RISK AND PROTECTIVE FACTORS IN ADOLESCENT MARIJUANA AND TOBACCO CO-USE: AN EXAMINATION USING VARIABLE- AND PERSON-CENTERED METHODS

Crystal Lederhos Smith

Adolescents often use substances such as tobacco and marijuana. Co-use of these substances can lead to physical, mental, and psychosocial difficulties beyond that which would be anticipated by simple additivity of their individual effects. Using mediation analysis (study one), moderated mediation analysis (study two), and latent class/profile analysis with a distal outcome (LPA; study three), this dissertation examined relationships between youth factors (internalizing, externalizing, and sensation seeking), age at first use of tobacco or marijuana, family factors (curfew, rules about tobacco product use in the home, availability of tobacco, parent talk about not using tobacco, expected parent reaction to tobacco use, and household tobacco use), and use and co-use outcomes in models representing lifetime and past 30-day use. Relationships were present between each youth factor (internalizing, externalizing, and sensation seeking) and lifetime tobacco and marijuana co-use in study one. For past 30-day use, externalizing and sensation seeking had significant associations, internalizing did not. Study two built upon these relationships - family factors of expected parent reaction and parent talk about tobacco use moderated paths leading to co-use. In study three’s LPA, five classes were present: 1) Family Risk, 2) Very Low Internalizers with Family Protection, 3) Internalizers with High Family Protection, 4) Above Average Youth Risk with Family Protection, 5) Internalizers with Family Risk. Each of these classes was differentially related to tobacco and marijuana use outcomes. The item probability patterns and relationships with the outcomes directed focus to the importance of the family factors of household tobacco use, availability, and rules about use in the home. Future studies should provide a more detailed view of the functioning of the home, including details about conversations between parents and youth, and youth behaviors. Based on the results of these three studies, I recommend that 1) an LPA of a more comprehensive set of youth factors with a distal substance use outcome and examination of potential moderation of these relationships by explicitly defined family factors be conducted, and 2) prevention and intervention programming address youth externalizing, sensation seeking, and family environment to be most effective.

RISK AND PROTECTIVE FACTORS IN ADOLESCENT MARIJUANA AND TOBACCO CO-USE: AN EXAMINATION USING VARIABLE- AND PERSON-CENTERED METHODS

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