Effect of Adolescent Cigarette Smoking on Adulthood Substance Use and Abuse: The Mediating Role of Educational Attainment and Long-term Unemployment

Background Even though the association between cigarette smoking and later substance use has been shown in the literature, there is still no compelling evidence that demonstrates the long-term effect. Few studies have examined the mediating mechanisms of the effect of adolescent cigarette smoking on the drug progression pathway.

Purpose We examined the long-term effect of adolescent smoking on later illegal drug use in a cohort of African Americans. We also examined the mediating role of educational attainment and unemployment in the drug progression pathway.

Methods The study used a longitudinal dataset from the Woodlawn project that followed 1242 African Americans from 1966-1967 (at age 6-7) through 2002-2003 (at age 42-43). We used the propensity score matching method to find a regular and a non-regular adolescent smoking group that had similar childhood characteristics and other covariates; we used the matched sample to assess the longitudinal effect of adolescent smoking on drug progression and the mediating effect of SES in the pathway.

Results Adolescent regular smokers showed significantly higher odds of using marijuana, cocaine and heroin, having alcohol abuse problems and any drug dependence and abuse problems in adulthood. We found that educational attainment mediated some of the drug progression pathway, including marijuana and cocaine use, but did not mediate the pathway to drug dependence or abuse.

Conclusions More focus needs to be put on high school dropout and development of interventions in community settings to alter the pathway for drug progression for those adolescents who use cigarettes regularly.