Transcript Adolescent Substance Use and Young Adult Outcomes: Evidence

Adolescent Tobacco Use and
Young Adult Outcomes
Kathy Georgiades & Michael Boyle
Background
• Rates of adolescent tobacco use are high
• Ontario Student Drug Use Survey (1999)
Tobacco use: 28%
• Long term implications for development
Tobacco Use  Poor Physical Health 
Tobacco Use  Psychosocial Outcomes ?
• Substance use in adolescence has
been shown to increase risk for later
psychosocial difficulties (e.g., Chassin et
al., 1999; Fergusson & Horwood, 1997; Jessor et
al. 1980; Kandel et al., 1986; Newcomb & Bentler,
1988)
• Extent to which these associations
reflect cause and effect linkages
remains controversial
At least two general explanations of
the linkages between adolescent
substance use and young adult
outcomes:
1) Problem Behavior Theory
2) Interference with Adolescent
Developing Competencies
Problem Behavior Theory
Adolescent
Substance Use
Adult Outcomes
Problem Behavior
Syndrome
Developing Competencies
Interference in
Development of
Competencies
Adolescent
Substance
Use
Adult
Outcomes
Objectives
To examine the association between tobacco
use in adolescence and young adult
outcomes
To determine whether the association
remains significant after controlling for
social and psychological factors
associated with adolescent tobacco use &
young adult outcomes
To determine whether the association is
specific to those who endorse use both in
adolescence and young adulthood
Method
Ontario Child Health Study
• 4-16 yrs in 1983  1987  2000
Sample for the present study:
• 12- 16 yrs in 1983 & 1987  Time 1 (T1)
• Followed in 2000  Time 2 (T2)
• N=1282
Variables
Young Adult Outcomes
Major Depressive Disorder
Physical Health
Years of Education
Tobacco Use T1 and T2: daily use > 1 month
Co-variates assessed at T1: family SES,
single parent home, sex, age, externalizing
and internalizing disorders, family
dysfunction, & grade failure
Results
11% (n=139) of adolescents reported daily
tobacco use at T1
Tobacco use in adolescence was associated
with:
family SES
parental education
externalizing & internalizing disorders
family dysfunction
grade failure
Unadjusted association between
tobacco use in adolescence and young
adult outcomes
Young Adult Outcomes
Tobacco Use T1
MDD
OR = 2.7 (1.8-4.2)
Physical Health
b = -3.9 (0.65) ***
Years of Education
b = -2.4 (0.25) ***
***p<0.001
3 comparison groups were created in
order to examine continuity & change in
tobacco use
1. Use of Tobacco only at T1 (n=53)
2. Use of Tobacco only at T2 (n=218)
3. Use of Tobacco at T1 & T2 (n=86)
Associations between tobacco use in
adolescence and major depressive
disorder in adulthood
Predictors
Unadjusted OR
Adjusted OR+
T1 only
1.0 (0.4-2.7)
0.7 (0.3-2.0)
T2 only
1.4 (0.8-2.2)
1.4 (0.9-2.3)
T1 & T2
4.3 (2.6-7.2)
3.8 (2.1-6.8)
+ Adjusted for T1: family SES, family type, sex, age, externalizing & internalizing
symptoms, family dysfunction & grade failure
Associations between tobacco use in
adolescence and physical health in
adulthood
Adjusted +
Predictors
Unadjusted
T1 only
-2.6 (1.0)*
-2.2 (1.1)*
T2 only
-1.4 (0.6)*
-1.4 (0.6)*
T1 & T2
-5.1 (0.8)***
-4.8 (0.9)***
+ Adjusted for T1: family SES, family type, sex, age, externalizing & internalizing
symptoms, family dysfunction & grade failure
*p<0.05, ***p<0.001
Associations between tobacco use in
adolescence and years of education
in adulthood
Predictors
Unadjusted
Adjusted +
T1 only
-2.0 (0.4)***
-1.3 (0.4)***
T2 only
-2.2 (0.2)***
-1.7 (0.2)***
T1 & T2
-3.4 (0.3)***
-2.5 (0.3)***
+ Adjusted for T1: family SES, family type, sex, age, externalizing & internalizing
symptoms, family dysfunction & grade failure
***p<0.001
Conclusions
Tobacco use in adolescence was
associated with clear increases in
rates of major depressive disorder,
poorer physical health and fewer
years of education in young adulthood
Conclusions (con’t)
Statistical adjustment of these risk factors
and of continuity of use, substantially
reduced the association between tobacco
use and major depressive disorder (MDD)
Only those adolescents who reported tobacco
use at both time points were at increased
risk for MDD
Conclusions (con’t)
Even after adjustment of adolescent
risk factors and tobacco use in
adulthood, adolescents who smoked
were at increased risk for poorer
physical health and fewer years of
education