Jackson, Kristina M

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Washington University School of MedicineDigital Commons@BeckerPosters 2003: Drinking and the High School Student2003Transitions in conjoint alcohol and tobacco useamong adolescentsKristina M. JacksonUniversity of Missouri - ColumbiaFollow this and additional works at: http://digitalcommons.wustl.edu/guzeposter2003Part of the Medicine and Health Sciences CommonsThis Poster is brought to you for free and open access by the 2003: Drinking and the High School Student at Digital Commons@Becker. It has beenaccepted for inclusion in Posters by an authorized administrator of Digital Commons@Becker. For more information, please contactengeszer@wustl.edu.Recommended CitationJackson, Kristina M., "Transitions in conjoint alcohol and tobacco use among adolescents" (2003). Posters. Paper 7 Samuel B. GuzeSymposium on Alcoholism.http://digitalcommons.wustl.edu/guzeposter2003/7Transitions in Conjoint Alcohol and Tobacco Use among AdolescentsKristina M. JacksonUniversity of Missouri, Columbia & Missouri Alcoholism Research CenterSupported by National Institute on Alcohol Abuse and Alcoholism Grants R21 AA12383 to Kristina M. Jackson and P50 AA11998 to Andrew C. Heath Introduction Alcohol and tobacco use co-occur – Social drinkers and alcoholics are more likely to smoke than are non-drinkers– Smokers are more likely than are non-smokers to drink and to develop alcohol use disorders Comorbidity could be due to directional influences between use of the two substances The relation between alcohol and tobacco use also may be due to common third variables (e.g., sex, race, personality)Introduction Recent research has theoretically and empirically characterized developmental patterns of drinking and smoking– With 2 timepoints, we can consider stable versus unstable behavior– Chassin, Presson, Sherman, & Edwards (1991) categorized smoking into 4 patterns: • Stable nonsmoker• Late-onset smoker• Non-persistent smokers• Stable smokers– They found different correlates of the four patternsThe Current Study No research has considered alcohol-tobacco comorbidity when examining developmental patterns  The current study examined the prospective (1-year) relation between developmental patterns of alcohol and tobacco use in a nationally representative sample of adolescentsParticipants & Procedure National Longitudinal Study of Adolescent Health (AddHealth) N=20,745 (49.5% male; 52% White, 22% Black, 17% Hispanic) Current study sample N=14,466 (those who provided complete data at both waves) Students from 132 schools in grades 7-12 were assessed in 1994/1995 – 45-60 minute school interview and 60-120 minute in-home interview– 14,738 students re-contacted/re-interviewed in 1996Measures Alcohol consumption (Times 1 and 2)– Past-year reference• Drink at least once/week• Drink heavily (5+ drinks/occ.) at least once/week• Get drunk at least once/week Tobacco use (Times 1 and 2) – 30-day reference• Smoke• Smoke > half-pack (10 cigarettes) per occasion• Smoke dailyMeasures (con’d) Demographics (Time 1 only)– Sex– Race • Dummy coded into Black, Hispanic, & Other • White as the reference group– Age (11 to 20)00.20.40.60.811st Qtr 2nd Qtrsubstance use endorsement probabilityNon-drinker (smoker) Onset Remit PersistA Priori Groupings Created 4-level (nominal) variables representing temporal patterns, based on responses at Years 1 & 2Year 1 Year 2– Non-drinker (non-smoker)         NO NO– Onset NO YES– Non-persistent YES NO– Persistent YES YESAnalytic Procedure Examined relationship between 4-level drinking variable & 4-level smoking variable using multinomial logistic regression Controlled for sex, race, and age Complex sampling design– Clustering of observations– Stratification– Unequal probability of inclusion (e.g., oversampling of Blacks)– Adjusted for complex sampling and non-response using StataPrevalence of Drinking Patterns across Alternate Definitions of Drinking Pattern Defined By:     Pattern: Drink at least once/week  Drink heavily at least once/week  Get drunk at least once/week  Nondrinker  84.3% 88.6% 90.0% Onset  7.1% 5.2% 5.0% Non-persist 4.6% 3.6% 2.9% Persistent 4.0% 2.7% 2.1%  Note. N’s range from 13,104 to 13,193.  Prevalence of Smoking Patterns across Alternate Definitions of Smoking Pattern Defined By:    Pattern: Smoke  Smoke half pack/ occasion  Smoke daily  Nonsmoker  75.4% 88.1% 85.2% Onset  8.0% 4.9% 5.9% Non-persist 3.8% 1.7% 1.9% Persistent 12.8% 5.4% 7.0%  Note. N’s range from 13,104 to 13,193.  Smoking DrinkingRange of Odds Ratios across Alternate Definitions  Smoking   Drinking Onset  Non-persist  Persist   Onset  3.77-8.29 1.37-4.75 4.33-7.29 Non-persist 3.35-5.93 5.73-11.22 5.43-10.53 Persistent 6.16-9.17 4.08-6.70 6.55-13.55  Note. Controlling for sex, race, and age. Parameters were obtained from multinomial logistic regressions predicting the 4-level drinking variable from the 4-level smoking variable, with non-drinkers/non-smokers as the reference groups.  Drinking SmokingRange of Odds Ratios across Alternate Definitions Smoking   Drinking Onset  Non-persist  Persist   Onset  3.76-8.26 1.38-4.76 5.89-8.83 Non-persist 3.39-5.95 5.74-11.24 5.17-10.72 Persistent 5.89-8.83 4.00-6.55 6.41-13.42  Note. Controlling for sex, race, and age. Parameters were obtained from multinomial logistic regressions predicting the 4-level smoking variable from the 4-level drinking variable, with non-drinkers/non-smokers as the reference groups.   Summary of Findings Drinking and smoking were highly associated both cross-sectionally and prospectively Relative to non-smokers, persistent smoking predicted drinking more than did any other smoking group Alternate definitions of smoking and drinking yielded similar findings – Contrary to what might be expected, given a dose-dependent association between drinking and smoking (Madden, Bucholz, Martin, & Heath, 2000)– Sample may have been too young to show full dose rangeSummary of Findings (con’d) Relative to non-drinkers, persistent drinking predicted smoking more than did any other drinking group – The only exception was that non-persistent drinking predicted non-persistent smoking most strongly, across all alternate definitions of smoking and drinking The alcohol-tobacco relation controlled for sex, race, and age, suggesting that the association was not due to these factors– Future research will consider the extent to which delinquency and negative affect account for the alcohol-tobacco relationLimitations Different timeframes for drinking and smoking– Drinking was referenced to a 12-month timeframe– Smoking was referenced to a 30-day timeframe Time interval not long enough to be informative developmentally– Changes in substance use over one year might not be meaningful Unclear the extent to which unstable patterns were due to measurement error– Might have been further confounded by creating binary variables from continuous variables

Transitions in conjoint  alcohol and tobacco use among adolescents

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Transitions in conjoint alcohol and tobacco use among adolescents

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