Longitudinal Smoking Patterns: Do They Predict Symptoms of ADHD in Adults?

Objective: The objective of this study was to assess whether comparisons of longitudinal smoking trajectories predict differences in symptoms of ADHD in adults. Method: Participants were interviewed 7 times between 14 and 43 years of age. ADHD symptoms at outcome were assessed with the World Health Organization ADHD Self-Report Scale. Bivariate and multivariate linear regression analyses assessed the associations between the trajectories of smoking and ADHD symptoms. Results: The multivariate analysis (R2 = .12) indicated that compared with being nonsmokers, the probability of being in the heavy/continuous group (standardized regression coefficient [SRC] = .17, p < .01) and in the late starter group (SRC = .11, p < .05) were significantly associated with adult ADHD symptoms. Conclusion: Longitudinal smoking patterns were associated with ADHD symptoms in adults. Chronic smoking jeopardizes both physical health and the ability to fulfill adult roles as employees, family members, and friends. Smoking cessation in adolescence may lessen the likelihood of ADHD symptoms in adulthood.

ADHD, Conduct Disorder, Substance Use Disorder, and Nonprescription Stimulant Use.

OBJECTIVE: To assess whether the relationship of an ADHD diagnosis by adolescence to nonprescription stimulant use in adulthood is direct or indirect, via Conduct Disorder (CD) and/or Substance Use Disorder (SUD). METHOD: Data were obtained from multiple waves of interviews and questionnaires completed by 551 community-based participants when they were between the mean ages of 14.1 and 36.6 years. RESULTS: The results of the structural equation model (SEM) supported both a direct association between early ADHD and later nonprescription stimulant use ( B = .18, z = 2.74) and the relationship from ADHD to later nonprescription stimulant use ( B = .01, z = 1.72) via CD and SUD. CONCLUSION: The longitudinal data supporting these paths suggest that efforts to prevent and treat the misuse of nonprescription stimulants may be more effective if attention is paid to those with a history of ADHD, as well as to those who also had CD and SUD.

Intergenerational Transmission of Externalizing Behavior.

This prospective longitudinal investigation examined the predictors of generation 2 (G2) parental substance use as related to their generation 3 (G3) offspring's externalizing behavior. The sample comprised 281 mother- or father- child (G2/G3) pairs. The results indicated that the G1/G2 (generations 1 and 2) parent-child relationship during G2's adolescence predicted externalizing behavior in the G2 young adults which correlated with G2 parental substance use. G2 parental substance use was related to subsequent G2 substance use disorders (SUDS), and to the G2/G3 parent-child relationship. The G2/G3 parent-child relationship and G2's SUDS each predicted G3 externalizing behavior. The results highlight the significance of breaking the chain of transmission of externalizing behavior across generations. Implications for policy and programs addressing the etiology of externalizing behavior in the offspring are discussed within a developmental framework.

Impact of conjoint trajectories of body mass index and marijuana use on short sleep duration.

BACKGROUND AND OBJECTIVES: We examined the association between the conjoint developmental trajectories of body mass index (BMI) and marijuana use from age 24 to age 32 and short sleep duration. METHODS: The participants included 158 African American male, 267 African American female, 166 Puerto Rican male, and 225 Puerto Rican female young adults (N=816). Using Mplus, we obtained the conjoint trajectories of BMI and marijuana use. Logistic regression analyses examined the association between the conjoint trajectories and short sleep duration. RESULTS: Five conjoint trajectory groups were extracted: normal BMI and no or low marijuana use, obese and no or low marijuana use, morbidly obese and some marijuana use, normal BMI and high marijuana use, and obese and high marijuana use. Those in the obese and no or low marijuana use group, the morbidly obese and some marijuana use group, and the obese and high marijuana use group were more likely to report shorter sleep duration than those with normal BMI and no or low marijuana use group. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: This study highlights the significance of examining joint trajectories over several developmental stages. In treating short sleep duration, we propose focusing on treating obesity, and also treating marijuana use if applicable.

Utilization of mental health services by minority urban adults: psychosocial predictors.

Although most mental disorders have their first onset by young adulthood, there are few longitudinal studies of these problems and related help-seeking behavior. The present study examined some early and current predictors of the use of mental health services among African-American and Puerto Rican participants in their mid-30s. The 674 participants (52.8 % African Americans, 47.2 % Puerto Ricans; 60.1 % women) in this study were first seen in 1990 when the participants attended schools serving the East Harlem area of New York City. A structural equation model controlling for the participants' gender, educational level in emerging adulthood, and age at the most recent data collection showed significant standardized pathways from both ethnicity (ß = -0.28; z = -4.82; p < 0.001) and psychological symptoms (ß = 0.15; z = 2.41; p < 0.05), both measured in emerging adulthood, to smoking in the early 30s. That, in turn, was associated with certain physical diseases and symptoms (i.e., respiratory) in the mid-30s (ß = 0.16; z = 2.59; p < 0.05). These physical diseases and symptoms had a cross-sectional association with family financial difficulty in the mid-30s (ß = 0.21; z = 4.53; p < 0.001), which in turn also had a cross-sectional association with psychiatric disorders (ß = 0.30; z = 5.30; p < 0.001). Psychiatric disorders had a cross-sectional association with mental health services utilization (ß = 0.65; z = 13.25; p < 0.001). Additional pathways from the other domains to mental health services utilization in the mid-30s were also supported by the mediating role of psychiatric disorders. Results obtained from this research offer theoretical and practical information regarding the processes leading to the use of mental health services.

Physical factors, personal characteristics, and substance use: associations with obesity.

BACKGROUND: Because obesity has become a major public health problem, attention to a range of its predictors is needed. This study examined the association of physical factors, personal characteristics, and substance use with obesity in a sample (N = 815) of African American and Puerto Rican young adults with a mean age of 32. METHODS: Body mass index (BMI) was calculated to assess obesity. Bivariate and multivariate logistic regression analyses were conducted. RESULTS: Bivariate analyses showed that protective factors such as physical activity (adjusted odds ratio [AOR] = .82, 95% confidence interval [CI] = .74-.91), healthy diet (AOR = .96, 95% CI = .93-.99), self-control (AOR = .93, 95% CI = .87-.98), and life satisfaction (AOR = .97, 95% CI = .95-.99) were associated with a reduced probability of being obese. Marijuana use was also associated with a decreased probability of obesity (AOR = .89, 95% CI = .80-.99), but was not considered a protective factor. Risk factors such as short sleep duration (AOR = 1.70, 95% CI = 1.24-2.33) and depressive mood (AOR = 1.05, 95% CI = 1.01-1.09) were associated with an increased probability of being obese. CONCLUSIONS: For African Americans and Puerto Ricans, programs to treat obesity should focus on increasing sleep, physical activity, and life satisfaction.

The smoking patterns of women in their forties: their relationship to later osteoporosis.

Osteoporosis is prevalent among women 50 years of age and older and accounts for numerous fractures and the related deaths of many sufferers. In this study, 22.4% of the women reported having osteoporosis. Smoking contributes substantially to osteoporotic fractures. This study assessed how different trajectories of women's smoking, covering the ages 40 to 48 years, relate to osteoporosis at age 65. Trajectory analysis of tobacco use data reveals smoking patterns which may have differing relationships to osteoporosis. Logistic regression analyses revealed the varying relationships of different smoking patterns to osteoporosis. As hypothesized, the chronic/heavy smokers were significantly more likely than the non-smokers to report having osteoporosis. Quitters and moderate smokers did not differ significantly from non-smokers on the osteoporosis measure. Chronic/heavy smokers should not be the only focus of public health efforts to reduce smoking and the associated risks of osteoporosis. The findings also highlight the efficacy of women smokers quitting in their 40s in order to reduce their likelihood of contracting osteoporosis.

Pathways to children's externalizing behavior: a three-generation study.

In this study, based on Family Interactional Theory (FIT), the authors tested a longitudinal model of the intergenerational effects of the grandmothers' parent-child relationships and the grandparents' smoking on the grandchildren's externalizing behavior via parents' psychological symptoms, tobacco use, and child rearing. Using Mplus, the authors obtained a structural equation model that demonstrated generational associations from grandmothers (G1) to parents (G2) to their oldest children (G3) and thus was in accord with FIT. They identified a pathway from the grandmothers' parenting to the grandchildren's externalizing behavior via the parents' psychological symptoms, their smoking, and their child rearing. Parents' psychological symptoms in adolescence were associated with their tobacco use in their late twenties, controlling for the continuity of their psychological symptoms and their tobacco use. This 3-generational model adds to the literature on parent-child relationships (G1), smoking from adolescence to early adulthood (G2), and externalizing behavior in the G3 child.

The Relationship between parental alcohol use, early and late adolescent alcohol use, and young adult psychological symptoms: a longitudinal study.

We tested the hypothesis that there is a mediational pathway from parental alcohol use during the participants' adolescence to the participants' psychological symptoms in young adulthood. This pathway includes the participants' alcohol use and their psychological symptoms, both during adolescence. The participants are inner city African American and Puerto Rican early adolescents followed until young adulthood. They reported their own and their parents' behavior. Structural equation modeling showed that parental alcohol use was related to early adolescent alcohol use, which was associated with late adolescent alcohol use. Late adolescent alcohol use was related to psychological symptoms in late adolescence, which predicted young adult psychological symptoms. Males reported more alcohol use and more psychological symptoms than females in late adolescence and more psychological symptoms in young adulthood. Findings suggest that parents' and adolescents' alcohol use should be a focus in interventions designed to prevent or treat psychological symptoms in late adolescence and young adulthood.

Adolescent attributes and young adult smoking cessation behavior.

This study collected data five times between 1983 and 2002 from 400 participants who originally came from upstate New York. These participants completed structured interviews as did their mothers three times. LISREL analysis generally supported the hypothesized model. The results indicated that having parents who smoked and having low educational aspirations and expectations were associated with being unconventional, which, in turn, was related to having low emotional control and reporting more internalizing behaviors. Internalizing behaviors were directly associated with a lower likelihood of smoking cessation, as was parental smoking. Research and clinical implications are discussed and the limitations noted.

Trajectories of cigarette smoking among African Americans and Puerto Ricans from adolescence to young adulthood: associations with dependence on alcohol and illegal drugs.

This study predicts that heterogeneous smoking trajectories covering four time points pose differential risks for dependence on alcohol and illegal drugs in young adulthood in an African American and Puerto Rican community sample (N = 475). The trajectory analysis yielded four smoking groups: nonsmokers, maturing out smokers, late-starting smokers, and early-starting continuous smokers. The early starting continuous group was more likely to become both alcohol- and drug-dependent in young adulthood than the other groups. Late-starting smokers were at higher risk than nonsmokers for drug dependence. Interventions are necessary from preadolescence through late adolescence to reduce the numbers of early and late smokers and their specific risks for substance dependence.

Grandmother and parent influences on child self-esteem.

OBJECTIVES: This study tests a model of intergenerational influences on childhood self-esteem that proposes paths from grandmothers' drug problems to grandchildren's self-esteem via parents' drug problems and parental adaptive child rearing and from grandmothers' maternal acceptance to grandchildren's self-esteem via parents' unconventionality and adaptive child rearing. METHODS: This longitudinal study uses data obtained from interviews with a New York City sample of black and Puerto Rican children (N = 149) and 1 of their parents and from mailed questionnaires or comparable interviews with those parents' mothers. Structural equation modeling was used to test the proposed model. RESULTS: The LISREL analysis found that, with 3 exceptions, all of the hypothesized paths were significant. The total effects analysis indicated that parents' adaptive child rearing was the strongest latent construct, a finding that was consistent with this construct's proximal position in the model. CONCLUSIONS: This study suggests that mothers' drug problems are not just near-term risks for their children, but also pose long-term risks for their children's future functioning as parents and thereby for their grandchildren. The relative strength of parents' adaptive child rearing in this intergenerational model indicates that this area should be the focus of therapeutic intervention efforts, but addressing future grandmothers' drug problems may have positive effects on multiple generations.

Smoking involvement during adolescence among African Americans and Puerto Ricans: risks to psychological and physical well-being in young adulthood.

The major aim of this study was to examine the longitudinal association between adolescent smoking involvement and self-reported psychological and physical outcomes in young adulthood. Participants included 333 African Americans and 329 Puerto Ricans who were surveyed in 1990 in their New York City schools and interviewed in 1995 and 2000-2001, primarily in their homes. The psychological outcomes included ego integration, symptoms of depression, anxiety, and interpersonal difficulty. The physical health measures included a general health rating, number of illnesses, and symptoms of ill health. Also, three scales measured problems due to alcohol, marijuana, and other illicit drug use. Smoking involvement varied by age, sex, and ethnicity but not by socioeconomic status nor by late adolescent parental status. Analysis showed that the relationships between adolescent smoking involvement and psychological and physical health problems in young adulthood remained significant even with control on demographic factors, earlier levels of the outcome variables, and marijuana use. The relationships between smoking behavior and problems with alcohol, marijuana and other illicit drug use were particularly strong. Thus, adolescent smoking seems to have a wide range of clinical implications for young adulthood.

Predictors of rebellious behavior in childhood parental drug use, peers, school environment, and child personality.

This study assesses the interrelationships among several sets of variables and rebellious behavior in a sample of Puerto Rican and African American elementary school-aged children. The independent sets of variables (domains) were child personality attributes, parental attributes, including parental marijuana use, peer factors, school environment, and ethnic identification and discrimination. The dependent or outcome variable was children's rebellious behavior. Children and their mothers were interviewed in their homes. Pearson correlations and hierarchical multiple regression analyses were used to assess the extent to which the independent variables were related to the children's rebellious behavior. Each of the domains was associated with children's rebellious behavior without control on the remaining domains. With control on the remaining domains, child personality accounted for the most variance in childhood rebellious behavior. With control on child personality, only the school environment remained significant. Children with personality traits that are associated with rebellious behavior may have parents who exhibit antisocial behavior and use marijuana. Furthermore, these children may be at risk for other problem behaviors, including legal drug use, and would benefit from interventions which address primarily their personality characteristics, but also their school environments.

The Effects of Parental Tobacco and Marijuana Use and Personality Attributes on Child Rearing in African-American and Puerto Rican Young Adults.

This study assessed the effect of the interrelationship of mothers' and fathers' tobacco and marijuana use with their personality attributes on some of their child rearing behaviors. We used a longitudinal design to analyze the data of 258 males and females who were seen four times over a 13-year period from early adolescence through young adult parenthood. Thirty-one percent of the multiple regression analyses revealed significant interactions between the effect of tobacco or marijuana use and a personality attribute on child rearing. The majority of these significant interactions suggested that protective personality characteristics were offset by substance use risks resulting in less adequate child rearing. If these results are substantiated in an experimental intervention, it suggests that having resilient personality attributes does not protect against the negative effects of tobacco or marijuana use on child rearing.

Tobacco use in adolescence: longitudinal links to later problem behavior among African American and Puerto Rican urban young adults.

In this study, the authors assessed the relationship between adolescent tobacco smoking and measures of inner control, deviant behavior, and associating with deviant peers, which are indicators of problem behavior. African American (N = 333) and Puerto Rican (N = 329) early adolescents completed questionnaires in their classrooms in 1990 at Time 1 (T1) and were individually interviewed thereafter when they were late adolescents in 1995 at Time 2 (T2) and as young adults in 2000 at Time 3 (T3). The authors used ordinary least squares regression analysis to assess the comparative association of adolescent smoking patterns at T1 and T2 and the young adult outcomes at T3; they controlled for demographic variables, level of the outcome measure at T2, and marijuana use at T2. The analyses suggested that experimental tobacco smokers demonstrated more problem behaviors than did nonsmokers, and late and continuous smokers demonstrated more problem behaviors as young adults than did experimental smokers and nonusers. These findings may provide a useful guide to a next step that involves translational research.

Smoking among New Yorican adolescents: time 1 predictors of time 2 tobacco use.

The authors identified longitudinal relationships between early risk and protective factors from the domains of family, personality, and peer influences and later tobacco use in Puerto Rican adolescents living in New York. Aspects of the ethnic minority experience as moderators of familial risk and protective factors were investigated. Participants were 282 female and 276 male Puerto Rican adolescents interviewed twice, 5 years apart. The authors used hierarchical regression analyses to identify a model with direct and indirect paths. Family, personality, peer, and early smoking domains were directly related to later adolescent smoking. Partial mediation occurred. The authors identified risk-protective and protective-protective interactions between variables from the ethnic minority experience and family domains. Interventions to reduce smoking among Puerto Rican adolescents should focus on multiple contexts, including aspects of the ethnic minority experience.

Illicit drug use and risky sexual behavior among African American and Puerto Rican urban adolescents: the longitudinal links.

The authors assessed whether (a) early illicit drug use predicted later risky sexual activity, (b) early risky sex predicted later illicit drug use, and (c) common factors affected both risky sexual behavior and illicit drug use. African American and Puerto Rican youth completed questionnaires in their classrooms at Time 1 (T1) and face-to-face interviews with the authors in their homes 5 years later at Time 2 (T2). Logistic regression analyses showed the association between T1 illicit drug use and T2 risky sexual activity and between T1 risky sexual behavior and T2 illicit drug use. With few exceptions, T1 illicit drug use was associated with all of the T2 risky sexual behaviors. After controlling for demographic factors, the authors found that multiple sex partners at T1 was not related to illicit drug use at T2. Condom use at T1 was related to illicit drug use at T2, whereas sexually transmitted diseases and adolescent pregnancy were not related to this drug use. The findings indicated that assessments of and treatments for substance use should focus on the risky sexual behaviors that seem to accompany illicit drug use.

Correlates of aggression in African American and Puerto Rican children.

The authors examined a cross-sectional interrelationship of psychosocial domains as they relate to aggression in a group of African American and English-speaking Puerto Rican children living in New York City. The population included 80 biological children of African American and Puerto Rican young adults who had been participating in the authors' ongoing longitudinal study, and 77 mothers or mother substitutes (rearing mothers) of those children. The authors performed hierarchical multiple regression analysis. The results indicated that (a) the child's personality and maternal attributes were significantly related to the child's aggression, despite control on all of the other domains and (b) the ethnic identification and discrimination domain was no longer related to the child's aggression with control on the mother-child relationship domain or on the child's personality domain. The findings have implications for clinical practice and public policy.