High IQ
Intelligence and substance use
Satoshi Kanazawa & Josephine Hellberg
Review of General Psychology, December 2010, Pages 382-396
Abstract:
Why do some individuals choose to drink alcohol, smoke cigarettes, and use illegal drugs while others do not? The origin of individual preferences and values is one of the remaining theoretical questions in social and behavioral sciences. The Savanna-IQ Interaction Hypothesis suggests that more intelligent individuals may be more likely to acquire and espouse evolutionarily novel values than less intelligent individuals. Consumption of alcohol, tobacco, and drugs is evolutionarily novel, so the Savanna-IQ Interaction Hypothesis would predict that more intelligent individuals are more likely to consume these substances. Analyses of two large, nationally representative, and prospectively longitudinal data from the United Kingdom and the United States partly support the prediction. More intelligent children, both in the United Kingdom and the United States, are more likely to grow up to consume more alcohol. More intelligent American children are more likely to grow up to consume more tobacco, while more intelligent British children are more likely to grow up to consume more illegal drugs.
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Changes in U.S. hospitalization and mortality rates following smoking bans
Kanaka Shetty, Thomas DeLeire, Chapin White & Jayanta Bhattacharya
Journal of Policy Analysis and Management, Winter 2011, Pages 6-28
Abstract:
U.S. state and local governments have increasingly adopted restrictions on smoking in public places. This paper analyzes nationally representative databases, including the Nationwide Inpatient Sample, to compare short-term changes in mortality and hospitalization rates in smoking-restricted regions with control regions. In contrast with smaller regional studies, we find that smoking bans are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction or other diseases. An analysis simulating smaller studies using subsamples reveals that large short-term increases in myocardial infarction incidence following a smoking ban are as common as the large decreases reported in the published literature.
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College students' use of cocaine: Results from a longitudinal study
Sarah Kasperski et al.
Addictive Behaviors, forthcoming
Abstract:
College students have high rates of heavy drinking and other risky behaviors, but little is known about trends in their use of cocaine. In this longitudinal study of 1,253 college students at one large, public university in the mid-Atlantic region, annual interviews assessed opportunity to use cocaine, cocaine use, and DSM-IV criteria for cocaine abuse and dependence. Follow-up rates exceeded 87% annually. Data from the first four years of college were analyzed to detect changes over time and possible gender differences. By their fourth year of college, 36%wt of students had been offered cocaine at least once in their lifetime, and 13%wt had used cocaine. Annual prevalence of cocaine use increased significantly over time (4%wt in Year 1 to 10%wt in Year 4) and remained similar across genders. Opportunities to use cocaine were significantly more prevalent for males than females during Years 2 through 4. Cocaine use given opportunity increased significantly over time for both males and females. Among 243 cocaine users, females (n = 113) had more serious use patterns than males, with higher average frequency of use (18.39 vs. 8.83 days during the peak year of use, p < .05) and greater likelihood of meeting criteria for cocaine dependence (9.3% vs. 2.5%, p < .05). Gender differences in typical cocaine dosage were not apparent. College administrators and health providers should be aware of the prevalence of cocaine use among student populations and design strategies to address the problem.
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The Budgetary Impact of Ending Drug Prohibition
Jeffrey Miron & Katherine Waldock
Cato Institute Working Paper, September 2010
Abstract:
State and federal governments in the United States face massive looming fiscal deficits. One policy change that can reduce deficits is ending the drug war. Legalization means reduced expenditure on enforcement and an increase in tax revenue from legalized sales. This report estimates that legalizing drugs would save roughly $41.3 billion per year in government expenditure on enforcement of prohibition. Of these savings, $25.7 billion would accrue to state and local governments, while $15.6 billion would accrue to the federal government. Approximately $8.7 billion of the savings would result from legalization of marijuana and $32.6 billion from legalization of other drugs. The report also estimates that drug legalization would yield tax revenue of $46.7 billion annually, assuming legal drugs were taxed at rates comparable to those on alcohol and tobacco. Approximately $8.7 billion of this revenue would result from legalization of marijuana and $38.0 billion from legalization of other drugs.
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Cigarette smoking during early pregnancy reduces the number of embryonic germ and somatic cells
L.S. Mamsen et al.
Human Reproduction, November 2010, Pages 2755-2761
Background: Cigarette smoking during pregnancy is associated with negative reproductive consequences for male fetuses in adult life such as reduced testicular volume and sperm concentration. The present study evaluates the number of germ and somatic cells present in human embryonic first-trimester gonads in relation to maternal smoking.
Methods: The study includes 24 human first-trimester testes, aged 37-68 days post-conception, obtained from women undergoing legal termination of pregnancy. A questionnaire was used to obtain information about smoking and drinking habits during pregnancy. Validated stereological methods were used to estimate gonadal cell numbers in histological sections. Results were also evaluated in the context of previously published data on ovaries from our laboratory.
Results: A significant reduction in the number of germ cells by 55% [95% confidence interval (CI) 74-21% reduction, P = 0.004] and somatic cells by 37% (95% CI 59-3%, P = 0.023) was observed in testes prenatally exposed to maternal cigarette smoking, compared with unexposed. The effect of maternal smoking was dose-dependent being higher in the heavy smokers and remained consistent after adjusting for possible confounders such as alcohol and coffee consumption (P = 0.002). The number of germ cells in embryonic gonads, irrespective of gender, was also significantly reduced by 41% (95% CI 58-19%, P = 0.001) in exposed versus non-exposed embryonic gonads.
Conclusions: Prenatal exposure to maternal cigarette smoke reduces the number of germ and somatic cells in embryonic male and female gonads. This effect may have long-term consequences on the future fertility of exposed offspring. These findings may provide one potential cause of the reduced fertility observed during recent years.
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Prenatal tobacco exposure: Developmental outcomes in the neonatal period
Kimberly Andrews Espy et al.
Developmental Psychology, forthcoming
Abstract:
Smoking during pregnancy is a persistent public health problem that has been linked to later adverse outcomes. The neonatal period - the first month of life - carries substantial developmental change in regulatory skills and is the period when tobacco metabolites are cleared physiologically. Studies to date mostly have used cross-sectional designs that limit characterizing potential impacts of prenatal tobacco exposure on the development of key self-regulatory processes and cannot disentangle short-term withdrawal effects from residual exposure-related impacts. In this study, pregnant participants (N = 304) were recruited prospectively during pregnancy, and smoking was measured at multiple time points, with both self-report and biochemical measures. Neonatal attention, irritable reactivity, and stress dysregulation were examined longitudinally at three time points during the first month of life, and physical growth indices were measured at birth. Tobacco-exposed infants showed significantly poorer attention skills after birth, and the magnitude of the difference between exposed and nonexposed groups attenuated across the neonatal period. In contrast, exposure-related differences in irritable reactivity largely were not evident across the 1st month of life, differing marginally at 4 weeks of age only. Third-trimester smoking was associated with pervasive, deleterious, dose-response impacts on physical growth measured at birth, whereas nearly all smoking indicators throughout pregnancy predicted level and growth rates of early attention. The observed neonatal pattern is consistent with the neurobiology of tobacco on the developing nervous system and fits with developmental vulnerabilities observed later in life.
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Exploring the link between racial discrimination and substance use: What mediates? What buffers?
Frederick Gibbons et al.
Journal of Personality and Social Psychology, November 2010, Pages 785-801
Abstract:
The relation between perceived racial discrimination and substance use was examined in 2 studies that were based on the prototype-willingness model (Gibbons, Gerrard, & Lane, 2003). Study 1, using structural equation modeling, revealed prospective relations between discrimination and use 5 years later in a panel of African American adolescents (M age 10.5 years at Time 1 [T1]) and their parents. For both groups, the relation was mediated by anger and/or hostility. For the adolescents, it was also mediated by behavioral willingness, and it was moderated by supportive parenting. Study 2 was a lab experiment in which a subset of the Study 1 adolescents (M age = 18.5 years) was asked to imagine a discriminatory experience, and then their affect and drug willingness were assessed. As in the survey study, discrimination was associated with more drug willingness, and that relation was again mediated by anger and moderated by supportive parenting. Implications of the results for research and interventions involving reactions to racial discrimination are discussed.
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College Students' Exposure to Tobacco Marketing in Nightclubs and Bars
Lee Ridner, John Myers, Ellen Hahn & Tiffany Ciszewski
Journal of American College Health, November-December 2010, Pages 159-164
Objective: To examine whether a college student's exposure to tobacco marketing in nightclubs and bars was affected by the presence of a smoke-free law.
Participants: A random sample (N = 478) of students participated in the survey (no smoke-free law, n = 240; smoke-free law, n = 238). The analysis was limited to students who reported being in nightclubs and bars (n = 171).
Methods: A nonexperimental, cross-sectional, 2-group design was used.
Results: Students in the smoke-free law city were more likely to be approached by tobacco marketers (34.7% versus 20.2%, p = .02), offered free gifts (41.7% versus 24.2%, p = .02), and take free gifts for themselves (34.7% versus 19.2%, p = .02). They were more likely to be exposed to direct marketing strategies (1.83 versus 1.12, p = .02). There was no difference on indirect tobacco marketing by site.
Conclusions: Tobacco marketing is pervasive in nightclubs and bars. Smoke-free laws may protect against exposure to secondhand smoke but not the "pro" smoking messages students encounter.
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Smoking Habits: Like Father, Like Son, Like Mother, Like Daughter?
Maria Loureiro, Anna Sanz-de-Galdeano & Daniela Vuri
Oxford Bulletin of Economics and Statistics, December 2010, Pages 717-743
Abstract:
We use instrumental variable methods to investigate whether the impact of parental smoking habits on their children's smoking decisions is a causal one. We find suggestive evidence of same-sex role models in two-parent households: mothers play a more crucial role in determining their daughters' smoking decisions, whereas fathers' smoking habits are primarily imitated by their sons. This same-sex parent-child link is no longer at play for teenagers living in single-mother households, for whom the influence of their only cohabiting parent turns out to be predominant independently of gender.
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Prescription drug laws, drug overdoses, and drug sales in New York and Pennsylvania
Leonard Paulozzi & Daniel Stier
Journal of Public Health Policy, December 2010, Pages 422-432
Abstract:
Drug overdose mortality nearly doubled in the United States from 1999 to 2004, with most of the increase due to prescription drug overdoses. Studying mortality rates in states that did not experience such increases may identify successful prescription overdose prevention strategies. We compared New York, a state that did not experience an overdose increase, with its neighbor, Pennsylvania. New York and Pennsylvania had prescription drug monitoring programs (PDMPs), but New York's PDMP was better funded and made use of serialized, tamperproof prescription forms. Per capita usage of the major prescription opioids in New York was two-thirds that of Pennsylvania. The drug overdose death rate in Pennsylvania was 1.6 times that of New York in 2006. Differences between New York and Pennsylvania might be due to the regulatory environment in New York State.
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Stigma and Treatment for Alcohol Disorders in the United States
K.M. Keyes et al.
American Journal of Epidemiology, 15 December 2010, Pages 1364-1372
Abstract:
Among a nationally representative sample of adults with an alcohol use disorder, the authors tested whether perceived stigmatization of alcoholism was associated with a lower likelihood of receiving alcohol-related services. Data were drawn from a face-to-face epidemiologic survey of 34,653 adults interviewed in 2004-2005 who were aged 20 years or older and residing in households and group quarters in the United States. Alcohol abuse/dependence was diagnosed by using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, version (AUDADIS-IV). The stigma measure used was the Perceived Devaluation-Discrimination Scale. The main outcome was lifetime intervention including professional services and 12-step groups for alcohol disorders. Individuals with a lifetime diagnosis of an alcohol use disorder were less likely to utilize alcohol services if they perceived higher stigma toward individuals with alcohol disorders (odds ratio = 0.37, 95% confidence interval: 0.18, 0.76). Higher perceived stigma was associated with male gender (β = -0.75; P < 0.01), nonwhite compared with non-Hispanic white race/ethnicity, lower income (β = 1.0; P < 0.01), education (β = 1.48; P < 0.01), and being previously married (β = 0.47; P = 0.02). Individuals reporting close contact with an alcohol-disordered individual (e.g., relative with an alcohol problem) reported lower perceived stigma (β = -1.70; P < 0.01). A link between highly stigmatized views of alcoholism and lack of services suggests that stigma reduction should be integrated into public health efforts to promote alcohol treatment.
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Forgiveness, Health, and Problematic Drinking among College Students in Southern Appalachia
Jon Webb & Ken Brewer
Journal of Health Psychology, November 2010, Pages 1257-1266
Abstract:
Evidence is growing regarding the salutary relationships between spirituality and health, including alcohol problems, yet little is known about spirituality and health in the context thereof. Cross-sectional associations between forgiveness and health were examined among college student problematic drinkers (n = 126; ♀ = 60%; M age = 22) in Southern Appalachia. Controlling for demographic variables (including religiosity), dimensions of forgiveness accounted for 7-33 percent of the variance in the health-related variables in a salutary fashion. Forgiveness of Self appears to be the most important dimension of forgiveness measured, yet the most difficult to develop.
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College Women: History of Childhood Abuse and Its Relationship to Smoking
Colmar De Von Figueroa-Moseley, Jill Marise Abramson & Geoffery Williams
Violence Against Women, November 2010, Pages 1242-1251
Abstract:
Few studies have examined the influence of childhood abuse on smoking in women. The objective of the study was to determine if abuse in childhood is associated with increased risk for smoking in women. Two hundred ninety-six women completed an anonymous survey on childhood abuse and smoking. Results showed that abuse was a better predictor of smoking than status variables. Those experiencing two or more abuses before age 17 were three times more likely to be early smokers and seven times more likely to be current smokers. Findings highlight abuse in childhood as a stressor that increases a woman's risk for smoking.
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Jessica Skidmore & James Murphy
Psychology of Addictive Behaviors, forthcoming
Abstract:
More than [3/4] of U.S. college students report a heavy drinking episode (HDE; 5 (for men) and 4 (for women) drinks during an occasion) in the previous 90 days. This pattern of drinking is associated with various risks and social problems for both the heavy drinkers and the larger college community. According to behavioral economics, college student drinking is a contextually bound phenomenon that is impacted by contingencies such as price and competing alternative reinforcers, including next-day responsibilities such as college classes. This study systematically examines the role of these variables by using hypothetical alcohol purchase tasks to analyze alcohol consumption and expenditures among college students who reported recent heavy drinking (N = 207, 53.1% women). The impact of gender and the personality risk factor sensation seeking (SS) were also assessed. Students were asked how many drinks they would purchase and consume across 17 drink prices and 3 next-day responsibility scenarios. Mean levels of hypothetical consumption were highly sensitive to both drink price and next-day responsibility, with the lowest drinking levels associated with high drink prices and a next-day test. Men and participants with greater levels of SS reported more demand overall (greater consumption and expenditures) than women and students with low SS personality. Contrary to our hypotheses women appeared to be less sensitive to increases in price than men. The results suggest that increasing drink prices and morning academic requirements may be useful in preventing heavy drinking among college students.
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Early adolescent cognitions as predictors of heavy alcohol use in high school
Judy Andrews, Sarah Hampson & Missy Peterson
Addictive Behaviors, forthcoming
Abstract:
The present study predicts heavy alcohol use across the high school years (age 14 through 18) from cognitions regarding the use of alcohol assessed in middle school. Using Latent Growth Modeling, we examined a structural model using data from 1011 participants in the Oregon Youth Substance Use Project. In this model, social images and descriptive norms regarding alcohol use in grade 7 were related to willingness and intention to drink alcohol in grade 8 and these variables were subsequently related to the intercept and slope of extent of heavy drinking across the high school years (grades 9 through 12). Across the sample, both descriptive norms and social images influenced the intercept of heavy drinking (in the 9th grade) through willingness to drink alcohol. Multiple sample analyses showed that social images also were directly related to the intercept of heavy drinking, for girls only. Results suggest that cognitions regarding alcohol use in middle school predict subsequent heavy drinking in high school. These findings emphasize the need for prevention programs targeting changing students' social images and encouraging a more accurate perception of peers' use when students are in middle school.
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The effects of residential proximity to bars on alcohol consumption
Gabriel Picone, Joe MacDougald, Frank Sloan, Alyssa Platt & Stefan Kertesz
International Journal of Health Care Finance and Economics, December 2010, Pages 347-367
Abstract:
A person's decision to drink alcohol is potentially influenced by both price and availability of alcohol in the local area. This study uses longitudinal data from 1985 to 2001 to empirically assess the impact of distance from place of residence to bars on alcohol consumption in four large U.S. cities from 1985 to 2001. Density of bars within 0.5 km of a person's residence is associated with small increases in alcohol consumption as measured by: daily alcohol consumption (ml) drinks per week, and weekly consumption of beer, wine, and liquor. When person-specific fixed effects are included, the relationship between alcohol consumption and the number of bars within a 0.5 km radius of the person's place of residence disappears. Tests for endogeneity of the number of bars within the immediate vicinity of respondents' homes fail to reject the null hypothesis that the number of bars is exogenous. We conclude that bar density in the area surrounding the individuals' homes has at most a very small positive effect on alcohol consumption.
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Mikael Svensson & Curt Hagquist
European Journal of Health Economics, December 2010, Pages 533-541
Abstract:
This paper examines how the unemployment rate is related to adolescent alcohol use and experience of binge drinking during a time period characterized by big societal changes. The paper uses repeated cross-sectional adolescent survey data from a Swedish region, collected in 1988, 1991, 1995, 1998, 2002 and 2005, and merges this with data on local unemployment rates for the same time periods. Individual level frequency of alcohol use as well as experience of binge drinking is connected to local level unemployment rate to estimate the relationship using multilevel modeling. The model includes municipality effects controlling for time-invariant differences between municipalities as well as year fixed effects controlling for municipality-invariant changes over time in alcohol use. The results show that the unemployment rate is negatively associated with adolescents' alcohol use and the experience of binge drinking. When the unemployment rate increases, more adolescents do not drink at all. Regular drinking (twice per month or more) is, on the other hand, unrelated to the unemployment rate. Examining gender-differences in the relationship, it is shown that the results are driven by behavior in girls, whereas drinking among boys does not show any significant relationship with changes in the unemployment rate.
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One for the road: Public transportation, alcohol consumption, and intoxicated driving
Kirabo Jackson & Emily Greene Owens
Journal of Public Economics, February 2011, Pages 106-121
Abstract:
We exploit arguably exogenous train schedule changes in Washington DC to investigate the relationship between public transportation, the risky decision to consume alcohol, and the criminal decision to engage in alcohol-impaired driving. Using variation over time, across days of the week, and over the course of the day, we provide evidence that overall there was little effect of expanded public transit service on DUI arrests, alcohol related fatal traffic and alcohol related arrests. However, we find that these overall effects mask considerable heterogeneity across geographic areas. Specifically, we find that areas where bars are within walking distance to transit stations experience increases in alcohol related arrests and decreases in DUI arrests. We observe no sign of behavioral changes in neighborhoods without any bars within walking distance of transit stations.
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Does Education Confer a Culture of Healthy Behavior? Smoking and Drinking Patterns in Danish Twins
Wendy Johnson et al.
American Journal of Epidemiology, January 2011, Pages 55-63
Abstract:
More education is associated with healthier smoking and drinking behaviors. Most analyses of effects of education focus on mean levels. Few studies have compared variance in health-related behaviors at different levels of education or analyzed how education impacts underlying genetic and environmental sources of health-related behaviors. This study explored these influences. In a 2002 postal questionnaire, 21,522 members of the Danish Twin Registry, born during 1931-1982, reported smoking and drinking habits. The authors used quantitative genetic models to examine how these behaviors' genetic and environmental variances differed with level of education, adjusting for birth-year effects. As expected, more education was associated with less smoking, and average drinking levels were highest among the most educated. At 2 standard deviations above the mean educational level, variance in smoking and drinking was about one-third that among those at 2 standard deviations below, because fewer highly educated people reported high levels of smoking or drinking. Because shared environmental variance was particularly restricted, one explanation is that education created a culture that discouraged smoking and heavy drinking. Correlations between shared environmental influences on education and the health behaviors were substantial among the well-educated for smoking in both sexes and drinking in males, reinforcing this notion.
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Social Norms of Alcohol, Smoking, and Marijuana Use Within a Canadian University Setting
Kelly Arbour-Nicitopoulos, Matthew Kwan, David Lowe, Sara Taman & Guy Faulkner
Journal of American College Health, November-December 2010, Pages 191-196
Objective: To study actual and perceived substance use in Canadian university students and to compare these rates with US peers.
Participants: Students (N = 1,203) from a large Canadian university.
Methods: Participants were surveyed using items from the National College Health (NCHA) Assessment of the American College Health Association questionnaire.
Results: Alcohol was the most common substance used (65.8%), followed by marijuana (13.5%) and cigarettes (13.5%). Substance use and norms were significantly less than the NCHA US data. Overall, respondents generally perceived the typical Canadian student to have used all 3 substances. Perceived norms significantly predicted use, with students more likely to use alcohol, cigarettes, or marijuana if they perceived the typical student to use these substances.
Conclusions: Similar to their US peers, Canadian university students have inaccurate perceptions of peer substance use. These misperceptions may have potentially negative influences on actual substance use and could be a target for intervention. Further research examining the cross-cultural differences for substance abuse is warranted.
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Psychosocial correlates of adolescent marijuana use: Variations by status of marijuana use
Tilda Farhat, Bruce Simons-Morton & Jeremy Luk
Addictive Behaviors, forthcoming
Introduction: This study examined the associations between psychosocial factors and status of marijuana use: former experimentation, current occasional, and current frequent use.
Methods: Data were collected from a nationally-representative sample of U.S. tenth-graders who participated in the 2005/6 Health Behavior in School-aged Children Study (n=1,465). Multinomial regressions, run separately by gender, examined the association of risk and protective factors from the individual (life satisfaction; academic achievement; aggression, bullying) and contextual (mothers and fathers' knowledge of adolescents' activities, school climate) domains with status of marijuana use (former experimentation, current occasional use, current frequent use).
Results: Former experimental and current marijuana use were negatively associated with protective factors such as academic achievement, mothers' and fathers' knowledge of adolescents' activities, and life satisfaction, but not with positive school climate. Former experimental and current marijuana use were positively associated with aggression and bullying perpetration. Most associations varied by gender and status of marijuana use. In adjusted analyses, aggression emerged as the sole risk factor and fathers' knowledge as the sole protective factor that were positively associated with most statuses of marijuana use, across gender.
Conclusion: Fathers may be particularly important in preventing adolescent marijuana use, and interventions promoting fathers' knowledge of adolescents' activities are warranted.
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Michael Slater & Andrew Hayes
Communication Research, December 2010, Pages 751-773
Abstract:
Prior research has found strong evidence of a prospective association between R-rated movie exposure and teen smoking. Using parallel process latent-growth modeling, the present study examines prospective associations between viewing of music video channels on television (e.g., MTV and VH-1) and changes over time in smoking and association with smoking peers. Results showed that baseline viewing of music-oriented channels such as MTV and VH-1 robustly predicted increasing trajectories of smoking and of associating with smoking peers, even after application of a variety of controls including parent reports of monitoring behavior. These results are consistent with the arguments from the reinforcing spirals model that such media use serves as a means of developing emergent adolescent social identities consistent with associating with smoking peers and acquiring smoking and other risk behaviors; evidence also suggests that media choice in reinforcing spiral processes are dynamic and evolve as social identity evolves.
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Tellervo Korhonen et al.
Twin Research and Human Genetics, December 2010, Pages 550-558
Abstract:
We examined whether externalizing problem behaviors (hyperactivity-impulsivity, aggressiveness, and inattention) predict illicit drug use independently, or whether their associations with drug use are mediated through cigarette smoking. We used a prospective longitudinal design within the FinnTwin12-17 study among Finnish adolescents with baseline at age 12 and follow-up surveys at ages 14 and 17. Path models were conducted with Mplus and included 1992 boys and 2123 girls. The outcome was self-reported ever use of cannabis or other illicit drugs at age 17. The predictors were: externalizing behaviors (hyperactivity-impulsivity, aggressiveness, and inattention) assessed by teachers and parents (age 12) and self-reported cigarette smoking (age 14). The findings differed across behavior studied. The association of hyperactivity-impulsivity with drug use was mostly mediated through earlier cigarette smoking. Concerning aggressiveness and inattention, the results were different among girls than boys. Among girls no significant mediation occurred, whereas among boys more consistent evidence on mediation was seen. Consistently in all models, the direct association of early cigarette smoking on drug use was strong and highly significant. We conclude that the associations of externalizing problem behaviors with illicit drug use are partially mediated through cigarette smoking. Although interventions targeting externalizing problem behaviors may protect adolescents from early onset smoking and subsequently experimenting with drugs, interventions to prevent cigarette smoking initiation are also important in reducing risk of later drug use.