Associations of Cumulative Contextual Risk at Birth with Substance Use Onset: Discrete-Time Survival Mediation Tests of Developmental Processes

Introduction: Children exposed to multiple environmental adversities early in development experience elevated risk for early-onset alcohol and tobacco use. However, the developmental mediators of these associations remain relatively unknown, which hinders understanding of malleable processes that can serve as targets to prevent substance use onset among vulnerable youth. This study examined childhood skills (e.g., normative developmental milestones in school and other environments), peer acceptance, and prosocial commitment as potential mediators of the long-term associations of early cumulative contextual risk (CCR) on adolescent alcohol and cigarette use onset.

Method: Secondary analyses of data from the 1986 Northern Finland Birth Cohort study were conducted. Participants were 6,191 individuals born in Finland. Using data from multi-informant surveys, participants were followed from the prenatal/birth period to mid-adolescence. CCR was measured as an additive score consisting of 10 dichotomized items covering prenatal/birth socioeconomic and familial risk factors (e.g., poverty, maternal use of alcohol during pregnancy). Childhood mediators were measured at ages 7 and 8 via parent- and teacher-report questionnaires. Substance use was measured via adolescent self-report at age 16. Discrete-time survival mediation models within a structural equation modeling framework were conducted in Mplus.

Results: CCR was associated with earlier onset of both alcohol (b=-.003, se=.001, p<.05) and cigarette (b=-.002, se=.001, p<.05) use. The indirect effects of CCR on substance use onset through skills were statistically significant for both alcohol use (b = .255, se = .02, p<.05) and cigarette use (b=.106, se=.021, p<.05). No other indirect effects were statistically significant, although prosocial commitment was associated with delayed alcohol and cigarette use onset (b=-.292, se=.116, p<.05).

Conclusions: Findings suggest that vulnerable children could benefit from early screening efforts combined with referral to preventive interventions that target malleable developmental processes. Efforts to bolster these processes could help reduce risk for early onset substance use and its well-documented adverse consequences.