Early Initiation Of Substance Use Research Articles

Behavioral and psychosocial correlates of hope among youth

IntroductionHope plays a crucial role in the well-being of youth, impacting various aspects of their lives. However, less is known about the role of hope in pre-adolescents. This study aims to explore the psychosocial and behavioral correlates of hope in 9–10-year-old pre-youth transitioning into adolescence. MethodsUsing data from the Adolescent Brain Cognitive Development (ABCD) study, 4631 youth entered our study. The investigation follows these individuals for up to 36 months, specifically observing the initiation of marijuana and tobacco use. The methods employed include bivariate correlations. ResultsBaseline high hope offered protection against marijuana and tobacco use over the following 36 months. Elevated levels of hope could be seen in pre-youth with higher family income and those experienced lower levels of stressful life events and financial difficulties. High hope was also linked to lower behavioral problems, improved emotional function, lower impulsivity, lower sensation seeking, and higher cognitive function. Notably, hope was not correlated with parental education, neighborhood income, family conflict, blood pressure, body mass index, grade point average, prosocial behaviors, or puberty. ConclusionIn conclusion, the findings suggest a close interplay between hope and various dimensions of resilience including lower tobacco and marijuana use. Higher levels of hope, influenced by factors such as family income and life events, may be a mechanism that connects hope to enhanced emotional and cognitive functioning and acts as a protective factor against early initiation of substance use. These findings underscore the potential utility of fostering hope as a strategy to promote positive development and reduce tobacco and marijuana use.

Adverse childhood experiences and early initiation of substance use: A survival analysis.

Early adversity, such as adverse childhood experiences (ACEs), is a risk factor for the development of substance use disorder (SUD). ACEs are associated with earlier initiation of substance use. This study examined the relationship between ACEs and age of initiation of substance use using survival analysis. It is hypothesized that individuals with higher ACEs will have an earlier age of initiation. Participants were recruited from the University of Kentucky's Laboratory for Human Behavioral Pharmacology. Participants were 18 years or older, English speaking, and actively engaged in substance use. Participants were not in substance abuse treatment nor were they seeking treatment. ACE scores were calculated, and age of substance use initiation was recorded. A Cox proportional hazard model was used to examine the effect of ACE score on age of substance use initiation. A total of 107 participants completed the study. An average number of 2.3 ACEs (SD = 2.2) were endorsed with 24% of participants reporting 4 or more ACEs. Higher ACE scores were associated with cigarette smoking and non-medical prescription opioid use onset ( hazard ratio (HR) = 1.14, 95% CI=1.02-1.28, p = 0.02, and HR=1.19, 95% CI = 1.04-1.37, p = 0.01, respectively. A significant association was found between higher ACE scores and earlier initiation of cigarette and non-medical prescription opioid use, consistent with prior research. Primary prevention of ACEs, screening for ACEs during childhood, and interventions for ACEs if detected, may help to reduce the risk of substance use/SUD in adulthood.

Are Campus Services Reaching Those in Need? Substance Use and Awareness of University Counseling Services

ABSTRACT Help-seeking is uncommon among college students with substance use concerns. Perceived access to services is associated with greater help-seeking behavior. This study identifies substance use-related risk factors associated with awareness of campus counseling services. College students aged 18 to 25 (N = 995) self-administered a web-based survey, reporting their demographics, substance use history, well-being, and counseling services available at their institution. Multiple logistic regression was used to identify factors associated with awareness of services. Overall, 78% of students were aware of counseling services available at their institution. Full-time enrollment (p = .038) and better mental well-being (p = .025) were associated with greater odds of awareness of services. Early initiation of substance use (p = .003) and past month high-intensity drinking (p = .003) were associated with lower odds of awareness of services. Innovative strategies are needed to ensure campus counseling services reach students at risk for substance use-related problems.

Tribal Reservation Adolescent Connections Study: A study protocol using mixed methods for examining social networks and associated outcomes among American Indian youth on a Northern Plains reservation

BackgroundRich cultural and traditional practices make interpersonal relationships vital for American Indian (AI) youth. Social relations and multigenerational networks (i.e., peer, family, kinship, and community) remain a salient fixture of AI culture, survival and thriving in reservation communities. Research in other populations has demonstrated how social networks impact youth risk and resilience, but data are lacking on AI adolescent networks. Intergenerational trauma from settler colonialism leads some AI youth to early initiation of substance use and subsequent substance misuse, along with disproportionately high risk for suicide and vulnerability to witnessing and experiencing violence. Using network data to develop prevention strategies among this population is a promising new avenue of research. In this study protocol paper, we describe the rationale and methodology of an exploratory study to be conducted with American Indian 9th and 10th graders at three schools on a Northern Plains reservation. MethodsThis mixed methods study will collect quantitative social network surveys (N = 300) and qualitative interviews (n = 30). The study will examine the extent to which existing social network theories and data metrics adequately characterize AI youth networks or how they may need to be expanded for this population. Associations of network characteristics with risk and protective factors for substance use, exposure to violence, and suicide will also be examined. DiscussionThis innovative methodological approach holds promise for informing the development of effective preventive approaches to address co-occurring risks for substance use, violence and suicide among AI adolescents. Understanding processes that impact social networks among AI adolescents can promote culturally resonant social relationships that may support better outcomes for youth.

Youth substance use service provider\u2019s perspectives on use and service access in ontario: time to reframe the discourse

BackgroundAge is a critical factor in substance use and related outcomes, with adolescence being a particularly sensitive period. Early initiation of substance use has been linked with higher risk for developing substance use disorders. In Ontario, Canada, substance use is common among youth, yet treatment is underutilized, suggesting the potential for an unmet need in terms of substance use care. Despite these challenges, there is limited research examining factors that contribute to youth substance use and youth-specific barriers to substance use care. To fill this knowledge gap, this study sought to include the unique perspectives of service providers who work directly with youth to examine these issues.MethodsWe used a cross-sectional mixed-methods design to examine factors that contribute to substance use among youth and identify youth-specific barriers to substance use among a sample of 54 Ontario-based youth service providers. Data collection included an online survey completed by all study participants followed by qualitative interviews of a subsample of 16 participants. Data analysis included basic frequency tabulations for survey results and thematic qualitative analyses to identify common themes.ResultsLicit substances were identified as the most commonly used among youth, where 94% of respondents identified cannabis use and 81% identified alcohol use. Thematic analyses identified the role of dominant substance use discourses in normalizing certain substances (i.e., cannabis and alcohol) while also endorsing stigmatizing beliefs and sentiments. According to youth service providers, the intersection of these two discourses simultaneously lead to an increase in substance use while deterring youth from seeking substance use care.ConclusionsNormalization and stigmatization are two dominant discourses around youth substance use, with important implications for public health interventions. Key public health strategies, as identified by participants, to reduce the overall negative effect of these factors include the need to reframe substance use discourse, from a moral failing to a public health issue and to educate youth about the impacts of use. To accomplish this goal educational campaigns to raise awareness around the health effects of use and address stigmatization are needed. Educational reforms are also needed to ensure that these programs are integrated into the school system.

Relationship Between the Early Initiation of Substance Use and Attempted Suicide Among in-School Adolescents in Seven Low- or Middle-Income African Countries: An Analysis of the Global School-Based Student Health Survey Data.

Background: Preventing suicide among adolescents is an urgent global public-health challenge, especially in Africa. Accordingly, the aim of this study was to examine the relationship between the early initiation (< 12 years old) of substance use (cigarette smoking, alcohol use, and drug use) and attempted suicide among in-school adolescents in seven African countries.Methods: Data on the early initiation of substance use and on attempted suicide among in-school adolescents over the previous 12 months in Benin, Liberia, Mauritius, Mozambique, Namibia, Seychelles, and the United Republic of Tanzania were collected from Global School-based Student Health Surveys and were pooled to determine the overall prevalence of these behaviors in adolescents. Univariate and multivariate logistic regressions were then performed to evaluate country-specific associations between the early initiation of substance use and attempted suicide in these adolescents, followed by meta-analyses to evaluate overall pooled associations.Results: In the abovementioned seven African low- or middle-income countries (LMICs), overall weighted prevalences of attempted suicide and early initiation of cigarette smoking, alcohol use, and drug use among in-school adolescents were 16.05, 7.76, 17.68, and 3.48%, respectively. Multivariate logistic regression analyses revealed that relative to non-smoking, the early initiation of smoking was significantly associated with attempted suicide in these adolescents [OR (95% CI) = 1.783 (1.219–2.348)]. Additionally, the relationship between early initiation of cigarette smoking and attempted suicide is mostly driven by a higher association in girls [OR (95% CI) = 1.867 (1.031–2.703)] than boys [OR (95% CI) = 1.392 (0.995−1.789)]. Moreover, relative to not using other drugs, the early and later initiation of other drug use were also significantly associated with attempted suicide in these adolescents [ORs (95% CIs) = 2.455 (1.701–3.208) and 1.548 (1.198–1.898)].Conclusion: Programs that can eliminate or decrease the early initiation of substance use among adolescents should be implemented in African LMICs to prevent subsequent suicide attempts, especially among adolescent girls.

Age of Substance Use Initiation and Sexual Violence Victimization among Female Adolescents.

Objective: In this study, I examined the association between age of substance use initiation and sexual violence (SV) among adolescent girls. Methods: Data were drawn from the 2017 Youth Risk Behavior Survey, and the sample included 7526 girls. Logistic regression was used to estimate the relationship between age of initiation of alcohol use, marijuana use and cigarette smoking, and SV, assessed by forced sexual intercourse and experiencing SV. Results: A dose-response association was observed between age of substance use initiation and SV. Across all 3 substance use variables and for both SV outcomes, those who initiated substance use before age 15 were more likely to experience SV than those who initiated at or after age 15, who, in turn, had a higher likelihood of experiencing SV than those who had never initiated substance use. Conclusion: Early initiation of substance use may be a meaningful marker of risk for SV victimization in later adolescence. SV prevention programs could use early initiation of substance use to identify adolescents who are at increased risk for SV and provide them with targeted interventions. To be more effective, primary prevention of SV may need to begin targeting substance use in early adolescence.

Short term effects of the REAL media e-learning media literacy substance prevention curriculum: An RCT of adolescents disseminated through a community organization

BackgroundThe primary aim of this study was to evaluate the short-term effects of testing an e-learning program to reduce adolescent substance use and abuse. Early initiation of substance use is linked to a variety of negative outcomes, thus effective intervention programs are needed. One approach is to use media literacy to capitalize on adolescents’ immersion with media in a variety of forms. We developed, implemented, and tested an engaging substance use prevention program by collaborating with a youth-oriented community partner (4-H). Methods639 middle adolescents from nine U.S. states participated in an RCT of REAL media. Participants completed a series of online surveys and were randomized to use an online substance prevention program (REAL media) or serve as control (delayed program use). Self-report surveys were administered at three points in time. This short-term evaluation uses data from the pretest (Time 1) and short-term posttest three-month surveys, which measured demographics, self-efficacy to counterargue, and injunctive and descriptive substance use norms. ResultsParticipants who completed the REAL media program reported increased self-efficacy to counterargue and decreased positive injunctive norms compared to control participants who did not complete the program. No significant differences were observed for descriptive norms. ConclusionsWe found support for the REAL media program in changing key predictors of youth substance use demonstrating (1) the efficacy of media literacy interventions targeting adolescents and (2) that e-learning substance use prevention efforts can be adapted for and implemented through community organizations.

Associations between racial and socioeconomic discrimination and risk behaviors among African-American adolescents and young adults: a latent class analysis.

Discrimination is a common stressor among African Americans and may increase vulnerability to risk behaviors, such as early initiation of substance use, substance use problems, and physical aggression; however, few studies have examined different types of discrimination and their associations with patterns of risk behaviors. This study examines the relationship between experiences of racial and socioeconomic discrimination and risk behaviors in African-American adolescents and young adults. We investigated associations of two discrimination types with risk behavior patterns identified with latent class analysis in a high-risk sample of African Americans (N = 797, Mage = 17.9years, 50.2% female). Four distinct classes of risk behaviors were characterized by High Use and Aggression (10%), Moderate Use and Aggression (10%), High Alcohol (17%), and Low Use and Aggression (63%). Classes that exhibit general risk behaviors, including substance use and aggression, were significantly associated with racial and socioeconomic discrimination, even in the fully adjusted model. Relative to other classes, the High Use and Aggression class demonstrated an elevated likelihood of experiencing both racial and socioeconomic discrimination. Findings support a link between racial and socioeconomic discrimination and risk behavior in African-American youth, which may be stronger for socioeconomic discrimination. Understanding the relationship between discrimination and risk behavior can inform future interventions to prevent substance misuse and conduct problems in youth. Further study is needed to elucidate the relationship between discrimination and other risk behaviors.

School-based interventions for preventing substance use in indigenous children ages 7–13: a scoping review protocol

IntroductionThroughout the world, indigenous peoples share traumatic colonial experiences that have caused gross inequalities for them and continue to impact every aspect of their lives. The effect of intergenerational trauma...

An examination of the association between early initiation of substance use and interrelated multilevel risk and protective factors among adolescents.

One of the major goals of drug use prevention programs is to delay the age of onset of substance use. What is called early initiation, usually occurring in adolescents under the age of 15, is a salient predictor of Substance Use Disorders later in adulthood. The causes of early initiation are complex and multifaceted and this has led to the identification of a rich set of risk and protective factors that influence age of onset. Nonetheless, there is little knowledge about the interdependence of these factors in their impact on early initiation. This paper addresses this question by applying Multiple Correspondence Analysis to data on family, community and social risk and protective factors from over 1200 adolescents. We find that community and to a lesser extent social factors are the most clearly associated to early initiation and we compare our results to those obtained from linear regression analyses of the same data that do not incorporate interdependence and find opposite results. We discuss the differences between linear regressions and MCA to evaluate the interplay of risk and protective factors and the implications of our findings for health policy and the design of prevention interventions aimed at delaying age of onset.

Age of onset of substance use in patients with dual diagnosis and its association with clinical characteristics, risk behaviors, course, and outcome: A retrospective study.

Research Question:Do patients with dual diagnosis (DD) with an early initiation of substance use and subsequent early onset substance use disorder (EOS) differ from those with late onset substance use disorder (LOS) regarding characteristics, sex-related risk behaviors, course, and outcome?Objectives:The aim is to study EOS and LOS groups of patients with DD attending a treatment center with regard to clinical characteristics, type of psychiatric disorders, risk behaviors, and short-term outcome.Materials and Methods:Retrospective chart review of patients diagnosed with DD (n = 307) with regard to the above variables. Diagnoses of both substance use disorders (SUDs) and psychiatric disorders were made by qualified psychiatrists as per the International Classification of Diseases, 10th revision.Results:Among 307 participants with DD, 100 were in EOS group (onset of SUD before 18 years of age as assessed clinically) and 207 in LOS group. Cannabis as the primary substance was more prevalent in the EOS (30%) than that of the LOS group (12%). Psychotic disorders were more prevalent in the EOS group (41%) followed by mood disorders (30%), while the reverse was true in the LOS group (27.5% and 56.5%, respectively). When compared to the LOS group, the EOS group had higher number of psychiatric admissions, reported higher prevalence of risky sexual behaviors (unprotected sexual intercourse, multiple sexual partners, and history of sexual intercourse with commercial sex workers), showed poorer treatment adherence, and worse outcome regarding both psychiatric disorder and SUD (all differences significant at P < 0.05).Conclusions:DD patients differ significantly based on the age of onset of substance use. These may have therapeutic and management implications.

Climate schools plus: An online, combined student and parent, universal drug prevention program

Early initiation of substance use significantly increases one's risk of developing substance use dependence and mental disorders later in life. To interrupt this trajectory, effective prevention during the adolescent period is critical. Parents play a key role in preventing substance use and related harms among adolescents and parenting interventions have been identified as critical components of effective prevention programs. Despite this, there is currently no substance use prevention program targeting both students and parents that adopts online delivery to overcome barriers to implementation and sustainability. The Climate Schools Plus (CSP) program was developed to meet this need. CSP is an online substance use prevention program for students and parents, based on the effective Climate Schools prevention program for students. This paper describes the development of the parent component of CSP including a literature review and results of a large scoping survey of parents of Australian high school students (n = 242). This paper also includes results of beta-testing of the developed program with relevant experts (n = 10), and parents of Australian high school students (n = 15). The CSP parent component consists of 1) a webinar which introduces shared rule ranking, 2) online modules and 3) summaries of student lessons. The parent program targets evidence-based modifiable factors associated with a delay in the onset of adolescent substance use and/or lower levels of adolescent substance use in the future; namely, rule-setting, monitoring, and modelling. To date, this is the first combined parent-student substance use prevention program to adopt an online delivery method.

Social Determinants of Alcohol Use and Heaving Episodic Drinking Among Hispanic Young Adults

Background: Although there are numerous preventive measures in the literature, a vast percentage of Hispanic young adults continue to engage in alcohol use and heavy episodic drinking. The purpose of the study was to examine social determinants of recent alcohol use and heavy episodic drinking among Hispanic young adults 18-25 years of age. Methods: In 2016, a secondary analysis (N = 3,452) was performed of 2012 National Survey on Drug Use and Health data. A series of logistic regression analyses were performed to determine whether recent alcohol use and heavy episodic drinking differed based on sex, education level, family income, employment status, location of residence (type of metro area), self-reported health status, first use of alcohol before age 21, first use of tobacco before age 21 and first use of marijuana before age 21. Results: Regarding alcohol use, 51.8% of Hispanic young adults reported that they had consumed alcohol in the past month and 35.0% reported that they had engaged in heavy episodic drinking. Hispanic young adults at highest risk for recent alcohol use were male, had some college or more, had high family income, were employed, lived in a large metropolitan area, had excellent/very good health status, and had early initiation of substance use. Those at highest risk for heavy episodic drinking were male, were employed, and had early initiation of substance use. Discussion: The present study found that a sizeable percentage of Hispanic young adults are involved in recent alcohol use and heavy episodic drinking. Since Hispanic young adults are disproportionately at risk for substance use and scarce resources are available to effectively address the needs of this population, further interventions are warranted. Findings may aid prevention scientists in developing, implementing and evaluating alcohol use programs for this population.

Early Initiation of Substance Use as an Indicator of Problematic Substance Use Among Young Men Who Have Sex with Men (YMSM)

ABSTRACTBackground and Objectives: Much research has documented that young men who have sex with men (YMSM) are at higher risk for substance use-related problems. This study examined the age of substance use initiation and it's relationship to current substance use-related problems among substance-using YMSM. Design and Methods: A cross-sectional survey of 191 YMSM (aged 18 to 29) with recent histories of prescription drug misuse was conducted in Philadelphia in 2012-13. Participants were surveyed about age of initiation of cigarette smoking, alcohol use to the point of intoxication, marijuana, prescription, and illicit drugs, and about alternate modes of prescription drug administration. The severity of participants' current substance use related problems was measured using the Drug Abuse Screening Test (DAST-10). Results: Mean age of initiation was 14.6 years for cigarette smoking, 15.3 years for alcohol use to the point of intoxication, 15.2 years for marijuana, 16.8 years for prescription drugs, and 17.9 years for illicit drugs. Use of 2 or more substances by the age of 15 was reported by 56% of the participants. Odds of substance-related problems were significantly greater among those who reported earlier initiation of alcohol, prescription drugs, or polysubstance use. Odds of prescription drug misuse via altered routes of administration were significantly greater among participants with earlier onset of alcohol, marijuana, prescription, illicit drugs, or polysubstance use. Discussion and Conclusions: This study demonstrates that earlier initiation of substance use is associated with higher risk of substance-related problems among substance-using YMSM. Early interventions addressing substance use initiation could benefit this population.

Did the dependent coverage expansion increase risky substance use among young adults?

BackgroundThe dependent coverage expansion (DCE) enacted through the Affordable Care Act increased health insurance coverage among young adults. Increasing insurance coverage in this age group has the potential for unintended consequences on risky substance use. MethodsRepeated cross-sectional surveys were used to compare change in substance use during the period the DCE was implemented in the 19–25year old target age group (Pre-DCE n=15,772, Post-DCE n=22,719) with contemporaneous change in a slightly older age group that was not targeted by the policy (Pre-DCE=19,851, Post-DCE n=28,157). Outcomes include 11 measures of alcohol, illicit drug and cigarette use. Statistical controls were included for demographic and socioeconomic factors and for early initiation of substance use to adjust for historical trends in developmental trajectories. ResultsRisky substance use decreased in young adults relative to the older age group over the period that the DCE was implemented. However, statistical adjustment for initiation of substance use prior to age 18, which is prior to exposure to the DCE, accounted for the differences between the age groups. In adjusted models, associations between the DCE and substance use outcomes range from 0.96 to 1.08 with p-values ranging from 0.330 to 0.963. ConclusionsHistorical trends in initiation of substance use prior to age 18, not the DCE, account for change in risky substance use among 19–25year olds relative to 26–34year olds. The evidence does not support the suggestion that health insurance coverage would increase risky substance use among young adults.

Relationship of Age for Grade and Pubertal Stage to Early Initiation of Substance Use.

IntroductionStudies suggest students who are substantially older than the average age for their grade engage in risky health behaviors, including substance use. However, most studies do not account for the distinct reasons why students are old for their grade (ie, grade retention vs delayed school entry) or for their pubertal stage. Thus, whether the association between age for grade and substance use is confounded by these factors is unknown. We sought to determine whether age, grade, or pubertal stage were associated with early substance use.MethodsCross-sectional Healthy Passages Wave I survey data from 5,147 fifth graders and their caregivers in Alabama, California, and Texas from 2004 through 2006 were analyzed in 2014. Logistic regressions examined whether older age for grade, grade retention, delayed school entry, or pubertal stage were associated with use of any substance, cigarettes, alcohol, or other drugs.ResultsSeventeen percent of fifth graders reported trying at least 1 substance. Among boys, advanced pubertal stage was associated with increased odds of cigarette, alcohol, or other drug use, whereas delayed school entry was associated with lower odds of any substance, alcohol, or other drug use. Among girls, advanced pubertal stage was associated only with higher odds of alcohol use, and delayed school entry was not associated with substance use. Neither older age for grade or grade retention was independently associated with substance use after controlling for potential confounders.ConclusionAdvanced pubertal stage may be a more important risk factor for substance use than age for grade. Pediatricians should consider initiating substance use screening earlier for patients with advanced pubertal stage.

Evaluation of underlying mechanisms in the link between childhood ADHD symptoms and risk for early initiation of substance use.

Although there has been support for attention-deficit/hyperactivity disorder (ADHD) as a risk for early substance use, this link is not fully established or understood. Furthermore, the potential mechanisms explaining these associations are unclear. The current study examined peer rejection, school bonding, and internalizing problems as potential mediators of the association between childhood ADHD symptoms and risk for early initiation of substance use. The sample included a control group of 126 students with problematic aggression (79% African American, 66% male) from an intervention study following children from fourth to ninth grade. Results suggested that ADHD symptoms follow a path to early initiation of tobacco use through the combined effects of peer rejection and internalizing problems as well as through internalizing problems alone. ADHD symptoms were also associated with the cubic slope of marijuana use initiation, such that increased ADHD symptoms were associated with a strong cubic trend (e.g., a more rapid acceleration of risk for initiation). ADHD symptoms were not associated with risk for early initiation of alcohol use. Identification of important vulnerability factors in children with ADHD symptoms highlight the need for primary prevention and psychological interventions that target these factors and decrease the likelihood of early tobacco and marijuana use initiation.

Neurobehavioral disinhibition predicts initiation of substance use in children with prenatal cocaine exposure

BackgroundIn previous work we (Fisher et al., 2011) examined the emergence of neurobehavioral disinhibition (ND) in adolescents with prenatal substance exposure. We computed ND factor scores at three age points (8/9, 11 and 13/14 years) and found that both prenatal substance exposure and early adversity predicted ND. The purpose of the current study was to determine the association between these ND scores and initiation of substance use between ages 8 and 16 in this cohort as early initiation of substance use has been related to later substance use disorders. Our hypothesis was that prenatal cocaine exposure predisposes the child to ND, which, in turn, is associated with initiation of substance use by age 16. MethodsWe studied 386 cocaine exposed and 517 unexposed children followed since birth in a longitudinal study. Five dichotomous variables were computed based on the subject's report of substance use: alcohol only; tobacco only; marijuana only; illicit substances and any substance. ResultsCox proportional hazard regression showed that the 8/9 year ND score was related to initiation of alcohol, tobacco, illicit and any substance use but not marijuana use. The trajectory of ND across the three age periods was related to substance use initiation in all five substance use categories. Prenatal cocaine exposure, although initially related to tobacco, marijuana and illicit substance initiation, was no longer significant with ND scores in the models. ConclusionPrenatal drug exposure appears to be a risk pathway to ND, which by 8/9 years portends substance use initiation.

Men's and Women's Pathways to Adulthood and Associated Substance Misuse

Social role transitions have been linked to changes in substance use and misuse during young adulthood. This study examined how commonly observed pathways to adulthood, defined by education, employment, marriage, and parenthood, were associated with alcohol, tobacco, and marijuana misuse from ages 18 to 33. Data came from a longitudinal panel of 412 men and 396 women recruited when they were in fifth grade in Seattle public schools in 1985. Participants were followed through age 33 in 2008, with 92% retention. Young adults who had little postsecondary education and remained unmarried through age 30 generally had the highest rates of substance misuse. Those who were involved in postsecondary education and postponed family formation had the lowest rates, particularly with respect to daily smoking and nicotine dependence. Parenting during the young adult years was associated with lower rates of substance misuse for both men and women. However, taking on parenting responsibilities early, during the late teen years and early 20s (observed mostly for women), was associated with higher rates of tobacco misuse. Differences in substance misuse by pathways to adulthood were fairly constant across the young adulthood years and were already observed at age 18, suggesting that substance misuse patterns are established early. Young adults may change their substance use only partially in response to new freedoms and responsibilities in young adulthood. Preventive efforts should include a focus on early initiation of substance use and educational experiences that move people into life trajectories and associated substance misuse patterns.