Teen attitudes toward smoking linked to likelihood of drinking and using drugs

NEW YORK (Sept. 30, 2009) -- New research by Weill Cornell Medical College researchers looks at the specific ways parents and peers influence teenagers to smoke, drink and use marijuana in combination. Among their findings: attitudes toward smoking influenced teenagers' use of multiple drugs (smoking, drinking and marijuana), and that this manifested itself differently in boys and girls.

For girls, friends were shown to be central. Ambivalent or permissive attitudes within their social group toward smoking were associated with poly-drug use -- defined as two or more of the following behaviors: smoking, drinking and marijuana use. This wasn't the case with boys, whose poly-drug use was instead predicted by the extent to which they perceived smoking to be prevalent in their larger age group -- not just among their friends.

"If a teenager feels smoking is socially acceptable and widely practiced, they are much more likely not only to smoke, but to also drink and possibly use marijuana," says lead author Dr. Jennifer A. Epstein, assistant professor of public health in the Division of Prevention and Health Behavior at Weill Cornell Medical College. "While the differences between how boys and girls are influenced by these social factors are subtle, they could help us develop new gender-specific educational tactics for preventing these behaviors."

The study also revealed several factors that were the same for boys and girls. When their friends drank alcohol or smoked or when their parents had permissive or ambivalent attitudes toward drinking, both teenage boys and girls were more likely to report poly-drug use. Other major variables included teenagers' inability to refuse drugs and achieve goals through their own efforts.

"A parent's opinion matters. Moms and dads are critical role models and should let their attitudes against drug use be known. It's also important to keep an eye on their child's social circle, since, especially for girls, it's their friends who are so central to influencing their behavior," says Dr. Epstein. "At the same time, parents can do things that reduce their child's risk for using drugs, such as teaching them to set goals and assert themselves."

Researchers analyzed confidential surveys taken by 2,400 sixth- and seventh-graders in inner-city schools in New York City. Questions dealt with substance use and several psychological factors that previous research suggests may be related to drug use. The majority of the schools serve youths from families with incomes averaged well below the federal poverty level.

The current study is one of the first to look at the relationships between smoking, drinking and marijuana use. The vast majority of research in this area has focused on a single substance in isolation, especially among white middle-class suburban populations. The importance of Dr. Epstein's approach is backed up by evidence suggesting that teenage poly-drug use is a significant risk factor for adult poly-drug use.

One implication of these findings, according to Dr. Epstein, is that "comprehensive prevention programs focusing on multiple gateway drugs (alcohol, cigarettes and marijuana) may prove to be more valuable than programs focusing on a single drug."

Study co-authors included Dr. Gilbert J. Botvin, chief of the Public Health Department's Division of Prevention and Health Behavior and professor of psychology in public health and psychology in psychiatry at Weill Cornell Medical College; and Margaret Doyle, formerly of Weill Cornell.

The study appears online in the July 1 issue of the Journal of Child and Adolescent Substance Abuse. The research was supported by a grant to Dr. Epstein from the National Institute on Drug Abuse (NIDA) to analyze data previously collected under a grant to Dr. Botvin from the National Cancer Institute (NCI). Some students in the NCI study received a prevention program called Life Skills Training (LST), while others did not. Dr. Botvin receives income from sales of the LST program. The data used by Dr. Epstein for the current NIDA study were from students who did not receive the LST program.

Weill Cornell Medical College, Cornell University's medical school located in New York City, is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Weill Cornell, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in areas such as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, transplantation medicine, infectious disease, obesity, cancer, psychiatry and public health -- and continue to delve ever deeper into the molecular basis of disease and social determinants of health in an effort to unlock the mysteries of the human body in health and sickness. In its commitment to global health and education, the Medical College has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, the Medical College is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances -- including the development of the Pap test for cervical cancer, the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial of gene therapy for Parkinson's disease, the first indication of bone marrow's critical role in tumor growth, and most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. For more information, visit www.med.cornell.edu.