title: Risk for inhalant initiation among middle school students: understanding individual, family, and peer risk and protective factors.
abstract: OBJECTIVE
  Because initiation of inhalants at an early age is associated with a range of health and behavioral problems, including an increased likelihood of inhalant dependence (based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), we conducted discrete time survival analyses to determine the role of time-invariant and time-variant (over five waves) risk and protective factors as well as grade in inhalant initiation among middle school students.
  
  
  METHODS
  The current study uses data from 3,215 students who were initially surveyed as sixth graders in 2008-2009 and were resurveyed in seventh and eighth grades. Students were part of a larger substance use prevention trial conducted in greater Los Angeles. The sample is racially/ethnically diverse (54% Hispanic/Latino, 16% Asian, 14% White, 3% African American) and 51% male.
  
  
  RESULTS
  Seventeen percent of youths initiated inhalants during middle school. Higher drug refusal self-efficacy, familism (i.e., values related to family), and parental respect were associated with decreased odds of inhalant initiation. Having a significant adult or older sibling who used substances was associated with increased risk of initiation, but adult influence declined linearly and by the end of seventh grade was no longer a risk factor. Self-rated popularity was associated with inhalant initiation in seventh grade only, and perceived substance use by peers was associated with inhalant initiation in sixth grade only.
  
  
  CONCLUSIONS
  The influence of adults, siblings, and peers on inhalant use may be strongest in sixth and seventh grade. Interventions to prevent inhalant initiation should target sixth and seventh graders, address influence by family and peers, and provide skills training to improve drug refusal self-efficacy.
authors.affiliation: RAND Corporation, Santa Monica, California.
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Ober
authors.forename: Jeremy N V
authors.initials: JN
authors.lastname: Miles
authors.forename: Brett
authors.initials: B
authors.lastname: Ewing
authors.forename: Joan S
authors.initials: JS
authors.lastname: Tucker
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: D'Amico
mesh_terms: D000293:Adolescent; D000367:Age Factors; D017668:Age of Onset; D002648:Child; D003625:Data Collection; D005006:Ethnicity / Q000706:statistics & numerical data; D005195:Family Relations; D005260:Female; D006801:Humans; D058545:Inhalant Abuse / Q000453:epidemiology* / Q000208:ethnology; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D010287:Parent-Child Relations; D010379:Peer Group; D012307:Risk Factors; D020377:Self Efficacy; D057566:Self Report; D013334:Students / Q000706:statistics & numerical data*; D013997:Time Factors