Religion, race among top predictors of substance use initiation in early adolescence

Key takeaways:

• Alcohol was the most frequently initiated substance in youths by age 12 years.
• Religion was the strongest predictor of substance use initiation, followed by race.

NEW YORK — Factors across multiple domains, including demographic characteristics and parenting behaviors, appeared predictive of substance use initiation in early adolescence, according to study results.

“Most of the previous studies I was looking at when I started getting into this work exclusively focused on only one or two of these domains, but very few integrated multiple,” ReJoyce Green, PhD, assistant professor in the department of psychiatry and behavioral sciences at Medical University of South Carolina, said during a special briefing at the American Psychiatric Association Annual Meeting that discussed the study results, published in American Journal of Psychiatry.

“That influenced our research question: How do predictors from multiple domains actually converge to impact risk for general substance use initiation?” she added.

To address this question, Green and colleagues recruited 6,829 youths aged 9 years to 10 years from the Adolescent Brain Cognitive Development study to examine predictors of substance use initiation, defined as trying any nonprescribed substance, in early adolescence across multiple domains.

The researchers examined a total of 420 variables as potential predictors of substance use initiation using a penalized logistic regression with elastic net. The assessed domains included demographic characteristics, self and peer involvement with substance use, parenting behaviors, mental and physical health, culture and environment, pubertal hormone levels, neurocognition and structural neuroimaging.

The primary outcome of the study was a child self-reported binary indicator of substance use initiation across a 3-year follow-up period, according to the researchers.

Overall, 982 youths (14.4%) reported substance use initiation by age 12 years; alcohol was the most common substance, followed by cannabis and nicotine.

Researchers then tested models that included different combinations of the variables to assess whether they predicted substance use initiation by early adolescence by calculating area under the curve. A model that only included self-report predictors showed an AUC in the test set of 0.666 (95% CI, 0.631-0.701), which appeared comparable to the final model that included all 420 predictors (AUC for test set = 0.659; 95% CI, 0.624 - 0.694).

Of the variables included in the final model, the researchers found that those in the sociodemographic, cultural and environmental, physical health and parenting behaviors domains had the largest coefficients.

The researchers reported that religion was the strongest predictor of substance use initiation. Specifically, youths with parent report of a religious preference of Mormon were less likely to initiate substance use (coefficient = –0.87), as were those with a religious preference of Muslim (coefficient = –0.25), whereas those with a religious preference for Jewish were more likely to initiate (coefficient = 0.32).

Race was also a top predictor of substance use initiation; specifically, Black youths were less likely to initiate (coefficient = –0.32).

Other predictors of youth less likely to initiate included household income of $12,000 to $15,999 and parents with less than a high school degree or GED, whereas predictors of youth being more likely to initiate included a history of detention or suspension, prenatal exposure to substance use, substance use availability and age at baseline.

“I think it will be really interesting to follow up with this cohort in later years to determine whether or not some of the same top predictors will be found when substance use rates are higher or across different patterns of substance use,” Green said.

“In terms of thinking about what we can do clinically with this, including a comprehensive assessment of different demographic measures or mental health factors can be particularly informative for providers in a variety of different settings,” she added.

Reference:

• Special briefing. Presented at: American Psychiatric Association Annual Meeting; May 4-8, 2024; New York.