Adolescent alcohol and tobacco use: onset, persistence and trajectories of use across two samples

Abstract

Aims-We examined the alcohol-tobacco relationship using two prospective, ethnically diverse samples. Trajectories of alcohol and tobacco use are portrayed overall and by sex and ethnicity. Using prospective analyses, we examine directional influences between alcohol and tobacco use, and we characterize initiation versus persistence of drinking and smoking as a function of use of the other substance.Design, setting-Data were from the National Longitudinal Study of Adolescent Health (AddHealth) and the Adolescent Health Risk Study (AHRS). Follow-up intervals for AddHealth and AHRS were 1 and 5 years, respectively.Participants-AddHealth respondents (n = 4831) were on average 14.8 years old (48% male, 23% black, 61% white) and AHRS respondents (n = 1814) were on average 16.7 years old (47% male, 44% black, 49% white).Measurements-Two alcohol consumption variables and two smoking variables were used: drinking frequency and heavy drinking frequency, and regular (current) smoking and daily number of cigarettes.Findings-Alcohol and tobacco use exhibited monotonic increases over adolescence and young adulthood. Men and white respondents reported more use than women and black respondents. Alcohol and tobacco were moderately associated at both times. Analyses revealed that prior alcohol use predicted tobacco use more strongly than the converse. Initiation of smoking was a function of prior drinking; to a lesser extent, initiation of drinking was a function of prior smoking. Persistence of smoking was a function of prior drinking and persistence of drinking was a function of prior smoking.Conclusions-Provisional support exists for the claim that alcohol use predicts tobacco use more strongly than the converse. For both drinking and smoking, onset and persistence are predicted by prior use of the other substance, and these associations were robust across sex and ethnicity.

Alcohol and tobacco use disorders in a general population: short-term and long-term associations from the St. Louis Epidemiological Catchment Area Study

“…These findings again suggest the possibility that prospective comorbidity is mediated by having a concurrent diagnosis with the other disorder (discussed in Section 4.1.2). Previous work in our laboratory showed persistence effects for drinking and smoking in adolescents over both 1 and 5 year intervals (Jackson et al, 2002), although using a sample of college students, persistence effects for AUD and TD over 6 years were not evident (Sher et al, 1996). Moreover, in the current study, we failed to find any evidence that short-term stability of a disorder was moderated by the other disorder for either AUD or TD.…”

“…Year 1 TD prospectively predicted diagnosis with an AUD at Year 2, although the converse was not true in this middle-aged sample. Although consistent with research in younger samples supporting a prospective association from tobacco involvement to alcohol involvement (Fleming et al 1989;Sher et al, 1996), this null finding for the prospective AUD to TD association is contrary to research showing prospective prediction from alcohol use to tobacco use over 1 year in 842 adolescents (Simon et al, 1995) and work showing a bi-directional association between alcohol and tobacco use disorders in a college sample (Sher et al, 1996) using a longer follow-up interval, and between alcohol and tobacco use in a nationally representative sample of adolescents and a community sample of adolescents/young adults (Jackson et al, 2002). However, we found that a baseline diagnosis of AUD did increase the likelihood of diagnosis with TD 15 years later.…”

“…Among college students, respondents were more likely to develop a TD either 3 or 6 years later if they had been diagnosed with AUD at baseline; likewise, respondents were more likely to develop a later AUD if they had been diagnosed with baseline TD (Sher et al, 1996). In a nationally representative sample of adolescents over 1 year and a community sample of adolescents/young adults over 5 years, onset of drinking was higher for baseline smokers and onset of smoking was higher for baseline drinkers, with similar magnitude across both directions (Jackson et al, 2002).…”

“…Additionally, racial differences have been observed for alcohol dependence (Caetano and Schafer, 1996;Robins and Regier, 1991) and TD (Andreski and Breslau, 1993;Breslau et al, 2001;Kandel and Chen, 2000) and smoking (Centers of Disease Control, 1999) such that African Americans tend to exhibit lower rates of alcohol and tobacco involvement than do Whites or Mexican Americans. Although the alcohol-tobacco use association was comparable across racial group among adolescents (Jackson et al, 2002), the moderating effect of race on comorbidity has not yet been examined in adults using diagnostic criteria for substance use disorders.…”

“…Bien and Burge, 1990;Istvan and Matarazzo, 1984), most work has been limited to cross-sectional analyses and/or use of consumption measures, particularly among adolescents (e.g. Fleming et al, 1989;Jackson et al, 2002;Rohde et al, 1995;Simon et al, 1995;Torabi et al, 1993). Although these studies are informative with regard to identifying risk factors for substance use onset, they fail to inform us about the etiology of a substance use disorder.…”