Early Age of Onset of Tobacco, Alcohol, and Marijuana Use Among Middle School Youth in Tennessee: Does Place Matter?

Introduction. Among U.S. adolescents (12-17 years), tobacco, alcohol and marijuana are commonly used substances. Recent data suggests that although trends in tobacco use have declined, marijuana and alcohol use rates are steadily increasing, especially among younger adolescents. The main purpose of this study was to characterize differences in tobacco, alcohol and marijuana onset among Appalachian and nonAppalachian middle school students in Tennessee. At present, there is limited research on tobacco and drug use among younger adolescents in Tennessee and Appalachia as a whole. Therefore, these findings have important implications for the assessment and prevention of risk behaviors among adolescents regionally and may help to establish priorities for policy and preventive measures. Methods. This is a secondary data analysis of the Youth Risk Behavior Survey (YRBS), consisting of data collected in 2010 from a representative sample (n=65,182) of middle schoolers in Tennessee. All analyses were performed on weighted data so that results represent all middle school students in Tennessee. Primary outcome variables included early age of onset (age) of alcohol, tobacco, and marijuana use. The primary exposure variable was region (Appalachia versus non-Appalachia). Multiple logistic regression was used to determine the association between early age of onset of cigarette, alcohol, and marijuana use, and region controlling for personal characteristics, other substance use, suicidal behaviors, body mass index, weight misperception and extreme weight control behaviors. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were reported. Results. Early initiators of cigarette, alcohol or marijuana had a two to four fold increase risk for experimentation with other substances compared to late age of onset, with cigarette use posing the highest risk [OR: 4.73, C.I. (4.47, 5.01)]. Middle schoolers in Appalachia were at greater risk for early age of onset of cigarette [OR: 1.502, C.I. (1.421, 1.587)] and marijuana use [OR: 1.268, C.I. (1.169, 1,375)] compared to non-Appalachia middle schoolers, and 80.9% less likely to use alcohol prior to age 12 [OR: 0.809, C.I. (0.777, 0.843). Other differences were observed for risk of early onset of use and gender, race/ethnicity, age, other substance use and EWCB. Conclusion. Differences in the pattern of substance use were observed for middle schoolers in Appalachia and non-Appalachia Tennessee. Better understanding of these differences will help inform public health policy and practice targeting cigarette, alcohol and marijuana use in the region