title: Exploring comorbid use of marijuana, tobacco, and alcohol among 14 to 15-year-olds: findings from a national survey on adolescent substance use.
abstract: BACKGROUND
  Understanding the patterns of comorbid substance use, particularly among adolescents, is necessary to address resulting harm. This study investigated the prevalence of comorbid use of marijuana, tobacco and binge drinking among 14 to 15-year-olds. The study also examined the relationship between comorbid substance use and behaviour frequency and explored common underlying risk factors for comorbid substance use.
  
  
  METHODS
  A nationally representative sample of 3,017 New Zealand Year 10 students completed self-report measures of marijuana use, tobacco use, binge drinking and socio-demographic characteristics in the 2012 Youth Insights Survey (YIS). Weighted population estimates were calculated. Ordinal logistic regression models were constructed to a) investigate the relationship between comorbidity and substance use behaviour frequency, and b) profile those with the greatest degree of comorbid substance use.
  
  
  RESULTS
  In the past month, one-in-twenty (4.7%) students had engaged in all three substance use behaviours, 5.8% in two, and 11.9% in one. Around half of adolescents who had engaged in one had also engaged in another, with three-quarters of tobacco-users also using marijuana and/or binge drinking. Respondents who reported a greater degree of comorbidity were likely to engage in substance use behaviour more frequently. Comorbid substance use was significantly predicted by gender, ethnicity, school decile status, past week income, social connectedness, and parental monitoring and rule enforcement.
  
  
  CONCLUSIONS
  The results identify a core group of adolescents sharing common characteristics who frequently engage in comorbid substance use behaviours. More sophisticated and wider interventions addressing multiple substances are required, especially for marijuana and tobacco use.
authors.affiliation: Health Promotion Agency, Wellington, New Zealand. j.white@hpa.org.nz.
authors.forename: Joanna
authors.initials: J
authors.lastname: White
authors.affiliation: Health Promotion Agency, Wellington, New Zealand. d.walton@hpa.org.nz.|University of Canterbury, Christchurch, New Zealand. d.walton@hpa.org.nz.
authors.forename: Darren
authors.initials: D
authors.lastname: Walton
authors.affiliation: National Institute for Health Innovation, University of Auckland, Auckland, New Zealand. n.walker@auckland.ac.nz.
authors.forename: Natalie
authors.initials: N
authors.lastname: Walker
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology*; D009520:New Zealand; D015995:Prevalence; D012307:Risk Factors; D012574:Schools; D057566:Self Report; D013334:Students; D019966:Substance-Related Disorders / Q000453:epidemiology*; D062789:Tobacco Products