Adolescent Tobacco Use and Young Adult

OutcomesKathy 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

Problem Behavior Syndrome

Adolescent Substance Use

Adult Outcomes

Developing Competencies

Adolescent Substance

Use

Interference in Development ofCompetencies

Adult Outcomes

ObjectivesTo 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

VariablesYoung 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

Results11% (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

Years of Education

***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

Predictors Unadjusted Adjusted +

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