Other substance use among high school students who use tobacco

doi:10.1016/S1054-139X(98)00023-8

Journal of Adolescent Health

Volume 23, Issue 5, November 1998, Pages 289-296

https://doi.org/10.1016/S1054-139X(98)00023-8 Get rights and content

Abstract

Purpose: To examine relationships between tobacco use and use of other substances among U.S. high school students, by gender and racial/ethnic subgroups.

Methods: Data about tobacco and other substance use were analyzed from the 1995 national Youth Risk Behavior Survey implemented by the Centers for Disease Control and Prevention.

Results: Compared to nonsmokers, current smokers were significantly more likely to report use of all other substances we examined, including lifetime use of cocaine, inhalants, other illegal substances, and multiple substances and current alcohol use, episodic heavy drinking, marijuana use, and cocaine use. A strong dose-dependent relationship between current cigarette smoking and other substance use was identified. Among smokeless tobacco users, a strong dose-dependent relationship was found for all examined substances with the exception of lifetime and current cocaine use. Finally, a pattern of risk emerged suggesting that the likelihood of other substance use increases as students move from no tobacco use to smokeless tobacco use only, to cigarette smoking only, and to use of both smokeless tobacco and cigarettes.

Conclusions: Programs designed to prevent tobacco or other substance use should consider that such use often occurs concomitantly.

Section snippets

Study design

The YRBS, implemented by the Centers for Disease Control and Prevention, monitors the prevalence of priority health risk behaviors among youth 11. In 1995, data about tobacco and other substance use were collected from a nationally representative sample of U.S. high school students. Sampling strategies and the psychometric properties of the questionnaire have been described elsewhere 11, 12, 13, 14. The overall response rate was 60% and the number of completed questionnaires was 10,904. Data

Current tobacco and substance use

Overall, 62.2 ± 2.4% (prevalence estimate ± 95% confidence interval) of students reported no current tobacco use, 3.1 ± 0.6% reported current use of smokeless tobacco but not cigarettes, 27.0 ± 1.7% reported current use of cigarettes but not smokeless tobacco, and 7.7 ± 1.6% reported current dual use. Overall, 7.0 ± 1.1% of students reported lifetime cocaine use, 20.3 ± 2.1% reported lifetime inhalant use, 16.0 ± 1.8% reported lifetime use of other illegal substances, and 22.5 ± 2.1% reported

Discussion

Consistent with other research 2, 3, 4, 5, 6, 7, 8, 9, 10, these data suggest a strong association between tobacco use and the use of other substances. This association held for most gender and racial/ethnic subgroups. In addition, a strong dose–response relationship between tobacco use and all other substances use was found. Lifetime use of cocaine, inhalants, other illegal substances, and multiple substances; current use of alcohol, marijuana, and cocaine; and current episodic heavy drinking

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Portrayals of character smoking and drinking in Argentine-, Mexican- and US-produced films
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However, high SES among film characters (at 40% in the US in Mexico) is more common than in reality, so this overall character bias contrasts with the reality that smoking is much more common among low SES groups (Centers for Disease Control and Prevention, 2015; Campuzano et al., 2004). The association between film character smoking and multiple risk behaviors and other substance use is consistent with published literature on the association between smoking and use of multiple substances in the population (Everett et al., 1998b; Lewinsohn et al., 1999). Finally, smoking was also associated with being a negative as opposed to a positive character, again consistent with prior research (Dalton et al., 2002; Omidvari et al., 2005).
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Nutritional status, nutritional self-perception, and use of licit drugs in adolescents
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The study included 210 adolescents with a median age of 148 months; 56.6% were females. Of the total sample, 6.6% have tried cigarettes, and 20% have tried alcohol; 32.3% had BMI Z‐Score≥1, 12.85% had BMI Z‐Score≥2, and 50.7% had a correct perception of his/her weight. After a multivariate analysis, only the self‐perception about weight statistically influenced experimentation of tobacco, and patients who identified themselves as having very high weight were more likely to experiment tobacco (odds ratio (OR) 13.57; confidence interval (95% CI) 2.05‐89.8; p=0.007); regarding alcohol use, adolescents who identified themselves as having high weight were 2.4 times more likely to experiment with alcohol than adolescents that identified themselves as having normal weight (95% CI 1.08‐5.32, p=0.031).
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Marijuana use and tobacco smoking cessation among heavy alcohol drinkers
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Current cigarette smokers are nearly four times more likely to use marijuana than non-smokers (Bell et al., 1997), and current marijuana users are five to seven times more likely than non-users to smoke tobacco (Mohler-Kuo et al., 2003; Richter et al., 2004). In addition, heavy drinking is prevalent among both cigarette (Chiolero et al., 2006; Dawson, 2000; Weitzman and Chen, 2005) and marijuana smokers (Bonn-Miller and Zvolensky, 2009; Dennis et al., 1999), and comorbid heavy drinking and marijuana use are particularly prevalent among heavy cigarette smokers (Bell et al., 1997; Everett et al., 1998; Richter et al., 2004; Wu et al., 1988). The concurrent use of marijuana, tobacco, and heavy alcohol use are linked to a number of health risks (Engs and Aldo-Benson, 1995; Giancola, 2002; Hall et al., 1994; Kalant, 2004; Presley et al., 1996; Tashkin et al., 1990; Wu et al., 1988), behavioral problems (Abbey, 1991; Abbey et al., 1998; Giancola, 2002; Hingson et al., 2002; Hingson et al., 2005; Jones et al., 2003; Kalant, 2004; Katz et al., 2000; Marcus and Reio, 2002; Montgomery and Haemmerlie, 1993; Newcomb and Bentler, 1986; Wood et al., 2000), and psychiatric comorbidity (Stinson et al., 2006).
Whereas problem drinking impedes smoking cessation, less is known whether marijuana use affects smoking cessation outcomes and whether smoking cessation treatment leads to changes in marijuana smoking.
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Differences between polytobacco users and cigarette-only smokers have also been noted. U.S. youth and young adults who are polytobacco users are more likely to use alcohol and illicit drugs than cigarette-only users (Coogan, Geller & Adams, 2000; Everett, Giovino, Warren, Crossett & Kann, 1998; Everett et al., 2000; Galanti & Gilljam, 2003; Lando, Haddock, Klesges, Talcott & Jensen, 1999; Simon, Sussman, Dent, Burton & Flay, 1993). U.S adolescent polytobacco users are more likely than cigarette-only users to engage in other risky behaviors such as drunk driving, fighting, and skipping classes (Coogan et al., 2000; Gilpin & Pierce, 2003; Simon et al., 1993).
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Original ArticlesOther substance use among high school students who use tobacco

Abstract

Section snippets

Study design

Current tobacco and substance use

Discussion

Cigarette smoking as a predictor of alcohol and other drug use by children and adolescents: Evidence of the “gateway drug effect.”

J Sch Health

A longitudinal analysis of adolescent smoking and its correlates

J Sch Health

Generic tobacco use among four ethnic groups in a school age population

J Drug Educ

Preventing tobacco use among young peopleA report of the Surgeon General

Relationship between cigarette smoking and health risk and problem behaviors among US adolescents

Arch Pediatr Adolesc Med

Role of cigarette smoking as a gateway drug to alcohol use in Hispanic junior high school students

NCI Monogr

Prevalence and sociobehavioral correlates of tobacco use among Hispanic childrenThe tobacco resistance activity program

J Sch Health

Characteristics of smokeless tobacco use among high school football players as related to type of smokeless tobacco and period of use

J Drug Educ

Use of smokeless tobacco among male adolescentsConcurrent and prospective relationships

NCI Monogr

Overview of the Youth Risk Behavior Surveillance System

Public Health Rep

CDC Surveillance SummariesYouth risk behavior surveillance—United States, 1993

MMWR

CDC Surveillance SummariesYouth risk behavior surveillance—United States, 1995

MMWR

Reliability of the Youth Risk Behavior Surveillance Survey questionnaire

Am J Epidemiol

Original Articles
Other substance use among high school students who use tobacco