Review of risk and protective factors of substance use and problem use in emerging adulthood
Highlights
► Reviews longitudinal predictors of substance use and abuse in emerging adulthood. ► Many fixed and variable markers of risk are identified in recent literature. ► Classified markers of risk as contextual or interpersonal factors. ► Some adolescent factors continue to predict, other factors unique to young adults.
Introduction
Prevention science is built on the premise that negative health outcomes can be prevented by reducing risk and enhancing promotive or protective factors in individuals and their environments during the course of development (Coie et al., 1993, Mrazek and Haggerty, 1994, O'Connell et al., 2009). Over the last 2 decades, the field of adolescent substance abuse prevention has grown dramatically through the identification of longitudinal precursors that predict an increased likelihood of problems (risk factors), those that mediate or moderate exposure to risk (protective factors) (Hawkins, Catalano, & Miller, 1992), or directly have an impact on decreasing the likelihood of problems (promotive factors, Sameroff, 2000). The term “protective factors” will be used in this article to refer to factors that decrease the risk of substance misuse (promotive and protective).
During the adolescent years, many youth experiment with drugs. For instance, 2011 data from the Monitoring the Future study report that one fifth (20%) of 8th graders, and approximately 38% of 10th graders have tried an illicit drug. That number rises to 50% by 12th grade (Johnston, O'Malley, Bachman, & Schulenberg, 2011). Prospective longitudinal studies demonstrate that there are a variety of risk and protective factors for adolescent substance abuse (Beato-Fernandez et al., 2005, Belcher and Shinitzky, 1998, Beyers et al., 2004, Branstrom et al., 2008, Challier et al., 2000, Costa et al., 1999, Donovan, 2004, Hawkins et al., 1995, Hawkins et al., 1992, Kandel et al., 1986, Kliewer and Murrelle, 2007, Labouvie and McGee, 1986, Newcomb and Felix-Ortiz, 1992, Oman et al., 2004, Ostaszewski and Zimmerman, 2006, Thompson and Auslander, 2007, White et al., 1987). Over the past two plus decades this information has been useful to the design and testing of a number of substance use prevention programs. As a result, there is now a growing evidence base of tested, effective prevention programs and policies to address risk and protection across childhood and adolescence.
The trajectories of lifetime prevalence of substance use and misuse peak in young adulthood, to 49% among 19- and 20-year-olds and 72% by age 27 (Johnston et al., 2009, SAMHSA Office of Applied Studies, 2009). Data from the Monitoring the Future study indicates that problem levels of alcohol use—daily use, binge drinking, and daily drunkenness—are highest during young adulthood (Johnston, O'Malley, Bachman, & Schulenberg, 2008). Among young adults, substance use has been linked to deaths, injuries, and among college students, academic problems, fighting, and sexual behavior problems. Using a nationally representative cross-sectional survey of college students from a sample of 119 public and private colleges, Wechsler, Lee, Kuo, and Lee (2000) found that frequent binge drinkers were over eight times more likely to get hurt or injured than non-binge drinkers, 17 more times more likely to have missed classes, seven times more likely to have engaged in unplanned sexual activity, and 8 times more likely to have gotten into trouble with campus or local police (Wechsler et al., 2000). Beyond injury, substance use is also associated with mortality among young adults. A recent study examining death rates revealed three quarters of all deaths among 20- to 24-year-olds are the result of that injuries. Poisoning was the third leading cause of injury-related death, behind motor vehicle/traffic-related deaths, and firearm-related deaths, all three of which are often substance involved. For example, of the deaths due to poisoning, the percent attributed to unintentional drug-related poisoning has increased from 59% in 1999 to 76% in 2005 (Fingerhut & Anderson, 2008).
Not only is emerging adulthood (usually defined as the period from age 18 to age 26) an important developmental period characterized by peak prevalence of substance use problems and problems related to use, it also sets the stage for later adult development (Arnett, 2005, George, 1993, Hogan and Astone, 1986, Shanahan, 2000). Many researchers (e.g., Osgood et al., 2004, Schulenberg and Maggs, 2002, Schulenberg et al., 2004, Shanahan, 2000) have identified this stage as a key developmental time period characterized by rapid transitions in social context, contexts that involve greater freedom and less social control than experienced during adolescence. Thus while some of the predictors of adolescent substance use will no doubt still influence emerging adult substance use, the changes in context, experience of greater freedom and less social control during emerging adulthood will undoubtedly become important new predictors of substance use and abuse. By the end of this period many young people begin to accomplish the developmental tasks of emerging adulthood and assume adult roles and responsibilities, including the establishment of strong relationships, marriage and family responsibilities, completion of school, beginning of career employment, and financial responsibility. Successful transition into adult roles is associated with decreasing drug use, and decreasing criminal and antisocial behavior (Schulenberg et al., 2004). However, for some, failing to achieve the developmental tasks of this period is associated with continuing risky sexual activity, acute as well as increasing drug use characterized by misuse, abuse, and dependence, financial instability, failure to establish meaningful relationships, and deteriorating mental health. Successful assumption of adult roles can have long-term implications for positive life trajectories, health, and wellbeing, making understanding of the adolescent and emerging adult predictors of emerging adult substance use and problems an important undertaking in understanding etiology as well as the development of preventive interventions.
Understanding both earlier predictors, as well as emerging adult predictors, will assist in the development of substance abuse prevention programs by increasing our understanding of why some substance abuse prevention programs begun prior to age 18 have had long term effects into young adulthood (e.g., Mason et al., 2009), while others that intend to impact those under 18 as well as those over 18 have only affected those over 18 (e.g., Wagenaar et al., 2000). Further, understanding of the predictors of emerging adult substance use may provide new targets for preventive intervention (Mason et al., 2009).
Finally, there is a growing body of longitudinal research that follows children and adolescents into emerging adulthood as well as longitudinal studies during emerging adulthood. In the early 1990s, Hawkins et al. (1992) conducted a comprehensive review of studies that examined risk and protective factors associated with adolescent substance use. Since that time, much research has focused on the young adult developmental period, providing new information on risk and protective factors associated with problem substance use. The journal Addiction (2008: 103 [suppl.1]) recently devoted a supplement to basic research examining adolescent predictors of adult alcohol use. In addition, several reviews have summarized correlates of college student drinking and intervention effectiveness within the college attending population (Baer, 2002, Borsari and Carey, 1999, Brady and Sonne, 1999, Carey et al., 2007, DeJong, 2002, Ham and Hope, 2003, Hingson and Howland, 2002, Hunter Fager and Mazurek Melnyk, 2004, Larimer and Cronce, 2002, Martens et al., 2006, Neighbors et al., 2007, Presley et al., 2002, Toomey et al., 2007, Walters and Neighbors, 2005). While this is impressive, the majority of young adults are not college students (National Center for Education Statistics (NCES) (NCES) 2007). Finally, as noted by Baer (2002), many studies examining risk factors associated with young adult outcomes are cross-sectional, limiting our ability to distinguish causal order.
Section snippets
Methods
This paper reviews the literature related to risk and protective factors that are specific to young adult alcohol, tobacco, and other drug (ATOD) use and problems, and discusses the utility of analyzing individual risk factors versus risk pathways that address the interplay between multiple factors in influencing outcomes. Our discussion is guided by the MacArthur approach to examining moderators and mediators (Kraemer et al., 1997, Kraemer et al., 2008, Kraemer et al., 2001). Kraemer et al.
Fixed markers of risk
Table 1 provides information on the studies that include fixed marker of risk for young adult substance use.
Discussion
Using the Hawkins et al. (1992) standard of two longitudinal studies for a predictor to be a risk or protective factor, this review reveals that many of the risk and protective factors associated with problem substance use in young adulthood are the same as those that predict adolescent substance use. Predictors from childhood and adolescence appear to predict young adult substance use. In addition, some of these same predictors measured in young adulthood also affect young adult substance use
Conclusion
This is the first comprehensive review of risk and protective factors that affect substance use and problem use in young adulthood. Risk and protective factors in this review span the life course to young adulthood, starting with factors that may play a role in utero. Many of the risk and protective factors pertinent to childhood and adolescence remained important in young adulthood. Several of the risk and protective factors that were specific to the young adult years pertained to the changing
Role of funding sources
Funding for this study was provided by a Department of Health and Human Services, SAMHSA, CSAP grant (5U79SPO11193-95) provided to the Washington State, Department of Social and Health Services, Division of Behavioral Health and Recovery. SAMHSA had no role in the study design, literature collection, analysis or interpretation, writing the manuscript, or the decision to submit the paper for publication.
Contributors
Andrea Stone prepared initial first draft of the manuscript. Linda Becker conducted supplemental literature searches and provided summaries of included dissertation results. Alice Huber provided organization for content including substantial restructuring of final draft. Richard Catalono provided the initial foundation and structure for this manuscript and contributed significantly to the introduction, discussion, and layout of the article. All authors contributed and have approved the final
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgments
The authors would like to thank the Washington State, Department of Social and Health Services, Division of Behavioral Health and Recovery, for providing the resources necessary to conduct this review.
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