National Institute of Health and Welfare & University of Helsinki, Helsinki, Finland.
J Am Acad Child Adolesc Psychiatry. 2010 Jan;49(1):61-9. doi: 10.1097/00004583-201001000-00010.
To examine externalizing behavior problems and cigarette smoking as predictors of subsequent cannabis use.
Dutch adolescents (N = 1,606; 854 girls and 752 boys) from the TRacking Adolescents' Individual Lives Survey (TRAILS) ongoing longitudinal study were examined at baseline (ages 10-12 [T1]) and at two follow-up assessments (ages 12-15 [T2] and 15-18 [T3]). The analysis focused on DSM-IV externalizing behavior (conduct, attention deficit hyperactivity, and oppositional) problems at T1, assessed by the Youth Self Report and the Child Behavior Check List, on self-reported ever smoking at T2, and on cannabis use at T3.
All associations of parent-rated externalizing behavior problems with cannabis were mediated by earlier smoking. Considering self-reported problems, none of these associations with cannabis were mediated by smoking, except the influence of self-reported conduct problems in girls. Interestingly, even after adjusting for externalizing problems, earlier smoking independently and consistently predicted cannabis use. The adjusted odds ratios for smoking varied in boys from 4.8 to 5.2 (ever) from 10 to 12 (daily) and from 22 to 23 (early-onset) whereas in girls from 4.9 to 5.0, 5.6 to 6.1, and 27 to 28, respectively (p <.001 for all).
Our findings challenge the view that externalizing behavior problems directly predict cannabis initiation. Such associations were inconsistent across informants and sexes and were often mediated by earlier smoking. Early smoking onset is a powerful predictor of later cannabis initiation independent of preceding externalizing behavior problems. Although externalizing behavior problems are important as a starting point for substance use trajectories, early-onset smoking should be identified as an important marker of cannabis use risk.
探讨外化行为问题和吸烟作为随后使用大麻的预测因子。
荷兰青少年（N=1606；854 名女孩和 752 名男孩）来自于正在进行的纵向研究青少年个体生活追踪调查（TRAILS），在基线（年龄 10-12 [T1]）和两次随访评估（年龄 12-15 [T2]和 15-18 [T3]）时进行了检查。分析集中在 T1 时 DSM-IV 外化行为（行为、注意力缺陷多动和对立）问题，使用青少年自评量表和儿童行为检查表进行评估，T2 时自我报告的吸烟情况，以及 T3 时大麻使用情况。
父母评定的外化行为问题与大麻的所有关联都通过早期吸烟来介导。考虑到自我报告的问题，除了女孩中自我报告的行为问题与大麻的关联之外，这些关联都没有通过吸烟来介导。有趣的是，即使在调整了外化问题后，早期吸烟仍然独立且一致地预测大麻使用。在男孩中，吸烟对大麻使用的调整后比值比从 10 到 12 岁（每天）从 4.8 到 5.2（曾经），从 10 到 12 岁（每天）从 22 到 23（早发），而在女孩中从 4.9 到 5.0、5.6 到 6.1 和 27 到 28，分别为（所有 p<0.001）。
我们的发现挑战了外化行为问题直接预测大麻起始的观点。这些关联在不同的信息提供者和性别之间不一致，并且经常通过早期吸烟来介导。早期吸烟的发生是独立于先前的外化行为问题的后期大麻起始的有力预测因子。虽然外化行为问题是物质使用轨迹的一个重要起点，但早期吸烟的发生应该被确定为大麻使用风险的一个重要标志。
