title: Delineating prototypical patterns of substance use initiations over time.
abstract: OBJECTIVE
  The purpose of this paper is to discover patterns of drug use initiations over time through a multiple event process survival mixture model (MEPSUM model), a novel approach for substance use and prevention research.
  
  
  METHODS
  The MEPSUM model combines survival analysis and mixture modeling-specifically latent class analysis-to examine individual differences in the timing of initiation and cumulative risk of substance use over time, and is applied to cross-sectional survey data on drug initiations.
  
  
  METHODS
  Data are drawn from the 2009 National Survey on Drug Use and Health.
  
  
  METHODS
  The survey includes responses from 55 772 individuals (52.05% female).
  
  
  METHODS
  The age of first use of nine different types of substances are examined, including alcohol, tobacco, cocaine and non-medical use of prescription drugs.
  
  
  RESULTS
  It is argued that six patterns parsimoniously describe the population's risk of initiating different substances over time, described colloquially as general abstainers; early, late and progressive soft drug users; and early and late hard drug users. Both gender and ethnicity significantly predict the patterns, with Caucasians and males having a higher risk for the hard drug-using patterns. The MEPSUM model produced stable results in this application, as the patterns are validated in a split-sample design.
  
  
  CONCLUSIONS
  The MEPSUM model provides a statistical framework from which to evaluate patterns of risk for drug initiations over time and predict substance use trajectories relevant to public health interventions. The patterns that result from the model can be used as outcomes for subsequent investigations of etiological and mediating mechanisms.
authors.affiliation: Department of Psychology, University of North Carolina at Chapel Hill, CB#3270, Davie Hall, Chapel Hill, NC, 27599, USA.
authors.forename: Danielle O
authors.initials: DO
authors.lastname: Dean
authors.forename: Veronica
authors.initials: V
authors.lastname: Cole
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bauer
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000437:Alcoholism / Q000453:epidemiology; D002648:Child; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology; D006801:Humans; D058545:Inhalant Abuse / Q000453:epidemiology; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology; D008385:Marijuana Smoking / Q000453:epidemiology*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D064424:Tobacco Use / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Intervention; latent class analysis; substance use initiation; substance use patterns; survival analysis