invited to complete mailed surveys and later given a web survey option. Those in condition 2 (N = 1,173), or enhanced web push, were invited to complete a web survey (the same as in the 2014 study, but with the addition of text messages and quick response (QR) codes and the web survey was optimized for mobile devices) and then later given a mailed survey option. Research aims were to examine response rates across conditions, as well as how responses were distributed across mode (paper, web), devices (computer, smartphone, table), and method of accessing the web survey (hand-entered URL, QR code, e-mail link, SMS link). Response rates differed significantly: the MTF control group was 34.2 percent, mail push was 35.4 percent, and enhanced web push was 42.05 percent. The higher response rate in the enhanced web push condition suggests that the additional strategies were effective at bringing in more respondents. Key estimates produced by the enhanced web push condition did not differ from those of the MTF control group.

Trajectories of Prescription Drug Misuse Among US Adults From Ages 18 to 50 Years

Importance

US adults born from 1965 to 1996 had high exposure to controlled medications, yet little is known about how this exposure has affected them over time. Prescription drug misuse (PDM) has increased among adults in the past 2 decades, with related increases in emergency department visits, overdoses, and deaths.

Objectives

To identify 32-year PDM trajectories involving opioids, stimulants, and sedatives or tranquilizers and to examine associations between these PDM trajectories and substance use disorder (SUD) symptoms in adulthood as well as between baseline characteristics and PDM trajectories.

Design, Setting, and Participants

This cohort study included 11 cohorts of adolescents who were followed up longitudinally from age 18 years (study start, 1976-1986) to age 50 years (2008-2018) in the Monitoring the Future (MTF) study, which included a national multistage random sample of US 12th grade students. Baseline surveys (modal age 18) were self-administered in classrooms. Ten follow-ups were conducted by mail. Data analysis was conducted from December 2020 to October 2021.

Main Outcomes and Measures

Sociodemographic variables were measured at baseline. PDM and SUD symptoms were measured at baseline and every follow-up. Latent profile analysis (LPA) was used to create PDM trajectory profiles. Associations between these PDM trajectories, SUD symptoms, and baseline sociodemographic characteristics were examined.

Results

The sample of 26 575 individuals was 50.8% (95% CI, 50.2%-51.4%) female and 79.3% (95% CI, 78.8%-79.8%) White. The baseline response rate ranged from 77% to 84%, and the 32-year retention rate was 53%. In adjusting for attrition, 45.7% (95% CI, 44.9%-46.4%) of the respondents reported past-year PDM at least once during the 32-year reporting period. Among those who reported PDM, the prevalence of poly-PDM was 40.3% (95% CI, 39.3%-41.3%). Based on LPA, the number of class-specific PDM trajectories ranged from 4 (prescription opioids) to 6 (prescription stimulants). For the class-combined analyses, we identified 8 PDM trajectories consisting of early peak trajectories (eg, age 18 years), later peak trajectories (eg, age 40 years), and a high-risk trajectory (eg, high frequency PDM at multiple ages). All PDM trajectories were associated with increased odds of developing SUD symptoms in middle adulthood, especially the later peak and high-risk trajectories compared with early peak trajectories (eg, peak at age 40 years: adjusted odds ratio [aOR], 5.17; 95% CI, 3.97-6.73; high-risk: aOR, 12.41; 95% CI, 8.47-18.24). Baseline characteristics associated with a high-risk trajectory were binge drinking (aOR, 1.69; 95% CI, 1.13-2.54), cigarette smoking (aOR, 2.30; 95% CI, 1.60-3.29), and marijuana use (aOR, 3.78; 95% CI, 2.38-6.01). More recent cohorts (eg, 1985-1986) had a higher risk of belonging to later peak PDM trajectories (ages 40 and 45 years) than the 1976-1978 cohort (age 40 years peak: aOR, 2.49; 95% CI, 1.69-3.68).

Conclusions and Relevance

In this cohort study, adults with later peak PDM trajectories were at increased risk of SUD symptoms in middle adulthood. These findings suggest the need to screen for PDM and SUD from adolescence through middle adulthood.

Cohort and age trends in age 35-45 prevalence of alcohol use disorder symptomology, by severity, sex, race, and education

AIMS

To present national trends by age and cohort among middle-aged adults in the prevalence of AUD symptomology, by severity, sex, race, and education.

DESIGN

National, multi-cohort longitudinal probability samples of US adults, with data collected at ages 35, 40, and 45 among 14 cohorts who reached age 45 between 2003 and 2016.

SETTING

Data were collected via self-administered questionnaires to adults in the United States.

PARTICIPANTS

The sample consisted of 20,634 individuals.

MEASUREMENTS

5-year prevalence of symptoms consistent with a DSM-5 AUD.

FINDINGS

Between ages 35-45 prevalence of any AUD symptoms decreased 19 %; decreases were most evident between ages 35-40. From 2003 to 2016, AUD symptoms were steady across cohort. However, because the pace of decrease across ages 35-45 slowed across cohort, cohort differences emerged at specific ages: age 35 prevalence decreased 18 % across cohort, but age 45 prevalence was equivalent across cohort. Age and cohort effects, and their interaction, did not vary by AUD severity level. Declines in AUD symptoms across age were 17 % slower for women, and declines in AUD symptoms across age and cohort were 11 % and 29 % slower, respectively, for those with a college degree. The protection afforded by a college degree was reversed among mild AUD and most pronounced for severe AUD.

CONCLUSIONS

AUDs may be more plastic and responsive to intervention during early mid-life than later. Despite progress in reducing the burden of AUD in the US population among younger middle-aged adults, an increased focus remains necessary as they continue to age.

Negative evaluation of role transitions is associated with perceived stress and alcohol consequences: Examination of the Transitions Overload Model in young adulthood using two years of monthly data

BACKGROUND

Young adulthood is characterized by transitions into and out of social roles in multiple domains. Consistent with self-medication models of alcohol use, the Transitions Overload Model (J Stud Alcohol Suppl, 14, 2002, 54) hypothesizes that one cause of increased alcohol use during young adulthood may be the stress of navigating simultaneous role transitions. This study examined the simultaneous occurrence of major developmental role transitions in the domains of education, employment, romantic relationships, and residential status and their associations with perceived stress, heavy episodic drinking (HED), and negative alcohol-related consequences. Further, we extended the Transitions Overload Model to explore whether the number of transitions rated as having a negative impact on one's life was related to perceived stress, HED, and alcohol-related consequences.

METHODS

A community sample of young adult drinkers (N = 767, 57% women, ages 18 to 25 years) in the Pacific Northwest provided monthly data across 2 years. Multilevel models were used to assess the average (between-person) and month-to-month (within-person) associations of role transitions with perceived stress, HED, and negative alcohol-related consequences.

RESULTS

Although having more role transitions was positively associated with HED frequency and alcohol-related consequences at both the between- and within-person (monthly) levels, it was not associated with increased stress. The number of transitions rated as having a negative impact on one's life, however, was positively associated with stress. Thus, rather than the total number of transitions, it is the number of negatively perceived major developmental role transitions that is associated with perceived stress and increased risk for negative alcohol-related consequences.

CONCLUSIONS

Contrary to Transitions Overload Model assumptions, more transitions were not a significant predictor of more perceived stress; rather, the evaluation of the transition as negative was associated with stress and negative alcohol-related outcomes. This distinction may help elucidate the etiology of stress and subsequent alcohol consequences and identify individuals at-risk of these effects.

Trends in the Prevalence of Concussion Reported by US Adolescents, 2016-2020

This study analyzes the increased incidence of concussion among US teens.

Boredom by Sensation-Seeking Interactions During Adolescence: Associations with Substance Use, Externalizing Behavior, and Internalizing Symptoms in a US National Sample

During adolescence, sensation seeking is linked to several adverse outcomes including substance use, risk taking, and psychopathology. Recent empirical interest in the construct of boredom has revealed that some similar associations may exist for boredom during adolescence. Both boredom and sensation seeking peak during adolescence, and yet, research on boredom and its interaction with sensation seeking are limited. In a multi-cohort, US nationally representative sample of 8th and 10th grade students from the monitoring the future study, latent-moderated structural equation modeling was used to estimate the association of boredom, sensation seeking, and their interaction, to substance use, externalizing behavior, and depressive affect. Moderation by gender was also tested. Boredom and sensation seeking were both significantly associated with most dependent variables. Significant interaction effects were found wherein individuals high on both boredom and sensation seeking reported the highest levels of depressive affect and externalizing behavior. There were no significant interaction effects for substance use indices. Gender moderation was found for depressive affect. The results of this study demonstrate the generalizability of boredom associations and the significance of boredom by sensation-seeking interactions across multiple mental health domains during adolescence. Prevention efforts that attend to both boredom and sensation seeking may be particularly effective for promoting mental health and preventing externalizing behavior.

Transitions Catalyst Model: Testing within- and between-Person Associations between Social Relationships and Alcohol Use, Motives, and Consequences among Young Adults

Background: The Transitions Catalyst Model suggests increased drinking during young adulthood is due to the notion that alcohol facilitates friendships and romantic/sexual relationships during a developmental period when these relationships are highly valued. However, little research has tested the utility of this model. We examined (1) whether young adults reported greater drinking and related consequences on months when friendships were more important to them or when they were dating casually, and (2) the extent to which social drinking motives explain these associations on a given month. Methods: Data were drawn from 752 young adults (ages 18-23 at screening) living in the Seattle, WA area (56.4% female). For 24 consecutive months, surveys assessed past month alcohol use and consequences, social drinking motives, friendship importance, and dating/relationship status. Bayesian multilevel models were conducted, adjusting for time-fixed and time-varying covariates. Results: Analyses included 11,591 monthly observations. Between-persons, greater average friendship importance was associated with greater drinking. On months when participants reported greater friendship importance than their own average, they reported greater drinking and alcohol consequences. Those who reported more months of casual dating reported greater drinking and consequences on average. Relative to casual dating months, participants reported less drinking during months they were single or in a relationship and fewer consequences during months in a relationship. Associations were partially accounted for by social motives. Discussion: Findings support the Transitions Catalyst Model. Effective strategies for reducing drinking and associated risks among young adults include brief interventions focused on how social drinking motives and relationships relate to drinking decisions.

Key Subgroup Differences in Age-Related Change From 18 to 55 in Alcohol and Marijuana Use: U.S. National Data

OBJECTIVE

This study examined age-related change in alcohol use, marijuana use, and the association between the two, from ages 18 to 55, in a national longitudinal sample.

METHOD

Data were from national Monitoring the Future study participants (N = 11,888) who were high school seniors in 1976-1980 and were eligible to respond to the age 55 survey in 2013-2017. Time-varying effect modeling was used to model past-30-day prevalence and associations between alcohol and marijuana across ages 18-55, overall and by sex, race/ethnicity, and college attendance.

RESULTS

Marijuana prevalence peaked at age 18 and was lowest in the late 40s; alcohol prevalence peaked at age 22 and was lowest in the early 40s. Associations between alcohol and marijuana use were strongest at age 18. Significant differences were observed by sex, race/ethnicity, and college attendance (e.g., women's use was lower and decreased faster in the late 30s than men's; White respondents' alcohol and marijuana use were higher and peaked before Black respondents'; compared with non-attenders, college attenders' use was higher for alcohol but lower for marijuana). The alcohol and marijuana use association was strongest at ages 18-20 for most subgroups, except Black respondents, for whom the association was strongest at age 30.

CONCLUSIONS

Longitudinal data showed patterns of alcohol and marijuana use across adulthood. Such patterns highlight sociodemographic risk factors across the life span, ages that should be targeted for clinician awareness and intervention efforts, and populations at particular risk of harm from alcohol and marijuana co-use during adulthood.

Key Subgroup Differences in Age-Related Change From 18 to 55 in Alcohol and Marijuana Use: U.S. National Data

OBJECTIVE

This study examined age-related change in alcohol use, marijuana use, and the association between the two, from ages 18 to 55, in a national longitudinal sample.

METHOD

Data were from national Monitoring the Future study participants (N = 11,888) who were high school seniors in 1976-1980 and were eligible to respond to the age 55 survey in 2013-2017. Time-varying effect modeling was used to model past-30-day prevalence and associations between alcohol and marijuana across ages 18-55, overall and by sex, race/ethnicity, and college attendance.

RESULTS

Marijuana prevalence peaked at age 18 and was lowest in the late 40s; alcohol prevalence peaked at age 22 and was lowest in the early 40s. Associations between alcohol and marijuana use were strongest at age 18. Significant differences were observed by sex, race/ethnicity, and college attendance (e.g., women's use was lower and decreased faster in the late 30s than men's; White respondents' alcohol and marijuana use were higher and peaked before Black respondents'; compared with non-attenders, college attenders' use was higher for alcohol but lower for marijuana). The alcohol and marijuana use association was strongest at ages 18-20 for most subgroups, except Black respondents, for whom the association was strongest at age 30.

CONCLUSIONS

Longitudinal data showed patterns of alcohol and marijuana use across adulthood. Such patterns highlight sociodemographic risk factors across the life span, ages that should be targeted for clinician awareness and intervention efforts, and populations at particular risk of harm from alcohol and marijuana co-use during adulthood.

Comparison of a web-push survey research protocol with a mailed paper and pencil protocol in the Monitoring the Future panel survey

AIMS

The experiment tested the effects of a web-push survey research protocol, compared with the standard mailed paper-and-pencil protocol, among young adults aged 19-30 years in the 'Monitoring the Future' (MTF) longitudinal study.

DESIGN, SETTING AND PARTICIPANTS

The US-based MTF study has measured substance use trends among young adults in panel samples followed biennially, using consistent mailed survey procedures from 1977 to 2017. In 2018, young adult participants in the MTF longitudinal component scheduled to be surveyed at ages 19-30 in 2018 (from high school senior cohorts of 2006-17, n = 14 709) were randomly assigned to receive the standard mail/paper survey procedures or new web-push procedures.

MEASUREMENTS

Primary outcomes were responding to the survey and prevalence estimates for past 30-day use of alcohol, cigarettes, marijuana and illicit drugs.

FINDINGS

The web-push response rate was 39.07% [95% confidence interval (CI) = 37.889, 40.258]; this was significantly better than the standard MTF response rate of 35.12% (95% CI = 33.964, 36.285). After adjusting for covariates, the web-push condition was associated with a 19% increase in the odds of responding compared with standard MTF (adjusted odds ratio = 1.188; 95% CI = 1.096, 1.287). Substance use prevalence estimates were very similar and differences became negligible when using attrition weights and controlling for socio-demographic characteristics.

CONCLUSIONS

The web-push protocol produced a higher response rate than the mailed pencil and paper protocol in the Monitoring the Future panel study, without substantially affecting estimates of substance use once attrition weights and socio-demographic variables were factored in.

Civic development across the transition to adulthood in a national U.S. sample: Variations by race/ethnicity, parent education, and gender

Despite a growing understanding about civic development, we know little about whether the developmental course of civic engagement is the same across different types of civic engagement or different groups of youth. To advance developmental science in this area, we documented age-related change in community service, political interest, electoral participation, and political voice across the transition to adulthood by race/ethnicity, parent education, gender, and their interactions. National multicohort probability samples of U.S. high school seniors from the Monitoring the Future study were assessed at baseline (age 18) and followed longitudinally via self-administered mail surveys across 6 follow-up waves to age 29/30. Of the sample (N = 12,557), 51.0% were women, 11.0% were Black, 7.0% were Latinx, 2.3% were Asian, and 75.4% were White. Community service decreased from age 18 to 24, then showed modest recovery. Political interest, electoral participation, and political voice increased steadily from 18 to 24 and less steeply thereafter. Intercepts and (to some extent) slopes varied by race/ethnicity, parent education, gender, and intersections of these factors. Black youth started and remained highest in community service and showed more accelerated growth in political interest and electoral participation. Young women reported higher community service, whereas gender gaps in political engagement trajectories favored young men. Black and Latinx young women stood out as having distinct civic trajectories. The role of parent education varied by race/ethnicity and gender. Diverse civic pathways advance theoretical understanding of civic development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Negative alcohol-related consequences experienced by young adults in the past 12 months: Differences by college attendance, living situation, binge drinking, and sex

PURPOSE

This study estimated the prevalence of negative consequences associated with alcohol use in a national sample of young adults one or two years after graduating from high school, focusing on differences by college attendance, living situation, binge drinking, and sex.

METHODS

A subsample (N = 1068) of U.S. nationally representative Monitoring the Future study 12th grade students from 2006 to 2016 cohorts was followed-up at modal age 19 or 20 (in 2008-2017) and asked about negative consequences related to their own alcohol use during the past 12 months. Differences in prevalence were estimated and multivariable models examined associations with college attendance, living situation, binge drinking, and sex.

RESULTS

Half of surveyed U.S. 19/20 year-old alcohol users (a third of non-binge drinkers and almost three-quarters of binge drinkers) experienced negative consequences in the past year. The likelihood of experiencing several consequence types was significantly associated with college attendance prior to controlling for living situation. In multivariable models controlling for living situation, unsafe driving due to drinking remained more likely for students attending 2-year colleges or vocational/technical schools than for 4-year college students or non-attenders. In general, negative consequence risk was elevated among young adults not living with parents (vs. those living with parents) and women (vs. men).

CONCLUSION

Negative consequences from alcohol use are prevalent among young adults and differ by college attendance, living situation, binge drinking, and sex. Students at 2-year/vocational/technical schools are at particular risk for unsafe driving, warranting specific research attention and targeted intervention.

Concussion, sensation-seeking and substance use among US adolescents

BACKGROUND

No large-scale epidemiological survey of adolescents in the US has assessed the association between lifetime history of concussion, propensity toward sensation-seeking, and recent substance use. Methods: This study assesses the association between lifetime history of diagnosed concussions, sensation-seeking, and recent substance use (i.e., cigarette use, binge drinking, marijuana use, illicit drug use, and nonmedical prescription drug use) using the 2016 and 2017 Monitoring the Future study of 25,408 8th, 10th, and 12th graders. Results: Lifetime diagnosis of concussion was associated with greater odds of past 30-day/2-week substance use. Adolescents who indicated multiple diagnosed concussions (versus none) had two times greater odds of all types of recent substance use, after adjusting for potential confounding factors. Adolescents indicating multiple diagnosed concussions also had higher adjusted odds of cigarette use, binge drinking, and marijuana use) when compared to adolescents who only indicated one diagnosed concussion. Accounting for adolescents' propensity toward sensation-seeking did not significantly change the association between substance use and multiple diagnosed concussions. Conclusions: This study provides needed epidemiological data regarding concussion and substance use among US adolescents. Exposure to a single diagnosed concussion is associated with a modest increase in the risk of substance use and this association increases with the accumulation of multiple diagnosed concussions. These associations hold when controlling for sensation-seeking. Substance use prevention efforts should be directed toward adolescents who have a history of multiple concussions.

Age, period and cohort effects in frequent cannabis use among US students: 1991-2018

BACKGROUND AND AIMS

As the legal status of cannabis changes across the United States and modes of administration expand, it is important to examine the potential impact on adolescent cannabis use. This study aimed to assess changes in prevalence of frequent cannabis use in adolescents in the United States and how far this varies by age and cohort.

DESIGN

Analysis of Monitoring the Future, a nationally representative annual survey of 8th-, 10th- and 12th-grade students in the United States conducted from 1991 to 2018.

SETTING

In-school surveys completed by US adolescents.

PARTICIPANTS

A total of 1 236 159 8th-, 10th- and 12th-graders; 51.5% female, 59.6% non-Hispanic white, 12.3% non-Hispanic black, 13.4% Hispanic and 14.7% other race/ethnicity.

MEASUREMENTS

Frequent cannabis use (FCU), defined as six or more occasions in the past 30 days, stratified by sex, race/ethnicity and parental education.

FINDINGS

FCU among US adolescents increased over the study period; the peak in 2010-18 was 11.4% among 18-year-old students. This increase was best explained by both period and cohort effects. Compared with respondents in 2005, adolescents surveyed in 2018 had period effects in FCU that were 1.6 times greater. Adolescents in younger birth cohorts (those born > 1988) had a lower increase in FCU than those born prior to 1988. Results were consistent across sex, parent education and race/ethnicity, with period effects indicating increasing FCU after 2005 and cohort effects indicating a lower magnitude of increase in more recent birth cohorts. Age and parental education disparities in FCU have increased over time, whereas race/ethnicity differences have converged over time; black students were 0.67 [95% confidence interval (CI) = 0.64-0.70] times as likely to use cannabis frequently as white students from 1991 to 2000, and 1.03 (95% CI = 0.98-1.09) times as likely from 2011 to 2018 (P-value for time interaction < 0.001).

CONCLUSIONS

The prevalence of frequent cannabis use (FCU) increased from 1991 to 2018 among older adolescents in the United States. Racial/ethnic differences in FCU converged, whereas parental education differences have diverged.

Two-Year Follow-up of a Sequential Mixed-Mode Experiment in the U.S. National Monitoring the Future Study

This study examines the two-year follow up (data collected in 2016 at modal age 21/22) of an original mixed-mode longitudinal survey experiment (data collected at modal age 19/20 in 2014). The study compares participant retention in the experimental conditions to retention in the standard Monitoring the Future (MTF) control condition (participants who completed an in-school baseline survey in 12^th grade in 2012 or 2013 and were selected to participate in the first follow-up survey by mail in 2014, N=2,451). A supplementary sample who completed the 12^th grade baseline survey in 2012 or 2013 but were not selected to participate in the main MTF follow-up (N=4,950) were recruited and randomly assigned to one of three experimental conditions: 1: Mail Push, 2: Web Push, 3: Web Push + Email in 2014 and again in 2016. Results from the first experiment indicated that Condition 3 (Web Push + Email) was promising based on similar response rates and lower costs (Patrick et al. 2018). The current study examines how experimental condition and type of 2014 response were associated with response in 2016, the extent to which response mode and device type changed from 2014 to 2016, and cumulative cost comparisons across conditions. Results indicated that responding via web in 2014 was associated with greater odds of participation again in 2016 regardless of condition; respondents tended to respond in the same mode although the "push" condition did move respondents toward web over paper; device type varied between waves; and the cumulative cost savings of Web Push + Email grew larger compared to the MTF Control. The web push strategy is therefore promising for maintaining respondent engagement while reducing cost.

Young adult longitudinal patterns of marijuana use among US National samples of 12th grade frequent marijuana users: a repeated-measures latent class analysis

BACKGROUND AND AIMS

Long-term frequent marijuana use is associated with significant negative outcomes, yet little is known about the longitudinal course of marijuana use among those who start frequent use during adolescence. Objectives are (a) to identify latent patterns of within-person marijuana use from ages 19-30 years among 12th graders reporting frequent marijuana use, (b) to examine if membership in identified patterns has changed across historical time and (c) to examine if key covariates differentiate class membership.

DESIGN, SETTING, PARTICIPANTS

Longitudinal, national US panel data from 4423 individuals [53.4% of the eligible sample; 2744 (62%) males] who reported frequent marijuana use in 12th grade (modal age 18 years; senior year cohorts 1976-2006) followed biennially from ages 19/20 to 29/30.

MEASUREMENTS

Self-reported past 30-day marijuana use (frequent use defined as use on 20+ occasions), demographics, college graduation, marriage and parenthood.

FINDINGS

Repeated-measures latent class analysis (RMLCA) identified five latent classes of past 30-day marijuana use from ages 19/20 to 29/30: continued frequent users (estimated membership 23.4%); frequent to non-frequent users (15.5%); consistent non-frequent users (18.4%); non-frequent users to discontinuers (19.5%); and discontinuers (23.2%). In multivariable models, membership in the highest-risk latent class (continued frequent users) versus one or more of the lower-risk latent classes was more likely for recent cohorts (P = 0.038 to <0.001), as well as those who did not marry (P = 0.039 to < 0.001) or become parents (P = 0.001) by modal age 29/30.

CONCLUSIONS

Nearly one in four 12th grade (modal age 18 years) frequent marijuana users in the US continues to report high frequency use to age 30; the proportion continuing high frequency use across young adulthood has increased among more recent cohorts.

Intergenerational continuity and stability in early family formation

This study examines intergenerational continuity (mean level similarity) and stability (maintenance of rank ordering of individuals) in age and marital status at the time of becoming a young parent using prospective data from 3 generations of 585 families. G2 participants were recruited at the age of 5 years and followed until the age of 28, by which time 227 had become parents themselves. The findings suggest that despite dramatic intergenerational discontinuities with young adults, on average, now being more likely to be unmarried and older at the time of becoming parents than in previous generations, intergenerational stability in age and marital status at the time of becoming a young parent is still substantial. This intergenerational stability was, for the most part, not moderated by demographic, familial, or behavioral factors, suggesting that a developmental, multigenerational perspective is necessary to understand what has previously been considered a largely demographic issue. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Alcohol motivations and behaviors during months young adults experience social role transitions: Microtransitions in early adulthood

The study examines how young adult transitions into and out of social roles (i.e., starting or ending a job, a romantic relationship, school) are associated with drinking motives (coping, enhancement, social, and conformity) and alcohol use in a given month. A community sample of young adult drinkers (N = 767; 56.3% female; 59.3% White; Ages 18-23) completed 24 consecutive months of online surveys (N = 15,333 months of data) about the previous month's experiences, social role transitions, and alcohol use. During the 2-year data collection window, participants reported starting/ending a job (10.0%/8.2%), a relationship (2.7%/4.3%), and school (9.2%/17.4%). Between persons, those who more often started jobs were more likely to drink and those who more often ended jobs had higher enhancement motives; those who more often ended relationships were more likely to drink, have a greater number of drinks when drinking, and have higher coping and enhancement motives; and those who more often started relationships had higher conformity motives. Within persons, during months when a relationship ended, participants reported stronger coping motives, and during months when a relationship started, they reported stronger social motives for drinking. During months when a relationship started or ended, participants also reported consuming a greater number of drinks when drinking. There were no differences based on starting or ending school. Young adult social role transitions are associated with concurrent changes in both alcohol use and motives for drinking. Understanding these contextual changes and their concomitant risks is key to providing salient interventions to reduce alcohol-related harm. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Sexual Minority Youth Report High-Intensity Binge Drinking: The Critical Role of School Victimization

PURPOSE

To examine standard binge drinking (≥4 drinks for females, ≥5 drinks for males) and high-intensity binge drinking (≥8 drinks for females, ≥10 drinks for males) among heterosexual and sexual minority youth in the US and whether reports of school-based victimization mediate this association.

METHODS

Survey data are from the 2015 Youth Risk Behavior Survey (YRBS; n = 10,839, M_age = 16.07). Logistic regression adjusted for race/ethnicity and age compared rates of standard and high-intensity binge drinking among heterosexual and sexual minority youth and whether experiences of school-based victimization mediated this association. Effects were tested in full sample and sex-stratified models.

RESULTS

Lesbian and bisexual girls and girls with male and female partners were more likely than heterosexual girls to report standard rates of binge drinking. Lesbian girls and girls reporting male and female sexual partners were more likely than heterosexual girls to report high-intensity binge drinking in the past 30 days. Compared with heterosexual boys, gay boys were significantly less likely to participate in high-intensity binge drinking. School-based victimization mediated all significant associations between sexual minority status and standard and high-intensity binge drinking, with the exception of lesbian girls.

CONCLUSION

Lesbian and behaviorally bisexual girls have elevated risk for high-intensity binge drinking relative to heterosexual girls. Findings point to the importance of policies that reduce school-based victimization as these experiences are associated with higher rates of standard and high-intensity binge drinking among sexual minority girls.

Parenting Processes and Adolescent Adjustment in Immigrant Latino Families: The Use of Residual Centering to Address the Multicollinearity Problem

Family cohesion and parental monitoring promote Latino adolescents' positive adjustment. For Latino immigrant families, these parenting processes tend to be interdependent due to shared roots in cultural values emphasizing family togetherness and parental authority. This covariance poses a significant methodological problem with respect to multicollinearity. The present article uses a novel technique-residual centering-to remove shared variance among family cohesion and parental monitoring constructs and, in turn, to identify how the unique variance of each is associated with Latino adolescent adjustment. Participants include 249 9th and 10th graders in Mexican and Central American immigrant families. We compared findings from structural equation models in which parenting constructs were examined simultaneously with residual-centered models, in which shared variance among parenting constructs was removed for each parenting variable. Findings from residual-centered models revealed that parents' monitoring of youth's daily activities was associated with less alcohol use and fewer youth depressive symptoms, and that parents' monitoring of youth's peer activities outside the home was associated with less marijuana use and more depressive symptoms. Family cohesion was unrelated to Latino youth outcomes in residual-centered models. By isolating specific, "pure" parenting effects, residual centering can clarify the ways in which family cohesion and parental monitoring behaviors matter for Latino adolescents' adjustment.

Lifetime Prevalence of Self-Reported Concussion Among Adolescents Involved in Competitive Sports: A National U.S. Study

PURPOSE

Examine lifetime prevalence of diagnosed concussion in US-national samples of 8th, 10th, and 12th graders involved in 16 different competitive sports; examine associations between concussion and individual sports, controlling for demographic characteristics and multiple sports involvement.

METHODS

Analysis of nationally representative Monitoring the Future data from 2 cohorts (2016-2017; n = 25,408).

RESULTS

Adolescents who participated in baseball, basketball, football, gymnastics, ice hockey, lacrosse, soccer, track, weightlifting, and 'other sports' had greater odds of reporting multiple diagnosed concussions compared with peers not participating in these sports. Adolescents who participated in tennis had lower odds of reporting any diagnosed concussion or multiple concussions. Females who participated in gymnastics, soccer, and swimming showed a stronger association in reporting a diagnosed concussion when compared with males who participated in these same types of sports.

CONCLUSIONS

The study provides needed epidemiological information on prevalence of reported diagnosed concussion among teens participating in popular school and community sports. Certain high contact (e.g., football) and high volume (e.g., basketball) sports need increased efforts to manage adolescent athletes who already have a history of concussion or repeated concussions.

Shifting Age of Peak Binge Drinking Prevalence: Historical Changes in Normative Trajectories Among Young Adults Aged 18 to 30

BACKGROUND

This study examined the extent to which the developmental pattern of prevalence of binge drinking in the past 2 weeks from ages 18 through 30 has changed across 29 cohorts of U.S. young adults, and whether the changes differed by gender.

METHODS

Analyses used national longitudinal data from 58,019 12th-grade students (from graduating high school classes 1976 to 2004) participating in the Monitoring the Future study followed through modal age 30 (with age 29/30 data collected from 1987 to 2016). Weighted time-varying effect modeling was used to model cohort group differences in age-related patterns of binge drinking.

RESULTS

The age of peak binge drinking prevalence increased across cohorts (from age 20 in 1976 to 1985 to 22 in 1996 to 2004 for women, and from 21 in 1976 to 1985 to 23 in 1996 to 2004 for men). Historical change in the developmental pattern of binge drinking across all ages of young adulthood differed for men and women. Even after controlling for key covariates, women in the more recent cohort group reported significantly higher binge drinking prevalence than women in earlier cohorts from ages 21 through 30. Men in the more recent cohort group reported higher binge drinking prevalence at ages 25 to 26, but prevalence levels then converged to those seen in earlier cohort groups by age 30.

CONCLUSIONS

An older age of peak binge drinking and a decreased rate of decline in the prevalence of binge drinking in later young adulthood among more recent cohorts have resulted in an extension of individual and societal risks associated with binge drinking, particularly for women, across young adulthood. High-risk alcohol use prevention efforts are needed throughout at least the third decade of life.

Simultaneous alcohol and marijuana use among underage young adults in the United States

OBJECTIVE

The current study examines the prevalence, stability, and correlates of simultaneous alcohol and marijuana (SAM) use among underage US young adults, a population at high risk for participating in this behavior.

METHOD

Analyses used data from 1719 respondents (46.8% men) who participated in the nationally representative 12th-grade Monitoring the Future study and provided responses to SAM use items at longitudinal follow-up at modal ages 19/20 between 2007 and 2016. Prevalence estimates and covariate associations with SAM use were estimated.

RESULTS

SAM use prevalence at modal age 19/20 was 22.5%. Multivariable models indicated that odds of age 19/20 SAM use were significantly (p < .05) higher for men (vs. women) and for respondents who started alcohol use by age 18 (vs. those who delayed uptake until after high school). Odds of SAM use were especially high for individuals attending college full-time and not living with parents. Among those who reported SAM use at modal age 18, 56.2% continued to report SAM use at modal age 19/20. Among those who did not report SAM use at modal age 18, only 14.2% reported SAM use at modal age 19/20.

CONCLUSIONS

SAM use among young adults aged 19/20 in the US is relatively common, but especially so for those who began such use by age 18, highlighting the early onset and stability of this behavior. Among underage drinkers, SAM risk varies by sex, race/ethnicity, college status, and living arrangements.

Tobacco and Alcohol Use Among Youth in Low and Middle Income Countries: A Multi-Country Analysis on the Influence of Structural and Micro-Level Factors

BACKGROUND

The transition from adolescence to adulthood is a critical life phase as it is during this period that substance use and disorders typically emerge and escalate. Globally, few studies have examined the prevalence and correlates of alcohol and tobacco use among youth (ages 15-24). This study seeks to bridge this gap by assessing the influence of structural and micro-level factors on tobacco and alcohol use among youth in Low- and Middle-income countries (LMICs).

METHODS

Data are drawn from the Multiple Indicator Cluster Surveys (MICS) conducted in 29 countries or regions in Eastern Europe, Latin America, Asia and Africa between 2010 and 2015. Analyses focus on lifetime prevalence and age of onset for tobacco and alcohol use.

RESULTS

Descriptive analyses highlight regional variations in the prevalence and age of onset of tobacco and alcohol use: tobacco use is more concentrated among youth in Eastern Europe but alcohol use is generalized across the regions. Using multi-level analyses, we find statistically significant main effects for age, gender, educational attainment, rural residence, marital status and exposure to mass media on tobacco and alcohol use outcomes as well as interaction effects for age, gender and education on tobacco and alcohol use outcomes. Conclusions/importance: These findings highlight the need for structural interventions to control tobacco social marketing, and for gender considerations in tobacco and alcohol use prevention programs and policies.

A prospective study of nonmedical use of prescription opioids during adolescence and subsequent substance use disorder symptoms in early midlife

BACKGROUND

This longitudinal study assesses characteristics associated with adolescents' nonmedical use of prescription opioids (NMUPO) including: frequency, co-ingestion, motives, specific opioid type; sequence of initiation of medical use of prescription opioids and NMUPO in relationship to subsequent substance use disorder (SUD) symptoms.

METHODS

Twenty-one independent national cohorts of U.S. high school seniors (n = 8,373) were surveyed and followed 17 years from adolescence to age 35.

RESULTS

The majority of adolescents who engaged in NMUPO reported occasional/frequent NMUPO, non-pain relief motives for NMUPO, simultaneous co-ingestion involving NMUPO and other drugs, opioid analgesics with high misuse potential, and multiple types of opioid analgesics. Adolescents who reported NMUPO for pain relief, NMUPO involving opioid analgesics with high misuse potential, or multiple prescription opioids had significantly greater odds of SUD symptoms at age 35, relative to those who had no history of NMUPO during adolescence. In addition, medical use of prescription opioids after initiating NMUPO (or NMUPO only) during adolescence was associated with significantly greater odds of subsequent SUD symptoms at age 35 relative to those who reported the medical use of prescription opioids only or had no medical use or NMUPO during adolescence.

CONCLUSIONS

This is the first U.S. national prospective study to examine the relationships between adolescents' NMUPO characteristics and later SUD symptoms in early midlife. Several characteristics (frequency, co-ingestion, motives, opioid type, and medical/NMUPO initiation history) were identified that could be used to screen and detect high-risk youth for indicated interventions to reduce prescription opioid misuse and SUDs.

Gender- and age-varying associations of sensation seeking and substance use across young adulthood

INTRODUCTION

Sensation seeking is associated with elevated risk for substance use among adolescents and young adults. However, whether these associations vary across age for young men and women is not well characterized.

METHODS

Using data from the Monitoring the Future (MTF) panel study, we examine the age-varying associations of sensation seeking and three types of substance use behavior (binge drinking, cigarette use, and marijuana use) across ages 18 to 30 using time-varying effect modeling. Analyses include participants in the eleven most recent MTF cohorts (12th-graders in 1994-2004), who are eligible to respond through age 29/30 (N = 6338 people; 30,237 observations).

RESULTS

While sensation seeking levels and substance use are lower among women, the magnitude of the association of sensation seeking with binge drinking and with marijuana use among women exceeds that of men in the later 20s. Differential age trends were observed; among men, the associations generally decreased or remained constant with age. Yet among women, the associations decayed more slowly or even increased with age. Specifically, the association of sensation seeking with marijuana use among women increased during the late 20s, such that the association at age 30 exceeded that in the early 20s.

CONCLUSIONS

The significantly stronger associations of sensation seeking with binge drinking and marijuana use observed among women compared to men during the mid- to late-20s suggests divergent risk factors across genders for substance use during young adulthood, with sensation seeking remaining a strong risk factor for women but not men.

Recent rapid decrease in adolescents' perception that marijuana is harmful, but no concurrent increase in use

BACKGROUND

National trends in adolescent's marijuana risk perceptions are traditionally used as a predictor of concurrent and future trends in adolescent marijuana use. We test the validity of this practice during a time of rapid marijuana policy change.

METHODS

Two repeated cross-sectional U.S. nationally-representative surveys of 8th, 10th, and 12th-graders: Monitoring the Future (MTF) (1991-2015; N = 1,181,692) and National Survey on Drug Use and Health (NSDUH) (2002-2014; N = 113,317). We examined trends in the year-to-year prevalence of perceiving no risk of harm in using marijuana regularly, and prevalence of regular marijuana use within the previous month. A piecewise linear regression model tested for a change in the relationship between trends. Similar analyses examined any past-month use and controlled for demographic characteristics.

RESULTS

Among MTF 12th-graders, the prevalence of regular marijuana use and risk perceptions changed similarly between 1991 and 2006 but diverged sharply afterward. The prevalence of regular marijuana use increased by ∼1 percentage point to 6.03% by 2015. In contrast, the proportion of 12th-graders that perceived marijuana as posing no risk increased over 11 percentage points to 21.39%. A similar divergence was found among NSDUH 12th-graders and other grades, for any past month marijuana use, and when controlling demographic characteristics.

CONCLUSIONS

An increase in adolescent marijuana use has not accompanied recent rapid decreases in marijuana risk perceptions. Policy makers may consider broader prevention strategies in addition to targeting marijuana risk perceptions. Further monitoring of predictors of marijuana use trends is needed as states legalize recreational marijuana use.

Psychosocial and neural indicators of resilience among youth with a family history of substance use disorder

BACKGROUND

Little is known regarding the combined influence of psychosocial and neural protective mechanisms against substance use. The present study examined the extent to which neuroimaging measures of disinhibition predicted resilience against binge drinking and marijuana use among youth with a family history of substance use disorder (SUD; FH+), accounting for psychosocial measures of behavioral control.

METHODS

Participants were 57 FH+ youth from the Michigan Longitudinal Study categorized into resilient and high-risk groups based on patterns of weekly binge drinking and monthly marijuana use during early adulthood. Psychosocial measures of behavioral control (reactive control and externalizing behavior during early and late adolescence) and neural measures of disinhibition (Go/No-Go task and Monetary Incentive Delay Task (MIDT) measured through functional magnetic resonance imaging (fMRI)) were entered sequentially in hierarchical logistic regression models to predict resilient versus high-risk groups.

RESULTS

Greater activation in the right dorsolateral prefrontal cortex (DLPFC) during correctly inhibited trials on the Go/No-Go task was a significant predictor of resilience (OR = 2.46, p < 0.05), over and above greater reactive control in early adolescence (OR = 4.96, p < 0.05) and lower externalizing behavior in late adolescence (OR = 0.64, p < 0.05). Neural activation in the ventral striatum associated with reward anticipation during the MIDT was not a significant predictor of resilience.

CONCLUSIONS

Brain function in the right DLPFC associated with inhibitory control may be a neural indicator of resilience against elevated substance use among FH+ youth, even after accounting for psychosocial measures of behavioral control.

How Collegiate Fraternity and Sorority Involvement Relates to Substance Use During Young Adulthood and Substance Use Disorders in Early Midlife: A National Longitudinal Study

PURPOSE

To assess how social fraternity involvement (i.e., membership and residence) in college relates to substance use behaviors and substance use disorder symptoms during young adulthood and early midlife in a national sample.

METHODS

National multi-cohort probability samples of US high school seniors from the Monitoring the Future study were assessed at baseline (age 18) and followed longitudinally via self-administered surveys across seven follow-up waves to age 35. The longitudinal sample consisted of 7,019 males and 8,661 females, of which 10% of males and 10% of females were active members of fraternities or sororities during college.

RESULTS

Male fraternity members who lived in fraternity houses during college had the highest levels of binge drinking and marijuana use relative to non-members and non-students in young adulthood that continued through age 35, controlling for adolescent sociodemographic and other characteristics. At age 35, 45% of the residential fraternity members reported alcohol use disorder (AUD) symptoms reflecting mild to severe AUDs; their adjusted odds of experiencing AUD symptoms at age 35 were higher than all other college and noncollege groups except non-residential fraternity members. Residential sorority members had higher odds of AUD symptoms at age 35 when compared with their noncollege female peers.

CONCLUSIONS

National longitudinal data confirm binge drinking and marijuana use are most prevalent among male fraternity residents relative to non-members and non-students. The increased risk of substance-related consequences associated with fraternity involvement was not developmentally limited to college and is associated with higher levels of long-term AUD symptoms during early midlife.

A Sequential Mixed-Mode Experiment in the U.S. National Monitoring the Future Study

The national Monitoring the Future (MTF) study examines substance use among adolescents and adults in the United States and has used paper questionnaires since it began in 1975. The current experiment tested three conditions as compared to the standard MTF follow-up protocol (i.e., MTF Control) for the first MTF follow-up survey at ages 19/20 years (i.e., one or two years after high school graduation). The MTF Control group included participants who completed in-school baseline surveys in the 12th grade in 2012-2013 and who were selected to participate in the first follow-up survey in 2014 (n = 2,451). A supplementary sample of participants who completed the 12th grade baseline survey in 2012 or 2013 but were not selected to participate in the main MTF follow-up (n = 4,950) were recruited and randomly assigned to one of three experimental conditions: (1) Mail Push, (2) Web Push, (3) Web Push + E-mail. Results indicated that the overall response rate was lower in Condition 2 compared to MTF Control and to Condition 1; there were no differences between Condition 3 and other conditions. Web response was highest in Condition 3; among web responders, smartphone response was also highest in Condition 3. Subgroup differences also emerged such that, for example, compared to white participants, Hispanics had greater odds of web (versus paper) response and blacks had greater odds of smartphone (versus computer or tablet) response. Item nonresponse was lowest in the Web Push conditions (compared to MTF Control) and on the web survey (compared to paper). Compared to MTF Control, Condition 3 respondents reported higher rates of alcohol use in the past 30 days. The total cost was lowest for Condition 3. Overall, the Condition 3 Web Push + E-mail design is promising. Future research is needed to continue to examine the implications of web and mobile response in large, national surveys.

Measuring alcohol use across the transition to adulthood: Racial/ethnic, sexual identity, and educational differences

BACKGROUND

Patterns of alcohol use change from adolescence to adulthood and may differ based on race/ethnicity, sexual identity, and education. If alcohol use measures do not operate consistently across groups and developmental periods, parameter estimates and conclusions may be biased.

OBJECTIVES

To test the measurement invariance of a multi-item alcohol use measure across groups defined by race/ethnicity, sexual identity, and college education during the transition to adulthood.

METHODS

Using three waves from the National Longitudinal Study of Adolescent to Adult Health, we tested configural, metric, and scalar invariance of a 3-item alcohol use measure for groups defined by race/ethnicity, sexual identity, and college education at three points during the transition to adulthood. We then assessed longitudinal measurement invariance to test the feasibility of modeling developmental changes in alcohol use within groups defined by these characteristics.

RESULTS

Overall, findings confirm notable variability in the construct reliability of a multi-item alcohol use measure during the transition to adulthood. The alcohol use measure failed tests of metric and scalar invariance, increasingly across ages, both between- and within-groups defined by race/ethnicity, sexual identity, and college education, particularly among females.

CONCLUSIONS

Measurement testing is a critical step when utilizing multi-item measures of alcohol use. Studies that do not account for the effects of group or longitudinal measurement non-invariance may be statistically biased, such that recommendations for risk and prevention efforts could be misguided.

Current High-Intensity Drinking Among Eighth and Tenth Grade Students in the U.S

INTRODUCTION

This study assessed the prevalence of current high-intensity drinking (i.e., having ten or more drinks in a row in the past 2 weeks) among national samples of U.S. eighth and tenth grade students (at modal ages 14 and 16 years, respectively).

METHODS

Data on high-intensity drinking were provided by 10,210 students participating in the nationally representative Monitoring the Future study in 2016, and analyzed in 2016-2017. Prevalence levels and interactions between grade and key covariates were estimated using procedures that adjusted for the Monitoring the Future study's complex sampling design.

RESULTS

Approximately 2% of adolescents reported current high-intensity drinking, with significant differences by grade (1.2% of eighth graders; 3.1% of tenth graders) and gender (1.7% female; 2.3% male). High-intensity drinking was significantly higher among eighth and tenth grade students who reported any cigarette or marijuana use than among students who reported never using either substance.

CONCLUSIONS

A meaningful percentage of young adolescents in the U.S. engage in high-intensity drinking.

Prevalence of Concussion Among US Adolescents and Correlated Factors

This study uses a national survey of US adolescents to examine the prevalence and correlates of self-reported diagnosed concussions to target and monitor prevention efforts.

Alcohol use from adolescence through early adulthood: an assessment of measurement invariance by age and gender

BACKGROUND AND AIMS

Studies on alcohol use and related constructs rarely test for measurement invariance to assess the reliability and validity of measures of alcohol use across different subpopulations of interest or ages. This failure to consider measurement invariance may result in biased parameter estimates and inferences. This study aimed to test measurement invariance of alcohol use across gender and age using a US nationally representative sample to inform future longitudinal studies assessing alcohol use.

DESIGN

The National Longitudinal Study of Adolescent to Adult Health, a school-based, nationally representative longitudinal study conducted in 1994-95, 2001-02 and 2008.

SETTING

All regions within the United States; participants were selected via a clustered sample design from 80 high schools that represented the national population.

PARTICIPANTS

Youth and young adults aged 13-31 years who had valid data on all three alcohol items within wave: 18 923 from wave 1; 14 315 from wave 3; and 14 785 from wave 4.

MEASUREMENTS

Alcohol use measurement models were constructed using past-year general drinking frequency, heavy episodic drinking frequency and average quantity when drinking. Configural (factor structure), metric (factor loadings) and scalar (item intercepts) measurement invariance models were tested by gender and for each year of age from 13 to 31 years.

FINDINGS

All models passed the threshold for configural invariance. Comparisons between males and females demonstrated metric (and usually scalar) non-invariance for most ages beyond middle adolescence. Nearly all 1- and 2-year contrasts passed metric invariance. Scalar non-invariance was most prevalent in age comparisons between late adolescence and early adulthood, particularly for tests using 2-year age increments.

CONCLUSIONS

Studies that do not account for the effects of gender and age on the measurement of alcohol use may be statistically biased.