title: Effect of Adolescent Cigarette Smoking on Adulthood Substance Use and Abuse: The Mediating Role of Educational Attainment.
abstract: BACKGROUND
  Even though the association between cigarette smoking and later substance use has been shown, there is still no compelling evidence that demonstrates the long-term effects in a high drug using community in African Americans. Few studies have examined the mediating mechanisms of the effect of adolescent cigarette smoking on the drug progression pathway.
  
  
  OBJECTIVE
  We examined the long-term influence of adolescent smoking on later illegal drug use in a cohort of urban African Americans, and the mediating role of educational attainment in the drug progression pathway.
  
  
  METHODS
  The study used a longitudinal dataset from the Woodlawn Project that followed 1,242 African Americans from 1966-1967 (at age 6-7) through 2002-2003 (at age 42-43). We used the propensity score matching method to find a regular and a nonregular adolescent smoking group that had similar childhood characteristics; we used the matched sample to assess the association between adolescent smoking and drug progression, and the mediating role of educational attainment.
  
  
  RESULTS
  Adolescent regular smokers showed significantly higher odds of using marijuana, cocaine, and heroin, having alcohol abuse problems and any drug dependence, and abuse problems in adulthood. We found that educational attainment mediated most of the drug progression pathway, including cigarette smoking, marijuana, cocaine and heroin use, and drug dependence or abuse problems in adulthood, but not alcohol abuse.
  
  
  CONCLUSIONS
  More focus needs to be put on high school dropout and development of interventions in community settings for African Americans to alter the pathway for drug progression for adolescents who use cigarettes regularly.
authors.affiliation: a Department of Public Health , National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan , Taiwan.
authors.forename: Carol
authors.initials: C
authors.lastname: Strong
authors.affiliation: b Department of Medical Oncology , Thomas Jefferson University , Philadelphia , Pennsylvania , USA.
authors.forename: Hee-Soon
authors.initials: HS
authors.lastname: Juon
authors.affiliation: c Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Ensminger
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000437:Alcoholism / Q000453:epidemiology*; D002641:Chicago / Q000453:epidemiology; D002648:Child; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology*; D016017:Odds Ratio; D057216:Propensity Score; D011446:Prospective Studies; D012044:Regression Analysis; D012907:Smoking / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology; D055815:Young Adult
keywords: African Americans; cigarette smoking; drug progression; gateway theory; propensity score matching; substance use