RESUMEN
BACKGROUND: Variation in drug policies, norms, and substance use over time and across countries may affect the normative sequences of adolescent substance use initiation. We estimated relative and absolute time-varying associations between prior alcohol and tobacco use and adolescent marijuana initiation in Argentina and Chile. Relative measures quantify the magnitude of the associations, whereas absolute measures quantify excess risk. METHODS: We analyzed repeated, cross-sectional survey data from the National Surveys on Drug Use Among Secondary School Students in Argentina (2001-2014) and Chile (2001-2017). Participants included 8th, 10th, and 12th grade students (N = 680,156). Linear regression models described trends over time in the average age of first use of alcohol, tobacco, and marijuana. Logistic regression models were used to estimate time-varying risk ratios and risk differences of the associations between prior alcohol and tobacco use and current-year marijuana initiation. RESULTS: Average age of marijuana initiation increased and then decreased in Argentina and declined in Chile. In both countries, the relative associations between prior tobacco use and marijuana initiation weakened amid declining rates of tobacco use; e.g., in Argentina, the risk ratio was 19.9 (95% CI: 9.0-30.8) in 2001 and 11.6 (95% CI: 9.0-13.2) in 2014. The relative association between prior alcohol use and marijuana initiation weakened Chile, but not in Argentina. On the contrary, risk differences (RD) increased substantially across both relationships and countries, e.g., in Argentina, the RD for tobacco was 3% (95% CI: 0.02-0.03) in 2001 and 12% (95% CI: 0.11-0.13) in 2014. CONCLUSION: Diverging trends in risk ratios and risk differences highlight the utility of examining multiple measures of association. Variation in the strength of the associations over time and place suggests the influence of environmental factors. Increasing risk differences indicate alcohol and tobacco use may be important targets for interventions to reduce adolescent marijuana use.
Asunto(s)
Conducta del Adolescente , Cannabis , Uso de la Marihuana , Trastornos Relacionados con Sustancias , Adolescente , Consumo de Bebidas Alcohólicas/epidemiología , Argentina/epidemiología , Chile/epidemiología , Estudios Transversales , Humanos , Nicotiana , Uso de Tabaco/epidemiologíaRESUMEN
AIMS: Amid changing marijuana policies in the Southern Cone, we examined relationships between marijuana-related risk factors and marijuana use among adolescents in Argentina, Chile, and Uruguay from 2001 to 2016. METHODS: Using cross-sectional surveys from 8th, 10th, and 12th graders and weighted time-varying effect models, we estimated associations between perceived risk (no/low risk versus moderate/great risk) and perceived availability (easy/very easy versus difficult/very difficult/not able to obtain) of marijuana, and any past-month marijuana use. RESULTS: In all countries, marijuana use increased over time and adolescents who perceived no/low risk and easy availability had higher odds of use. In Argentina, the bivariate risk/use association weakened from 2001 (ORâ¯=â¯15.24, 95%CIâ¯=â¯9.63, 24.12) to 2004 [ORâ¯=â¯3.86 (2.72, 5.48)] and strengthened until 2011 [ORâ¯=â¯8.22 (7.56, 10.30)]; the availability/use association strengthened from 2005 [ORâ¯=â¯5.32 (4.05, 6.98)] to 2009 [ORâ¯=â¯20.77 (15.57, 27.70)] and weakened until 2014 [ORâ¯=â¯11.00 (9.11, 13.27)]. In Chile, the risk/use association weakened from 2001 [ORâ¯=â¯7.22 (6.57, 7.95)] to 2015 [ORâ¯=â¯5.58 (4.82, 6.48)]; the availability/use association weakened from 2001 [ORâ¯=â¯5.92 (4.96, 7.06)] to 2015 [ORâ¯=â¯4.10 (3.15, 5.34)]. In Uruguay, the risk/use association weakened from 2003 [ORâ¯=â¯34.22 (22.76, 51.46)] to 2016 [ORâ¯=â¯6.23 (4.96, 7.83)]; the availability/use association weakened from 2005 [ORâ¯=â¯29.13 (13.39, 63.39) to 2007 [ORâ¯=â¯9.42 (3.85, 23.07)], and strengthened until 2016 [ORâ¯=â¯22.68 (12.03, 42.76)]. CONCLUSIONS: Overall, the association between risk and use weakened in all countries, suggesting risk perceptions became a weaker determinant of marijuana use. Perceived availability remained strongly associated with use and may become an increasingly important driver of use (particularly in Uruguay and Argentina).