Full length articleChildhood weight status and timing of first substance use in an ethnically diverse sample
Introduction
According to recent data (Johnston et al., 2015), approximately 14% of 8th graders (ages 13–14 on average) smoked a cigarette, 27% consumed alcohol, and 16% used marijuana at some point in their lives. Although substance use is increasingly normative over the course of adolescence, consequences of early-onset use are far-reaching. Early drinking and drug use are associated with increased risk of accidental falls, burns, and drownings (Bass et al., 1985, Spirito et al., 1997), physical fighting (Dukarm et al., 1996, Hingson et al., 2001), and risky sexual activities (Tapert et al., 2001). Among longer term consequences, early drinking and drug use are predictive of later problem use, including elevated risk of substance dependence (Grant and Dawson, 1997, Hingson et al., 2006, Robins and Przybeck, 1985).
Identifying predictors of early-onset substance use is critical to inform preventive efforts. However, much literature on predictors of early use predates more recent attention to the obesity epidemic in the U.S. (Ogden et al., 2014), ignoring weight status as a potential risk-factor. This is especially true of research on racial/ethnic minorities, whose rates of smoking, drinking, and marijuana use during adolescence are fast approaching or have surpassed those of Whites (Johnston et al., 2014) and for whom prevalence of obesity is comparatively high. Indeed, current estimates suggest that 22% of Hispanic and 20% of non-Hispanic Black children meet criteria for obesity, relative to 14% of non-Hispanic White children (Ogden et al., 2014).
Although associations between concurrently assessed obesity and use of cigarettes, alcohol, and marijuana are reported in adolescent samples (e.g., Farhat et al., 2010, Fonseca et al., 2009, Ratcliff et al., 2011, Sanderson et al., 2015), few longitudinal analyses have been conducted where temporal primacy of weight status relative to substance use can be achieved. Compared to findings from cross-sectional studies, longitudinal findings suggest small to moderate effects of obesity or overweight status on subsequent smoking with largely nonsignificant effects on later use of alcohol and marijuana (Huang et al., 2013; Lanza et al., 2014; Pasch et al., 2008, Pasch et al., 2012). In the single study to predict timing of first substance use from weight status, Caria and colleagues (2009) found that girls who were obese or overweight in 5th grade were more likely to initiate smoking through age 18, compared to healthy-weight peers. For males, no significant effect of weight status was observed.
Findings by Caria et al. (2009) highlight sex as a potential moderator of risk associated with weight status, although pooling of data from males and females is typical of analyses published to-date. Such pooling, regardless of reason (e.g., reduced statistical power or desire to generalize more broadly), may obscure important within-group patterns of associations given differences by sex related to substance use and weight status. For example, compared to females, males report earlier use of cigarettes (Harrell et al., 1998), alcohol (Alvanzo et al., 2011), and marijuana (Kosterman et al., 2000). Males also report heavier and more frequent use across most substance classes (Johnston et al., 2014) and demonstrate higher lifetime prevalence of substance use disorder (Brady and Randall, 1999, Kessler et al., 2005). Additionally, in the U.S., males are more likely than females to be obese or overweight as children, although this pattern is reversed for Black children (Ogden et al., 2014, Wang and Beydoun, 2007).
It is also common for studies linking weight status and adolescent substance use to pool across racial/ethnic group, which may likewise obscure important differences in observed relationships. Compared to non-Hispanic Whites, Black youth report later use of cigarettes (Harrell et al., 1998) and alcohol (Blum et al., 2000) and are at overall reduced risk of substance dependence (Breslau et al., 2006, Muthén and Muthén, 2000). Historically, Hispanic adolescents had lower rates of substance use than non-Hispanic Whites (Blum et al., 2000), but higher than Black youth (Johnston et al., 2010). More recent data suggest that rates of substance use by Hispanic adolescents now exceed those of both non-Hispanic White and Black youth, especially during early adolescence (Johnston et al., 2014). Regarding weight status, as noted, non-Asian minorities account for a disproportionate number of obese children (Ogden et al., 2014).
Preliminary evidence that associations between weight status and substance use differ by race/ethnicity was reported in a recent analysis of the Youth Risk Behavior Survey of high school students. In the only study to stratify by race/ethnicity, Sanderson et al. (2015) reported a number of cross-group variations, although formal tests of differences were not performed. Compared to healthy-weight White females, for example, overweight and obese White females were at increased odds of lifetime smoking and current smoking. Odds of ever smoking and current smoking were also elevated among obese but not overweight White males, relative to healthy-weight White males. Among Hispanic and Black youth, findings were nonsignificant with two exceptions: obese Hispanic females were at increased odds of current smoking with overweight status predictive of early (before age 13) use of marijuana.
In the present study, we extend prior research by examining associations between childhood weight status and timing of first cigarette, alcohol, and marijuana use, the latter prospectively assessed from early adolescence. Consistent with Sanderson and colleagues (Sanderson et al., 2015), analyses were conducted separately for Hispanic, Black, and White females and males. In addition to testing for differences by sex and race/ethnicity, we examined outcomes associated with obese, overweight, and underweight statuses. Although obese and overweight statuses are often examined as a single category of “obese or overweight” (e.g., Caria et al., 2009; Lanza et al., 2014), stronger negative effects of obesity relative to overweight status have been reported for a number of outcomes associated with early-onset substance use, including peer victimization (Pearce et al., 2002, Sullivan et al., 2006), diminished self-esteem (Franklin et al., 2006, Strauss, 2000), and academic difficulties (Ary et al., 1999, Falkner et al., 2001). To our knowledge, the present study is the first to examine underweight status in the context of adolescent substance use, and the first to examine the moderating roles of sex and race/ethnicity.
Section snippets
Participants
Data were drawn from child samples of the 1979 National Longitudinal Survey of Youth (NLSY79) or Children of the NLSY (CNLSY; Bureau of Labor Statistics, 2012b). NLSY79 is a large, nationally-representative sample of 12,686 male and female individuals aged 14–22 years at baseline interview (Bureau of Labor Statistics, 2012a). NLSY79 surveys were conducted annually through 1994 and biennially since 1996. In 1986, biennial assessment of biological children of female participants began. By 2010,
Results
There were significant differences in timing of first substance use by offspring sex and race/ethnicity (see Table 1). Within racial/ethnic group, earlier initiation of all substance classes was observed for Hispanic and Black males compared to females (log-rank tests, p < 0.05); earlier marijuana use was observed for White males compared to females (log-rank tests, p < 0.000). Relative to White females, Hispanic females reported earlier use of marijuana (log-rank tests, p = 0.003) with Black females
Discussion
The present study is the first to examine timing of first substance use as a function of childhood weight status and the potential moderating roles of sex and race/ethnicity. With data drawn from a national longitudinal sample, we predicted age at first cigarette, alcohol, and marijuana use from obese, overweight, and underweight statuses assessed at ages 7 or 8. Although we found the overall effects of weight status on first substance use were relatively small in magnitude, different patterns
Role of funding sources
Funding for this study was provided by NIDA grant DA023696. NIDA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors
Author Duckworth conducted literature searches and authors Duckworth, Doran, and Waldron conducted the statistical analyses. Author Duckworth wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript. Conflict of Interest: none. Acknowledgements We wish to thank the NLSY respondents and their families.
Conflict of interest
None.
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