Polydrug use among urban adolescent cigarette smokers

•96% of urban adolescent smokers (N = 169) from San Francisco reported polydrug use.•Adolescents reporting only light/intermittent smoking may be using multiple drugs.•18% (n = 29) reported early use (age ≤ 16) of harder drugs and depressive symptoms.•Depressive symptoms could precede more problematic drug use.•Early prevention/cessation intervention including depression screening is called for.

PurposeAdolescent smokers are at increased risk for polydrug use, which is associated with more consequences than use of a single drug. Here we classified subgroups of polydrug use among urban adolescent cigarette-smokers; described the sociodemographic, smoking, and depression correlates; and identified three-year outcomes associated with subgroup membership.MethodsAdolescent cigarette smokers (N = 176; Mage = 16.1; 35% male; 27% white) completed surveys assessing drug use, smoking characteristics, demographics, and depressive symptoms at baseline and 12, 24, and 36 months follow-up.ResultsAlmost all participants (96%) reported using, on average, two (SD = 0.97) substances (including other tobacco products) in addition to cigarettes. Latent class analysis revealed two distinct classes of polydrug users. “Limited Range Use” (84%) class members reported current use of other tobacco, alcohol, and marijuana, as did “Extended Range Use” class members (16%) who also reported current use of “harder drugs” (i.e., cocaine/crack, hallucinogens, ecstasy, and misused prescriptions). The classes did not differ on demographics or baseline likelihood of marijuana (χ2 = 0.25; p < 0.62) or alcohol use (χ2 = 3.3; p < 0.07). At baseline, a larger proportion of Extended Range Use class members reported both smoking the entire cigarette and symptoms of clinical depression. Extended Range Use class membership at baseline predicted higher mean depression scores at 24 and 36 months.ConclusionAdolescent cigarette-smokers who reported extended range use (18%) also reported symptoms of clinical depression at baseline and follow-up. These findings indicate a need for early monitoring of depression symptoms and prevention and cessation interventions targeting this high-risk group.