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The literature has shown that people who do not drink alcohol are at greater risk for death than light to moderate drinkers, yet the reasons for this remain largely unexplained. We examine whether variation in people's reasons for nondrinking explains the increased mortality. Our data come from the 1988-2006 National Health Interview Survey Linked Mortality File ( N = 41,076 individuals age 21 and above, of whom 10,421 died over the follow-up period). The results indicate that nondrinkers include several different groups that have unique mortality risks. Among abstainers and light drinkers the risk of mortality is the same as light drinkers for a subgroup who report that they do not drink because of their family upbringing, and moral/religious reasons. In contrast, the risk of mortality is higher than light drinkers for former drinkers who cite health problems or who report problematic drinking behaviors. Our findings address a notable gap in the literature and may inform social policies to reduce or prevent alcohol abuse, increase health, and lengthen life. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Nonmedical use of prescription pain drugs (hereafter “analgesics”) has increased substantially in recent years. It is not known whether today''s youth are disproportionately driving this increase or, instead, the trend is a general one that has affected cohorts of all ages similarly. To address this question we present the first age–period–cohort analysis of nonmedical use of analgesics. Methods: Data come from the National Survey on Drug Use and Health, a series of annual, nationally representative, cross-sectional surveys of the US civilian, noninstitutionalized population. The analysis focuses on the years 1985–2009 and uses the recently developed “intrinsic estimator” algorithm to disentangle age–period–cohort effects. Results: Substantial increases in the prevalence of nonmedical analgesics use (NAU) have occurred across all cohorts and ages in recent years, but this increase is significantly amplified among today''s adolescents. The odds of past-year NAU for today''s youngest cohort (born 1980–1994) are higher than would be expected on the basis of their age and broad, historical period influences that have increased use across people of all ages and cohorts. The independent influence of cohort on past-year NAU is about 40% higher for today''s youth cohort than any of the cohorts that came before them. This finding is present among men, women, non-Hispanic whites, non-Hispanic blacks, and Hispanics. Conclusions: Although nonmedical use of analgesics is evident among all ages, cohorts, and periods, today''s younger cohorts warrant special attention for substance abuse policies and interventions targeted at reversing the increase in NAU. [Copyright &y& Elsevier]

This article examines how educational disparities in mortality emerge, grow, decline, and disappear across causes of death in the United States, and how these changes contribute to the enduring association between education and mortality over time. Focusing on adults age 40 to 64 years, we first examine the extent to which educational disparities in mortality persisted from 1989 to 2007. We then test the fundamental cause prediction that educational disparities in mortality persist, in part, by shifting to new health outcomes over time. We focus on the period from 1999 to 2007, when all causes of death were coded to the same classification system. Results indicate (1) substantial widening and narrowing of educational disparities in mortality across causes of death, (2) almost all causes of death with increasing mortality rates also had widening educational disparities, and (3) the total educational disparity in mortality would be about 25 percent smaller today if not for newly emergent and growing educational disparities since 1999. These results point to the theoretical and policy importance of identifying social forces that cause health disparities to widen over time. [ABSTRACT FROM PUBLISHER]

Despite the substantial and prolonged sociological interest in health disparities, much remains unknown about the processes that initiate them. To investigate this topic, we focus on the case study of cocaine use, for which a socioeconomic disparity emerged across all age groups in a short period of time around 1990. We examine whether the newly-formed disparity represents a selective remnant of previous users or, instead, a selective recruitment of new users. To evaluate these two potential processes we use latent class regression on a nationally representative cohort with repeated measures of past-year cocaine use before and after 1990. Results support the "remnant" hypothesis and show that the newly-formed disparity resulted primarily because people in the lower social strata were less likely to have a trajectory of cocaine use with a sharp drop in use after 1990. These results point to the "remnant" concept as a way to bring together disparity analysis of very different and diverse health outcomes. [ABSTRACT FROM AUTHOR]

A robust and very persistent association between indicators of socioeconomic status (SES) and the onset of life-threatening disease is a prominent concern of medical sociology. The persistence of the association over time and its generality across very different places suggests that no fixed set of intervening risk and protective factors can account for the connection. Instead, fundamental-cause theory views SES-related resources of knowledge, money, power prestige, and beneficial social connections as flexible resources that allow people to avoid risks and adopt protective strategies no matter what the risk and protective factors are in a given place or time. Recently, however, intelligence has been proposed as an alternative flexible resource that could fully account for the association between SES and health and thereby find its place as the epidemiologists' "elusive fundamental cause" (Gottfredson 2004). We examine the direct effects of intelligence test scores and adult SES in two data sets containing measures of intelligence, SES, and health. In analyses of prospective data from both the Wisconsin Longitudinal Study and the Health and Retirement Survey, we find little evidence of a direct effect of intelligence on health once adult education and income are held constant. In contrast, the significant effects of education and income on health change very little when intelligence is controlled. Although data limitations do not allow a definitive resolution of the issue, this evidence is inconsistent with the claim that intelligence is the elusive fundamental cause of health disparities, and instead supports the idea that the flexible resources people actively use to gain a health advantage are the SES-related resources of knowledge, money, power, prestige, and beneficial social connections. [ABSTRACT FROM AUTHOR]

Background: An organizationally healthy school environment is associated with favorable student and staff outcomes and thus is often targeted by school improvement initiatives. However, few studies have differentiated staff-level from school-level predictors of organizational health. Social disorganization theory suggests that school-level factors, such as faculty turnover, student mobility, and concentration of student poverty, would be negatively associated with school organizational health, but these relationships may be moderated by staff-level factors. Methods: The present study examined the association among school-and staff-level predictors of staff-perceived school organizational health (eg, academic emphasis, collegial leadership, and staff affiliation), as measured by the Organizational Health Inventory. Results: Multilevel analyses on data from 1395 staff across 37 elementary schools indicated that school membership accounted for between 26% and 35% of the variance in different components of staff-perceived organizational health. Two-level hierarchical analyses indicated that both school-and staff-level characteristics are important predictors of organizational health. Furthermore, some school and staff characteristics interacted to predict staff affiliation and collegial leadership. Conclusions: Findings suggest that factors at both the school and staff level are important potential targets for school improvement. Administrators aiming to improve relationships among staff members should be cognizant of staff-level characteristics (race, age, and role in school) associated with less favorable perceptions of the school environment, whereas efforts to enhance student work ethic and discipline should target schools with specific school-level characteristics (high rates of faculty turnover and student mobility). [ABSTRACT FROM AUTHOR]

Competing theoretical interpretations posit children's capacity for self-regulation as playing a spurious role, a mediating role, and a moderating role in the relationship between children's socioeconomic status (SES) and the adjustment to school. This study empirically examined these interpretations by investigating the rote of children's self-regulation in the relationship between children's SES and three school adjustment outcome: (1) overall problems in children's interpersonal relationships in school, (2) teachers assessment of hyperactivity-attention deficiency, and (3) teachers' expectations of children's present and future scholastic ability. The results indicated that associations between self-regulation outcomes and the adjustment to school were not spurious; they persisted after children's SES background was controlled Self-regulation served as a mediator of the association between children's SES and both interpersonal problems at school and teachers' expectations, and self-regulation served as a moderator of the relationship between children's SES and teachers' assessment of hyperactivity-attention deficiency. [ABSTRACT FROM AUTHOR]

Numerous studies document lower levels of depression among adults with higher education, but little is known about the way in which the association varies over the life course. Do depression levels diverge or converge across educational strata with age? This study investigates how the association between education and depression changes with age and tests the extent to which these changes are accounted for by physical health problems, widowed status, employment status, coping resources, household income, and financial strain. Data for this investigation come from the Work, Family, and Well-Being Study, 1990, a nationally representative sample of 2,031 adults aged 18 to 90 interviewed by telephone. Findings indicate that the association between depression and education strengthens with increasing age. Physical health problems among adults with lower education account for most of the diverging gap in depression. These results show that an integration of insights from the stress paradigm and the life course perspective can lead to a fuller understanding of socioeconomic inequality and its influence on psychological functioning. [ABSTRACT FROM AUTHOR]

Background: How adolescent substance use and perceived availability of substances have changed during the COVID-19 pandemic remain largely unknown. Substantial reduction in availability of substances would present a unique opportunity to consider the supply-side hypothesis that reductions in drug availability will lead to reductions in drug prevalence.Methods: Longitudinal data come from Monitoring the Future and are based on responses from 582 adolescents who were originally surveyed as part of a national sample of 12th grade students in early 2020, one month before social distancing policies began. They were surveyed again after social distancing policies were implemented, in the summer of 2020.Results: Perceived availability of marijuana and alcohol declined across the two survey waves at the largest levels ever recorded in the 46 years of the project, by an absolute 17 %, p < .01 and 24 %, p < .01, respectively. Despite these declines, prevalence levels did not significantly change across the two waves for marijuana use in the past 30 days or for binge drinking in the past two weeks. Perceived availability of vaping devices significantly declined, from 73 % to 63 %, as did nicotine vaping prevalence in the past 30 days, from 24 % to 17 %.Conclusions: Perceived availability of marijuana, alcohol, and vaping devices declined at historic rates during the pandemic of 2020. Lack of accompanying reductions in prevalence for marijuana and binge drinking demonstrates the substantial challenges facing a supply-side approach to the reduction of adolescent use of these substances. [ABSTRACT FROM AUTHOR]

Pathways to attainment are modified through historical time, reflecting the progressive consolidation of the educational trajectory in the life courses as well as changing patterns of social class and the economy. Using data from the Occupational Changes in a Generation surveys, this study examines a series of hypotheses that interrelate educational attainment with historical change- expansions and contractions in labor market sectors; and socioeconomic status. Consistent with expectations, opportunities in manufacturing drew students from primary school before World War II, while expansions in the government sector increased the likelihood of drop-out at the secondary and tertiary levels after the war. In this later period, students from the lower and middle classes often were more like! to leave school because of economic expansion. Thus, through historical time the capacity of the economy to draw students from school has progressed upward through the educational career and has affected the lower and middle classes disproportionately. [ABSTRACT FROM AUTHOR]

The values that shape individuals' career decisions are not necessarily reinforced by subsequent work experience. Those who value service to society, for example, are most likely to enter teaching, but qualitative research suggests that service-oriented teachers encounter much frustration and are prime candidates for leaving teaching. This study investigated the effect of motivation for service on persistence in teaching among two cohorts of American teachers: a 1960s cohort in an era that highlighted the call to public service and a 1970s cohort in a more egocentric era. The authors found that strong service values increased the likelihood that men in both cohorts and women in the 1970s cohort would leave the profession, but not women in the 1960s cohort, when few alternative careers were open to women. [ABSTRACT FROM AUTHOR]

People make planful decisions about school and work, but structures of opportunity both constrain and enable pathways to achievement. What is the role of planful competence in times of social change? Drawing on data from the Stanford-Terman sample, the authors examine the role of history and adolescent planfulness in the attainment of men who were born between 1904 and 1917. Men born between 1904 and 1910 avoided the labor markets of the Great Depression by extending their higher education; adolescent planfulness was of little consequence for their adult educational attainment, since they stayed in school irrespective of their planfulness. However, men born between 1911 and 1917 faced viable options between school and work, especially in the postwar economy; for these men, adolescent planfulness was a strong, positive predictor of educational attainment. These findings are compared with insights from the 1962 Occupational Changes in a Generation data set, a nationally representative sample. [ABSTRACT FROM AUTHOR]

Past research has found significant nicotine use disparities for reservation-area American Indian adolescents when compared to national levels. However, adolescent nicotine use has changed markedly, with reduced smoking and rapid increases in nicotine vaping. This study presents 2021–2022 prevalence estimates of tobacco product use, perceived harm and availability for reservation-area American Indian youth, with comparisons to the Monitoring the Future (MTF) national study. Participants were 8th, 10th and 12th grade students. American Indian data were 33 reservation-area schools in 2021–2022 (n=2420); MTF data were 308 schools in Spring 2022 (n=31,438). Measures were lifetime, 30-day cigarette smoking, smokeless tobacco use, and nicotine vaping; past-year nicotine vaping; daily smoking; perceived harmfulness and availability of these tobacco products. Prevalence and 95% confidence intervals were computed by grade. Estimated prevalence of lifetime, monthly and daily cigarette smoking among American Indian 8th and 10th graders was higher than national levels. Nicotine vaping prevalence was similar between samples. American Indian students were less likely to report tobacco product use poses great risk, but also less likely to report tobacco products are easily available. Although estimated smoking prevalence among American Indian 8th and 10th graders was higher than national levels, prevalence appears lower than reported in earlier studies, suggesting declining disparities. Prevalence of nicotine vaping among reservation-area American Indian adolescents generally mirrors the national population; however, a lower percentage reported regular nicotine vaping poses a serious risk. This discrepancy suggests a need for prevention and intervention efforts culturally tailored for this population. • 2021–2022 tobacco use prevalence in reservation-area American Indian youth appears to be lower than previous estimates. • Nicotine vaping prevalence among American Indian adolescents mirrors national prevalence. • Nicotine vaping is more prevalent than other tobacco use among American Indian adolescents. • American Indian adolescents perceived less risk from nicotine vaping compared to a national sample. • Culturally-tailored education about harms of vaping is critical to lowering use. [ABSTRACT FROM AUTHOR]

Introduction: In the past decade, marijuana use prevalence among adolescents has remained relatively steady while cigarette and alcohol prevalence has declined. We examined historical trends in: average grade of onset of marijuana, alcohol, and cigarette use by 12th grade; proportion who try alcohol/cigarettes before first marijuana use, among those who use by 12th grade; and conditional probability of marijuana use by 12th grade after trying alcohol/cigarettes.Methods: Data were drawn from 40 yearly, cross-sectional surveys of 12th grade US adolescents. A subset of students (N = 246,050) were asked when they first used each substance. We reconstructed cohorts of substance use from grade-of-onset to determine sequence of drug use, as well as probability of marijuana use in the same or later grade.Results: Average grade of first alcohol and cigarette use by 12th grade increased across time; e.g., first cigarette increased from grade 7.9 in 1986 to 9.0 by 2016 (β=0.04, SE = 0.001, p < 0.01). The proportion of 12th grade adolescents who smoke cigarettes before marijuana fell below 50% in 2006. Each one-year increase was associated with 1.11 times increased odds of first cigarette in a grade after first marijuana (95% C.I. 1.11-1.12). Among those who initiate alcohol/cigarettes prior to marijuana by 12th grade, the probability of subsequent marijuana use is increasing.Conclusion: Marijuana is increasingly the first substance in the sequence of adolescent drug use. Reducing adolescent smoking has been a remarkable achievement of the past 20 years; those who continue to smoke are at higher risk for progression to marijuana use. [ABSTRACT FROM AUTHOR]

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. 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. 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). 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. • Longer-term alcohol prevalence trends deviated downward in 2020. • Among those who drank, alcohol frequency deviated upward in 2020. • Drinking to relax/relieve tension and because of boredom deviated upward in 2020. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the prevalence, patterns, and correlates of self-reported nicotine dependence symptoms among U.S. youth who use JUUL - a widely-sold e-cigarette brand - in 2019 and compare findings to nicotine dependence symptoms in youth who smoke cigarettes.Methods: Data were from a nationally-representative subsample of 8th, 10th, and 12th grade students in the Monitoring the Future Study who had used JUUL or cigarettes in the past 30 days. Participants self-reported presence/absence of 9 different nicotine dependence symptoms for JUUL or cigarettes. Weighted percentages for JUUL or cigarette nicotine dependence symptom status (≥1 vs. 0 symptoms) and severity (count, range: 0-9) were calculated. Among JUUL users, we estimated associations of sociodemographic characteristics and other substance use with nicotine dependence and severity.Results: Among 1,748 past 30-day JUUL users, 41.3 % screened positive for ≥1 nicotine dependence symptoms; the mean symptom count was 1.6 (SD = 2.6). Non-nicotine substance use and more frequent JUUL use was associated with significantly greater odds of dependence and more severe dependence symptoms in multivariable models. The severity distribution of most (craving) and least (inability to quit) dependence symptom types observed in JUUL dependence paralleled those observed in analysis of combustible cigarette dependence symptoms in past 30-day smokers.Conclusion: A substantial proportion of U.S. adolescent JUUL users reported symptoms of nicotine dependence, which is greater for those who vape more frequently and use other substances. Nicotine dependence screening, prevention, and regulatory policies addressing use of JUUL or similar e-cigarette products should be considered to protect U.S. youth. [ABSTRACT FROM AUTHOR]

Background: Perceived risk of harm has long been a key preventive factor for adolescent marijuana use. However, in recent years, perceived risk has decreased markedly and marijuana use has increased only slightly, leading to new questions about their association. This study investigates the magnitude and stability of the US adolescent marijuana risk/use association from 1991 to 2016, overall and by gender and race/ethnicity.Methods: Self-reported data on past 12-month marijuana use, perceived risk of regular marijuana use, gender, and race/ethnicity were obtained from 275,768 US 12th grade students participating in the nationally representative Monitoring the Future study. Time-varying effect modeling (TVEM) was used to examine the marijuana risk/use association over time.Results: Both before and after controlling for gender and race/ethnicity, perceived risk was a strong protective factor against adolescent marijuana use. The magnitude of the great risk/use association strengthened for Hispanic students; remained generally stable over time for 12th graders overall, males, females, and White students; and weakened for Black students. The magnitude of the moderate risk/use association strengthened for 12th graders overall, males, females, White and Hispanic students, but did not continue to strengthen for Black students from 2005 onwards. In general, marijuana use prevalence decreased over time within all levels of perceived risk.Conclusions: Perceived risk remains a strong protective factor for adolescent marijuana use, and the protective association for moderate risk (vs. no/slight risk) is actually increasing over time. Results suggest that accurate and credible information on the risks associated with marijuana use should remain a key component of prevention efforts. [ABSTRACT FROM AUTHOR]

This paper examines associations among parental and adolescent health behaviors and pathways to adulthood. Using data from the National Longitudinal Study of Adolescent to Adult Health, we identify a set of latent classes describing pathways into adulthood and examine health-related predictors of these pathways. The identified pathways are consistent with prior research using other sources of data. Results also show that both adolescent and parental health behaviors differentiate pathways. Parental and adolescent smoking are associated with lowered probability of the higher education pathway and higher likelihood of the work and the work & family pathways (entry into the workforce soon after high school completion). Adolescent drinking is positively associated with the work pathway and the higher education pathway, but decreases the likelihood of the work & family pathway. Neither parental nor adolescent obesity are associated with any of the pathways to adulthood. When combined, parental/adolescent smoking and adolescent drinking are associated with displacement from the basic institutions of school, work, and family. [ABSTRACT FROM AUTHOR]

Aims: Preference for risky activities is an important developmentally graded predictor of substance use. Population-level trends in adolescent risk preference, as well as the way in which risk preference may be a conduit to risk behavior, have never been documented. The present study examines population-level trends in risk preference among U.S. high school seniors for the 36 years from 1976 to 2011, as well as trends in the association between risk preference and substance use and other problem behaviors.Methods: Data were drawn from yearly nationally representative cross-sectional surveys of US high school seniors (N=91,860). Risk preference was measured consistently with two items. Marijuana and cocaine use, binge drinking, and conduct problems were assessed. Trends were tested using JoinPoint software.Results: The mean level of reported risk preference among US 12th graders has increased over time, especially in the 1980s. For example, the proportion of high school females who reported enjoying activities that were "a little dangerous" more than doubled, from 4.9% in 1976 to 10.8% in 1988. While risk preference reports among adolescent males leveled off in 1992, risk preference reports among females show a continued positive overall slope through 2011. The magnitude of the association between risk preference and marijuana use has increased over time.Conclusions: Reported preference for risky activities has increased among adolescents in the US, especially among young women. Reported risk preference is increasingly associated with a higher use of marijuana. Our findings argue for the importance of placing risk preference within a multi-level framework that attends to historical variation. [ABSTRACT FROM AUTHOR]

Background: As e-cigarette use continues to increase in the U.S., research is needed to understand its prospective risk for cigarette smoking and other substance use in young adulthood, including alcohol, marijuana, and nonmedical prescription drugs (NMPDs).Methods: This study used data from the Monitoring the Future (MTF) study a nationally representative annual survey of 12th graders (modal age 18) in the US. The analytic sample included 2014-2016 MTF cohorts that were selected and completed follow up one year later (modal age 19; n = 717). Using logistic regression, we examined cross-sectional and prospective associations of past 30-day e-cigarette use with past 30-day cigarette, alcohol, marijuana, and NMPD use. We examined prospective associations among the full sample and associations with incidence of each of these substances among those who reported no history of use in 12th grade.Results: In cross-sectional analysis, those who reported past 30-day e-cigarette use at age 18 were more likely to report past 30-day cigarette use, alcohol use, marijuana use, and NMPD use at age 19. In multivariable longitudinal analysis, past 30-day e-cigarette users at age 18 were more likely to report past 30-day cigarette, marijuana, and NMPD use at age 19, including e-cigarette users who had no history of using these substances at age 18.Conclusions: This study suggests that e-cigarette use may be an indicator of future substance use risk in young adulthood. Adolescent e-cigarette users may benefit from secondary prevention efforts to mitigate this risk. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of adolescent nicotine vaping declined substantially after the COVID-19 pandemic onset in the United States during the Spring of 2020. This study examines whether the decline continued from 2022 to 2023, and the extent to which any decline reflects the lasting influence of lowered levels of initiation 3 years earlier, at the onset of the pandemic., Aims and Methods: Data for this study come from nationally representative, cross-sectional surveys of U.S. 12th-grade (n = 9854) and 10th-grade (n = 14 663) students administered in the Spring of 2022 and 2023. The main outcomes are past 12-month nicotine vaping and grade first ever vaped nicotine., Results: From 2022 to 2023 prevalence of past 12-month nicotine vaping declined a relative 20% for 12th-grade students, from 24.3% to 19.1%, and for 10th-grade students by a relative 16%, from 17.8% to 15.1%. Among 12th-grade students who vaped nicotine in the past 12 months, a significant decline in prevalence took place only among those who first ever vaped nicotine in ninth grade, and not among those who first ever vaped nicotine in any other grade. Among 10th grade students who vaped nicotine in the past 12 months, a significant decline in prevalence took place only among those who first ever vaped nicotine in seventh grade, and not among those who first ever vaped nicotine in any other grade., Conclusions: These results contribute national-level evidence that forestalled initiation of nicotine use for 1 year may have a lasting effect that continues to lower adolescents' levels of use many years afterward., Implications: These findings caution against looking to contemporaneous policy for explanations of the large, 1-year decline in nicotine vaping from 2022 to 2023. It can be tempting to interpret the decline as a victory for current efforts to restrict adolescent access to vaping products, or current education/media campaigns that warn adolescents of the dangers of vaping. The findings of this study suggest, instead, that the 1-year vaping declines primarily result from declines in initiation that were set into place 3 years ago during the pandemic onset, more so than the immediate result of contemporaneous policy., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Importance: Gummies, flavored vaping devices, and other cannabis products containing psychoactive hemp-derived Δ8-tetrahydrocannabinol (THC) are increasingly marketed in the US with claims of being federally legal and comparable to marijuana. National data on prevalence and correlates of Δ8-THC use and comparisons to marijuana use among adolescents in the US are lacking., Objective: To estimate the self-reported prevalence of and sociodemographic and policy factors associated with Δ8-THC and marijuana use among US adolescents in the past 12 months., Design, Setting, and Participants: This nationally representative cross-sectional analysis included a randomly selected subset of 12th-grade students in 27 US states who participated in the Monitoring the Future Study in-school survey during February to June 2023., Exposures: Self-reported sex, race, ethnicity, and parental education; census region; state-level adult-use (ie, recreational) marijuana legalization (yes vs no); and state-level Δ8-THC policies (regulated vs not regulated)., Main Outcomes and Measures: The primary outcome was self-reported Δ8-THC and marijuana use in the past 12 months (any vs no use and number of occasions used)., Results: In the sample of 2186 12th-grade students (mean age, 17.7 years; 1054 [48.9% weighted] were female; 232 [11.1%] were Black, 411 [23.5%] were Hispanic, 1113 [46.1%] were White, and 328 [14.2%] were multiracial), prevalence of self-reported use in the past 12 months was 11.4% (95% CI, 8.6%-14.2%) for Δ8-THC and 30.4% (95% CI, 26.5%-34.4%) for marijuana. Of those 295 participants reporting Δ8-THC use, 35.4% used it at least 10 times in the past 12 months. Prevalence of Δ8-THC use was lower in Western vs Southern census regions (5.0% vs 14.3%; risk difference [RD], -9.4% [95% CI, -15.2% to -3.5%]; adjusted risk ratio [aRR], 0.35 [95% CI, 0.16-0.77]), states in which Δ8-THC was regulated vs not regulated (5.7% vs 14.4%; RD, -8.6% [95% CI, -12.9% to -4.4%]; aRR, 0.42 [95% CI, 0.23-0.74]), and states with vs without legal adult-use marijuana (8.0% vs 14.0%; RD, -6.0% [95% CI, -10.8% to -1.2%]; aRR, 0.56 [95% CI, 0.35-0.91]). Use in the past 12 months was lower among Hispanic than White participants for Δ8-THC (7.3% vs 14.4%; RD, -7.2% [95% CI, -12.2% to -2.1%]; aRR, 0.54 [95% CI, 0.34-0.87]) and marijuana (24.5% vs 33.0%; RD, -8.5% [95% CI, -14.9% to -2.1%]; aRR, 0.74 [95% CI, 0.59-0.94]). Δ8-THC and marijuana use prevalence did not differ by sex or parental education., Conclusions and Relevance: Δ8-THC use prevalence is appreciable among US adolescents and is higher in states without marijuana legalization or existing Δ8-THC regulations. Prioritizing surveillance, policy, and public health efforts addressing adolescent Δ8-THC use may be warranted.

Background: National programs that reduce adolescent cannabis use warrant renewed attention in light of current discussions to reform cannabis legislation, including the possibility of legalization for recreational use. This study measures the size of a decrease in a country's prevalence of adolescent cannabis use that accompanies a decrease in its prevalence of adolescents who had ever smoked a cigarette., Methods: Data are from the European School Survey Project on Alcohol and Other Drugs (ESPAD), which is a collaborative effort of more than 40 European countries to surveil adolescent substance use. This study uses data from the seven survey administrations in 1995, 1999, 2003, 2007, 2011, 2015, and 2019. The main analysis is a fixed-effect regression analysis of country-level, four-year changes in adolescent lifetime cannabis use prevalence on country-level, four-year changes in adolescent lifetime cigarette use prevalence., Results: Decreases in the national prevalence of adolescents who had ever smoked a cigarette were accompanied by decreases half as large in national prevalence of adolescent lifetime cannabis use., Conclusion: For European countries considering the legalization of adult recreational cannabis use, tobacco control can offer a tool to help counter potential increases in cannabis use among adolescents., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: To examine if the record declines in adolescent substance use after the onset of the COVID-19 pandemic resulted from reduced levels of initiation, defined as any lifetime use., Methods: We analyzed data from the nationally representative, cross-sectional, annual Monitoring the Future surveys of eighth, 10th, and 12th grade students from 2019 to 2022. Measures included past 12-month use of cannabis, nicotine vaping, and alcohol as well as self-reported grade of initiation of each substance. Analyses are based on randomly selected subsamples of students who received questions on both prevalence and grade of first use, resulting in a total sample size of 96,990 students., Results: Levels of the past 12-month substance use were markedly lower after the onset of the pandemic, in 2021 and 2022. In eighth and 10th grade, levels were at least one-third lower for cannabis and nicotine vaping and 13%-31% lower for alcohol. In 12th grade, the decreases ranged from 9% to 23%. Lower levels of initiation in seventh grade in 2020-2021 accounted for half or more of the overall prevalence decreases in eighth grade in 2021- 2022. Lower levels of initiation in ninth grade in 2020-2021 accounted for 45% or more of the overall prevalence decreases in 10th grade in 2021-2022. Declines in 12th grade substance use prevalence were not consistently linked to lower initiation in earlier grades., Discussion: Much of the declines in overall prevalence of adolescent substance use after the onset of the COVID-19 pandemic trace back specifically to declines in substance use initiation in seventh and ninth grades., (Copyright © 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Commercial tobacco use is the leading cause of preventable disease and death in the United States. Despite declines in overall tobacco product use among youths, disparities persist. This report uses biennial data from the 2015-2021 cycles of the nationally representative Youth Risk Behavior Survey to assess prevalence and trends in electronic vapor product (EVP) use among high school students, including ever use, current use (past 30 days), and daily use. Data from 2021 also included usual source of EVPs among students who currently used EVPs. Overall, in 2021, 36.2% had ever used EVPs, 18.0% currently used EVPs, and 5.0% used EVPs daily, with variation in prevalence by demographic characteristics. Prevalence of ever use and current use of EVPs was higher among female students than male students. Prevalence of ever use, current use, and daily use of EVPs was lower among Asian students than Black or African American (Black), Hispanic, Native Hawaiian or other Pacific Islander, White, and multiracial students. Prevalence of ever use, current use, and daily use of EVPs was higher among bisexual students than among students who were not bisexual. During 2015-2021, although ever use of EVPs decreased overall (from 44.9% to 36.2%) and current use of EVPs was stable overall, daily EVP use increased overall (from 2.0 to 5.0%) and among female (from 1.1% to 5.6%), male (from 2.8% to 4.5%), Black (from 1.1% to 3.1%), Hispanic (from 2.6% to 3.4%), multiracial (from 2.8% to 5.3%) and White (from 1.9% to 6.5%) students. Among students who currently use EVPs, 54.1% usually got or bought EVPs from a friend, family member, or someone else. Continued surveillance of EVP and other tobacco product use is necessary to document and understand youth tobacco product usage. These findings can be used to inform youth-focused tobacco prevention and control strategies at the local, state, tribal, and national levels., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Introduction: This study presents data from 2 population-based surveys of youth (reservation-area American Indian adolescents and U.S. adolescents) on self, family, and friend morbidity and changes in substance use and negative impacts during COVID-19., Methods: Data were obtained in spring 2021 from surveys of American Indian students living on or near reservations (8th grade, n =398; 10th grade, n =367; 12th grade, n =290) and national students from Monitoring the Future (8th grade, n =11,446; 10th grade, n =11,792; 12th grade, n =9,022). The main outcomes were COVID-19 testing, perceived morbidity/mortality, substance-use changes, and emotional changes during COVID-19., Results: The American Indian sample had a greater proportion of testing (e.g., American Indian 8th grade: 58.1% [95% CI=48.6, 68.8]; Monitoring the Future 8th grade: 43.6% [95% CI=39.8, 47.5]) and friend/family hospitalization (e.g., American Indian 8th grade: 36.2% [95% CI=26.2, 47.5]; Monitoring the Future 8th grade: 11.9% [95% CI=10.6, 13.3]). Across grades, greater proportions of the national sample reported increased anxiety, anger, boredom, loneliness, depression, worry, and trouble concentrating, whereas greater proportions of reservation-area American Indians reported decreased anxiety, loneliness, and depression., Conclusions: Findings indicate that reservation-area American Indian youth experienced unique health consequences 1 year into the COVID-19 pandemic compared with national students, illustrating the need for American Indian-specific COVID-19 public health monitoring and response., Competing Interests: Declaration of interest: none.

Background: Nicotine vaping among U.S. adolescents has risen rapidly over the past decade, particularly for youth in grade 12. While previous studies examined the relationship between nicotine vaping and combustible cigarette use, less is known about the co-occurrence between vaping and other tobacco products., Methods: Using Monitoring the Future grade 12 data (2017-2019), we investigated associations between past 30-day nicotine vaping and non-vaping, non-cigarette tobacco use (smokeless tobacco, large cigars, cigarillos, hookah). Population prevalences of four categories were assessed: neither, vaping only, non-vaping of non-cigarette tobacco only, or both. We further investigated these relationships with logistic regressions accounting for the complex survey design (unadjusted, demographic-adjusted, and further adjusted for other substance use). Finally, analyses were stratified by combustible cigarette use., Results: Depending on the non-cigarette tobacco product, 2.5% to 5.4% of grade 12 students vaped nicotine and used a non-cigarette tobacco product. Controlling for demographics, cigarillo use was associated with nicotine vaping (adjusted RR = 3.44, 95% CI: 3.08, 3.84), as was hookah use (aRR = 3.51, 95% CI: 2.92, 4.23), smokeless tobacco (aRR = 2.97, 95% CI: 2.51, 3.52), and cigar use (aRR = 2.90, 95% CI: 2.49, 3.37). Controlling for cannabis and all non-cigarette tobacco products simultaneously attenuated associations. Associations were stronger among students who did not use cigarettes., Discussion: Nicotine vaping is associated with use of many non-cigarette tobacco products, including smokeless tobacco, cigarillos, cigars, and hookah. As prevalence of nicotine vaping remains high among adolescents, we should monitor co-use of vaping and other tobacco products., Competing Interests: Declaration of Competing Interest Authors have no interests to declare.

Purpose: While there is a well-established association between depression and cigarette use, the mental health sequelae of vaping nicotine remain unclear. This study examined whether adolescents with depressive symptoms had higher odds of vaping nicotine than others, and how this association differed when examining vaping with cigarette use, vaping without cigarette use, and cigarette use alone., Methods: Using 2017-2019 Monitoring the Future data, we examined U.S. adolescents in the eighth, 10th and 12th grades surveyed in schools across the contiguous states. Depressive symptoms were measured by using questions around negative affect and hopelessness. The outcome included vaping with cigarette use; vaping without cigarette use; cigarette use alone; and neither. Control covariates included sex, race, highest level of parental education, and average grades., Results: The sample included 32,636 adolescents. Depressive symptoms were positively associated with comorbid vaping and cigarette use across all grades (eighth graders: adjusted odds ratio [aOR] = 3.52 [95% confidence interval (CI): 1.94-6.39]; 10th graders: aOR = 2.26 [95% CI: 1.51-3.38]; 12th graders: aOR = 1.81 [95% CI: 1.05-3.12]); vaping without cigarette use among eighth graders (eighth graders: aOR = 2.01 [95% CI: 1.46-2.77]; 10th graders: aOR = 1.20 [95% CI: .97-1.49]; 12th graders: aOR = 1.20 [95% CI: .84-1.70]); and cigarette use alone among eighth and 10th graders (eighth graders: aOR = 2.91 [95% CI: 1.50-5.62]; 10th graders: aOR = 2.29 [95% CI: 1.35-3.88]; 12th graders: aOR = 1.73 [95% CI: .83-3.61])., Conclusions: Eighth grade adolescents with depressive symptoms have increased odds of vaping nicotine with and without cigarette use. As vaping prevalence increases, clinician assessment of adolescent vaping should concomitantly acknowledge potential mental health correlates. Vaping may be a marker for a broader constellation of adolescent health concerns, including mental health., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Adolescents cannabis users are at a substantially elevated risk for use of highly addictive drugs such as cocaine, heroin, and nonmedical use of prescription drugs. Unknown is whether this elevated risk applies to adolescent cannabis users who have never smoked a combustible cigarette, a group that has grown considerably in size in recent years. This study documents the recent growth in the proportion of adolescent cannabis users who abstain from combustible cigarette use, and examines their probability for use of addictive drugs., Methods: Data are annual, cross-sectional, nationally-representative Monitoring the Future surveys of 607,932 U.S. 12 th grade students from 1976-2020., Results: Among ever cannabis users, the percentage who had never smoked a combustible cigarette grew from 11% in 2000 to 58% in 2020. This group had levels of addictive drug use that were 8% higher than their peers. In comparison, adolescents who had ever used cannabis - regardless of whether they had ever smoked a cigarette - had levels of addictive drug use 500% higher than their peers., Conclusions: Adolescent cannabis users who have not smoked a combustible cigarette have much lower levels of addictive drug use than the group of cannabis users as a whole. These results suggest policies and laws aimed at reducing adolescent prevalence of addictive drugs may do better to focus on cigarette use of adolescent cannabis users rather than cannabis use per se., Competing Interests: Conflicts of Interests and Competing Interests: The author has no relevant financial or non-financial interests to disclose.

Aims: In the last decade the relatively lower levels of marijuana use for black relative to non-black high school seniors has grown smaller and disappeared, drawing to a close a unique disparity that actually favored a disadvantaged group for at least thirty years. In this study we test trends in cigarette smoking and religiosity as possible explanations for this closing disparity. The study also examines whether increasing marijuana levels for black adolescents is better characterized as a cohort effect or an historical period effect., Design: Analyses use relative risk regression and focus on data from yearly, cross-sectional surveys from the time period 2008-2017., Setting and Participants: Data comes from the nationally-representative Monitoring the Future survey, which conducts in-school surveys of secondary school students. The analysis uses data from 114,552 high school seniors (in 12th grade), 123,594 in 10th grade, and 136,741 in 8th grade., Findings: Past 12-month marijuana prevalence significantly increased for black as compared to non-black adolescents from 2008 to 2017 in 12th grade, 10th grade, and 8th grade. The increase attenuated by more than half and was not statistically significant after adjusting for cigarette smoking. In contrast, the increase was little changed after adjusting adolescent levels of religiosity. The increase is better characterized as a cohort effect than a period effect., Conclusions: These results support the increase in marijuana use for black relative to non-black adolescents as an unexpected consequence of the great decline in adolescent cigarette smoking, which has occurred slower for black adolescents., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: This study presents the first nationally-representative estimates of adolescent nicotine prevalence that take into account adolescent reports of substances vaped. These reports allow nicotine estimates that consider the impact of the newly-emerged group of adolescents who report vaping only non-nicotine substances such as flavoring and/or marijuana and do not use nicotine in any form - a group typically treated as nicotine users., Methods: Data come from Monitoring the Future and are a randomly-selected subsample of 2231 U.S. 12th grade students who answered surveys with detailed questions on tobacco use and vaping in 2017., Results: Among 12th grade students 24.7% used nicotine in the last 30 days. This estimate does not include the 3.8% of students who vaped only non-nicotine substances and did not use nicotine in any other form. These students more closely resemble their peers who do not use nicotine than those who do, in terms of perceived risk and disapproval of cigarettes, as well as percentage of friends who use cigarettes., Conclusions: A decline in nicotine prevalence was statistically significant, but not strikingly large, after taking into account students who vape non-nicotine substances and do not use nicotine in any form. These students are largely similar to their peers who do not use nicotine, which underscores the importance of efforts to alert youth that they may be vaping nicotine unknowingly, and prevent them from doing so.

Introduction: Vaping has recently increased in popularity among adolescents. Little is known about heterogeneity of vapers, particularly in terms of why they vape. Identifying major subgroups of adolescent vapers by reasons for vaping is important to understand adolescent vaping behavior and to identify those most at risk for other substance use., Methods: Monitoring Future data from 2015 and 2016 were used in a latent class analysis to identify subgroups of 12th graders based on their endorsement of 10 potential reasons for vaping. Multinomial regression with a latent class outcome was used to predict class membership., Results: Three distinct classes of vapers were identified: adolescents who were (1) Vaping to Experiment (29.4%), (2) Vaping to Replace Cigarettes (7.3%), and (3) Vaping for Taste + Entertainment (63.4%). Vaping only flavors was associated with lower odds of membership and cigarette use was associated with higher odds of membership in the Vaping to Replace Cigarettes subgroup, and marijuana was associated with lower odds of membership in the Vaping to Experiment subgroup, compared with the Vaping for Taste + Entertainment subgroup., Conclusions: This study identified multiple subgroups of vapers based on reasons for vaping. Whereas a small subgroup vaped for reasons related to cigarette use, most adolescent vapers reported vaping for reasons unrelated to cigarette use. There were considerable differences in primary reasons for vaping and risk for traditional cigarette and other substance use, suggesting different intervention strategies may be needed for different subgroups of vapers., (Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To prospectively examine vaping as a predictor of future cigarette smoking among youth with and without previous cigarette smoking experience. A secondary aim is to investigate whether vaping may desensitise youth to the dangers of smoking., Methods: Analysis of prospective longitudinal panel data from the nationally representative Monitoring the Future study. The analysis is based on 347 12th grade students who were part of a randomly selected subsample that completed in-school surveys in 2014 and were resurveyed 1-year later., Results: Among youth who had never smoked a cigarette by 12th grade, baseline, recent vapers were more than 4 times (relative risk (RR)=4.78) more likely to report past-year cigarette smoking at follow-up, even among youth who reported the highest possible level of perceived risk for cigarette smoking at baseline. Among 12th grade students who had smoked in the past but had not recently smoked at baseline, recent vapers were twice (RR=2.15) as likely to report smoking in the past 12 months at the follow-up. Vaping did not predict cessation of smoking among recent smokers at baseline. Among never-smokers at baseline, recent vapers were more than 4 times (RR=4.73) more likely to move away from the perception of cigarettes as posing a 'great risk' of harm, a finding consistent with a desensitisation process., Conclusions: These results contribute to the growing body of evidence supporting vaping as a one-way bridge to cigarette smoking among youth. Vaping as a risk factor for future smoking is a strong, scientifically-based rationale for restricting youth access to e-cigarettes., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Introduction: This study examines the role of e-cigarettes in the drug use patterns of adolescents. Of specific interest is whether adolescent e-cigarette users fall into a group of (1) youth who do not use traditional drugs of abuse or (2) polysubstance users., Methods: Using latent class analysis, we identify major "classes" of substance users on the basis of recent use of e-cigarettes, alcohol, marijuana, cigarettes, and prescription drugs. Analyses are conducted separately for adolescents in 8th, 10th, and 12th grades. Data come from 16 615 participants in the 2014 Monitoring the Future survey., Results: Youth who do not use traditional drugs of abuse account for about 50% of e-cigarette users in 8th grade, 35% in 10th grade, and 17% in 12th grade. These youth come from a large "low-level users" group found in each grade, characterized by low probability of use for all substances (e-cigarette probability in this group for 8th graders = .046; 10th graders = .071; 12th graders = .027). Other e-cigarette users come from a smaller, "poly-users" group found in each grade, characterized by high-to-moderate probabilities (.83-.21) of using e-cigarettes and other substances. Specific to 12th grade is a third, additional polysubstance group characterized by high likelihood of e-cigarette use (.93)., Conclusions: The proportion of e-cigarette users who do not use traditional drugs of abuse is larger at younger ages. Longitudinal panel studies starting at 8th and 10th grades may best inform the current debate on whether e-cigarette use is a risk or protective factor for future transition to the use of other substances., Implications: The proportion of e-cigarette users who do not use traditional drugs of abuse is larger at younger ages. Longitudinal panel studies starting at 8th and 10th grades may best inform the current debate on whether e-cigarette use is a risk or protective factor for future transition to the use of other substances., (© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

In this study we consider the health implications of the sequencing of a college degree vis-à-vis familial roles during the transition to adulthood. We hypothesize that people who earned a college degree before assuming familial roles will have better health than people who earned a college degree afterwards. To test this hypothesis, we focus on obesity and use data from the National Longitudinal Study of Adolescent Health. Results show that marriage before completion of college was associated with a 50% higher probability of becoming obese when compared with marriage after completion of college. Parenthood before college completion was associated with a greater than twofold increase in the probability of becoming obese when compared to parenthood afterwards for black men. These findings suggest that the well-established association of education with health depends on its place in a sequence of roles., (© American Sociological Association 2015.)

Background: This analysis examines decriminalization as a risk factor for future increases in youth marijuana acceptance and use. Specifically, we examine marijuana-related behaviors and attitudes of 8th, 10th, and 12th graders in California as compared to other U.S. states during the years before and after California passed legislation in 2010 to decriminalize marijuana., Methods: Data come from Monitoring the Future, an annual, nationally representative survey of 8th, 10th, and 12th grade students., Results: In 2012 and afterwards California 12th graders as compared to their peers in other states became (a) 25% more likely to have used marijuana in the past 30 days, (b) 20% less likely to perceive regular marijuana use as a great health risk, (c) 20% less likely to strongly disapprove of regular marijuana use, and (d) about 60% more likely to expect to be using marijuana five years in the future. Analysis of 10th graders raises the possibility that the findings among 12th graders may reflect a cohort effect that was set into place two years earlier., Conclusion: These results provide empirical evidence to support concerns that decriminalization may be a risk factor for future increases in youth marijuana use and acceptance., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Evaluating population-level patterns of heavy episodic drinking by age, period, and cohort is critical to understanding population-level influences on rates over time and to forecasting future trends for public health planning efforts. The present study examined trends in heavy episodic drinking in the US from 1985 through 2009 in a nationally representative sample that included adolescents and adults., Methods: Data are drawn from repeated cross-sectional surveys of US households as part of the National Household Survey on Drug Use and Health conducted in 1985, 1988, and annually from 1990 though 2009, inclusive (N=809,281). Heavy episodic drinking was defined as any instance of consuming five or more drinks in one sitting in the past month. Age-period-cohort models were identified using the Intrinsic Estimator algorithm., Results: Heavy episodic drinking is decreasing in the US among adolescents and young adults, with the most recently born cohorts (born in the 1990s) at lower odds of heavy episodic drinking compared with cohorts born in the 1960s, 1970s, and 1980s. Results were consistent across sex and race/ethnicity, with the exception that the decrease is not apparent among Hispanics., Conclusions: These data are promising in that young cohorts appear to be reducing heavy episodic drinking, however the lack of decrease among Hispanics suggests targeted intervention and prevention as well as increased surveillance are necessary., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)