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Role transitions, past life events, and their associations with multiple categories of substance use among emerging adults

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Role transitions, past life events, and their associations with multiple categories of substance use among emerging adults

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Content Role transitions, past life events, and their associations with multiple categories of
substance use among emerging adults

By

Jon-Patrick Allem

A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(PREVENTIVE MEDICINE: HEALTH BEHAVIOR RESEARCH)

MAY 2015

2

Table of Contents

List of Tables and Figures…………………………………………………………………3
Abstract....………………………………………………………………………………....4
Preface…..………………………………………………………………………………....5
Study #1 Empirical versus theoretical claims about the association between role
transitions and substance use among Hispanic emerging adults………………………...11
Introduction………………………………………………………………………..…...11
Methods………………………………………………………………………..….........20
Results...…………………...…………………………………………………………...25
Discussion………….…………………………………………………………………..30
Limitations……………………………………………………………………………..33
Study #2 Adverse childhood experiences and substance use among Hispanic emerging
adults……………………………………………………………………………………..36
Introduction……………………….…….……………………………………………...36
Methods………………………………………………………………………………...39
Results…………………….……………………………………………………………46
Discussion………….…………………………………………………………………..51
Limitations……………………………………………………………………………..52
Study #3 Characteristics of emerging adulthood and electronic cigarette use among
college students…………………………………………………………………………..55
Introduction………………….………..………………………………………………...55
Methods…………………………………………………………………………...........59
Results…………………….……………………………………………………………65
Discussion………….…………………………………………………………………..69
Limitations…………………………….……………………………………………….71
Concluding remarks……………………………………………………………………...74
References………………………………………………………………………………..76

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List of Tables
Table 1. Role transitions and past-month
substance use in year 1 of emerging adulthood…………………………………….. pg. 28

Table 2. Role transitions and past-month
substance use in year 2 of emerging adulthood……………………………………...pg. 29

Table 3. Sample characteristics..…………………………………………………….pg. 48

List of Figures

Figure 1. Theoretical model ………………………………………….………………pg. 9

Figure 2. Accumulated number of adverse childhood experiences
and substance use…………………………………………………………………… pg. 49

Figure 3. Categories of adverse childhood experiences and substance use………….pg. 50

Figure 4. Characteristics of emerging adulthood and e-cigarette use………………..pg. 68

4

Abstract
In emerging adulthood (18 to 25), in industrialized societies, young people
experience life transitions, and have the time to explore and develop. Instability in
emerging adulthood from changing residences, romantic relationships, school, and work
has been hypothesized to increase rates of substance use among young people. Disruption
of daily life may lead to anxiety, stress and sadness, which could ultimately lead to
substance use as a form of self-medication. The aims of the present dissertation are in
part based on testing hypotheses revolving around how disruption of daily life is
associated with various kinds of substance use in emerging adulthood. Study #1 builds on
the growing body of research that has suggested that specific role transitions are
associated with substance use among emerging adults. This study describes the current
methodological limitations commonly found in this literature, and demonstrates a way to
overcome such limitations by applying a novel matching method to longitudinal data.
Study #2 explores whether or not emerging adults who experienced trauma in childhood
engage in substance use as maladaptive coping strategy in order to avoid negative
emotions. Taken together, Study #1 and Study #2 have the ability to demonstrate which
specific life events (both past and present) are associated with substance use among
emerging adults. Study #3 extends the research on role transitions and other
characteristics of emerging adulthood to the use of electronic cigarettes. Given the
growing popularity of this emerging tobacco product, exploring how role transitions are
associated with e-cigarettes is a natural progression for research focused on emerging
adults. Collectively, Study #1, #2, and #3 build on the literature focusing on emerging
adults and substance use in general, and specifically build on the literature that suggests
substance use starts and increases after disruption of daily life in emerging adulthood.

5

Preface
In 2000, Jeffry Jensen Arnett, Ph.D., proposed a new life stage between the ages
of 18 to 25, which he termed emerging adulthood (Arnett, 2000). In emerging adulthood,
in industrialized societies, young people experience life transitions, and have the time to
explore and develop. This life stage, Arnett argued, is distinct from both adolescence and
adulthood, where young people have more autonomy, but have not yet engaged in all
adult responsibilities (Arnett, 2000). Arnett’s work expanded prior research on young
adults (considered between the ages of 20 to 45) that focused on how the decision to
become married or not affected one’s development and life trajectory (Erikson, 1959), as
well as how young adults explored different possibilities during this period (Keniston,
1970). By expanding earlier work and specifying the years of emerging adulthood,
Arnett’s work has provided valuable context to researchers across scientific disciplines
that investigate this age group.
Three factors are credited for the rise of emerging adulthood, starting with the
transition from an industrial to an information-based economy, and the concomitant need
for post-secondary education (Tanner & Arnett, 2009). As a result of pursuing and
obtaining more education, careers, marriages, and parenthood have started to take place
later in life for recent generations. Second, increases in the educational and professional
opportunities available to women have allowed more women to seek out post-secondary
education in their late teens and twenties instead of becoming married and bearing
children (Tanner & Arnett, 2009). Lastly, increased acceptance of premarital sex has
allowed young people to engage in sexual experiences prior to marriage without major
sanctions from society (Tanner & Arnett, 2009). With the prolonging of marriage,

6

parenthood, and the establishment of careers in recent decades, young people in
industrialized societies have used their late teens and early twenties to explore potential
life directions.
Research has demonstrated that emerging adults’ conception of adulthood focuses
on self-sufficiency e.g., accepting responsibility for one’s self, making decisions
autonomously, and financial independence (Arnett & Galambos, 2003). This consensus
spans across ethnic groups in the United States (U.S.), but emerging adults from minority
cultures have been more likely than Non-Hispanic Whites to also emphasize obligation
toward others (e.g., family members) as a criteria for adulthood (Arnett, 2003). While
emerging adulthood is a normative life stage in OECD countries, in developing countries
emerging adulthood exists among the small but growing middle class. Emerging adults
living in more populated rural areas often experience a truncated adolescence, and many
take on adult roles by their teens (Arnett, 2011). Given the cultural psychology of
emerging adulthood, Arnett has described the beliefs that underlie and sustain this new
life stage. He noted four beliefs: 1) independence and self-sufficiency should be attained
before entering into adult commitments, 2) romantic love should be the basis of marriage,
3) work should be an expression of one’s identity, 4) the years from the late teens through
at least the mid-twenties should be a time of self-focused leisure and fun (Arnett, 2011).
The suggestion that 18 to 25 year olds in developing countries do not experience
emerging adulthood calls into question Arnett’s belief that emerging adulthood is a
distinct life stage. It is generally recognized that in order for a life stage to exist it must be
universally experienced and if not experienced have severe consequences on
development. Arnett, however, does not believe that it is harmful to forgo emerging

7

adulthood (Arnett, 2000). In other words, entering the workforce by choice or by external
factors as well as marriage without exploring different possibilities may not result in
negative consequences for the individual. Classifying emerging adulthood as a life stage
has greater implications. For example, the distinguishing of adolescence as a life stage at
the turn of the 20
th
century, was succeeded by institutional changes, policy changes, and
normative expectations of adolescents held by society at large. In this regard, defining
emerging adulthood a life stage would have similar implications as policies would have
to be shaped to extend to 18-25 years olds in a meaningful fashion. Notwithstanding,
viewing emerging adulthood as a cultural theory that endeavors to help understand the
behaviors, thoughts, and emotions of emerging adults has been useful to scientists
investigating this age group.
Emerging adulthood affords young people the opportunity for identity
exploration in love, work, and perspective (Arnett, 2006). For example, trials in love in
emerging adulthood tend to entail multifaceted levels of intimacy as opposed to in
adolescence, where trials in love are often fleeting (Shulman & Connolly, 2013).
Emerging adults start to plan out their career objectives establishing work experience that
lead to a job or career they hold through adulthood (Arnett, 2004). Emerging adults also
reexamine their perspectives, or worldviews, during this period. Here emerging adults
start to refine the perspectives they developed as children in their parents’ household, and
produce their own independent beliefs (Arnett, 2007). Arnett (2000) also argued that a
function of emerging adults’ identity exploration is engaging in risky behaviors.
Sensation seeking, the yearning for intense experiences, Arnett believed, motivates
emerging adults to engage in risky behaviors, such as substance use, and unprotected sex

8

(Arnett, 2000). Emerging adults appear to chase intense experiences liberally compared
to adolescents, as they are free from parental control, as well as adults because they are
not yet constrained by the responsibilities of child rearing (Arnett, 2006).
Young people may engage in substance use as a function of identity exploration
in emerging adulthood (Schwartz, Zamboanga, Luyckx, Meca, & Ritchie, 2013). In other
words, emerging adults may use substances as a way of exploring a variety of different
experiences, or they may use substances in order to alleviate uneasy feelings due to
identity uncertainty. Risky behaviors like substance use may be highly tolerated or
encouraged during emerging adulthood (Sussman & Arnett, 2014). Instability in
emerging adulthood from changing residences, romantic relationships, school, and work
has been hypothesized to increase rates of substance use among young people (Arnett,
2005). Specifically, Arnett hypothesized, “substance use in emerging adulthood will rise
after specific instability events, i.e., in the weeks following a transition in residence, love,
school, or work” (Arnett, 2005). Disruption of daily life may lead to anxiety, stress and
sadness, which could ultimately lead to substance use as a form of self-medication
(Khantzian 1997).
The aims of the present dissertation are in part based on testing hypotheses
revolving around how disruption of daily life is associated with various kinds of
substance use in emerging adulthood. Sinha (2008) proposed a theoretical model where
stress leads to increases in substance use as a way to reduce stress-related negative affect.
This process becomes reinforcing as a maladaptive coping mechanism. The three studies
described herein are based on the model that substance use is a maladaptive coping
strategy, and will increase when specific events are experienced (Figure 1).

9

Figure 1. Theoretical model

Study #1 builds on the growing body of research that has suggested that specific
role transitions are associated with substance use among emerging adults. This study
describes the current methodological limitations commonly found in this literature, and
demonstrates a way to overcome such limitations by applying a novel matching method
to longitudinal data. While identifying which role transitions are associated with
substance use will be useful in furthering the literature on emerging adults, a critical next
step to understanding substance use behaviors among this priority population may
involve understanding how past events, or adverse childhood experiences, are associated
with substance use. Study #2 explores whether or not emerging adults who experienced
trauma in childhood engage in substance use as maladaptive coping strategy in order to
avoid negative emotions. Taken together, Study #1 and Study #2 have the ability to
demonstrate which specific life events (both past and present) are associated with
substance use among emerging adults.
Study #1 and #2 comprise samples of Hispanic emerging adults. Hispanics, one of
the fastest growing populations in the U.S. made up 17% of the U.S. population in 2014

10

(Brown, 2014). Hispanic emerging adults have been described as a priority population for
substance use prevention (Stone, Becker, Huber, & Catalano, 2012). Hispanic emerging
adults are distinctive because their obligations grow toward scholastics and work, as well
as toward their immediate and extended families during this period (Arnett, 2003). Their
commitment toward family is likely a function of the collectivistic values they
experienced growing up (Shkodriani & Gibbons, 1995; Gaines et al., 1997). There has
been multiple calls to increase research on the correlates of substance use among
emerging adults (Sussman & Arnett, 2014), especially among Non-Hispanic White
populations (Unger, 2012; Unger, 2014). The literature on substance use among Hispanic
emerging adults is growing, but still in its nascent stage (Allem, Soto, Baezconde-
Garbanati, Sussman, & Unger, 2013). Study #1 and #2 endeavor to help fill this gap.
Study #3 extends the research on role transitions and other characteristics of
emerging adulthood to the use of electronic cigarettes. Given the growing popularity of
this emerging tobacco product, exploring how role transitions are associated with e-
cigarettes is a natural progression for research focused on emerging adults. Study #3
comprises an ethnically diverse sample of emerging adults, which is absent in the current
literature. Collectively, Study #1, #2, and #3 build on the literature focusing on emerging
adults and substance use in general, and specifically build on the literature that suggests
substance use starts and increases after disruption of daily life in emerging adulthood.

11

Study # 1
Empirical versus theoretical claims about the association between role transitions
and substance use among Hispanic emerging adults

Introduction
Emerging adulthood is a life stage between the ages of 18 to 25, and is
characterized by changes in relationships, education, work, and viewpoints on life
(Arnett, 2011). This time of development is also the period in life when the risk of
substance use is at its peak (Substance Abuse and Mental Health Services
Administration, 2012). Circumstances unique to emerging adulthood may be playing a
prominent role in substance use during this period. Arnett (2005) hypothesized,
“substance use in emerging adulthood will rise after specific instability events, i.e., in the
weeks following a transition in residence, love, school, or work.” Disruption of daily life
may lead to negative affect, which could ultimately lead to substance use as a form of
self-medication (Khantzian, 1997; Sinha, 2008). Among emerging adults, Hispanics have
been described as a priority population for substance use prevention (Stone, Becker,
Huber, & Catalano, 2012). Hispanics are distinctive, as their obligations grow toward
scholastics and work, as well as toward their immediate and extended families in
emerging adulthood (Arnett, 2003).
Prior research has shown that specific role transitions in emerging adulthood were
associated with past-month cigarette use, including becoming a caregiver for a family
member or relative, loss of a job, starting to date someone new, experiencing a breakup,
being arrested, and becoming addicted to drugs and/or alcohol among Hispanics (Allem,
Soto, Baezconde-Garbanati, & Unger, 2013). In a separate study, role transitions taking
place in the past year were found to be associated with past-month marijuana use

12

including being arrested, experiencing a breakup, and dating someone new among
Hispanics (Allem, Lisha, Soto, Baezconde-Garbanati, & Unger, 2013). Role transitions
associated with binge drinking included being arrested, experiencing a breakup, dating
someone new, a demotion at work, a new romance, and starting a new job among
Hispanics (Allem et al., 2013a). Findings from these cross-sectional studies have
contributed to the growing literature on role transitions and substance use among
emerging adults, but in order to further understand these associations, research is needed
that takes into account how substance use in adolescence influences role transitions and
substance use in emerging adulthood.
Substance use in high school was shown to be associated with specific role
transitions in emerging adulthood (Allem et al., 2013), making it hard to parse out the
causal direction of these associations e.g., endogeneity. For example, Hispanic
adolescents who reported past-month binge drinking in high school were more likely to
report having had a baby in emerging adulthood compared to adolescents who did not
report binge drinking in high school (Allem et al., 2013). Additionally, Hispanic
adolescents who reported past-month cigarette smoking in high school were more likely
to report having moved in with a boyfriend or girlfriend in emerging adulthood (Allem et
al., 2013). Endogeneity is just one of many methodological issues that need to be
resolved in the current literature on the association between role transitions and substance
use among emerging adults. Longitudinal data is needed that allow for the inclusion of
substance use behaviors in high school. Controlling for such characteristics assures that
research exploring role transitions and substance use in emerging adulthood is not simply
describing associations among previous substance users.

13

Longitudinal research among a community sample of emerging adults
demonstrated that substance use (e.g., heavy drinking, marijuana use, and cigarette use)
increased for participants who experienced a breakup compared to participants who
remained in a relationship (Fleming, White, Oesterle, Haggerty, & Catalano, 2010). This
study did not find significant associations between going from being single to a
committed relationship and marijuana use or heavy drinking, however found this
transition was associated with an increase in cigarette smoking (Fleming et al., 2010).
Fleming et al. (2010) described associations between transitions in romance and
substance use, but they did not examine alternative role transitions that could also
influence substance use.
Staff et al.’s (2010) longitudinal study measured role transitions in romance,
work, and education, and examined their associations with substance use among young
adults aged 18 to 28. They found experiencing a breakup contributed to increased rates of
substance use (e.g., heavy drinking, cigarette use, and marijuana use) for participants.
Staff et al. (2010) also found that becoming engaged reduced substance use, while
cigarette, marijuana, and cocaine use declined after the receipt of a baccalaureate degree,
but alcohol use increased. Substance use was not associated with the acquisition of full-
time work among participants. Staff et al. (2010) concluded that transitions surrounding
around romance were more important to patterns of substance use relative to work and
education after they included measures of all transitions into a single model. In other
words, the magnitude of the associations between work and education with substance use
was mitigated in their full models. This conclusion may have been premature because

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including measures of all transitions into a single model likely resulted in post-treatment
bias.
Post-treatment bias occurs when some of the control variables in a single model
are at least in part consequences of the primary explanatory variable (King, Keohane, &
Verba,1994; King & Zeng, 2006; King & Zeng, 2007; King, Nielsen, Coberley, Pope, &
Wells, 2011). King and Zeng (2006) offer several examples that illustrated how
inferences are biased as a result of controlling for post-treatment variables. For instance,
one scenario considered a researcher that was interested in predicting the vote with
partisan identification (a common explanatory variable in political behavior research). If
the researcher controlled for the intended vote five minutes before walking into the
voting booth, their estimate of the effect of partisan identification would be nearly zero.
King and Zeng (2006) provided a formal explanation for why this is the case, which goes
beyond the scope of the present study. In approachable terms, the researcher
inappropriately controlled for the consequence of their key causal variable, and for most
of the effects of it, therefore biasing the overall effect. In the same scenario, the
researcher should control for a pre-treatment variable like ethnicity that cannot be a
consequence of partisan identification, but may be a confounding variable. In sum,
regression-type models require separating out the pre- and post- treatment variables, and
controlling for pre-treatment characteristics. In certain fields of science, this is often
easier said than done. In the case of Staff et al. (2010), certain role transitions included in
their final model may have been a consequence of a transition in the same model,
therefore negating the association between one transition and the outcome of interest. It is
easy to imagine a participant in Staff et al.’s (2010) study who became engaged after

15

securing full-time employment, which also succeeded the confirmation of a bachelor’s
degree. Post-treatment bias is another methodological issue that needs to be resolved
when exploring the association between role transitions and substance use among
emerging adults.
Prior research has relied on analytical approaches that often times produce results
that are more theoretical e.g., findings based on the specifications of a model, rather than
empirical e.g., results that are a reflection of the data generation process (King & Zeng,
2006). Informally defined, model dependence at a given value (x) is the difference
between predicted outcomes for any two models that fit about equally well (assuming the
functional form is stable or smooth (King & Zeng, 2006). When one is making an
inference near the data, the results are not as model dependent. When one is making an
inference far from the data, one doesn’t have the data to go on, so the inferences rely on
small features of the model, which make the inferences more dependent on the model. An
existing approach to determine whether results are empirical or theoretical is to perform
sensitivity testing (Rosenbaum, 2002).
Sensitivity testing requires specification of a class of models, estimation of all the
models, and an inspection of how much inferences change. If conclusions don’t change
drastically, results are suggested to be robust. These results, however, are only robust to
the tests conducted. In some sense, sensitivity testing only proves that the analyst did not
specify an extreme enough model. An example of results that appear to be sensitive to
model specification was found in Huh, Huang, Liao, Pentz, & Chou’s (2013) study that
used latent class analysis, along with growth mixture models, to explore the associations
between varying types of role transitions and frequency of alcohol and cigarette use. The

16

authors concluded that specific role transitions came together to influence trajectories of
substance use, however the authors conceded that their final models were not optimal. In
other words, due to local maxima problems the authors’ could not employ the models
denoted as optimal by model-fit indices. The nature of the authors’ conclusions might
not have changed given an alternative statistical approach where an emphasis was on
falsifiable hypotheses stated a priori, however removing model dependence from
analytical approaches would provide a more empirical picture of the relationship between
role transitions and substance use among emerging adults.
If the importance of role transitions in emerging adulthood is going to be better
understood, research must also avoid drawing conclusions from overfitted models.
Capitalizing on the idiosyncratic characteristics of the sample at hand is known as
overfitting (Babyak, 2004). Results from an overfitted model don’t exist in the
population, and will not replicate. One way to run the risk of overfitting a model is by
running a number of statistical tests. Testing a large number of variables, interactions,
and forms of the same variable (e.g., linear versus quadratic) without explicit rational
runs the risk of arriving at an overfitted model (Babyak, 2004). This usually takes place
in the form of prescreening bivaraite associations (Sun, Shook, & Kay, 1996), or the
automated version of this screening process known as stepwise regression. For example,
Cohen, Kasen, Chen, Hartmak, and Gordon (2003) wanted to know if the development of
role transitions differed by the demographic characteristics of their participants. In order
to investigate these associations the authors ran a repeated number of exploratory tests.
Among other findings, the authors concluded that role transitions pertaining to romantic
relationships developed differently for Black and Non-Hispanic White participants by

17

age, and also depended on gender. The authors later qualified this specific finding by
suggesting that their cell sizes were not large enough to draw strong conclusions about
these associations. The authors potentially arrived at results from an overfitted model.
The evidence of this is seen in the number of tests they performed without a correction.
Additionally, the authors’ sample size did not support the number of tests the authors
conducted.
Adequate sample sizes are needed to generate reasonably accurate estimates. In
the case of overfitting, if the sample size is not sufficient, the analyst has to find ways to
simplify the model e.g., use fewer degrees of freedom, or correct for overfitting. A
common justification for adding and/or subtracting variables from a model is by
providing evidence of improvement in model fit. Cohen et al. (2003) reported that model
fit indices improved after incorporating additional variables into their models, which
suggested the authors found there analytical decisions to be justified. Assessing model fit,
however, does not speak to the problem of overfitting, and the substantive meaning of
model fit is often misunderstood (King, 1986; King 1991). If the literature on role
transitions and substance use is to move forward, results must be based on theoretically
driven hypotheses that can be falsified, rather than on results based on unique
characteristics of the data under examination. In other words, similar to model-
dependence, results from overfitted models do not provide an empirical picture of the
relationship between role transitions and substance use.
A critical next step in moving forward the literature on role transitions and
substance use among emerging adults is to employ analytical methods that attempt to
address the methodological issues raised herein. A common approach to improving

18

causal inference in observational research is to employ matching methods (Stuart, 2010).
Matching methods can reduce model dependence (Ho, Imai, King, & Stuart, 2007).
Matching is a nonparametric, non-model based approach that, when used appropriately,
can make parametric models work better rather than substitute for them (Imai, King, &
Stuart, 2008). That is, matching is not an estimator, but a preprocessing method. The
overall idea of matching is to condense the data. If each treated unit (primary explanatory
variable coded 1) exactly matches a control unit (primary explanatory variable coded 0)
with respect to the control variables, then the treated and control groups are identical, the
control variables are no longer confounders, and the functional form of the model is not a
concern e.g., a difference in means is informative enough. If treated and control groups
are better balanced (e.g., equal number of treated and control units) due to condensing,
model dependence is reduced. If condensing is a function of the primary explanatory
variable and the control variables, but not the outcome variable of interest, no bias is
introduced. In other words, condensing does not bias inferences because the procedure
does not predetermine the outcome of interest (King et al., 1994).
The majority of matching methods involve identifying, for each treated unit, one
or more control units that are “similar” on covariates. How “similar” is defined
distinguishes between such methods. It is often difficult to match on all pre-treatment
control variables in order to arrive at a perfectly balanced number of pairs. Propensity
score matching, one of the most popular matching methods circumvents this requirement
by reducing all the elements of the control variables down to a scalar (Rosenbaum &
Rubin, 1983; Lanza, Moore, & Butera, 2013). The condensing process then proceeds by
matching treatment and control units on the value of this scalar also known as the

19

propensity score. One problem with this approach is that the correct specification of the
propensity score is determined by whether matching on the score achieves balance, rather
than measures of model fit. The condition, which allows reducing all the elements of the
control variables down to a scalar, does not often hold in practice except in rare
circumstances. This requires adjustments to the model that produced the original
propensity score. Matching methods, like coarsened exact matching (CEM), have since
been developed to overcome these limitations.
CEM is a method that allows the balance between the treatment and control
groups to be chosen before estimation rather than being revealed through the iterative
process of checking after estimation, modifying the method, and more estimation (Iacus,
King, & Porro, 2009). This method guarantees that adjusting the imbalance on one
variable has no effect on the balance of any other e.g., monotonic imbalance (Iacus, King,
& Porro, 2012). Best described, “CEM strictly bounds through ex ante user choice both
the degree of model dependence and the average treatment-effect estimation error,
eliminates the need for separate procedure to restrict data to common empirical support,
meets congruence principle, is robust to measurement error, … can be completely
automated, and is extremely fast computationally, even with very large datasets”
(Blackwell, Stefano, Iacus, King, & Porro, 2009).
The current study aimed to improve upon the current literature on role transitions
and substance use by applying CEM to longitudinal data among Hispanic emerging
adults. In doing so, the present study could improve the literature in several ways. First,
using a matching method addressed prior methodological limitations pertaining to model
dependence/overfitting. Second, this study matched on substance use in high school

20

therefore better described the function of role transitions and substance use in emerging
adulthood. Matching on substance use in high school assured that this study was not
simply describing the associations among prior substance users. Third, this study
matched on role transitions that took place in consecutive years in emerging adulthood.
This demonstrated whether experiencing the same transition in consecutive years is
associated with substance use. Lastly, this study measured transitions that have been
theoretically described to be associated with substance use e.g., transitions in residence,
love, school, and work (Arnett, 2005). Taken together, this study has the potential to
improve upon the current literature on substance use and role transitions, and better
inform intervention and prevention programs for Hispanic emerging adults.
Hypothesis 1: Transitions in residence, love, school, and work will be positively
associated with substance use.
Methods
Participants filled out surveys for Project RED, a longitudinal study of
acculturation and substance use among Hispanics in Southern California. Originally,
participants joined the study as adolescents, while in attendance at one of seven high
schools in the greater Los Angeles area. Schools were invited to participate if 70% or
more of their student body comprised Hispanics, as indicated by data from the California
Board of Education. The present study used data from the last year of high school when
data were gathered (11
th
grade) in fall of 2007. For the high school-based survey, data
collectors distributed surveys to all students who had provided parental consent and
student assent. The university’s Institutional Review Board approved all procedures.

21

Participants from the original high school cohorts who self-identified as Hispanic,
Latino or Latina, Mexican, Mexican-American, Chicano or Chicana, Central American,
South American, Mestizo, La Raza, or Spanish were contacted to participate in the survey
in emerging adulthood. Research assistants sent letters to participants’ last known
addresses, and invited them to call a toll-free phone number, or visit a website to
participate in the study. All emerging adults provided verbal consent over the phone, or
read the consent script online, and clicked a button to indicate consent, and participated in
the survey. If participants could not be contacted with the information they had provided
in high school, staff searched for them online using social networking sites, and publicly
available search engines. Data gathered from 2011 to 213 (n=1,416) served as the first
year of emerging adulthood, and data gathered from 2013 to 2014 (n= 1,406) served as
the second year of emerging adulthood in the present study. Each participant was invited
to participate in the survey in a 12-month time span from when they were previously
surveyed. Those lost to follow-up from high school to emerging adulthood were more
likely to be male, report binge drinking, marijuana use, and hard drug use in high school,
but did not differ on age, or smoking status in high school.
Measures
For the present study, data collected from the last cohort in high school (11
th

grade) was used to create measures of substance use that occurred prior to emerging
adulthood. Past-month cigarette use, binge drinking (five or more drinks of alcohol in a
row, that is, within a couple of hours), marijuana use, and hard drug use (e.g., cocaine,
methamphetamines, ecstasy, hallucinogens, or inhalants) were measured. Each item was

22

coded “Yes” = 1 and “No” = 0 where a 1 indicated any use of the substance in the past-
month.
Role transitions were measured in each year of emerging adulthood. Items were
prefaced with “Has this happened to you in the last year?” and coded “Yes” = 1 or “No”
= 0. The items were, “Started a romantic relationship,” “Broke up with boyfriend or
girlfriend,” “Got a new job,” and “Started college or new school or classes.” Transition in
residence was measured by the question “How often have you moved in the last 12
months?” Responses were coded 1, the participant moved, or 0, the participant did not
move in the past 12 months.
Negative affect, such as feeling depressed, could confound the relationship
between role transitions and substance use. As such, a version of the Boston short-form
CES-D as developed by Kohout and colleagues (1993), and validated among Hispanics
by Grzywacz and colleagues (2006), was adopted to measure depression in emerging
adulthood in the present study. Participants were prompted with the statement, “These
next question are about how you have felt in the past week…” and provided ten survey
items which included, “I felt depressed,” “I felt that everything I did was difficult,” “I
didn’t sleep well,” “I was happy,” “I felt lonely,” “People were unfriendly,” “I enjoyed
life,” “I felt sad,” “I felt people disliked me,” and “I could not get ‘going’.” Response
options were “Less than 1 day or never” coded as 1, “1-2 days” coded as 2, “3-4 days”
coded as 3, and “5-7 days” coded as 4. Response options for items “I was happy,” and “I
enjoyed life” were reverse coded. For each of the ten items, participants who reported
either a 0 or 1 were then recoded to 0 and those who reported a 2, 3 or 4, were recoded to
1 to approximate the yes/no response sequence described by Kohout and colleagues

23

(1993). Responses to the ten items were then summed (Cronbach’s alpha =. 84). Age and
gender were also measured in emerging adulthood.
Data from each year of emerging adulthood was used to create measures of
substance use, which served as the present study’s outcomes of interest. Past-month
cigarette use, binge drinking (e.g., five or more drinks of alcohol in a row, that is, within
a couple of hours), marijuana use, and hard drug use (e.g., cocaine, methamphetamines,
ecstasy, hallucinogens, or inhalants) were the outcomes of interest. Each outcome was
coded “Yes” = 1 and “No” = 0 where a 1 indicated any use of the substance in the past-
month.
Analytical approach
The analytical approach began with processing the data to reduce imbalance. A
global imbalance statistic (GI) as described by Iacus, King, and Porro (2008) was
reported to demonstrate how much imbalance was reduced as a result of matching.
Perfect global balance is indicated by a GI = 0 and larger values indicate larger imbalance
between the groups, with a maximum GI = 1.0. Matching started by identifying the
primary explanatory variable or treatment variable. Herein the treatment variable,
considered in the treatment group, was 1 for participants who experienced the specified
role transition (e.g., new job), and 0 for participants who did not experience the role
transition in the specified time period e.g., year one or year two of emerging adulthood.
Once each primary explanatory variable was defined, data was condensed so that
imbalance was reduced between treatment and control groups by the CEM algorithm.
The algorithm works as follows: 1) the process started with the primary explanatory
variable and the control variables X which are duplicated and defined as X*. 2) X* are

24

then coarsened with CEM’s automatic binning algorithm (think histogram) employed to
coarsen levels of depression. 3) Next one stratum per unique observation X* was created,
and each observation was placed in a stratum. 4) The strata were then assigned to the
original data, X, and any observation whose stratum did not contain at least one treatment
and control unit was dropped (Blackwell et al, 2009).
Initially, the pretreatment variables (control variables that were matched on)
included cigarette use, binge drinking, marijuana use, and hard drug use in high school,
as well as age, gender, and levels of depression in emerging adulthood. Each substance
use outcome was then regressed on each primary explanatory variable. These estimates
produced a specific version of a causal effect e.g., the sample average treatment effect on
the treated (SATT) (Imbens, 2004). In other words, the coefficients describing the
relationship between each role transition and each outcome of interest represented a
causal effect. Again, matching on substance use in high school assured that this analysis
was not simply describing the associations among prior substance users.
Next, the pretreatment variables were redefined and included age, gender,
cigarette use, binge drinking, marijuana use, and hard drug use in high school, levels of
depression in emerging adulthood, and one role transition from year one in emerging
adulthood. In other words, if the primary explanatory variable was a new job in year two
of emerging adulthood, experiencing a new job in emerging adulthood in year one was
included as a pretreatment control variable, and subsequently was included in the
condensing process along with the other control variables. This process was repeated for
each role transition. Each substance use outcome in year two of emerging adulthood was
then regressed on each role transition in year two of emerging adulthood. Again, this

25

analysis demonstrated whether experiencing the same transition in consecutive years was
associated with substance use.
CEM attempts to use as much of the data as possible, which results in strata that
may include different number of treated and control units. To compensate for the
differential strata sizes, CEM returns weights to be used in subsequent analyses.
Therefore, the SATT estimate is the coefficient on the treated variable produced by a
logistic regression that has been weighted. The SATT was reported for each combination
of role transition and category of substance use for each year of emerging adulthood.
Results
The average age of participants when measured in high school was 16 years and
44% were male. Among participants in high school 9% reported past-month hard drug
use, 23% reported past-month binge drinking, 17% reported past-month marijuana use,
and 9% reported past-month cigarette use. The average age of participants in year one of
emerging adulthood was 22 and 41% were male. Among participants in year one of
emerging adulthood 5% reported past-month hard drug use, 45% reported past-month
binge drinking, 23% reported past-month marijuana use, and 22% reported past-month
cigarette use. The average age of participants in year two of emerging adulthood was 23
and 41% were male. Among participants in year two of emerging adulthood 7% reported
past-month hard drug use, 44% reported past-month binge drinking, 25% reported past-
month marijuana use, and 21% reported past-month cigarette use.
When starting a new romantic relationship was defined as the primary
explanatory variable, the measure of imbalance for the set of control variables was GI =
.24478697 prior to matching, and was GI = 4.80 X 10
-16
after matching suggesting almost

26

perfect balance between treatment and control groups was achieved. This transition was
positively and significantly associated with past-month cigarette use, binge drinking, and
marijuana use in year one of emerging adulthood (Table 1.) When experiencing a
breakup was defined as the primary explanatory variable, the measure of imbalance for
the set of control variables was GI = .29475812 prior to matching, and was GI = 3.513 X
10
-15
after matching. This transition was positively and significantly associated with past-
month binge drinking, marijuana use, and hard drug use in year one of emerging
adulthood.
When starting a new job was defined as the primary explanatory variable, the
measure of imbalance for the set of the control variables was GI = .22106457 prior to
matching, and was GI = 3.176 X 10
-15
after matching. This transition was positively and
significantly associated with past-month binge drinking and marijuana use in year one of
emerging adulthood. When starting school was defined as the primary explanatory
variable the measure of imbalance for the set of control variables was GI = .21826367
prior to matching, and was GI = 5.050 X 10
-16
after matching. This transition, however,
was not significantly associated with past-month substance use in year one of emerging
adulthood. Similarly, when moving residences was defined as the primary explanatory
variable the measure of imbalance for the set of control variables was GI = .2494296
prior to matching, and was GI = 6.026 X 10
-16
after matching. This transition was also not
significantly associated with past-month substance use in year one of emerging
adulthood.
When starting a new romantic relationship was defined as the primary
explanatory variable in year two of emerging adulthood the measure of imbalance for the

27

set of control variables, which included starting a new romantic relationship in year one
of emerging adulthood, was GI = .46795322 prior to matching, and was GI = 3.385 X 10
-
15
after matching. This transition was positively and significantly associated with past-
month cigarette use and binge drinking in year two of emerging adulthood (Table 2).
When experiencing a breakup was defined as the primary explanatory variable in year
two of emerging adulthood, the measure of imbalance for the set of control variables was
GI = .44681454 prior to matching, and was GI = 4.675 X 10
-16
after matching. This
transition was positively and significantly associated with past-month cigarette use, binge
drinking, and marijuana use in year two of emerging adulthood.
When starting a new job was defined as the primary explanatory variable in year
two of emerging adulthood the measure of imbalance for the set of control variables was
GI = .36438526 prior to matching, and was GI = 3.016 X 10
-16
after matching. This
transition was positively and significantly associated with past-month binge drinking and
marijuana use in year two of emerging adulthood. When starting school was defined as
the primary explanatory variable in year two of emerging adulthood the measure of
imbalance for the set of control variables was GI = .47197348 prior to matching, and was
GI = 7.733 X 10
-16
after matching. This transition however was not significantly
associated with past-month substance use in year two of emerging adulthood. When
moving residences was defined as the primary explanatory variable in year two of
emerging adulthood the measure of imbalance for the set of control variables was GI =
.52675706 prior to matching, and was GI = 1.048 X 10
-15
after matching. This transition
was positively and significantly associated with past-month binge drinking in year two of
emerging adulthood.

28

Table 1.
Role transitions and past-month substance use in year 1 of emerging adulthood.
a

Cigarettes Binge drinking Marijuana Hard-drugs
Transition OR (95% CI)
Started romance

Experienced breakup

Started job

Started school

Moved residences

1.75 (1.32, 2.32)
n=1,192

1.30 (0.97, 1.74)
n=1,201

1.25 (0.95, 1.64)
n=1,219

1.00 (0.76, 1.33)
n=1,218

1.03 (0.76, 1.40)
n=1,195

1.49 (1.17, 1.89)
n=1,188

1.70 (1.31, 2.22)
n=1,195

1.26 (1.01, 1.60)
n=1,215

1.03 (0.82, 1.29)
n=1,212

1.03 (0.81, 1.32)
n=1,190

1.35 (1.02, 1.79)
n=1,185

1.83 (1.36, 2.45)
n=1,193

1.35 (1.03, 1.76)
n=1,212

1.19 (0.91, 1.59)
n=1,209

1.19 (0.90, 1.60)
n=1,189

0.95 (0.53, 1.71)
n=1,197

1.78 (1.06, 3.00)
n=1,203

1.29 (0.75, 2.22)
n=1,222

0.91 (0.52, 1.62)
n=1,220

0.99 (0.57, 1.75)
n=1,199

a
Numbers in cells are odds ratios with 95% confidence intervals and useful sample size. An individual cell describes the
relationship between a role transition and an outcome of interest after coarsened exact matching was used to reduce
imbalance. Participants were matched on substance use in high school, gender, levels of depression, and age as measured
in year one of emerging adulthood.

29

Table 2.
Role transitions and past-month substance use in year 2 of emerging adulthood.
a

Cigarettes Binge drinking Marijuana Hard-drugs
Transition OR (95% CI)
Started romance

Experienced breakup

Started job

Started school

Moved residences

1.40 (1.01, 1.94)
n=1,043

1.66 (1.18, 2.35)
n=1,042

1.16 (0.85, 1.58)
n=1,124

1.00 (0.72, 1.39)
n=1,084

1.12 (0.78, 1.58)
n=1,068

1.37 (1.06, 1.79)
n=1,038

1.50 (1.13, 2.00)
n=1,038

1.71 (1.35, 2.18)
n=1,119

0.82 (0.64, 1.04)
n=1,079

1.34 (1.03, 1.74)
n=1,065

0.80 (0.59, 1.09)
n=1,032

1.44 (1.04, 2.00)
n=1,033

1.34 (1.01, 1.78)
n=1,114

1.04 (0.78, 1.40)
n=1,075

0.94 (0.69, 1.27)
n=1,057

1.16 (0.69, 1.97)
n=1,039

1.50 (0.90, 2.49)
n=1,038

0.98 (0.59, 1.65)
n=1,120

1.24 (0.73, 2.12)
n=1,080

1.50 (0.85, 2.64)
n=1,064
a
Numbers in cells are odds ratios with 95% confidence intervals and useful sample size. An individual cell describes the
relationship between a role transition and an outcome of interest after coarsened exact matching was used to reduce
imbalance. Participants were matched on substance use in high school, gender, levels of depression, age, and a prior role
transition as measured in year 1 of emerging adulthood.

30

Discussion
The present study identified specific role transitions that were associated with
substance use among Hispanic emerging adults. The findings presented herein improve
the literature on role transitions and substance use among emerging adults in several
ways. The longitudinal data utilized in this study allowed for the inclusion of substance
use behaviors in high school. Controlling for such characteristics assured that the findings
presented herein were not simply describing the associations between role transitions and
substance use among previous substance users. The hypotheses tested herein were
theoretically driven and falsifiable. By employing CEM, model dependence was reduced
assuring that the findings presented herein described an empirical picture of the data
generation process rather than idiosyncratic characteristics of the data. Findings were also
void of post-treatment bias while considering pretreatment variables that could serve as
potential confounders such as negative affect and prior substance use behaviors. These
findings should be incorporated into intervention and prevention programs in the future.
Starting a new romantic relationship was associated with increased cigarette use,
binge drinking, and marijuana use, which is similar to findings from cross-sectional
research (Allem et al., 2013;Allem et al., 2013a), as well as longitudinal research
(Fleming et al., 2010; Staff et al., 2010), among emerging adults. Starting a romantic
relationship was associated with increased cigarette use and binge drinking after taking
into account those who already experienced this transition in the prior year. These
findings demonstrated that transitions that occur in consecutive years, or occur repeatedly
throughout emerging adulthood, have similar influences on substance use. This suggests
that emerging adults do not become desensitized to role transitions by virtue of

31

experiencing them multiple times. Substance use may be relied upon to cope in order to
deal with negative affect from uncertainty and stress that accompanies transitions in love.
These patterns may persist until the individual learns more adaptive coping strategies.
Experiencing a breakup was associated with increased binge drinking, marijuana
use, and hard drug use, which is similar to prior research (Allem, Soto, Baezconde-
Garbanati & Unger, 2015; Allem et al., 2013a; Allem et al., 2013). Experiencing a
breakup was associated with increased cigarette use, binge drinking, and marijuana use
after taking into account those who already experienced this transition in the prior year.
Similar to starting a new romantic relationship, experiencing a breakup is a transition that
continues to influence substance use decisions throughout emerging adulthood.
Romantic relationships -starting and stopping- may be one of the most salient role
transitions experienced by emerging adults causing feelings of anxiety during the initial
stages of the relationship, and causing feelings of distress at the dissolution of the
relationship. The findings presented herein suggested polysubstance use might also occur
among emerging adults who recently start or stop romantic relationships. The
combination of cigarettes, alcohol, marijuana, and hard drugs may be preferred among
emerging adults who experience transitions in romance because of a more intense need of
relief, and a perceived feeling that more relief will come from using multiple substances
beyond that perceived with using one substance alone.
Starting a new job was associated with increased binge drinking and marijuana
use. These relationships persisted after taking into account those who already experienced
starting a new job in the prior year. These findings departed from earlier research that
reported substance use was not associated with the acquisition of full-time work among

32

emerging adults (Staff et al., 2010). An even earlier studied reported that obtaining
fulltime employment after college was associated with reduced drinking among emerging
adults (Gotham, Sher, & Wood, 1997). These discrepancies may be a result of post-
treatment bias found in earlier studies (Staff et al., 2010), where the researcher controlled
for the consequence of their key causal variable, and for most of the effects of it,
therefore biasing the overall effect. Alternatively, these discrepancies may be a result of
differences in conceptualization and operationalization of transitions in employment. The
present study captures a new job transition whereas previous measures capture, what
some may say is, a milestone of emerging adulthood--fulltime employment after college.
In contrast to prior studies, the present study may be describing the relationship between
changes in jobs and substance use among individuals who do not consider their current
job a long time commitment or a stable/reliable source of income. Additionally, the
present sample of emerging adults comprised those who attend college and those who do
not. This sample of emerging adults may be particularly sensitive to employment and the
subsequent stress from new employment because they grew up in a time of economic
turmoil (e.g., the Great Recession). As such, new employment may be perceived as a
source of stress that leads to substance use until perceptions of job security are solidified,
or positive coping strategies are developed.
Transitions in education were not associated with substance use in either year of
emerging adulthood. The present study asked participants about starting college or new
classes whereas previous studies measured completion of post-secondary education (Staff
et al., 2010). Staff and colleagues (2010) found that cigarette, marijuana, and cocaine use
declined after the receipt of a baccalaureate degree, but alcohol use increased. Future

33

research should examine both the commencement and completion of education as it
pertains to substance use in order to parse out these associations among emerging adults.
Samples that include emerging adults who attend college and those who do not are
necessary in order to better understand the relationship between transitions in education
and substance use.
Transition in residency was not associated with substance use outcomes in year
one of emerging adulthood, but was associated with binge drinking in year two. Future
research should examine the context of transition in residency. Emerging adults may
move for a variety of reasons in emerging adulthood including financial constraints, start
of a new job, or new school, romantic relationships etc. These nuances may be important
to better understanding the relationship between transitions in residency and substance
use.
Limitations
This study is not without its limitations. The role transitions examined herein may
not reflect all the important transitions in emerging adulthood that are associated with
substance use. This study, however, used the role transitions previously hypothesized to
be associated with substance use among emerging adults. This study showed which
specific role transitions were associated with substance use, however did not demonstrate
whether or not the accumulated number of role transitions experienced in a short period
of time were associated with substance use. Demonstrating a possible dose response
relationship using matching techniques like the one proposed herein is, however,
computationally complicated and lacks theoretical support. Using a data processing
technique like matching ultimately reduces the sample size used in analyses. This could

34

result in a loss of statistical power increasing the chances of committing a type 2 error.
The measure of hard drug use did not include all known hard drugs (e.g., heroin), but did
include five substances. All outcomes were dichotomous limiting the understanding of
frequency of substance use. The findings herein may not generalize to other racial/ethnic
groups.
Notwithstanding these limitations, findings from this study should inform
intervention and prevention programs aimed at reducing the use of substances, and
substance use related disparities among Hispanic emerging adults. It is crucial to know
which role transitions are associated with substance use among emerging adults in order
to design tailored prevention and intervention programs. Previous intervention programs
for Hispanics have not discerned between emerging adults and other age groups (Webb,
Rodríguez-Esquivel, & Baker, 2010). In other words, previous intervention programs
have not focused on the unique characteristics taking place in their participants’ lives,
with the exception of pregnancy (Fitzgerald, 2012; Simmons, Cruz, Brandon, & Quinn,
2011; Pollak et al., 2010), and how these characteristics may drive the prevalence of
substance use. Intervention planners should consider the findings described herein as a
point of departure in the creation of such programs for Hispanic emerging adults.
Intervention programs for Hispanics are often tailored on the basis of a general cultural
framework (Woodruff, Talavera, & Elder, 2002). For example, Promotores or health
advisors who share commonalities with their participants (e.g., ascriptive traits, cultural
values, social network) have been employed to deliver intervention programs to Hispanic
smokers based on the belief that participants will be more responsive to someone from
their community from who they are familiar (Woodruff et al., 2002). Culturally tailored

35

interventions, however, have produced small effect sizes (Webb et al., 2010), or null
results (Cabriales, Cooper, Salgado-Garcia, Naylor, & Gonzalez, 2012). Programs that
have been successful have utilized counseling over the phone (Wetter et al., 2007),
however this approach was not tested among emerging adults. What may be missing from
intervention programs is an appreciation of different age groups among adults. The age
group at highest risk of substance use may need an intervention program cultivated to
address the specific characteristics in emerging adulthood that are associated with
substance use. One way to compliment interventions motivated by a cultural framework
would be to incorporate characteristics from emerging adulthood into program material
for emerging adults. The findings from this study should galvanize the design of specific
intervention and prevention programs for Hispanic emerging adults that will ultimately
lead to a reduction in the prevalence of substance use among this priority population.

36

Study #2
Adverse childhood experiences and substance use among Hispanic emerging adults
Introduction
Emerging adulthood is a time of exploration, transition, and development between
the ages of 18 and 25 (Arnett, 2011). The use of tobacco products, illicit drugs, and binge
drinking can undermine optimal development. In the U.S. emerging adults had the
highest rate of tobacco product use (38.1%) compared with youths aged 12 to 17 (8.6%),
and older adults aged 26 or older (27.0%) in 2012 (Substance Abuse and Mental Health
Services Administration, 2013). The rate of current illicit drug use (e.g.,
marijuana/hashish, cocaine [including crack], heroin, hallucinogens, inhalants, or
prescription-type psychotherapeutics used nonmedically) was also higher among
emerging adults (21.3%) than among youths (9.5%), and older adults (7.0%) in 2012
(Substance Abuse and Mental Health Services Administration, 2013). Additionally, the
rate of binge drinking (e.g., five or more drinks on the same occasion) was higher among
emerging adults (39.5%) than among youths (7.2%), and among persons older than 65
(8.2%) in 2012 (Substance Abuse and Mental Health Services Administration, 2013).
The prevalence of tobacco product use, drug use, and binge drinking varies by
ethnicity (Regina, Miles, Tucker, Zhou, & D'Amico, 2010), with Hispanics described as a
priority population for substance use prevention (Stone, Becker, Huber, & Catalano,
2012). The literature on substance use among Hispanic emerging adults is growing, but
still in its nascent stage. Recent studies have focused on how role transitions, or
disruptions of daily life, are associated with substance use among Hispanic emerging
adults. These studies viewed substance use as a maladaptive coping strategy where

37

substance use starts and increases for emerging adults shortly after a role transition is
experienced (Arnett, 2005). For example, loss of a job, experiencing a breakup, starting
to date someone new, being arrested, and becoming a caregiver for a family member
were associated with past-month cigarette use (Allem, Soto, Baezconde-Garbanati, &
Unger, 2013). Being arrested, experiencing a breakup, starting to date someone new,
starting a new job, and experience a demotion at work were found to be associated with
binge drinking and marijuana use among Hispanic emerging adults (Allem, Lisha, Soto,
Baezconde-Garbanati, & Unger, 2013). While identifying which role transitions are
associated with substance use has been useful in furthering the literature on Hispanic
emerging adults, a critical next step to reducing the prevalence of substance use among
this priority population may involve understanding how adverse childhood experiences
are associated with substance use (Rosenberg, 2011). Emerging adults who experienced
stressful childhoods may also engage in substance use as maladaptive coping strategies in
order to avoid negative emotions.
Frameworks that describe early emotional development provide insight to why
maladaptive coping mechanisms start and continue among individuals who experience
trauma in childhood (Bradley et al., 2011; Gerson & Rappaport, 2013; Schore, 2009).
One of the earliest unfortunate situations an individual can be born into is abuse in
childhood. Abuse and other traumatic events ultimately impact how the child sees the
world and views interpersonal relationships (Schore, 2009). An automatic response to
overwhelming situations, especially situations out of the control of the child, is to
disassociate (e.g. detach from the immediate surroundings) (Dalenberg et al, 2012).
When mechanisms like disassociation are repeatedly used as a defense in order to shutout

38

affective responses to events or people, there are direct consequences on child
development (Schore, 2014). One such consequence is the inability to form secure
attachment (e.g., a biological impulse to gravitate toward a caregiver or parent in the face
of discomfort) (Schore, 2002; Landers & Sullivan, 2012; Sullivan, 2012), which has been
described as the biological preamble for processes like intimacy and emotional regulation
(Porgess & Furman, 2011).
It has been shown that biological experiences provide the capacity for individuals
to develop attachment and eventually emotional regulation (Porgess, 2009; Rincón-
Cortés & Sullivan, 2014). This biological development starts in infancy and is informed
by social relationships. One specific requisite for secure attachment is the sense of safety
(Porgess, 2003). The feeling of safety is developed by reciprocal signals between
offspring and caregiver, and is molded by the offspring’s environment. If the feeling of
safety is present for the offspring, secure attachment can develop (Porgess, 2001). In
other words, there are substrates for intimacy that allows for closeness and the capacity
for emotional regulation, and in the presence of adverse childhood experiences these
processes are retarded, and the ability to form secure attachment, and subsequently the
ability to regulate emotions is curbed. With an impaired ability to regulate emotions,
individuals may engage in substance use in order to cope with the sequela of trauma.
Adverse childhood experiences violate one of the pillars of group oriented
cultural paradigms, the family (Triandis, McCusker, & Hui, 1990). Given the
collectivistic values Hispanics encounter growing up (Arnett, 2003; Shkodriani &
Gibbons, 1995; Gaines et al., 1997), this betrayal may have an influential role in
substance use decisions. Alternatively, adverse childhood experiences may not have an

39

association with substance use among Hispanics, as their strong family ties could
mitigate the potential maladaptive behaviors associated with these adverse experiences.
This study examined whether or not adverse childhood experiences were associated with
substance use among Hispanic emerging adults in order to inform prevention and
intervention programs for this priority population.
Hypothesis 1: The accumulated number of adverse childhood experiences will be
positively associated with substance use.
Hypothesis 2: Individual adverse childhood experiences will be positively
associated with substance use.
Methods

Participants

Participants filled out surveys for Project RED (Retiendo y Entendiendo
Diversidad para Salud), a longitudinal study of cultural risk and protective factors for
substance use among Hispanics in Southern California (Lorenzo-Blanco, Unger, Ritt-
Olson, Soto, & Baezconde-Garbanati, 2013). Originally, participants joined the study as
adolescents, while attending one of seven high schools in the greater Los Angeles area.
Details on school recruitment, student recruitment, and survey procedures have been
published elsewhere (Unger, Ritt-Olson, Wagner, Soto, & Baezconde-Garbanati, 2009).
The university’s Institutional Review Board approved all procedures. Participants who
self-identified as Hispanic, Latino or Latina, Mexican, Mexican-American, Chicano or
Chicana, Central American, South American, Mestizo, La Raza, or Spanish were
surveyed in emerging adulthood from January 2012 to December 2013. Research
assistants sent letters to respondents’ last known addresses, and invited them to call a toll-

40

free phone number, or visit a website to participate in the study. If participants could not
be contacted with the information they had provided in high school, staff searched for
them online using social networking sites, and publicly available search engines. These
tracking procedures resulted in 2,151 participants with valid contact information. A total
of 1,420 (66%) emerging adults provided verbal consent over the phone, or read the
consent script online, and clicked a button to indicate consent, and participated in the
survey. Those lost to follow-up were significantly more likely to be male, report binge
drinking, marijuana use, and hard drug use in high school, but did not differ on age, or
smoking status in high school.
Measures

Researchers at Kaiser Permanente originally developed the adverse childhood
experiences scale (Felitti et al., 1998); this scale was adopted for the present study. The
adverse childhood experiences score is an integer count of eight distinct categories of
adverse childhood experiences, and measures cumulative exposure to trauma in
childhood. Prior to the adverse childhood experiences scale, research had shown physical
and sexual abuse in childhood was associated with deleterious health behaviors
(Heffernan et al., 2000; Kendler, 2000). The adverse childhood experiences scale added a
comprehensive approach to measuring trauma in childhood. In other words, prior to the
development of the adverse childhood experiences scale, few studies examined childhood
trauma in relation to multiple distressing childhood exposures. Trauma in childhood does
not regularly result in a diagnosis of post-traumatic stress disorder (PTSD) (Copeland,
Keeler, Angold, & Costello, 2007), providing further rationale for studying distressing

41

events in childhood with an integer count rather than exclusively studying those with a
clinical diagnosis.
Coding of the adverse childhood experiences measures, and the subsequent
analysis strategy were informed by prior research conducted by the original authors of the
scale (Anda et al., 1999). All questions regarding adverse childhood experiences referred
to the participants’ first 18 years of life. Participants were prompted with the statement:
“The next set of questions will be about events that may have happened to you while
growing up in the first 18 years of life…” Verbal abuse was determined from answers to
the following two questions: “…how often did a parent, stepparent, or adult living in your
home swear at you, insult you, or put you down?” and “…how often did a parent,
stepparent, or adult living in your home threaten to hit you or throw something at you, but
didn’t do it?” Responses of “often,” or “very often,” to either item defined verbal abuse
during childhood. Physical abuse was determined from answers to the following two
questions: “…how often did a parent, stepparent, or adult living in your home push, grab,
slap, or throw something at you?” and “…how often did a parent, stepparent, or adult
living in your home hit you so hard that you had marks or were injured?” A participant
was defined as being physically abused if their response was either “often,” or “very
often,” to the first question or “sometimes,” “often,” or “very often,” to the second.
Sexual abuse was measured by the following: “Some people, while they are growing up
in their first 18 years of life, had a sexual experience with an adult or someone at least 5
years older than themselves. These experiences may have involved a relative, family
friend, or stranger. During the first 18 years of life, did an adult, relative, family friend, or
stranger ever (1) touch or fondle your body in a sexual way, (2) have you touch their

42

body in a sexual way, (3) attempt to have any type of sexual intercourse with you (oral,
anal, or vaginal), (4) actually have any type of sexual intercourse with you (oral, anal, or
vaginal)?” A “yes” response to any 1 of the 4 questions defined a participant as having
experienced sexual abuse during childhood.
Battered mother was determined by answers to four questions as follows:
“Sometimes physical blows occur between parents. While you were growing up in your
first 18 years of life, how often did your father (or stepfather) or mother’s boyfriend do
any of these things to your mother (or stepmother) (1) push, grab, slap or throw
something at her, (2) kick, bite, hit her with a fist, or hit her with something hard, (3)
repeatedly hit her over at least a few minutes, (4) threaten her with a knife or gun, or use
a knife or gun to hurt her?” A response of “sometimes,” “often,” or “very often” to at
least 1 of the first 2 questions or any response other than “never” to at least 1 of the third
and fourth questions defined a participant as was having had a battered mother.
Household substance abuse was determined by asking participants if they lived with
anyone who was a problem drinker or alcoholic, or with anyone who used street drugs
during childhood. A “yes” response to either question indicated childhood exposure to
substance abuse in the household. Mental illness in the household was determined by
asking participants if anyone in their household was depressed or mentally ill, or anyone
in their household attempt to commit suicide during childhood. A “yes” response to either
question indicated childhood exposure to mental illness in the household. Parental
separation or divorce was determined by a “yes” response to the question: “Were your
parents ever separated or divorced?” Incarcerated household members was determined

43

by a “yes” response to the question: “While you were growing up, that is, in your first 18
years of life, did anyone in your household go to prison?”
Poor mental health, such as feeling depressed, could confound the relationship
between adverse childhood experiences and substance use (Anda et al., 2002; Douglas et
al., 2010). As such, a version of the Boston short-form CES-D as developed by Kohout
and colleagues (1993), and validated among Hispanics by Grzywacz and colleagues
(2006), was adopted to measure depression. Participants were prompted with the
statement, “These next question are about how you have felt in the past week…” and
provided ten survey items which included, “I felt depressed,” “I felt that everything I did
was difficult,” “I didn’t sleep well,” “I was happy,” “I felt lonely,” “People were
unfriendly,” “I enjoyed life,” “I felt sad,” “I felt people disliked me,” and “I could not get
‘going’.” Response options were “Less than 1 day or never” coded as 1, “1-2 days” coded
as 2, “3-4 days” coded as 3, and “5-7 days” coded as 4. Response options for items “I
was happy,” and “I enjoyed life” were reverse coded. For each of the ten items,
participants who reported either a 0 or 1 were then recoded to 0 and those who reported a
2, 3 or 4, were recoded to 1 to approximate the yes/no response sequence described by
Kohout and colleagues (1993). Responses to the ten items were then summed
(Cronbach’s alpha =. 84). Age and gender were also measured in this study.
Past-month cigarette use, past-month marijuana use, past-month binge drinking
(e.g., five or more drinks of alcohol in a row, that is, within a couple of hours) and past-
month hard drug use (e.g., cocaine, methamphetamines, MDMA or Ecstasy, LSD, and
Inhalants) were the four specific outcomes of interest. Each outcome was coded so that a
1, or a “yes” response, represented any use in the past-month of the specific substance in

44

question. A 0, or a “no” response, represented that the respondent did not use the
substance in question in the past-month.
Analysis plan

While data gathered from Project RED is longitudinal, data was analyzed from a
single time point (year 2 of emerging adulthood-the year adverse childhood experiences
were measured). The total number of adverse childhood experiences was summed for
each participant (range, 0-8); each substance use outcome was then regressed on the
summed score as an ordinal variable. This analysis determined if the accumulated
number of adverse childhood experiences was associated with increased substance use
(H1). Each substance use outcome was then regressed on each category of adverse
childhood experiences. This analysis determined which category of adverse childhood
experiences was associated with increased substance use (H2). For every model the
control variables were age, gender, and levels of depression.
Statistical significance for all tests were determined by p<.05. For all analyses,
quantities of interest were calculated using the estimates from each multivariable analysis
by simulation using 1,000 randomly drawn sets of estimates from a sampling distribution
with mean equal to the maximum likelihood point estimates, and variance equal to the
variance-covariance matrix of the estimates, with covariates held at their mean values
(King, Tomz, & Wittenberg, 2000). This analytical approach is akin to a bootstrapping
approach, or a fully Bayesian Markov-Chain Monte Carlo (MCMC) technique, however
unlike bootstrapping it does not give bias estimates for certain quantities of interest e.g.,
max(Y), and unlike MCMC there are no problems stemming from model convergence
(King et al., 2000).

45

There are multiple benefits of this simulation approach, including converting raw
statistical results into results that everyone, regardless of statistical training, can
comprehend e.g., reporting results in term of probabilities rather than in terms of odds
ratios or log of odds. This conversion of results allows for meaningful communication
between scientists and nonscientists when discussing the relationships between
explanatory variables and the outcome of interest. This simulation approach also provides
an assessment of uncertainty surrounding any quantity of interest (e.g., checks the
stability of the results). Moreover, interpreting results from statistical analyses require
more than an evaluation of estimated parameters. Providing meaningful interpretations of
data require an evaluation of the functions of the estimated parameters. The most
common functions of estimated parameters include the predicted value of the dependent
variable for a specific subject or subset of subjects in the data, and the effect of a change
in an explanatory variable on the predicted value of the dependent variable. The
calculation of a function itself is computationally straightforward; however providing a
measure of efficiency (confidence interval) of the function’s value is challenging, and
often times undefined (cannot arrive at a closed form solution). By employing this
simulation procedure, this study will be able to provide confidence intervals that allow
for an evaluation of the function itself e.g., evaluate the proportion of the function’s
values that would fall within a given range, if the data generation process were repeated
m times.
This analytical strategy can be delineated in five steps: 1) Following the
procedure for simulating parameters, draw one value of the vector γ = vector (beta or
coefficient, corresponding probability value or alpha). 2) Choose one value for each

46

explanatory variable and denote the vector of values as Xc. 3) Taking the simulated effect
coefficient from the top portion of γ, compute the estimate of the beta or coefficient for
some value of Xc. 4) Dram m values (m will be equal to 1,000) of the outcome variable
from the random component of the equation. This step simulates fundamental
uncertainty. 5) Average over the fundamental uncertainty by calculating the mean of the
m simulations to yield one simulated expected value E(Y).
Results
Among the participants, 41% were male, and the average age was 22 years (Table
1). The three most common adverse childhood experiences were parental
separation/divorce (37%), household substance abuse (36%), and physical abuse (30%).
The average number of adverse childhood experiences was two. Twenty-seven percent
(27%) of participants reported 0 adverse childhood experiences, and 1% of participants
reported experiencing all 8. The accumulated number of adverse childhood experiences
was statistically significantly associated with each category of substance use.
A difference in the number of adverse childhood experiences, from 0 to 8, was
associated with a 22% (95% Confidence Interval [CI], 11 to 35) higher probability of
cigarette smoking among Hispanic emerging adults (Figure 1A). The same, 0 to 8,
difference in the number of childhood experiences was associated with a 24% (95% CI,
13 to 35) higher probability of binge drinking among Hispanic emerging adults (Figure
1B). Additionally, the same difference in the number of adverse childhood experiences,
from 0 to 8, was associated with a 31% (95% CI, 19 to 44), and 12% (95% CI, 4 to 20%
higher probability of marijuana use (Figure 1C), and hard drug use (Figure 1D),
respectively among Hispanic emerging adults.

47

Specific categories of adverse childhood experiences were also statistically
significantly associated with substance use. Participants who reported verbal abuse,
household substance abuse, parental separation or divorce, and mental illness in the
household had higher probabilities of past-month cigarette use, ranging from 9% (95%
CI, 3 to 16) to 7% (95% CI, 1 to 13), compared to those who did not respectively (Figure
2A). Participants who reported physical abuse, household substance abuse, an
incarcerated household member, mental illness in the household, sexual abuse, and verbal
abuse had higher probabilities of past-month binge drinking, ranging from 13% (95% CI,
7 to 19) to 7% (95% CI, 0 to 15), compared to those who did not respectively.
Participants who reported mental illness in the household, parental separation or divorce,
verbal abuse, household substance abuse, and physical abuse had higher probabilities of
past-month marijuana use, ranging from 12% (95% CI, 6 to 19) to 9% (95% CI, 4 to 14),
compared to those who did not respectively (Figure 2B). Participants who reported
sexual abuse, verbal abuse, and physical abuse had higher probabilities of past-month
hard drug use, ranging from 6% (95% CI, 2 to 10) to 3% (95% CI, 1 to 6), compared to
those who did not respectively.

48

Table 3.

Sample Characteristics.
a

Mean 95% C.I. N
Age
Male
Past 30 day binge drinking
Past 30 day marijuana use
Past 30 day smoking
Past 30 day hard-drugs
Parental separation/divorce
Household substance abuse
Physical abuse
Incarcerated household member
Mental illness in household
Sexual abuse
Verbal abuse
Battered mother
22.60
.41
.45
.24
.23
.05
.37
.36
.30
.23
.22
.16
.16
.13
22.58, 22.62
.38, .44
.43, .48
.22, .26
.20, .25
.04, .06
.35, .40
.33, .38
.27, .32
.21, .25
.20, .24
.14, .18
.15, .18
.11, .15
1417
1420
1396
1396
1406
1410
1391
1402
1394
1394
1402
1392
1394
1400
a
Brief demographic and prevalence characteristics of sample. Numbers in cells are
means, associated 95% confidence intervals, and useful sample size for each concept.

49

A. Cigarettes B. Binge drinking

C. Marijuana D. Hard-drugs

Figure 2. Accumulated number of adverse childhood experiences and substance use. (A) Shows the predicted probability of past-month cigarette use,
(B) past-month binge drinking, (C) past-month marijuana use, and (D) past-month hard drug use by number of number of adverse childhood experiences.
The estimates were produced by simulation using 1000 randomly drawn sets of estimates from the coefficient covariance matrix of each logistic regression
model with covariates held at their mean values.

50

A. Cigarettes and binge drinking

B. Marijuana and hard drugs

Figure 3. Categories of adverse childhood experiences and substance use.
(A) Shows the change in predicted probability of past-month cigarette use, and binge drinking, while (B) shows the change in predicted probability of past-
month marijuana use, and hard drug use, with 95% confidence intervals. An overlapping confidence interval with zero indicates a null result with α = .05.
Estimates were calculated by simulating the first difference in each adverse childhood experience e.g., verbal abuse from 0 to 1. Each estimate was arrived
by the use of 1000 randomly drawn sets of estimates from each respective coefficient covariance matrix with control variables held at their mean values.

51

Discussion

The present findings suggest there is a positive association between adverse
childhood experiences and substance use among Hispanic emerging adults. Earlier
studies have shown associations between adverse childhood experiences and cigarette use
(Anda et al., 1999), alcohol use (Dube, Anda, Felitti, Edwards, & Croft, 2002) and drug
use (Dube et al., 2003). These studies, however, did not comprise a sample of participants
in the age group at highest risk for substance use, a priority ethnic population, nor did
they include a sample of participants drawn from a collectivistic culture. Adverse
childhood experiences represent the harms or disturbances within families or group
dynamics. These disturbances could be paramount for populations like Hispanic
emerging adults, as families are perceived as a source of strength, and support, making
Hispanic emerging adults especially vulnerable to the sequela of trauma in childhood.
There may be several explanations for these associations. Adverse events may
make children more aggressive, more oppositional, or less bounded to schools, churches,
and community organizations, so they start to affiliate with deviant peer groups who
influence decisions regarding substance use. Certain adverse childhood experiences
involve substance use, or may be more likely to occur when someone is using substances,
therefore these associations may reflect an inherited susceptibility to substance use.
Adverse experiences taking place in childhood may impair the cognitive, emotional, and
behavior development of children (Repetti, Taylor, & Seeman, 2002). This impairment
may be a function of changes in the brain’s physiology during the course of development
(McEwen, 2007), and/or it may be a result of environmental factors inhibiting the child’s
ability to develop (Jaffee & Maikovich-Fong, 2011). In either case, these impairments

52

may lead the child to develop unhealthy coping mechanisms (Stevens, Colwell, Smith,
Robinson, & McMillan, 2005). Unhealthy coping mechanisms such as smoking, binge
drinking, marijuana use, or hard drug use may not dissipate until they are properly
treated, and the individual learns more effective responses to negative emotions. If not
corrected by emerging adulthood, addiction may set in with a physiological need for
substances posing as an additional barrier to abstinence in the future.
Limitations
Limitations of this study include reliance upon self-reported data to determine
substance use, and to determine adverse childhood experiences. Studies of test-retest
reliability of retrospective reports of adverse childhood experiences have shown
agreement (Dube, Williamson, Thompson, Felitti, & Anda, 2004), while other
examinations suggested adult retrospective reports might be unreliable and bias (Hard &
Rutter, 2004). It is likely, however, that false negatives would be more common than
false positive biasing results toward the null. In other words, individuals may be reticent
to admit trauma in childhood therefore biasing the results toward no association with
substance use. Given the significant associations found between adverse childhood
experiences and substance use in the present study, one may conclude Hispanic emerging
adults are willing to report on their adverse childhood experiences.
The adverse childhood experiences scale employed in the present study may not
be an exhaustive measure of exposure to trauma in childhood. Previous research has
suggested peer rejection, exposure to violence outside the home, low socioeconomic
status, and poor academic performance be incorporated into the scale (Finkelhor,
Shattuck, Turner, & Hamby, 2013). Including these constructs, and expanding the scale

53

should be an area of future research. The scale used herein is one of many ways exposure
to trauma in childhood has been correlated with substance use (Young-Wolff, Kendler, &
Prescott, 2012; Schilling, Aseltine, & Gore, 2007; Douglas et al., 2010; Kabiru, Beguy, &
Ezeh, 2010; Kauhanen, Leino, Lakka, Lynch, & Kauhanen, 2011; Koss et al., 2003;
Schellekens et al., 2013; Zlotnick, Tam, & Robertson; 2004; Low et al., 2012; Rothman,
Bernstein, & Strunin, 2010; Meara & Frank, 2005). Future research should compare and
contrast the multitude of ways exposure to trauma in childhood can be measured in order
to improve the understanding on how adverse childhood experiences are associated with
substance use.
Conclusion
Findings presented herein coincide with prior research on Hispanic emerging
adults that suggest substance use is used as a maladaptive coping strategy (Allem et al.,
2013a; Allem et al, 2013b). Collectively, these findings indicate that substances are used
as a way to relieve negative emotions from stress, and that life events, both past and
present, are associated with these deleterious coping strategies among Hispanic emerging
adults. Findings from the present study coupled with earlier studies should inform
prevention and intervention programs targeted at this priority population. Primary and
secondary prevention programs could focus on emotional regulation and/or cognitive
restructuring, and the development of coping skills that address the distress associated
with the problematic relationships and behaviors within the family. Participants could
undergo group sessions that emphasize coping skills, mindfulness and social support.
Certified specialists in the area of trauma recovery could lead programs on how to
address short-term and long-term consequences of victimization and trauma. The cost of

54

substance use treatment in the U. S. extends to the hundreds of billions of dollars each
year (Meara & Frank, 2005). If treatment and prevention programs are not addressing the
underlying experiences that drive individuals to use substances, programs should be
reorganized in order to fully optimize these expenditures.

55

Study #3
Characteristics of emerging adulthood and electronic cigarette use among college
students
Introduction

Electronic cigarettes (e-cigarettes) were introduced into the United States (U.S.)
market roughly eight years ago (Cobb, & Abrams, 2014). A systematic review of the
literature concluded that overall population level awareness of e-cigarettes increased from
16% to 58% from 2009 to 2011, and overall current use of e-cigarettes increased from
1% to 6% (Pepper & Brewer, 2013). More than 250 e-cigarette brands are currently
available in retail stores and online (Benowitz, 2013), with products rapidly evolving to
meet consumer preferences and choice. Expenditures for e-cigarette advertising increased
from $6.4 million in 2011 to $18.3 million in 2012 (Kim, Arnold, Makarenko, 2014) with
health claims that are unsubstantiated by the present scientific evidence often used to sell
this product (Grana & Ling, 2014; The Lancet 2014). The number of e-cigarette users in
the U.S. alone is estimated to be 2.5 million (Cressey, 2013), and annual e-cigarette sales
in the U.S. were projected to reach $1.7 billion by the end of 2013 (Mangan, 2013), and
surpass $2.0 billion by the end of 2014 (Cobb & Abrams, 2014).
Our understanding of what drives the use of e-cigarettes has greatly lagged behind
the growth in popularity of this emerging tobacco product. The current literature does not
provide a comprehensive understanding of the personal, social, and cultural risk and
protective factors associated with e-cigarette use among the general population. Even
less is known about e-cigarette use among individuals from ethnically diverse
backgrounds, or among individuals in the phase of the life course when experimentation

56

with substances is highest e.g., emerging adulthood (ages 18 to 25) (U.S. Department of
Health and Human Services, 2012; SAMHSA, 2012).
Population-based surveys have found that emerging adults were more likely to
use emerging tobacco products, including e-cigarettes, compared to other age groups
(McMillen, Maduka, & Winickoff, 2012; McMillen, Gottlieb, Shaefer, Winickoff, &
Klein, 2014; Coleman et al., 2014). The factors that drive e-cigarette use are unclear, and
this lack of understanding is most evident among emerging adults (Carroll Chapman &
Wu, 2014). The initial research on e-cigarette use among emerging adults has been
comprised of focus groups among college students, or survey research on regional
samples with limited survey measures. For example, one focus group study illustrated
that emerging adults perceived e-cigarettes as accessible, convenient, and modern, with
half of the participants admitting they would try an e-cigarette, if offered one by a friend
(Choi, Fabian, Mottey, Corbett, & Forster, 2012). Findings from a mid-western regional
sample of emerging adults demonstrated that about 70% of the sample reported
awareness of e-cigarettes, 7.0% reported ever having used e-cigarettes, and about 1%
reported having used e-cigarettes in the past 30 days (Choi, & Forster, 2013). Participants
who were aware of e-cigarettes believed that e-cigarettes can help people quit smoking,
and are less harmful than combustible cigarettes, and about a quarter believed that e-
cigarettes are less addictive than combustible cigarettes (Choi, & Forster, 2013). In
essence, positive expectations about the use of e-cigarettes have been shown to be
associated with e-cigarette use in both cross sectional (Pokhrel, Little, Fagan, Muranaka,
& Herzong, 2014), and longitudinal research among emerging adults (Choi & Forster,
2014).

57

Studies on e-cigarette use among college students have been conducted on
predominantly Non-Hispanic white samples. For example, Sutfin, McCoy, Morrell,
Hoeppner, and Wolfson (2013) performed one of the largest studies on e-cigarette use
among emerging adults, and their sample comprised 80% Non-Hispanic white students
residing in North Carolina. Given the current literature, it is crucial that further empirical
research be conducted comprising samples of diverse participants, with the goal to
identify the additional factors associated with e-cigarette use among emerging adults. The
present study will add to the scientific knowledge by describing personal factors
associated with e-cigarette use among an underrepresented, and potentially more
vulnerable, sample of emerging adults.
Emerging adulthood is characterized by change, identity exploration, and
development (Arnett, 2011). This life stage is distinct from both adolescence and
adulthood, where young people have more autonomy, but have not yet engaged in all the
responsibilities of adult life (Arnett, 2000). In emerging adulthood, in industrialized
societies, young people experience life transitions and have the time to explore and
develop (Arnett, 2000). A crucial next step to understanding e-cigarette use among
emerging adults may involve understanding how transition-to-adulthood themes, or how
the specific thoughts and feelings regarding emerging adulthood, are associated with e-
cigarette use.
Hypothesis 1: Themes of emerging adulthood will be positively associated with
e-cigarette use.
This study expects the risk/protective factor profile for e-cigarettes to be different
from that of other substances due to their increasing trendiness and the fact that they are

58

marketed as less harmful than combustible cigarettes. For example, they may appeal to
emerging adults who are seeking to appear more “hip” by engaging in a behavior that is
growing in popularity among young people in the U.S., or they may appeal to emerging
adults who are trying to protect their families from secondhand smoke. Emerging adults
might perceive that using e-cigarettes help them to achieve certain developmental tasks of
emerging adulthood (e.g., individuation from parents, exploration of possibilities and
identities). Because multiple life transitions occur during emerging adulthood (e.g.,
starting to date, a new job), it is also crucial to know whether or not the accumulated
number of role transitions experienced by emerging adults is associated with e-cigarette
use. Understanding these associations is critical as one transition alone may not act to
influence e-cigarette use decisions, but rather a series of transitions taking place all in a
short period of time. Additionally, it is crucial to know which specific transitions are
associated with e-cigarette use.
Hypothesis 2: Those who experience many role transitions will be at greater risk
of e-cigarette use compared to those who experience few transitions.
Hypothesis 3: Specific transitions will be positively associated with e-cigarette
use.
Instability in emerging adulthood from changing residences, romantic
relationships, school, and work has been hypothesized to increase rates of substance use
among young people (Arnett, 2005). Arnett hypothesized, “substance use in emerging
adulthood will rise after specific instability events, i.e., in the weeks following a
transition in residence, love, school, or work” (Arnett, 2005). Disruption of daily life may
lead to anxiety, stress and sadness, which could ultimately lead to substance, or nicotine,

59

use as a form of self-medication (Khantzian, 1997). The hypotheses introduced in this
study are based on the assumption that nicotine is used as a maladaptive coping strategy,
and will start, and increase, when role transitions are experienced. Sinha (2008) proposed
a theoretical model where stress leads to increases in substance use as a way to reduce
stress-related negative affect. This process becomes reinforcing as a maladaptive coping
mechanism. This study will explore whether or not disruption of daily life or role
transitions, are associated with e-cigarette use in emerging adulthood potentially
alleviating uncomfortable feelings.
Methods
In order to survey an ethnically and sociodemographically diverse sample of
emerging adults, we coordinated with administrators from two colleges in the California
State University (CSU) system that facilitated access to an ethnically diverse sample of
emerging adults in the Los Angeles area. These two schools were among the most
socially diverse in the CSU system (College Portraits, 2013). This cultural, social and
economic diversity provided a unique opportunity to examine transition-to-adulthood
themes, role transitions, and e-cigarette use among a sample of emerging adults that is
absent in the current literature.
Campus wide emails were circulated and administrators from each college
campus posted flyers, and announced the current study on their respective CSU portal
systems (accessible by each campus homepage). Students received a description of the
study, were guaranteed confidentiality, and electronically signed consent forms. This
study employed a web-based survey tool that allowed participants to click on a link on a
computer or smart phone and submit responses electronically. All respondents were

60

offered a five-dollar gift card after they had completed the survey. All data were de-
identified for analytic purposes, and the institutional review board of the principal
investigator’s university approved all study procedures.
Measures
Transition-to-adulthood themes were assessed with the Inventory of the
Dimensions of Emerging Adulthood (IDEA) (Reifman, Arnett, & Colwell, 2007). The
IDEA instrument has six subscales, which measure the main themes or pillars of
emerging adulthood (Arnett, 2000). The survey items were prompted with “Please think
about this time in your life. By ‘time in your life,’ we are referring to the present time,
plus the last few years that have gone by, and the next few years to come, as you see
them. In short, you should think about a roughly five-year period, with the present time
right in the middle. Is this time in your life a …” Responses for each item included
“strongly disagree” coded 1, “somewhat disagree” coded 2, “agree” coded 3, and
“strongly agree” coded 4. The subscales, corresponding reliability coefficient, and an
example question are as follows: Identity Exploration (Cronbach's alpha [α]=0.83) e.g.,
“time of finding out who you are?”, Experimentation/Possibilities (α=0.78) e.g., “time of
many possibilities?”, Negativity/Instability (α=0.82) e.g., “time of confusion?”, Other-
Focused e.g., (α=0.66) “time of responsibility for others?”, Self-Focused (α=0.77) e.g.,
“time of personal freedom?”, and Feeling “In-Between” (α=0.72) e.g., “time of feeling
adult in some ways but not others?”.
The list of role transitions was developed by Allem, Soto, Baezconde-Garbanati,
and, Unger (2013), and modified for the present study to include 22 non-redundant role
transitions. The survey items for these 22 transitions were prompted with “Has this

61

happened to you in the last year?” with responses coded 1 “yes” or 0 “no”. The 22 items
were, “Started dating someone,” “Started a new romantic relationship,” “Got engaged,”
“Got married,” “Moved in with boyfriend or girlfriend,” “Broke up with boyfriend or
girlfriend,” “Got a divorce,” “Had a baby,” “Lost a baby,” “Got a new job,” “Lost a job,”
“You were demoted or forced to work fewer hours,” “You were unemployed, seeking
work but unable to find it,” “Had to care for a parent or relative,” “Stopped having to care
for a parent or relative,” “Had to babysit siblings or family members,” “Stopped
babysitting siblings or family members,” “Got extremely ill,” “Overcame serious illness,”
“Were arrested,” “Became addicted to drugs or alcohol,” and “Overcame addiction to
drugs or alcohol.” Summing the 22 individual role transitions created the measure of
accumulated number of role transitions. The highest 1.5% of total transitions experienced
(>9 transitions) was recoded as the 98.5% value (8 transitions). This adjustment
prevented extrapolation to a very small group where very few cases were observed but
reduced the skewness of the measure.
The outcomes of interest were lifetime e-cigarette use, and past-month e-cigarette
use. Survey items on e-cigarette use were prompted with the following statement, “The
next few questions are about electronic or e-cigarettes, also called vape pens or e-
hookahs. E-cigarettes are battery operated and produce vapor instead of smoke. There are
also e-pipes and e-cigars. Some e-cigarettes are disposable and some are rechargeable.
Fluid for e-cigarettes comes in many different flavors and nicotine concentrations and is
sometimes called ‘juice’ or ‘e-juice’. When we ask bout an ‘e-cigarette’ in the next few
questions, we mean any product that fits this description.” Each outcome was coded 1
“yes” and 0 “no” with a 1 indicating any use of an e-cigarette in the specified time period

62

e.g., lifetime use, and past-month use. Age was coded in years, and gender was coded 1
“male” or 0 “female.” Race/ethnicity was coded into five categories: 1) Non-Hispanic
White, 2) Hispanic or Latino/a, 3) Black or African American, 4) Other (Asian, American
Indian, Alaska Native, Native Hawaiian, or Pacific Islander), and 5) multiracial. When
the measure of race/ethnicity was used in analyses, indicator variables represented each
group with Non-Hispanic Whites used as the reference category in regression models.
Analysis plan
Given the two colleges used as sampling sites, students attending the same college
may have shared similar characteristics relative to those who did not. However,
appropriate diagnostics revealed that intraclass correlation (ICC) was negligible in this
study. For example, the ICCs were 4.08 X 10
-16
and 2.37 X 10
-22
for lifetime and past-
month e-cigarette use respectively.
This study hypothesized that themes of emerging adulthood (e.g., time of
instability/negativity) will be associated with e-cigarette use (H1). Initially, lifetime and
past-month e-cigarette use were regressed on the six subscales of emerging adulthood
respectively. Lifetime and past-month e-cigarette use were then regressed on the
significant subscales while controlling for age, gender, and ethnicity, respectively. The
events per variable (EPV) rule in logistic regression suggested separate models were
appropriate. The EPV rule recommends 10 to 15 cases (“1s” in the dependent variable in
this instance) for each explanatory variable in the model. This study had 68 past-month e-
cigarette users, suggesting more than 6 explanatory variables in any one model would
have run the high risk of overfitting said model (Greenland, 1989; Harrell, Lee & Mark,
1996).

63

This study also hypothesized that those who experienced many role transitions
will be at greater risk of e-cigarette use compared to those who experienced few
transitions (H2). Bivariable associations between the accumulated number of role
transitions and e-cigarette use were plotted using locally weighted scatter plot smoothing
(lowess) as described by Cleveland (1997), and applied to tobacco-related behavior by
Allem and colleagues (2012). Lowess is a desirable smoothing method because it tends to
follow the data. A .80 bandwidth was used so that the associations grossly fit the general
trends. Alternative bandwidths (e.g., .67 and .90) were used to verify the original
patterns. This analysis demonstrated that the relationship between the accumulated
number of role transitions and e-cigarette use was curvilinear. Spline logistic regressions
with knots to approximate the association between role transitions and e-cigarette use
were computed controlling for age gender, and ethnicity. A knot at five transitions was
determined appropriate. In other words, the relationship between e-cigarette use and the
accumulated number of role transitions dramatically changed after five transitions, where
those who experienced between zero and five transitions were more likely to report
lifetime as well as past-month e-cigarette use, where those who reported more than five
transitions were less likely to report lifetime and past-month e-cigarette use.
Lastly, this study hypothesized that specific role transitions would be associated
with e-cigarette use (H3). To avoid potential problems of multicollinearity as well as
overfitting the model, 22 generalized linear models examined the relationships between
each transition, and e-cigarette use controlling for age, gender and ethnicity. Given the
nature of the data (pilot study), relationships between specific role transitions and e-

64

cigarette use significant at p<.05 were reported. Associations significant after a
Bonferonni correction (p-values < .002 [.05/22]) were distinguished.
For all analyses, the quantity of interest, either the probability of lifetime e-
cigarette use, or past-month e-cigarette use, was calculated using the estimates from a
multivariable analysis by simulation using 1,000 randomly drawn sets of estimates from a
sampling distribution with mean equal to the maximum likelihood point estimates, and
variance equal to the variance-covariance matrix of the estimates, with covariates held at
their mean values (King, Tomz, & Wittenberg, 2000). The proposed analytical strategy is
akin to a bootstrapping approach, or a fully Bayesian Markov-Chain Monte Carlo
(MCMC) technique, however unlike bootstrapping it does not give bias estimates for
certain quantities of interest e.g., max(Y), and unlike MCMC there are no problems
stemming from model convergence (King, Tomz, & Wittenberg, 2000).
This analytical strategy can be delineated in five steps: 1) Following the
procedure for simulating parameters, draw one value of the vector γ = vector (beta or
coefficient, corresponding probability value or alpha). 2) Choose one value for each
explanatory variable and denote the vector of values as Xc. 3) Taking the simulated effect
coefficients from the top portion of γ, compute the estimate of the beta or coefficient for
some value of Xc. 4) Dram m values (for this study m will be equal to 1,000) of the
outcome variable from the random component of the equation. This step simulates
fundamental uncertainty. 5) Average over the fundamental uncertainty by calculating the
mean of the m simulations to yield one simulated expected value E(Y). There are
multiple benefits of this simulation approach, including providing an assessment of
uncertainty surrounding any quantity of interest, as well as the conversion of raw

65

statistical results into results that everyone, regardless of statistical training, can
comprehend, and reporting results in term of probabilities rather than in terms of odds
ratios or log of odds.
Results
Among the participants (n=555), 79% were female, the average age was 22, 45%
reported lifetime e-cigarette use, and 12% reported past-month e-cigarette use. Males
were statistically significantly more likely to report lifetime e-cigarette use compared to
females (57% vs. 46%; p=0.0061), but did not differ on past-month e-cigarette use. The
sample was ethnically diverse, with 18% Non-Hispanic White, 14% American Indian or
Alaskan Native or Asian or Native Hawaiian or Pacific Islander, 46% Hispanic or
Latino/a, 12% African American or Black, and 10% multiracial. E-cigarette use was not
dependent on race/ethnicity in either the case of lifetime use (χ
2
(4)
= 7.6512; p=0.105) or
past-month use (χ
2
(4)
=
0.7216; p=0.949).
Participants who felt emerging adulthood was a time of experimentation and
possibilities were more likely to report lifetime and past-month e-cigarette use. A
difference in score on the experimentation/possibilities subscale between the
10
th
percentile and the 90
th
percentile was associated with a 28% (95% Confidence
Interval [CI], 11% to 44%) higher probability of lifetime e-cigarette use, and a 13% (95%
CI 0% to 26%) higher probability of past-month e-cigarette use (Figure 1A). Conclusions
did not change after controlling for age, gender and ethnicity. The remaining IDEA
subscales were not statistically significantly associated with lifetime or past-month e-
cigarette use.

66

Estimates suggested that the increasing and decreasing trends between number of
role transitions and e-cigarette use were significant at and before five as well as after five,
using spline logistic regression with a knot at five transitions. A difference in the number
of role transitions, from 0 to 5, was associated with a 27% (95% CI, 12 to 40) higher
probability of lifetime e-cigarette use (Figure 1B). A difference in the number of role
transitions, from 6 to 8, was associated with a -4% (95% CI, -6 to -1) decrease in
probability of lifetime e-cigarette use. A difference in the number of role transitions, from
0 to 5, was associated with a 9% (95% CI, 2 to 15) higher probability of past-month e-
cigarette use (Figure 1C). A difference in the number of role transitions, from 6 to 8, was
associated with a -3% (95% CI, -4 to -2) decrease in probability of past-month e-cigarette
use.
Specific role transitions were associated with lifetime e-cigarette use (Figure 1D).
Participants who started to date someone new were 14% (95% CI, 6 to 23) more likely to
report lifetime e-cigarette use compared with those who did not start dating someone
new. Similarly, participants who started a new romantic relationship were 11% (95% CI,
2 to 20) more likely to report lifetime e-cigarette use compared with those who did not.
Participants who experienced a breakup were 11% (95% CI, 1 to 20) more likely to report
lifetime e-cigarette use compared with those who did not experience a breakup.
Participants who reported losing a job or experienced a demotion were 13% (95% CI, 1
to 26) and 12% (95% CI, 0 to 23) more likely to report lifetime e-cigarette use compared
with those who did not respectively. The association between started to date someone
new and lifetime e-cigarette use was significant after the Bonferonni correction with

67

p<.002. Specific role transitions were not statistically significantly related to past-month
e-cigarette use.

68

A. IDEA and e-cigarette use B. Total transitions and lifetime e-cigarette use

C. Total transitions and past-month e-cigarette use D. Specific transitions and lifetime e-cigarette use

Figure 4. Characteristics of emerging adulthood and e-cigarette use. (A) Shows the difference in predicted probabilities of lifetime and past-month e-
cigarette use when the 10
th
and 90
th
percentile IDEA scores are included in computations with 95% confidence intervals. (B) Shows the predicted
probability of lifetime e-cigarette use by number of role transitions. (C) Shows the predicted probability of past-month e-cigarette use by number of role
transitions. (D) Shows the difference in predicted probability of lifetime e-cigarette use, with 95% confidence intervals. Estimates were calculated by
simulating the first difference in each role transition e.g., experiencing a breakup from 0 to 1. Each estimate was arrived by use of 1000 random drawn sets
of estimates from each respective coefficient covariance matrix with control variables held at their mean values.

69

Discussion
The present study identified one transition-to-adulthood theme that was associated
with e-cigarette use. Feeling that emerging adulthood was a time of experimentation and
possibility was associated with an increased probability of lifetime and past-month e-
cigarette use. Themes of experimentation and possibility have been previously found to
be associated with drug and alcohol use (Lisha et al., 2014). These themes should be
discussed in prevention programs with an emphasis on promoting recreational activities
and projects that introduce emerging adults to new and exciting activities that fulfill their
need for experimentation and possibilities that are distinct from using emerging tobacco
products. Activities might include sports, art, entertainment activities, or even business
ventures. Oftentimes these activities are less available post-high school, but might be
important to incorporate in these older age groups as the demographics of this transitional
period are very different from how they were decades ago (Arnett & Tanner, 2006).
The present study also identified the group of emerging adults at highest risk of e-
cigarette use based on their accumulated number of role transitions experienced. Findings
suggested that those who experienced five transitions were at highest risk of lifetime and
past-month e-cigarette use. Alternatively, those who experienced more than five were
significantly less likely to use e-cigarettes. These patterns may reflect two distinct groups
of emerging adults. For example, certain emerging adults may be overwhelmed by
multiple transitions and look toward substance use including nicotine as a way to
alleviate negative affect. For these emerging adults, prevention programs should warn
participants about the possible stress from role transitions and should be taught positive
coping mechanisms or resilience skills. Other emerging adults may strive on taking on

70

many transitions or may not perceive multiple transitions as stressful, but rather as
opportunities for accomplishment. These emerging adults may have sufficient coping
skills allowing them to take on many role transitions. As such, nicotine would not be used
to alleviate stress and e-cigarettes may not serve a purpose.
Specific role transitions were associated with lifetime e-cigarette use. For
example, the start of a romantic relationship as well as the dissolution of a relationship
was associated with a higher probability of lifetime e-cigarette use. These findings are
consistent with prior studies where starting and ending romantic relationships were
associated with cigarette use (Allem et al., 2013), and hard drug use (Allem, Soto,
Baezconde-Garbanati, & Unger, 2015), among emerging adults. Fluctuations in one’s
work life were also associated with lifetime e-cigarette use. Earlier research on emerging
adults, demonstrated that loss of a job was associated with cigarette use (Allem et al.,
2013), while experiencing a demotion was associated with binge drinking (Allem, Lisha,
Soto, Baezconde-Garbanati, & Unger, 2013). Setbacks in the process of securing full-
time employment or maintaining part-time employment, especially while in college, may
drive emerging adults to use nicotine as a way to alleviate negative affect. Specific role
transitions were not associated with past-month e-cigarette use. This may be due to the
limited sample size of emerging adults who both experience specific transitions (e.g.,
demotion) as well as use e-cigarettes in the past-month. Future research should explore
these associations in population-based sample of emerging adults before a definitive
conclusion is drawn about these associations.
While the majority of prior research has been focused on Non-Hispanic white
college students, this study was original, as it described the personal factors associated

71

with e-cigarette use among a more diverse, underrepresented sample of emerging adults.
One reason the literature on e-cigarette use among this population is small has to do with
the difficulty in enlisting emerging adults, especially racial/ethnic minorities, into
scientific studies. The difficulty in recruiting emerging adults in tobacco-related research
has been well documented (Ramo, Hall, & Prochaska, 2010). Barriers cited by emerging
adults for participating in health research in general have included time constraints,
communication issues, fear, and perceiving participation as unimportant (Bost, 2005).
This study circumvented issues of recruitment by enlisting participants from two of the
most socially diverse college campuses in California. Emerging adults from these
campuses likely experience more role transitions compared to Non-Hispanic white
college students living in dorms at private universities with full financial support from
their parents. Given the nature of previous research on e-cigarette use, a socially diverse
sample of emerging adults should prove to be of great import to the advancement of the
scientific understanding of e-cigarette behavior.
Limitations
This study is not without its limitations. For example, the relationship between
role transitions and e-cigarette use was analyzed at a single time point. Although role
transitions were assessed over the past year and e-cigarette use was assessed over the past
month, suggesting that transitions preceded the use of e-cigarettes, it is equally plausible
that e-cigarette use occurred prior to the role transitions. The role transitions in this study
may not include all relevant transitions that are experienced by emerging adults that
could be associated with e-cigarette use. Longitudinal studies in the future should
determine whether or not role transitions precede use of e-cigarettes or whether or not

72

role transitions are associated with frequency of e-cigarette use (e.g., going from
initiation to daily use).
Additionally, the IDEA instrument may not be a perfect measure of transition-to-
adulthood themes, but currently is the only scale available to assess these constructs. E-
cigarette use was a dichotomous outcome, limiting the understanding of frequency of use.
Findings may not generalize to emerging adults in other regions of the U.S. or to those
not enrolled in college. The present study’s sample had a disproportionate number of
female participants, and findings should be interpreted with this in mind. Females,
however, made up the majority of the students (64% and 55%) at both California
campuses in which participants were recruited (College Portraits, 2013). Future research
should focus on sampling a nationally representative sample of emerging adults and test
additional hypotheses that address the ever-changing tobacco product market.
Conclusion
Notwithstanding these limitations, findings from the present study addresses
multiple research priorities delineated by the FDA Center for Tobacco Products e.g.,
findings describe behaviors of individuals using e-cigarettes, as well as identify cognitive
and affective factors associated with e-cigarette use among emerging adults. By
appreciating the unique characteristics in emerging adulthood, the present findings move
forward the literature on e-cigarette use among emerging adults. E-cigarette use poses
numerous concerns to public health including emerging adults initiating in smoking, and
use of other nicotine products, undermining decades of health campaigns on the harms of
smoking (The Lancet Oncology, 2013). Emerging adults who initiate e-cigarette use, or
“vaping,” (as it’s referred to by e-cigarette users) may struggle with a lifetime of nicotine

73

dependence, transitioning back and forth from e-cigarettes to combustible cigarettes. This
dual use may also hinder cessation among current smokers. Additionally, e-cigarettes
threaten to renormalize smoking (Benowitz, 2013). In other words, witnessing people
puffing away on e-cigarettes or cigarettes may once again become socially acceptable.
Previous findings suggest that e-cigarettes are perceived as symbolically and functionally
similar to combustible cigarettes (Pepper et al., 2013), which could also undermine the
denormalization of cigarette smoking. With these public health concerns in mind,
understanding the correlates of e-cigarette use among a priority population like emerging
adults is of utmost importance. Findings from this pilot study should be a point of
departure for future studies looking to understand the risk and protective factors of e-
cigarettes among emerging adults.

74

Concluding remarks
The three studies present herein tested hypotheses revolving around how
disruption of daily life is associated with substance use in emerging adulthood. Study #1
built on the growing body of research that has suggested that specific role transitions are
associated with substance use among emerging adults. This study described the current
methodological limitations commonly found in this literature, and demonstrated a way to
overcome such limitations by applying a novel matching method to longitudinal data.
Substance use may be relied upon to cope in order to deal with negative affect from
uncertainty and stress that accompanies transitions during emerging adulthood. These
patterns may persist until emerging adults learn more adaptive coping strategies. Findings
from this study should inform intervention and prevention programs aimed at reducing
the use of substances, and substance use related disparities among Hispanic emerging
adults.
Study #2 explored whether or not emerging adults who experienced trauma in
childhood engaged in substance use as maladaptive coping strategy in order to avoid
negative emotions. Findings suggested there were gradient relationships between the
accumulated number of adverse childhood experiences and four different types of
substance use. Specific adverse childhood experiences were also found to be associated
with each specific substance under examination. Findings should be integrated into
prevention/intervention programs in hopes of quelling the duration and severity of
substance use behaviors among Hispanic emerging adults. Collectively, findings from
Study #1 and #2 indicated that substances are used as a way to relieve negative emotions
from stress, and that life events, both past and present, are associated with these

75

deleterious coping strategies among Hispanic emerging adults. Findings from these
studies coupled with earlier studies should galvanize the creation of prevention and
intervention programs targeted at this priority population.
Study #3 extended the research on role transitions and other characteristics of
emerging adulthood to the use of e-cigarettes. By appreciating the unique characteristics
in emerging adulthood, findings from this study moved forward the literature on e-
cigarette use among emerging adults. This study found that participants who felt
emerging adulthood was a time of experimentation and possibility were more likely to
report lifetime and past-month e-cigarette use. Among role transitions, several were
found to be risk factors for lifetime e-cigarette use such as loss of a job, a demotion at
work, starting to date someone new, and experiencing a breakup. Findings suggested that
those who experienced five transitions were at highest risk of lifetime and past-month e-
cigarette use. Prevention and intervention programs should acknowledge the importance
of these characteristics of emerging adulthood especially as they contribute to the
aggregation of e-cigarette use patterns. Findings from this pilot study should be a point of
departure for future studies looking to understand the risk and protective factors of e-
cigarettes among emerging adults. Collectively, Study #1, #2, and #3 moved forward the
literature focused on emerging adults and substance use in general, and specifically
advanced the literature that suggested substance use starts and increases after disruption
of daily life in emerging adulthood.

76

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Abstract (if available)

Abstract In emerging adulthood (18 to 25), in industrialized societies, young people experience life transitions, and have the time to explore and develop. Instability in emerging adulthood from changing residences, romantic relationships, school, and work has been hypothesized to increase rates of substance use among young people. Disruption of daily life may lead to anxiety, stress and sadness, which could ultimately lead to substance use as a form of self-medication. The aims of the present dissertation are in part based on testing hypotheses revolving around how disruption of daily life is associated with various kinds of substance use in emerging adulthood. Study #1 builds on the growing body of research that has suggested that specific role transitions are associated with substance use among emerging adults. This study describes the current methodological limitations commonly found in this literature, and demonstrates a way to overcome such limitations by applying a novel matching method to longitudinal data. Study #2 explores whether or not emerging adults who experienced trauma in childhood engage in substance use as maladaptive coping strategy in order to avoid negative emotions. Taken together, Study #1 and Study #2 have the ability to demonstrate which specific life events (both past and present) are associated with substance use among emerging adults. Study #3 extends the research on role transitions and other characteristics of emerging adulthood to the use of electronic cigarettes. Given the growing popularity of this emerging tobacco product, exploring how role transitions are associated with e-cigarettes is a natural progression for research focused on emerging adults. Collectively, Study #1, #2, and #3 build on the literature focusing on emerging adults and substance use in general, and specifically build on the literature that suggests substance use starts and increases after disruption of daily life in emerging adulthood.

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Asset Metadata

Creator Allem, Jon-Patrick (author)

Core Title Role transitions, past life events, and their associations with multiple categories of substance use among emerging adults

School Keck School of Medicine

Degree Doctor of Philosophy

Degree Program Preventive Medicine (Health Behavior)

Publication Date 04/21/2015

Defense Date 03/24/2015

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag emerging adults,OAI-PMH Harvest,substance use

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Unger, Jennifer B. (committee chair), Baezconde-Garbanati, Lourdes (committee member), Sussman, Steven (committee member)

Creator Email allem@usc.edu,jonpatrickallem@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c3-554439

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