tm substance use transitions from initial use to regular use to discontinuance ralph s. caraballo,...

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Substance Use Transitions from Initial Use to Regular Use to Discontinuance

Ralph S. Caraballo, Ph.D., MPHOffice on Smoking and Health, CDC, Atlanta GA

Gary A. Giovino, Ph.DRoswell Park Cancer Institute, Buffalo NY

2002 National Conference on Tobacco or Health:Trends in Tobacco Cessation: The Latest Evidence

San Francisco, CANovember 20, 2002

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Introduction

Transitional stages in the process of smoking uptake is a topic of considerable research interest

Previous work assessing national transitional probabilities for selected substances (Giovino et al., Epidemiologic Reviews 1995) used data from 1993 National Household Survey on Drug Abuse (NHSDA)

The 1993 NHSDA analyses are limited, because available items at the time only measured ever use and current use

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Purposes of Today’s Talk

Update analyses with more recent survey information (1996-1998 NHSDA)

Expand upon previous analyses by using measures of ever use and early use that involve indicators of progression

Compare current use among ever users and persons who have progressed to various stages across substances

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Purposes of Today’s Talk(Cont.)

Compare progression from ever use across substances

Assess duration of cigarette smoking initiation from first trying to smoking daily among persons aged 30-39 years

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Methods

NHSDA 1996-1998 (combined data) Participants aged 12 years or older Persons who had ever used cigarettes,

marijuana, cocaine, crack, heroin, hallucinogens, or inhalants

Sample Population (n=68,274) Study Population (n=19,222)

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Definitions

Ever substance use was defined as reporting yes to question: “Did you ever use (substance)?”

Current substance use was defined as reporting to have used 1 or more days during the past 30 days

Percent Distribution of the Unweighted Sample Population (n=68,274) by Age Group—

NHSDA 1996-1998

Ages 18-2517%

Ages 26+ 57%

Ages 12-17

26%

Percent Distribution of the Population (N = 216,232,778) by Age Group —

NHSDA 1996-1998

Ages 18-25

12%

78%

Ages 12-17

10%

Ages 26+

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Current* Use Prevalence in the U.S. Population Aged 12 Years or Older, by Substance—NHSDA 1996-1998

Per c

e nt

26.1

4.7

0.7 0.2 0.1 0.6 0.40

5

10

15

20

25

30

35

Cigarettes Marijuana Cocaine Crack Heroin Hallucin Inhalants

*Used 1 or more days in the past 30 daysSource: NHSDA 1996-1998 aggregated data

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37.9

14.5

7.012.0

9.76.5 6.8

05

101520253035404550


Percent that Still Use (Current) Among Ever Users, by Substance—NHSDA 1996-1998

*Used 1 or more days in the past 30 daysSource: NHSDA 1996-1998 aggregated data

Per c

e nt

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62.1

85.593.0

88.0 90.3 93.5 93.2

0102030405060708090

100


Percent that Discontinued Using (Former) Among Ever Users, by Substance—NHSDA 1996-1998

Per c

e nt

* Ever used, but not during past 30 daysSource: NHSDA 1996-1998 aggregated data

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0102030405060708090

100

1-11 12-100 >= 101

Number of Days In Lifetime Used

Perc

ent

Percent Current Users Among Ever* Users Aged 12-17 Years, by Number of Days They Ever Used—

NHSDA, 1996-1998

*Ever is defined as any use (at least once) in lifetimeSource: NHSDA 1996-1998 (aggregated data)

Cigarettes

Marijuana

InhalantHallucinogenCrack

Cocaine

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Percent Who Discontinued Using Among Ever* Users Aged 12-17 Years, by Number of Days They Ever Used—

NHSDA, 1996-1998

0102030405060708090

100

1-11 12-100 >= 101


Perc

ent

*Ever is defined as any use (at least once) in lifetimeSource: NHSDA 1996-1998 (aggregated data)

Cigarettes

Marijuana

Inhalant

Hallucinogen

Crack

Cocaine

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0102030405060708090

100

1-11 12-100 >= 101


Perc

ent

Percent Current Users Among Ever* Users Aged 18-25 Years, by Number of Days They Ever Used—

NHSDA, 1996-1998

Source: NHSDA 1996-1998 (aggregated data)

Cigarettes

Marijuana

InhalantHallucinogen

Crack

Cocaine

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0102030405060708090

100

1-11 12-100 >= 101


Perc

ent

Percent Who Discontinued Using Among Ever* Users Aged 18-25 Years, by Number of Days They Ever Used—

NHSDA, 1996-1998


Cigarettes

Marijuana


Crack

Cocaine

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0102030405060708090

100

1-11 12-100 >= 101


Perc

ent

Percent of Ever (at least once) Substance Users Aged18-25 Years Who Were Current Regular* Users, by

Number of Days They Ever Used—NHSDA, 1996-1998

* Regular user is defined as using it 6 or more days in past 30 daysSource: NHSDA 1996-1998 (aggregated data)

Cigarettes

Marijuana


CrackCocaine

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0102030405060708090

100

1-11 12-100 >= 101


Perc

ent

Percent Current Users Among Ever* Users Aged 26 Years or Older, by Number of Days They Ever Used—

NHSDA, 1996-1998


Cigarettes

Marijuana


CrackCocaine

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0102030405060708090

100

1-11 12-100 >= 101


Perc

ent

Percent Who Discontinued Using Among Ever* Users Aged 26 Years or Older, by Number of Days They Ever

Used—NHSDA, 1996-1998


Cigarettes

Marijuana


CrackCocaine

Percent of Current Users Who Used 6 Days in Past 30 Days Among Current Users Who Used > 300 Days in

Lifetime, by Age and Substance of Use

010

203040

50607080

90100

Cigarettes Marijuana Cocaine Crack Hallucinogen Inhalant

Perc

ent

12-17 18-25 26+

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Percent of Ever Users (1+ days) Who Used the Substance at Least 3 Days, and Percent of Users of At Least 3 Days

Who Used the Substance at Least 101 Days

Ever Users Who Used At Least 3 Days

Users for at Least 3 days that Used 101+ Days

Substance No. % (95% CI) No. % (95% CI)Cigarettes 39,896 83.3 (±1.3) 31,061 77.0 (±2.0)

Marijuana 22,005 76.3 (±2.0) 16,597 40.1 (±2.8)

Cocaine 6,559 73.4 (±3.6) 4,641 26.9 (±4.2)

Crack 1,745 68.2 (±7.9) 1,163 39.0 (±9.1)

Heroin 680 66.6 (±12.8) 423 43.4 (±15.2)

Hallucinogen 6,355 65.8 (±3.8) 3,906 20.2 (±4.7)

Inhalants 4,178 58.4 (±5.2) 2,370 12.5 (±4.6)

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Substance No. % (95% CI)

Cigarettes 39,896 64.1 (±2.1)

Marijuana 22,005 30.6 (±2.3)

Cocaine 6,559 19.8 (±3.3)

Crack 1,745 26.6 (±6.8)

Heroin 680 28.9 (±11.4)

Hallucinogen 6,355 13.3 (±3.3)

Inhalants 4,178 7.3 (±2.7)

Percent of Ever Users (1+ days) Who Used the Substance at Least 101 Days

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Cumulative Age of Initiation of Cigarette Smoking* Among Persons Aged 30-39 Years—

United States, 1996-1998

0102030405060708090

100

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38Age

Perc

ent

* Among persons 30-39 years old who have ever smoked dailySource: National Household Survey on Drug Abuse, 1996-1998 public use data tapes

Age First Tried a Cigarette

Age Began Smoking Daily

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0

0.5

1

1.5

2

2.5

3

3.5

11 12 13 14 15 16 17 18 19 20 21 22 23-24

Age first tried a cigarette

Dur

atio

n (y

ears

)

30-3940-4950-5960-69

Age Of First Tried a Cigarette and Duration to Become a Daily Smoker, by Age Cohort—NHSDA 1996-1998


Plot of the predicted values

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Discussion

Even when measures of progression beyond ever use are incorporated into the analyses, cigarette smokers are more likely to remain current users over time than are users of other substances

Differences in the cost of, availability of, and social sanctions and controls applicable to each substance may account for some of the observed variability

One interpretation:“Many people discontinue their use of illicit drugs as they assume adult roles.”

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Discussion(Cont.)

Even when not taking current use into account, EVER CIGARETTE SMOKERS are more likely to use cigarettes for a longer period of time (# days ever smoked) than are users of other substances

There is definitely a decreasing trend in DURATION as the age of first trying a cigarette gets older. This is, as the age at which a person first tries a cigarette gets older, the time it takes them to start smoking daily gets shorter

tm substance use transitions from initial use to regular use to discontinuance ralph s. caraballo,...

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