title: The role of first use of inhalants within sequencing pattern of first use of drugs among Brazilian university students.
abstract: The present study investigated the role of first use of inhalants within a first drug sequencing pattern. In a representative sample of university students from 27 Brazilian capitals (n = 12,711), we analyzed the patterns of transition from/to first use of inhalants to/from the first use of alcohol, tobacco, cannabis, cocaine, hallucinogens, ecstasy, amphetamines, prescription opioids, and tranquilizers. Cox proportional hazards models were used to analyze data. Drugs that were not specified as the pair of drugs tested in each model were included as time-varying covariates in all models. In this sample, first use of inhalants was preceded only by the first use of alcohol and tobacco. However, first use of inhalants preceded first use of cannabis, amphetamines, cocaine, and tranquilizers. First use of inhalants preceded the first use of prescription opioids, and vice versa. This study highlights the need to intervene early with youths who are at risk of or just beginning to use inhalants, because this class of drugs seems to be the first illegal drug in Brazil to be experimented by respondents in our sample. There is also a call for attention to individuals who have already first used inhalants because of their higher chance to experiment with other drugs such as cannabis, cocaine, and prescription drugs. All these findings show an in-transition culture of drug use, which should be tracked through time, because some classical models (i.e., gateway model) might be outdated and might also not fit within different settings.
authors.affiliation: Department of Psychiatry, Medical School, University of São Paulo.
authors.forename: João Maurício
authors.initials: JM
authors.lastname: Castaldelli-Maia
authors.affiliation: Department of Psychiatry, Medical School, University of São Paulo.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Nicastri
authors.affiliation: Department of Psychiatry, Medical School, University of São Paulo.
authors.forename: Lúcio
authors.initials: L
authors.lastname: Garcia de Oliveira
authors.affiliation: Department of Psychiatry, Medical School, University of São Paulo.
authors.forename: Arthur
authors.initials: A
authors.lastname: Guerra de Andrade
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health.
authors.forename: Silvia S
authors.initials: SS
authors.lastname: Martins
mesh_terms: D000328:Adult; D000435:Alcoholic Intoxication / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D058999:Drug-Seeking Behavior; D005260:Female; D006306:Health Surveys; D006801:Humans; D058545:Inhalant Abuse / Q000453:epidemiology*; D008297:Male; D008960:Models, Psychological; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D013334:Students; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014495:Universities; D014504:Urban Health; D055815:Young Adult