title: Relationship of Age for Grade and Pubertal Stage to Early Initiation of Substance Use.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. Email: rdudovitz@mednet.ucla.edu.
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Dudovitz
authors.affiliation: University of California Los Angeles, Los Angeles, California, and RAND Corp, Santa Monica, California.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
authors.affiliation: RAND Corp, Santa Monica, California.
authors.forename: Marc N
authors.initials: MN
authors.lastname: Elliott
authors.affiliation: University of Alabama, Birmingham, Alabama.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Davies
authors.affiliation: University of Texas Health Science Center, Houston, Texas.
authors.forename: Susan
authors.initials: S
authors.lastname: Tortolero
authors.affiliation: University of Texas Health Science Center, Houston, Texas.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Baumler
authors.affiliation: Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Banspach
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
mesh_terms: D017668:Age of Onset; D000407:Alabama / Q000453:epidemiology; D000428:Alcohol Drinking; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011627:Puberty; D012307:Risk Factors; D012309:Risk-Taking; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013781:Texas / Q000453:epidemiology