Concurrent Use of Alcohol and Cigarettes from Adolescence to Young Adulthood: An Examination of Developmental Trajectories and Outcomes

Abstract

Concurrent use of alcohol and tobacco is common among adolescents, yet little is known about the developmental patterns of concurrent use, or the consequences associated with such patterns during young adulthood. Using data collected at six time points during 1985–1995 as part of an evaluation of a school-based substance abuse prevention program in California and Oregon, this study used latent growth mixture modeling to identify five distinct developmental trajectories of concurrent use of alcohol and tobacco from ages 13–23 in a cohort of 5873 individuals and compared these distinct groups with respect to demographic characteristics and young adult outcomes (at age 23 and age 29). Results suggest that while it is common during adolescence to drink but not smoke, it is very unusual to smoke and not drink. Compared to young people who smoked and drank consistently throughout their teens and early twenties, those who drank consistently but smoked only occasionally or dramatically decreased their smoking over time had lower rates of deviant behavior and predatory violence at age 23 and were less likely to have a history of arrest and substance use problems by age 29. This close examination of concurrent use of alcohol and cigarette use from ages 13–23 further accentuates the importance of curbing smoking behavior among adolescents before it becomes habitual.

Keywords:

• smoking
• drinking
• adolescence
• young adulthood
• trajectory

Additional information

Notes on contributors

Maria Orlando

Maria Orlando is a Quantitative Psychologist specializing in health research at RAND. She has extensive knowledge of test theory including Item Response Theory (IRT) and of advanced multivariate analysis methods such as Structural Equation Modeling (SEM) and latent growth mixture modeling. Her current research on instrument development and validation is supported by grants from the National Institute of Drug Abuse and the National Institute of Mental Health. Grants from these institutes have also supported Dr. Orlando's work examining trends in substance use over time through advanced analysis of longitudinal data, as well as mediation analysis of a school-based drug prevention program.

Joan S. Tucker

Joan Tucker, Ph.D., a social psychologist and Behavioral Scientist at RAND, conducts research on developmental trajectories of substance use, risk factors for initiation and escalation, and short- and long-term consequences of use during adolescence and young adulthood. Recent work has focused on identifying trajectories of cigarette smoking and binge drinking, important psychosocial factors that foreshadow escalated use, ages of greatest risk for escalated use, and trajectory groups that exhibit the greatest problems transitioning to young adulthood. Other recent studies have investigated early smoking and drinking as risk factors for later problem behaviors during young adulthood, as well as identified key predictors of smoking escalation during adolescence and smoking cessation during late adolescence and young adulthood.

Phyllis L. Ellickson

Phyllis L. Ellickson is Director of the Center for Research on Child and Adolescent Health, and a Senior Behavioral Scientist at RAND. A nationally recognized expert on drug prevention and adolescent problem behavior, she led the team that developed and evaluated Project ALERT, a widely acclaimed prevention program. With support from the National Institute of Drug Abuse, she is now testing an expanded version of Project ALERT that includes a high school component. She has also published extensively on the patterns and antecedents of adolescent drug use, violence and dropping out; racial ethnic differences in drug use; and the challenges of conducting large-scale field trials and field experiments. Her other current research focuses on the patterns and consequences of drug use among young adults, how advertising affects adolescent alcohol use, and the links between HIV risk, violence, and substance abuse.

David J. Klein

David J. Klein is an Associate Quantitative Analyst in RAND's Statistical Research and Consulting Group, performing data management and statistical analysis. He has worked on a wide variety of research projects at RAND, mostly in the health field. Among others, his current projects include studies on substance use, parent-child communications, quality and quantity of health care usage, and medical education.