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

Introduction

Studies 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.

Methods

Cross-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.

Results

Seventeen 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.

Conclusion

Advanced 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.

Table 3

Predictors of Delayed School Entry, Fifth-Grade Participants, Healthy Passages Survey, Los Angeles, California; Birmingham, Alabama; and Houston, Texas, 2014a

Predictors	Odds Ratio (95% CI)
Parental involvementb	0.90 (0.55–1.48)
No. of elementary schools attended	1.17 (1.05–1.31)
Family composition
2-Parent household	1 [Reference]
Single-parent household	1.22 (0.85–1.76)
Other family composition	0.96 (0.46–2.04)
Household income
<$25,000	1 [Reference]
$25,000–$49,999	0.64 (0.41–1.01)
$50,000–$99,999	0.77 (0.43–1.37)
≥$100,000	1.14 (0.65–1.99)
Parental level of education
Less than high school	1 [Reference]
High school	1.17 (0.72–1.90)
Some college	0.63 (0.36–1.11)
College graduate	1.04 (0.54–2.01)
No health insurance	1.30 (0.84–2.01)
Born outside United States	2.83 (1.70–4.72)
Male	1.17(0.88–1.56)
Race/ethnicity
White	1 [Reference]
Black	0.51 (0.34–0.80)
Latino	0.51 (0.29–0.89)
Other	0.99 (0.54–1.80)

Abbreviation: CI, confidence interval.

a Model also controls for site, interview date, and missing values for income (8.6%) and parent education (1.9%).

b Parental involvement is the level of involvement parents have in their children’s social and scholastic lives, as measured by parents’ responses on the FACES III scale (2,23).

Full article at:   http://goo.gl/NJD8Ha

By:  Rebecca N. Dudovitz, MD, MS, Paul J. Chung, MD, MS, Marc N. Elliott, PhD, Susan L. Davies, PhD, Susan Tortolero, PhD, Elizabeth Baumler, PhD, Stephen W. Banspach, PhD, and Mark A. Schuster, MD, PhD

Author Affiliations: Paul J. Chung, University of California Los Angeles, Los Angeles, California, and RAND Corp, Santa Monica, California; Marc N. Elliott, RAND Corp, Santa Monica, California; Susan L. Davies, University of Alabama, Birmingham, Alabama; Susan Tortolero, Elizabeth Baumler, University of Texas Health Science Center, Houston, Texas; Stephen W. Banspach, Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Mark A. Schuster, Division of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts.

Corresponding author.

Corresponding Author: Rebecca Dudovitz, Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Ave, 12-358 CHS, MC: 175217, Los Angeles, CA 90095. Telephone: 310-794-8833. Email: ude.alcu.tendem@ztivodudr.

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