Trends in the sequence of initiation of alcohol, tobacco, and marijuana use among adolescents in Argentina and Chile from 2001 to 2017

Julia P. Schleimer, Nathan Smith, Vini Natalie Zaninovic, Katherine M. Keyes, Alvaro Castillo-Carniglia, Ariadne Rivera-Aguirre, Magdalena Cerdá

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Variation in drug policies, norms, and substance use over time and across countries may affect the normative sequences of adolescent substance use initiation. We estimated relative and absolute time-varying associations between prior alcohol and tobacco use and adolescent marijuana initiation in Argentina and Chile. Relative measures quantify the magnitude of the associations, whereas absolute measures quantify excess risk. Methods: We analyzed repeated, cross-sectional survey data from the National Surveys on Drug Use Among Secondary School Students in Argentina (2001–2014) and Chile (2001–2017). Participants included 8th, 10th, and 12th grade students (N = 680,156). Linear regression models described trends over time in the average age of first use of alcohol, tobacco, and marijuana. Logistic regression models were used to estimate time-varying risk ratios and risk differences of the associations between prior alcohol and tobacco use and current-year marijuana initiation. Results: Average age of marijuana initiation increased and then decreased in Argentina and declined in Chile. In both countries, the relative associations between prior tobacco use and marijuana initiation weakened amid declining rates of tobacco use; e.g., in Argentina, the risk ratio was 19.9 (95% CI: 9.0–30.8) in 2001 and 11.6 (95% CI: 9.0–13.2) in 2014. The relative association between prior alcohol use and marijuana initiation weakened Chile, but not in Argentina. On the contrary, risk differences (RD) increased substantially across both relationships and countries, e.g., in Argentina, the RD for tobacco was 3% (95% CI: 0.02–0.03) in 2001 and 12% (95% CI: 0.11–0.13) in 2014. Conclusion: Diverging trends in risk ratios and risk differences highlight the utility of examining multiple measures of association. Variation in the strength of the associations over time and place suggests the influence of environmental factors. Increasing risk differences indicate alcohol and tobacco use may be important targets for interventions to reduce adolescent marijuana use.

Original languageEnglish (US)
Article number103494
JournalInternational Journal of Drug Policy
Volume100
DOIs
StatePublished - Feb 2022
Externally publishedYes

Keywords

  • Adolescent
  • Alcohol
  • Marijuana
  • Substance use
  • Tobacco

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

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