Lifetime use of cigarettes, alcohol, marijuana and inhalants in Latino early adolescents.

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Lifetime Use of Cigarettes, Alcohol, Marijuana and Inhalants in Latino Early Adolescents a

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Claudia Kouyoumdjian , Bianca L. Guzmán & Nancy Leon a

California State University, Los Angeles, California Published online: 18 May 2015.

Click for updates To cite this article: Claudia Kouyoumdjian, Bianca L. Guzmán & Nancy Leon (2015) Lifetime Use of Cigarettes, Alcohol, Marijuana and Inhalants in Latino Early Adolescents, Journal of Ethnicity in Substance Abuse, 14:2, 113-132, DOI: 10.1080/15332640.2014.973625 To link to this article: http://dx.doi.org/10.1080/15332640.2014.973625

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Journal of Ethnicity in Substance Abuse, 14:113–132, 2015 Copyright # Taylor & Francis Group, LLC ISSN: 1533-2640 print=1533-2659 online DOI: 10.1080/15332640.2014.973625

Lifetime Use of Cigarettes, Alcohol, Marijuana and Inhalants in Latino Early Adolescents CLAUDIA KOUYOUMDJIAN, BIANCA L. GUZMAŃ, and NANCY LEON


California State University, Los Angeles, California

A growing population in the US is Latinos, an ethnic group defined by people of origin from Latin America. By 2050, Hispanics will be at least one quarter of the United States population (U.S. Census Bureau, 2006) with a substantial proportion under the age of 25 (Vaughan, Kratz, & D’argent, 2011). Yet, the literature on substance use among Latino adolescents is not advancing parallel to the growth of the population (Szapocznik, Lopez, Prado, Schwartz, & Pantin, 2006). Health concerns during early adolescence can have a lasting impact on the Latino community and society at large, as early substance initiation can lead to addiction during adulthood (Behrendt, Wittchen, Ho¨fler, Lieb, & Beesdo, 2009). Therefore, research that aims to identify psychosocial determinants that serve as risk and protective factors specific to Latino early adolescents is needed as a critical first step in the development of culturally specific prevention initiatives (Vaughan et al., 2011). KEYWORDS Alcohol, marijuana, inhalant, adolescent, Latino

A large portion of research on substance use and Latino adolescents has been conducted with specialized populations, such as children of alcoholics (e.g., Chassin, Pitts, Delucia, & Todd, 1999), or adolescents in continuation schools (Skara, Sussman, & Dent, 2001), incarcerated (Rowe, Wet, Greenbaum, & Liddle, 2008), or from clinical samples (Stevens, Murphy, & McKnight, 2003). Moreover, there is less research with a general school-age population (Marsiglia, Kulis, Hussaini, Nieri, & Becerra, 2010; Marsiglia, Nagoshi, Parsai, & Gonzalez-Castro, 2012). There is also a relatively small amount of research Address correspondence to Claudia Kouyoumdjian, Department of Child and Family Studies, California State University, Los Angeles, 5151 State University Drive, Los Angeles, CA 90032. E-mail: [email protected]. 113


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C. Kouyoumdjian et al.

with Latino early adolescent populations (Wallace et al., 2003) that specifically explores gender differences. Further, current research on adolescent substance use tends to examine only one substance, or examine one substance, like alcohol, against an aggregated score of drugs that is usually labeled as illicit (Letcher & Slesnick, 2013; Lopez et al., 2009). This other illicit drug use category usually involves combining several substances such as marijuana and cocaine together to form an additional drug category (Guo, Hill, Hawkins, Catalano, & Abbott, 2002). Such aggregated factors of drug use do not provide a clear picture of how individual and familial psychosocial determinants act as protective and=or risk factors with single-substance use or how these determinants may differentially impact each substance. The current study examines lifetime use of cigarettes, alcohol, marijuana, and inhalants in Latino early adolescents.

Substance Use National statistics suggest that by the end of high school, Latino adolescents’ lifetime use is approximately 48.6% for cigarettes, 74.1% for alcohol, 42.1% for marijuana, and 14.4% for inhalants (Centers for Disease Control and Prevention, 2011). In 2011 the Youth Risk Behavior Surveillance System (YRBSS) report conducted by the Centers for Disease Control and Prevention (CDC) reported that 41.1% of Latino 9th grade adolescents had ever tried cigarettes. The prevalence of having ever smoked cigarettes was higher among boys (45.1%) than girls (36.9%). With regards to alcohol use, 66.1% of Latino 9th graders reported having an alcoholic drink, specifically, 62.4% of boys and 69.9% of girls (CDC, 2011). Overall marijuana use for Latino 9th graders was 34.9% in 2011, with a higher prevalence among boys (37.7%) than girls (32.1%; YRBSS, 2011). The prevalence of inhalants was 15.9% among Latino ninth grade adolescents, which was higher among girls (18.6%) than boys (13.3%; YRBSS, 2011). Given the proportions of substance use among Latino 9th grade boys and girls and the gender differences across substances, it becomes important to examine the unique role that each substance plays with this population.

Psychosocial Determinants FAMILY Research consistently finds that family plays a critical role in the initiation and use of substances for Latino adolescents (Pokhrel, Unger, Wagner, Ritt-Olson, & Sussman, 2008; Ramirez et al., 2004; Shin & Hecht, 2013). Latino cultural values of familism, that is, valuing family traditions and a close and extended family network, can play a protective role in preventing or delaying


Substance Use Among Latino Early Adolescents

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the use of inhalants and cigarettes (Ramirez et al., 2004; Romero & Ruiz, 2007). Nevertheless, research has found that familism only influences marijuana and inhalant use when adolescents display high levels of knowledge about drugs (Ramirez et al., 2004). Other research finds that familism is not related to substance use (Unger et al., 2002). Such inconsistencies necessitate research that can explore how the importance of family traditions impacts early adolescents’ experiences in relation to cigarette, alcohol, marijuana and inhalant use. Furthermore, family characteristics such as home language (Allen et al., 2008), family structure (Farrell & White, 1998), household size (Reinherz et al., 2000), and parental level of education (Melotti, Heron, Hickman, Macleod, Araya, & Lewis, 2011) have also been associated with overall drug use. For example some research suggests that English language use is associated with higher cigarette (Unger et al., 2000), alcohol (Marsiglia & Waller, 2002), and marijuana use (Mcqueen, Getz, & Bray 2003), while other research finds that Spanish language (Allen et al., 2008) or Spanish–English language use (Marsiglia & Waller, 2002) increases the likelihood of substance use. Family structure has often been seen as a risk factor, with single-parent homes increasing the likelihood of substance use (Broman, Li, & Reckase, 2008; Griffin, Botvin, Scheier, Diaz, & Miller, 2000). Yet, the majority of Latinos in the US live in two-parent homes (U.S. Census Bureau, 2012), necessitating further research on the role of family structure on Latino early adolescents. Socioeconomic status (SES) as measured by maternal and paternal education has been linked to marijuana, alcohol, and cigarette use (Goodman & Huang, 2002). Research that has examined the role of maternal education on alcohol and cigarette use among early adolescents suggests that maternal education makes a unique contribution compared to other socioeconomic factors (Melotti et al., 2011). Mothers may engage in more health-related conversations, which vary in content by level of education. In addition to SES, the size of the household can determine the amount of resources available, and as a result, research finds that household size can have both risk and protective factors (Foster & Kalil, 2007). Altogether, there is a need to simultaneously examine the importance of family, language use, structure, SES, size, and education in relation to likelihood of trying cigarettes, alcohol, marijuana, and inhalants. Little research has examined these factors. EDUCATION Another consistent finding in the substance use literature is the role of grades as a risk factor (Balsa, Giuliano, & French, 2011; Mensch & Kandel, 1988; McCaffrey, Liccardo Pacula, Han, & Ellickson, 2010; Schulenberg, Bachman, O’Malley, & Johnston, 1994) with gender differences noted. For example,

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Balsa et al. found that boys that had difficulties in school and had more absences had more negative alcohol effects. For girls, although alcohol use did not significantly affect GPA, it did predict greater difficulty in school. Cigarette, marijuana, and other substances also increase the likelihood of dropping out (McCaffrey et al., 2010; Mensch & Kandel, 1988). Additionally, the younger the initiation into alcohol, marijuana, and other illicit drugs for boys, and cigarettes and marijuana for girls, the greater the chances of not completing high school (Beauvais, Wayman, Jumper-Thurman, Plested, & Helm, 2002; Mensch & Kandel, 1988). Once again given these conflicting results it is important to further examine how these differences fluctuate by gender. SEXUAL BEHAVIORS Substance use, such as alcohol and marijuana, has been found to be consistently associated with early adolescent sexual activity (CDC, 2011; Deardorff, Gonzales, Christopher, Roosa & Millsap, 2005; Guzmań & Dello Stritto, 2012; Letcher & Slesnick, 2013; Rothman, Wise, Bernstein, & Bernstein, 2009). Approximately 22.4% of Latino 9th grade students surveyed in the national 2011 Youth Risk Behavior Surveillance Survey reported having had intercourse. Of these sexually active adolescents 22.4% are engaging in riskier sexual behaviors, as they reported alcohol or drug use before last sexual intercourse. Latino boys (26.3%) are more likely than girls (17.7%) to engage in sex while under the influence of substances (YRBSS, 2011). Much of the research with Latino youth tends to suggest that Latinos are at an increased risk for early sexual activity, which co-occurs with drug use (Hallfors, Waller, Bauer, Ford, & Halpern, 2005). For example, the age at which adolescents try their first drink is associated with age of sexual debut (Rothman et al., 2009). There has been virtually no recent research that examines the role that sexual behaviors have on the use of marijuana and inhalants of Latino early adolescents. Therefore, it is important to examine the relationship between sexual behavior and substance use for this population. CURRENT STUDY The current study examines whether the likelihoods that adolescents will ever try cigarettes, alcohol, marijuana, or inhalants are related to their endorsement of the importance of family, home language, family structure, household size, maternal education, grades, and sexual behaviors. We hypothesize the endorsement of the importance of family will serve as a protective factor, negatively predicting use across all substances. Moreover, being in a home environment that is characterized by English speaking, single parenthood, large household size, or lower maternal education will


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increase the likelihood of ever trying cigarettes, alcohol, marijuana, or inhalants. We also hypothesize that higher grades will decrease, while sexual behaviors will increase, the likelihood of ever trying cigarettes, alcohol, marijuana, or inhalants.

METHOD


Sample and Procedure The data used for the current study are derived from the pretest of a large scale intervention study called the Community Awareness and Motivation Partnership (CAMP), which is a theater-based project aimed at decreasing teenage pregnancy (for an additional discussion of the CAMP project see Guzman, Casad, Schlehofer-Sutton, Villanueva, & Feria, 2003). All students enrolled in 9th grade at one high school in 2011 were invited to participate in the project. A total of 340 adolescents who returned signed consent and assent forms participated in the intervention. This was the majority of the 9th grade class, which is a normative sample of early adolescents in urban environments. The data reported on for this study is from a subsample of 317 adolescents who self-identified as being Latino whose mean age was 14.35 years. The majority of adolescents were born in the US (92%), from immigrant parents (foreign-born mothers 74%, foreign-born fathers 73%). The original study and subsequent secondary analyses were approved by the Institutional Review Board.

Measures SUBSTANCE USE Cigarettes, alcohol, marijuana, and inhalants were measured using a single item that asked how many times adolescents had used each substance. The response choices included 1 ¼ ‘‘never,’’ 2 ¼ ‘‘1 time,’’ 3 ¼ ‘‘2 to 4 times,’’ 4 ¼ ‘‘5 or more times.’’ For the purpose of examining if adolescents had ever tried a particular substance, each item was converted into a dichotomous variable, 0 ¼ ‘‘no,’’ 1 ¼ ‘‘yes.’’ Table 1 displays the number of participants that had ever tried each substance by gender. IMPORTANCE OF FAMILY A single item was used to examine the importance of family to adolescents. Using a 5-point Likert scale (1 ¼ not at all important to 5 ¼ very important) participants responded to the stem: ‘‘How important are each of the following to you?’’ The response options for this question included my family traditions. Higher scores on the item indicated greater value placed on family.

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TABLE 1 Means, Standard Deviation, and Percentages of Covariates


Variable Importance of family Home language Spanish Spanish and English English Family structure No parents Single parent Two parents Maternal education I don’t know Less than high school High school degree Some college=vocational school and beyond Household size Grades Mostly As Mostly Bs Mostly Cs Mostly Ds and Fs Sexual behavior

M(SD) or n(%) 4.03(1.00) 157(51) 100(32) 53(17) 10(3) 62(25) 245(72) 74(23) 69(22) 117(37) 57(18) 5.58 (1.925) 68(22) 137(45) 66(22) 35(11) 2.6 (1.963)

HOME LANGUAGE Participants were asked what language adults in their home spoke most of the time, and were provided three response choices: ‘‘1 ¼ Spanish,’’ ‘‘2 ¼ Both English and Spanish,’’ and ‘‘3 ¼ English.’’

FAMILY STRUCTURE Participants reported on the people who currently reside in their home, checking all that apply from a list of relationships. Response items included: mom, dad, uncle, aunt, sister, brother, grandma, grandpa, stepmom, stepdad, cousin, and other. For the purpose of examining family structure, if adolescents marked both mother and father they were categorized as residing in a two-parent home, if they marked either mom or dad they were categorized as residing in a single-parent home, and if they reported neither mom nor dad they were categorized as residing in a no-parent home.

HOUSEHOLD SIZE Participants reported on the number of people who currently reside in their home, with higher numbers representing a greater number of individuals in the household.


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MATERNAL EDUCATION Participants reported on how much schooling their mothers completed. Response choices included (1) I don’t know, (2) Elementary school, (3) Middle school, (4) High school, (5) Some college, (6) Vocational school, (7) College graduate. Responses were recoded to (1) I don’t know, (2) No high school degree, (3) High school, (4) Some college and beyond. GRADES


Participants were asked to report their grades on their most recent report card and were provided the following response choices: ‘‘1 ¼ Mostly As & Bs,’’ ‘‘2 ¼ Mostly Cs,’’ ‘‘3 ¼ Mostly Ds & Fs.’’ SEXUAL BEHAVIOR Sexual behavior was measured using nine items on whether adolescents had ever engaged in a particular sexual behavior (e.g., kissing, masturbation, vaginal intercourse). The sexual behavior total score was created by adding the number of sexual behaviors adolescents reported. Scores ranged from 0 ¼ never engaged in any sexual behavior to 9 ¼ engaged in all sexual behaviors listed.

Analytic Plan The research questions in this study were addressed using logistic regression analyses. Six separate models were estimated, (1) lifetime cigarette use, (2) lifetime alcohol use for girls, (3) lifetime alcohol use for boys, (4) lifetime marijuana use, (5) lifetime inhalant use for girls, and (6) lifetime inhalant use for boys. For all models the dependent variable was yes=no for lifetime use. The covariates for all models were importance of family, language use, family structure, household size, maternal education, grades, and sexual behaviors.

RESULTS Descriptive Analyses Descriptive statistics of the variables of interest are summarized in Table 1. In terms of family, adolescents rated family traditions as important. The majority of adolescents in the current sample came from predominantly Spanish-speaking or bilingual homes, with two parents and a total of 6 to 7 individuals in the household. Moreover, the majority of mothers had less than a high school degree. The majority of adolescents report grades of A,

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TABLE 2 Frequency and Percentage of Substance Use among Boys and Girls Current study

Latino national (YRBSS)

Los Angeles (YRBSS)

Frequency (%)

(%)

(%)

Substance Boys (n ¼ 150) Girls (n ¼ 160) Smoked cigarettes Drank alcohol Used marijuana Used inhalants


32 82 51 32

(20.8) (54.3) (33) (20.8)

27 106 51 47

(16.8) (65.8) (31.7) (29.4)

Boys

Girls

Boys

Girls

51.5 72.4 42.5 13.1

45.3 74.1 37.2 15.7

39.9 63.8 40.8 12.4

38.2 66.3 40.5 16.8

p > .05.

B, and C in school and on average had only engaged in sexual behaviors, such as kissing and making out with clothes on. Table 2 summarizes prevalence of substance use by gender, including data from the current study and local and national data provided by the YRBSS. In the current study, alcohol was the most frequently tried substance followed by marijuana, inhalants, and cigarettes, which reflects the pattern of early adolescents of the Los Angeles area provided by the YRBSS. It is important to note that there is a different pattern nationally for Latino early adolescents, with alcohol continuing to be the most frequently used substance, however, followed by cigarettes, then marijuana and inhalants. A chi-square test of independence was performed to examine the relation between gender and each substance. The relation between gender and alcohol was significant, X2 (1, N ¼ 313) ¼ 4.61, p < .05. Girls were more likely than boys to have ever tried alcohol. The relation between gender and inhalants was also significant, X2 (1, N ¼ 315) ¼ 3.19, p < .05. Girls were more likely than boys to have ever tried inhalants. Chi-square tests of independence revealed no statistically significant relation between gender and cigarettes, and gender and marijuana.

Predictors of Cigarette Use Results from the logistic regression model predicting cigarette use are presented in Table 3, which shows the adjusted odds ratios and confidence level. The results from the final model indicate that both family and individual factors impact cigarette use. As the size of the household increases, adolescents are more likely to have ever used cigarettes. Adolescents with grades of Cs are 3.87 times more likely than those with As to have ever tried cigarettes. Moreover, as the number of sexual behaviors increases, so does the likelihood of cigarette use. The coefficient on household size has a Wald statistic equal to 6.54, which is significant at the .01 level (95% confidence level); C grades has a Wald statistic equal to 3.91, which is significant at the .05 level (95% confidence level); and sexual behavior has a Wald statistic equal to 42.89, which is

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TABLE 3 Odds Ratios (ORs) for Incremental Increase for Predictors for Cigarette Lifetime Use Lifetime cigarette use


Step and predictor Step 1 Importance of family Home language Spanish Bilingual Family structure No parents Single parent Household size Maternal education Less than high school High school degree Some college and beyond Grades Mostly Ds and Fs Mostly Cs Mostly As and Bs Sexual behavior Constant

OR

95% CI

.88

.60–1.28

.65 .72

.21–2.05 .23–2.28

6.48 1.23 1.27

.78–54.04 .48–3.14 1.06–1.51

1.32 3.53 .99

.36–4.84 .97–12.82 .32–3.08

2.53 3.87 2.15 1.93 .00

.56–11.36 1.01–14.76 .63–7.29 1.59–2.35 —

p < .05, p < .01, p < .001. A test of the full model against a constant only model was statistically significant for cigarettes (X2 ¼ 90.306, p < .001 with df ¼ 13). CI ¼ confidence interval.

significant at the .001 level (95% confidence level). The overall model is significant at the .001 level according to the Model chi-square statistic. The model predicts 87% of the responses correctly. The Nagelkerke R2 is .0.43.

Predictors of Alcohol Use Table 4 shows the adjusted odds ratios and confidence level for lifetime alcohol by gender. For young girls, the results from the final model indicated that adolescents with a mother with a high school diploma are 5.74 times more likely to ever had tried alcohol than those with mothers with some college and beyond. Additionally, as the number of sexual behaviors increased, adolescents were more likely to have ever tried alcohol. The coefficient on maternal education (high school) has a Wald statistic equal to 6.43, which is significant at the .01 level (95% confidence level), and sexual behaviors has a Wald statistic equal to 15.77, which is significant at the .001 level (95% confidence level). The overall model is significant at the .001 level according to the Model chi-square statistic. The model predicts 78% of the responses correctly. The Nagelkerke R2 is .0.43. For young boys, the results from the final model indicated that boys who were in Spanish-speaking and bilingual homes and those that lived in

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TABLE 4 Odds Ratios (ORs) for Incremental Increase for Predictors by Alcohol Lifetime Use and Gender Lifetime alcohol use Boys


Step and predictor Step 1 Importance of family Home language Spanish Bilingual Family Structure No parents Single parent Household size Maternal education Less than high school High school degree Some college and beyond Grades Mostly Ds and Fs Mostly Cs Mostly As and Bs Sexual behavior Constant

Girls

OR

95% CI

OR

95% CI

.83

.51–1.36

.99

.63–1.56

4.00 9.15

1.05–15.19 2.18–38.37

.26 2.07

.06–1.05 .53–8.10

1.24 5.61 .83

.06–25.43 1.47–21.42 .64–1.07

1.06 .71 .89

.03–33.11 .23–2.20 .71–1.10

.84 1.95 2.16

.20–3.52 .40–9.51 .57–8.21

3.08 5.74 .84

.76–12.50 1.49–22.15 .28–2.54

.73 6.76 1.47 1.91 .10

.13–4.05 1.60–28.60 .45–4.83 1.43–2.54 —

6.25 3.46 1.50 2.19 .51

.57–68.01 .90–13.34 .55–4.04 1.49–3.22 —

p < .05, p < .01, p < .001. A test of the full model against a constant only model was statistically significant for alcohol for girls (X2 ¼ 55.887, p < .001 with df ¼ 13) and for boys (X2 ¼ 62.324, p < .001 with df ¼ 13). CI ¼ confidence interval.

single-parent homes had a greater likelihood of ever trying alcohol. Adolescent boys who reported mostly C grades were 6.76 times more likely than those with mostly As to ever try alcohol. Additionally, the number of sexual behaviors significantly increased the likelihood of ever trying alcohol. The coefficient on Spanish has a Wald statistic equal to 4.13, which is significant at the .05 level (95% confidence level); bilingual has a Wald statistic equal to 9.15, which is significant at the .01 level (95% confidence level); C grades has a Wald statistic equal to 6.736 which is significant at the .01 level (95% confidence level); and sexual behavior has a Wald statistic equal to 19.47, which is significant at the .001 level (95% confidence level). The overall model is significant at the .001 level according to the Model chi-square statistic. The model predicts 76% of the responses correctly. The Nagelkerke R2 is .0.48.

Predictors of Marijuana Use Results from the logistic regression model predicting marijuana use are presented in Table 5, which shows the adjusted odds ratios and confidence level. As the endorsement of family traditions increased, the likelihood of

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TABLE 5 Odds Ratios (ORs) for Incremental Increase for Predictors by Marijuana Lifetime Use Lifetime marijuana use



OR

95% CI

.71

.53–.96

1.39 2.49

.54–3.54 .96–6.42

2.86 1.06 1.06

.45–18.33 .50–2.24 .91–1.24

.83 1.22 1.23

.32–2.14 .46–3.26 .53–2.86

6.34 3.10 2.12 1.66 .07

1.98–20.33 1.14–8.40 .87–5.14 1.40–1.96 —

p < .05, p < .01, p < .001. A test of the full model against a constant-only model was statistically significant for marijuana (X2 ¼ 91.027, p < .001 with df ¼ 13).

marijuana use decreased. Adolescents with grades of Ds and Fs were 6.43 times more likely and adolescents with grades of Cs are 3.10 times more likely than those with As to have ever tried marijuana. Moreover, as the number of sexual behaviors increased, so did the likelihood of marijuana use. The coefficient on family has a Wald statistic equal to 5.064, which is significant at the .05 level (95% confidence level); D and F grades has a Wald statistic equal to 9.66, which is significant at the .01 level (95% confidence level); C grades has a Wald statistic equal to 4.94, which is significant at the .05 level (95% confidence level); and sex has a Wald statistic equal to 34.76, which is significant at the .01 level (95% confidence level). The overall model is significant at the .001 level according to the Model chi-square statistic. The model predicts 78% of the responses correctly. The Nagelkerke R2 is .0.37.

Predictors of Inhalant Use Table 6 shows the adjusted odds ratios and confidence level for lifetime alcohol by gender. For young girls, the results from the final model indicated that as the endorsement of family traditions increased, the likelihood of inhalant use decreased. Adolescent girls with grades of Ds and Fs were 23.06 times more likely and adolescents with grades of Cs are 4.70 times more likely than

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TABLE 6 Odds Ratios (ORs) for Incremental Increase for Predictors by Inhalants Lifetime Use and Gender Lifetime inhalant use Boys



Girls

OR

95% CI

OR

95% CI

1.03

.63–1.67

.55

.35–.85

1.11 1.21

.31–4.01 .30–4.99

1.21 4.20

.23–6.28 .88–20.00

12.13 .31 .81

.52–281.68 .07–1.35 .60–1.09

1.15 .40 .84

.06–22.02 .12–1.31 .66–1.07

1.07 2.76 4.98

.16–7.05 .36–21.20 .95–26.24

1.30 2.58 .86

.32–5.28 .69–9.64 .24–3.05

9.95 4.61 3.87 1.27 .04

1.22–81.27 .72–29.45 .68–22.12 1.02–1.58 —

23.06 4.70 1.38 1.30 1.31

3.75–141.69 1.24–17.92 .44–4.30 1.01–1.67 —

p < .05, p < .01, p < .001. A test of the full model against a constant-only model was statistically significant for inhalants for girls (X2 ¼ 49.188, p < .001 with df ¼ 13) and for boys (X2 ¼ 32.231, p < .001 with df ¼ 13).

those with As to have ever tried inhalants. Additionally, as the number of sexual behaviors increased, adolescents were more likely to have ever tried inhalants. The coefficient on family has a Wald statistic equal to 7.14, which is significant at the .01 level (95% confidence level); D and F grades has a Wald statistic equal to 11.48, which is significant at the .001 level (95% confidence level); C grades has a Wald statistic equal to 5.15, which is significant at the .05 level (95% confidence level); and sex has a Wald statistic equal to 4.02, which is significant at the .05 level (95% confidence level). The overall model is significant at the .001 level according to the Model chi-square statistic. The model predicts 80% of the responses correctly. The Nagelkerke R2 is .0.40. Adolescent boys with grades of Ds and Fs were 9.95 times more likely than those with As to have ever tried inhalants. Additionally, the number of sexual behaviors significantly increased the likelihood of ever trying inhalants. The coefficient on D and F grades has a Wald statistic equal to 4.60, which is significant at the .05 level (95% confidence level), and sex has a Wald statistic equal to 4.37, which is significant at the .05 level (95% confidence level). The overall model is significant at the .01 level according to


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the Model chi-square statistic. The model predicts 80% of the responses correctly. The Nagelkerke R2 is .0.31.


Discussion The current study examined the likelihood of lifetime use of cigarettes, alcohol, marijuana, and inhalants in Latino early adolescents. Compared to national data on Latino 9th grade students from the YRBSS in 2011, the current sample reported lower rates of lifetime cigarette use, similar rates of alcohol and marijuana, and higher rates of inhalant use. Of particular concern is the high rate of inhalants among young girls (Guzman & Kouyoumdjian, in press): 29.4% in the current study, which is higher than the national average of 15.7% for Latino 9th grade girls, and higher than 9th grade girls in the Los Angeles region from diverse ethnic groups (YRBSS, 2011). Young girls, particularly Latina girls from low-income communities, may engage in higher rates of inhalant use given the accessibility and affordability of the substances. Additionally, and of greater concern, is the link between early inhalant users and emotional problems. Latina girls in the US have high rates of suicide, which some research has begun to explain through the challenges that arise in the unique convergence of cultural, familial, and development factors (Zayas & Pilat, 2008). Latino early adolescents, particularly girls, may be experiencing depression, anxiety, feelings of isolation, and self-blame, and use inhalants to cope with the challenges. However, further research is needed to examine how cultural, familial, and developmental factors may be impacting inhalant use. In examining predictors of substance use, the current findings suggest that family characteristics have a unique influence on adolescent substance use, varying by type of drug. On the other hand, individual-level factors such as academic grades and sexual behavior are more consistent predictors of an increased likelihood of general substance use.

Family Consistent with research on the larger concept of familism, the importance of family traditions served as a protective factor. After accounting for family characteristics, the adolescent’s value of family traditions played a protective role in adolescents’ use of marijuana and inhalants, drugs that societal norms label as taboo substances at any age. In these cases, adolescents’ perceptions of the importance of their family played a more significant role than family structure characteristics that past research has highlighted as predictors (e.g., single parenthood). It may be that during adolescence, an age characterized by autonomy and identity exploration, individual-level variables such as the internalization of family beliefs play a more prominent role in their experience compared to family characteristics.


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Home language, a proxy measure of acculturation (Acevedo, 2000; Sundquist & Winkleby, 1999), had limited impact on substance use. In the current study, home language only impacted alcohol odds, with being in a bilingual or Spanish-speaking home increasing the odds of ever trying alcohol. This is contrary to past research that finds high levels of acculturation (i.e., English-speaking homes) to be associated with greater substance initiation and use (Martinez, 2006). It may be that in bilingual households, adolescent boys feel more pressure to maintain dual identities, having to prove to their peers that they can fit in and fulfill stereotypes of U.S. alcohol consumption culture. Bilingual adolescent boys may also be using alcohol as a coping mechanism to alleviate acculturative stressors. However, further research is needed that examines the process of acculturation with diverse measures that may capture factors that can create stressors unique for young girls. Family structure and household size also had a limited influence on adolescent substance use. Consistent with past research boys in single-parent homes had higher odds of ever trying alcohol than boys from two-parent homes. It is important to be mindful that the majority of the current sample is not from a single-headed household. Further research on single-parent homes, and the additional stressors and sources of support, is needed to understand how boys are influenced. Moreover, the current study found that household size only increased the likelihood of lifetime cigarette use. It may be that in larger households, adolescents are exposed to a higher number of individuals who smoke cigarettes. On the other hand, it may be that the influence of large household size is a reflection of a busier household with lower levels of parental monitoring, which increases the chances of cigarette use. The social acceptability of each substance may be one explanation for the different pattern of influence. There is limited research on maternal education as a predictor for substance use, and while some research suggests that maternal education no longer influences substance use once other variables are included in statistical models (Guilamo-Ramos, Jaccard, Johansson, & Tunisi, 2004), other research suggests it makes a unique contribution across multiple substances (Melloti et al., 2011). The current study found that maternal education only influenced the likelihood of alcohol consumption for girls. Mothers with higher levels of education may be engaging in more health-related conversations, particularly with their daughters, decreasing their likelihood of alcohol consumption. In sum, parental and household characteristics had limited influence across substances, each making only a small contribution to cigarette, alcohol, or marijuana. It is important to note that no family variables impacted inhalant use. Inhalant use may be better explained by individual-level variables; however, it is important not to dismiss family in serving a protective role. Parent-adolescent relationship quality may moderate the relationship of emotional well-being and inhalant use.


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Grades Research consistently finds that lower academic achievement is associated with cigarettes, alcohol, and other drugs (Balsa et al., 2011; Vaughan et al., 2011; McCaffrey et al., 2010). However, the current study found that adolescents with a higher likelihood of ever trying cigarettes, alcohol (for boys), marijuana use, and inhalant use (for girls) were students with average academic success. Research often discusses the lowest achieving adolescents as having the highest risk of substance use and abuse (Bond et al., 2007; Bryant & Zimmerman, 2002); however, the current study found that achieving Ds and Fs did not increase the likelihood of cigarette and alcohol consumption. However, Ds and Fs did increase the odds of ever trying marijuana and inhalant use. This finding is particularly important for programming that targets ‘‘at-risk’’ youth as defined by poor academic achievement, as they may be missing the opportunity to aid academically average children who also have greater odds of cigarette, marijuana, and inhalant use.

Sex Adolescent sexual activity was the only psychosocial factor that influenced all substances examined in this study, increasing the likelihood of lifetime use. Moreover, sex was a significant influence for both boys and girls. As has been cited in the adolescent sexual health research, risky sexual behavior is highly related to substance use (Guo et al., 2002; Shrier, Harris, Sternber, & Beardslee, 2001; Silverman, Raj, Mucci, & Hathaway, 2001). The current study is in line with previous research in this area that suggests that early sexual behaviors are associated with greater substance use. Given that this study has consistent findings with previous research with this population, it is important to take note that policies and programming related to both substance use and safer sex behavior need to co-occur in order to have the most impact on the lifetime health of Latino populations.

Limitations and Future Research The current study contributes to the research by exploring normative sample of early adolescent Latinos. One limitation of the current study is the examination of lifetime use of substances. Future research needs to examine current use and abuse of substances with normative Latino adolescents. This study is also limited by a correlational design, and thus future research should examine substance use longitudinally, to be able to include age of initiation as well as shifts in the amount of substance use over time. Given the higher rate of inhalant use in the current sample compared to national 9th grade averages of Latino adolescents, further research is needed, including an examination of the neurobiological implications of exposure to inhalants.


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Given the diverse pattern of influence on each substance, future research should avoid creating composite variables of substance use. The current study suggests that overall grades and sexual activity influence multiple substances; however, several family factors uniquely increase the likelihood of lifetime use of certain drugs. While adolescents’ endorsement of the importance of family decreased the likelihood of marijuana use and inhalant use (for girls only), these beliefs did not influence alcohol or cigarette use. Certain family characteristics (e.g., household size, language spoken at home, and family structure) increased the likelihood of cigarette use and alcohol, but did not statistically significantly influence the likelihood of ever trying marijuana or inhalant use. It may be that family characteristics such as size and structure influence the access to substances that are more common (i.e., cigarettes and alcohol), while individual attitudes and behaviors (i.e., importance of family, grades, and sex), influence an adolescent’s choice to engage in substances that are more taboo (i.e., marijuana and inhalants). The increase use of alcohol and other drugs by young girls in recent years (Wallace et al., 2003) necessitates further research on gender determinants of substance use. The current study suggests that factors that influence young boys’ substance use do not necessarily influence young girls. While home language and family structure increased the likelihood of ever trying alcohol for young boys, these variables were not statistically significant for young girls. Moreover, while the importance of family protected young girls from ever trying inhalants, this was not the case for boys. In sum, the current study contributes to our understanding of the role that drug use plays in adolescents who do not come from highly specialized populations or engage in multiple behaviors labeled as risky. Moreover, it sheds further light on substance use research by disaggregating substance use among early adolescents. It continues to highlight the importance of addressing co-occurring behaviors such as academic difficulties, sexual behaviors, and substance use.

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