Ethnic differences in adolescent substance initiation sequences

Objectives: To evaluate ethnic differences in the initiation sequences of t obacco, alcohol, marijuana, and cocaine use among US high school students a nd to determine if ethnicity is a predictor of progression from licit to il licit substances or initiation of illicit substances before licit substance s. Design: Cross-sectional analyses of the Centers for Disease Control and Pre vention's 1995 Youth Risk Behavior Survey. Setting: US high schools. Participants: A total of 8550 high school students randomly selected by clu ster design. Main Outcome Measures: Respondents were categorized based on self-reported sequence of initiating substances as follows: none, licit substances only, licit substances then illicit substances (typical), illicit substances firs t (reverse), and licit and illicit substances at the same time (concurrent) . Results: Adjusting forage, maternal education, and region, progression from licit to illicit substances was significantly associated with black ethnic ity (odds ratio [ OR], 1.5, 95% confidence interval [Cf], 1.04-2.1) and mal e sex (OR, 1.4; 95% CI, 1.2-1.6). Black male and Latino female students who se mothers completed at least high school were more likely than white stude nts with similarly educated mothers to initiate illicit substances before l icit substances (OR, 3.0; 95% CI, 1.7-5.3; and OR, 5.9; 95% CI, 1.7-20; res pec tively). Similar trends were noted for the concurrent sequence. Conclusions: The pattern of initiating tobacco, alcohol, marijuana, and coc aine use differs by ethnicity. Maternal education may be a proxy variable f or other significant risk factors.