1. Adolescent Tobacco Use and Young Adult Outcomes Kathy Georgiades & Michael Boyle

2. Background Rates of adolescent tobacco use are high Ontario Student Drug Use Survey (1999) Tobacco use: 28% Long term implications for development Tobacco Use  Poor Physical Health  Tobacco Use  Psychosocial Outcomes ?

3. Substance use in adolescence has been shown to increase risk for later psychosocial difficulties (e.g., Chassin et al., 1999; Fergusson & Horwood, 1997; Jessor et al. 1980; Kandel et al., 1986; Newcomb & Bentler, 1988) Extent to which these associations reflect cause and effect linkages remains controversial

4. At least two general explanations of the linkages between adolescent substance use and young adult outcomes: 1) Problem Behavior Theory 2) Interference with Adolescent Developing Competencies

5. Problem Behavior Theory Problem Behavior Syndrome Adolescent Substance Use Adult Outcomes

6. Developing Competencies Adolescent Substance Use Interference in Development of Competencies Adult Outcomes

7. Objectives To examine the association between tobacco use in adolescence and young adult outcomes To determine whether the association remains significant after controlling for social and psychological factors associated with adolescent tobacco use & young adult outcomes To determine whether the association is specific to those who endorse use both in adolescence and young adulthood

8. Method Ontario Child Health Study 4-16 yrs in 1983  1987  2000 Sample for the present study: 12- 16 yrs in 1983 & 1987  Time 1 (T1) Followed in 2000  Time 2 (T2) N=1282

9. Variables Young Adult Outcomes Major Depressive Disorder Physical Health Years of Education Tobacco Use T1 and T2: daily use > 1 month Co-variates assessed at T1: family SES, single parent home, sex, age, externalizing and internalizing disorders, family dysfunction, & grade failure

10. Results 11% (n=139) of adolescents reported daily tobacco use at T1 Tobacco use in adolescence was associated with: family SES parental education externalizing & internalizing disorders family dysfunction grade failure

11. Unadjusted association between tobacco use in adolescence and young adult outcomes Young Adult OutcomesTobacco Use T1 MDD OR = 2.7 (1.8-4.2) Physical Health   Years of Education   ***p<0.001

12. 3 comparison groups were created in order to examine continuity & change in tobacco use 1. Use of Tobacco only at T1 (n=53) 2. Use of Tobacco only at T2 (n=218) 3. Use of Tobacco at T1 & T2 (n=86)

13. Associations between tobacco use in adolescence and major depressive disorder in adulthood Predictors Unadjusted OR Adjusted OR + T1 only 1.0 (0.4-2.7) 0.7 (0.3-2.0) T2 only 1.4 (0.8-2.2) 1.4 (0.9-2.3) T1 & T2 4.3 (2.6-7.2)  3.8 (2.1-6.8) + Adjusted for T1: family SES, family type, sex, age, externalizing & internalizing symptoms, family dysfunction & grade failure

14. Associations between tobacco use in adolescence and physical health in adulthood Predictors Unadjusted Adjusted + T1 only -2.6 (1.0) * -2.2 (1.1) * T2 only -1.4 (0.6) * -1.4 (0.6) * T1 & T2 -5.1 (0.8) *** -4.8 (0.9) *** + Adjusted for T1: family SES, family type, sex, age, externalizing & internalizing symptoms, family dysfunction & grade failure *p<0.05, ***p<0.001

15. Associations between tobacco use in adolescence and years of education in adulthood Predictors Unadjusted Adjusted + T1 only -2.0 (0.4) *** -1.3 (0.4) *** T2 only -2.2 (0.2) *** -1.7 (0.2) *** T1 & T2 -3.4 (0.3) ***   -2.5 (0.3) *** + Adjusted for T1: family SES, family type, sex, age, externalizing & internalizing symptoms, family dysfunction & grade failure ***p<0.001

16. Conclusions Tobacco use in adolescence was associated with clear increases in rates of major depressive disorder, poorer physical health and fewer years of education in young adulthood

17. Conclusions (con’t) Statistical adjustment of these risk factors and of continuity of use, substantially reduced the association between tobacco use and major depressive disorder (MDD) Only those adolescents who reported tobacco use at both time points were at increased risk for MDD

18. Conclusions (con’t) Even after adjustment of adolescent risk factors and tobacco use in adulthood, adolescents who smoked were at increased risk for poorer physical health and fewer years of education