Differentiating Externalizing versus Internalizing Behaviors as Risk Factors for Alcohol, Marijuana, and Various Tobacco Use Among Young Adults Public

Abstract

Introduction: Alcohol, marijuana, and tobacco use are prevalent in young adults and may be differentially associated with psychological symptoms characterized as externalizing (ADHD) or internalizing behaviors (depression, anxiety). This study examined the use of alcohol, marijuana, and various tobacco products in relation to symptoms of ADHD, depression, and anxiety.

Methods: We analyzed data from 2,397 US college students (aged 18-25) enrolled in a two-year, six-wave longitudinal study launched in 2014. Specifically, we administered the Adult ADHD Self-Report Scale, Patient Health Questionnaire – 9 item (assessing depressive symptoms), and the Zung Self-Rating Anxiety Scale in Waves 1-5 and assessed past 30-day use of alcohol, marijuana, and tobacco products (cigarettes, little cigars/cigarillos [LCCs], smokeless tobacco, e-cigarettes, hookah), as well as nicotine dependence per the Hooked-on Nicotine Checklist at Wave 6. We conducted multivariable regressions for each substance use outcome.

Results: Participants were 20.49 (SD=1.93) years old, 64.7% female, and 65.5% White. In multivariable analyses controlling for sociodemographics, alcohol use and marijuana use were predicted by higher levels of ADHD symptoms (p=.042 and p=.019, respectively). Cigarette and LCC use were predicted by higher levels of depressive (p=.001 and p=.002, respectively) and anxiety symptoms (p=.020 and p=.027, respectively). Nicotine dependence was correlated with greater anxiety symptoms (p=.026). However, smokeless tobacco use was predicted by greater ADHD symptoms (p=.050); neither e-cigarette nor hookah use were predicted by these psychological symptoms.

Conclusion: Results indicate that further research is needed to determine distinct psychological risk factors for the use of the range of substances, particularly alternative tobacco products.

Table of Contents

TABLE OF CONTENTS 

INTRODUCTION………………………………………………………………….……1

 

LITERATURE REVIEW…………………………………………………………….…2

METHODS…………………………………………………....……………………….…4

RESULTS………………………………………………………………………………...8

DISCUSSION…………………………………………………………………………...11

 

REFERENCES………………………………………………………………………….15

 

TABLES………………………………………………………………………………....20

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	Risk factors Substance Use Tobacco use Marijuana use Young adults Alcohol use
Committee Chair / Thesis Advisor	Berg, Carla, Emory University
Committee Members	Windle, Michael, Emory University Haardörfer, Regine, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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