1. www.alcoholandhealth.org1 Journal Club Alcohol and Health: Current Evidence November–December 2004

2. www.alcoholandhealth.org2 Featured Article Associations between early-adolescent substance use and subsequent young-adult substance use disorders and psychiatric disorders among a multiethnic male sample in South Florida Gil AG, et al. Am J Pub Health. 2004;94(9):1603–1609.

3. www.alcoholandhealth.org3 Study Objective To examine the associations between early-adolescent substance use and subsequent young-adult substance use disorders and psychiatric disorders in a community sample of males

4. www.alcoholandhealth.org4 Study Design Researchers surveyed boys who were entering middle school between 1990 and 1993. They conducted follow-up interviews of a random sample of these boys (942 boys interviewed) approximately 7–10 years later.

5. www.alcoholandhealth.org5 Assessing Validity of an Article about Prognosis Are the results valid? What are the results? How can I apply the results to patient care?

6. www.alcoholandhealth.org6 Are the Results Valid? Was the sample representative? Were the subjects sufficiently homogeneous with respect to prognostic risk? Was follow-up sufficiently complete? Were objective and unbiased outcome criteria used?

7. www.alcoholandhealth.org7 Was the sample representative? All public middle and high schools in a populous county in South Florida agreed to participate. The sample is representative of the ethnically diverse population in South Florida.

8. www.alcoholandhealth.org8 Were the subjects sufficiently homogeneous with respect to prognostic risk? Yes. –Eligibility criteria did not include any factors related to the risk of substance use or abuse.

9. www.alcoholandhealth.org9 Was follow-up sufficiently complete? Follow-up was adequate. –942 of 1273 randomly selected young men (who had been surveyed as boys) were interviewed at follow-up (76.4%). –There were no differences in 28 early-adolescent risk behaviors and family characteristics between the original sample and those completing follow-up.

10. www.alcoholandhealth.org10 Were objective and unbiased outcome criteria used? Yes. –Young-adult substance use disorders and psychiatric disorders were assessed using the Composite International Diagnostic Interview, a reliable and valid structured interview to determine DSM-IV diagnoses.

11. www.alcoholandhealth.org11 What are the Results? How likely are the outcomes over time? How precise are the estimates of likelihood?

12. www.alcoholandhealth.org12 How likely are the outcomes over time? DSM-IV Disorder% of Sample (N=942) Alcohol abuse21.6% Alcohol dependence9.4% Marijuana abuse15.1% Marijuana dependence14.4% Any substance use disorder43.5% Prevalence of DSM-IV Disorders in Young Adulthood

13. www.alcoholandhealth.org13 How likely are the outcomes over time (cont.)? DSM-IV Disorder Total (N=942) Non-Hispanic Whites (N=259) African Americans (N=240) US-Born Hispanics (N=251) Foreign- Born Hispanics (N=192) Alcohol abuse21.6%26.1%9.2%26.7%24.9% Alcohol dependence 9.4%15.2%4.6%5.6%12.6% Marijuana abuse 15.1%19.8%10.1%17.9%11.2% Marijuana dependence 14.4% 11.1%17.1%14.7% Any substance use disorder 43.5%52.8%28.6%47.3%44.9% Prevalence of DSM-IV Disorders in Young Adulthood by Race

14. www.alcoholandhealth.org14 How likely are the outcomes over time (cont.)? Alcohol AbuseAlcohol Dependence Any Substance Use Disorder ExperimentersOR* 1.7 95% CI**, 1.1–2.7 2.3 1.1–4.8 2.1 1.5–3.1 Regular users2.5 1.5–4.1 3.7 1.7–8.0 4.1 4.1–6.2 Odds of Substance Use Disorders in Adulthood Among Adolescent Users *Odds ratio compared with abstainers; all comparisons are significant **CI=confidence intervals Experimenters=1–9 lifetime drinks; no more than 1 lifetime use of illicit drugs during adolescence Regular users=alcohol use on >=10 occasions; illicit drug use on >6 occasions

15. www.alcoholandhealth.org15 How likely are the outcomes over time (cont.)? Odds of Substance Use Disorders in Adulthood by Race Alcohol AbuseAlcohol Dependence Any Substance Use Disorder Non-Hispanic Whites: Experimenters Regular Users OR 3.0, 95% CI, 1.2–7.8 2.3, 0.9–6.2 1.8, 0.5–6.8 3.8, 1.1–13.8 2.3, 1.9–4.9 4.3, 2.0–9.3 African Americans: Experimenters Regular Users 1.1, 0.4–3.7 3.4, 1.0–12.2 3.7, 0.4–10.1 7.9, 0.8-14.5 2.4, 1.0–4.9 6.6, 2.5–17.5 US-Born Hispanics: Experimenters Regular Users 1.6, 0.7–4.2 3.1, 1.1-8.4 0.6, 0.1–1.7 0.8, 0.2–1.2 2.0, 0.9–4.4 2.8, 1.2–6.4 Foreign-Born Hispanics: Experimenters Regular Users 1.1, 0.4–2.6 1.2, 0.5–3.3 1.5, 0.5–4.8 2.0, 0.6–7.0 1.6, 0.7–3.2 2.8, 1.2–6.5

16. www.alcoholandhealth.org16 How likely are the outcomes over time (cont.)? Odds of Any Psychiatric Disorder in Adulthood Among Adolescent Users TotalNon- Hispanic Whites African Americans US-Born Hispanics Foreign- Born Hispanics ExperimentersOR 1.8 95% CI, 1.2 – 2.8 1.3 0.5 – 3.1 3.1 1.5 – 6.6 1.4 0.6 – 3.2 1.9 0.9 – 4.3 Regular users1.9 1.2 – 2.9 2.2 0.9 – 5.2 3.4 1.3 – 8.9 1.8 0.7 – 4.2 0.8 0.3 – 2.1

17. www.alcoholandhealth.org17 How precise are the estimates of likelihood? Standard errors for prevalence estimates were small, ranging from 1%–2%. Confidence intervals for the following associations did not include 1.0: –early experimental and regular use and later alcohol abuse, dependence, or any substance use disorder in the total sample –early regular use and any substance use disorder among all races –early experimental and regular use and any later psychiatric disorder in the total sample and among African Americans

18. www.alcoholandhealth.org18 How Can I Apply the Results to Patient Care? Were the study subjects similar to those in my area? Was the follow-up sufficiently long? Can I use the results in the management of patients in my practice?

19. www.alcoholandhealth.org19 Were the study subjects similar to those in my area? All subjects were from a populous, ethnically diverse county in South Florida. The population is similar to that of other large and diverse metropolitan counties in the United States. The subjects are not likely representative of boys in other geographic areas.

20. www.alcoholandhealth.org20 Was the follow-up sufficiently long? Follow-up was sufficiently long to determine the association between substance use in early adolescence and substance use disorders in young adulthood.

21. www.alcoholandhealth.org21 Can I use the results in the management of patients in my practice? These prospectively collected data suggest that early substance use is associated with later abuse and dependence and psychiatric disorders. They do not definitively answer whether early use is a marker for the risk, or a cause, of a later problem. This study also suggests that an ethnic group with a lower prevalence of early substance use is not necessarily protected from the development of abuse or dependence.

22. www.alcoholandhealth.org22 Can I use the results in the management of patients in my practice (cont.)? Because boys with substance use disorders were not excluded from the sample at study enrollment (not an inception cohort), it is not clear whether the results apply to those with and/or without such disorders. The generalizability of these results to other populations is also unclear.