Diminished alternative reinforcement as a mechanism linking conduct problems and substance use in adolescence: a longitudinal examination.
AIMS
To determine whether diminished alternative reinforcement (i.e. engagement and enjoyment from substance-free activities) mediated the longitudinal association of conduct problems with substance use in early-mid-adolescence.


DESIGN
Structural equation modeling tested whether the association between wave 1 (baseline) conduct problems and wave 3 (24-month follow-up) substance use outcomes was mediated by diminished alternative reinforcement at wave 2 (12-month follow-up). Additional analyses tested whether sex and socio-economic status moderated this association.


SETTING
Ten high schools in Los Angeles, CA, USA, 2013-15.


PARTICIPANTS
Students (n = 3396, 53.5% female, mean [standard deviation (SD)] age at wave 1 baseline = 14.1 (0.42) years).


MEASUREMENTS
Self-reported conduct problems (11-item questionnaire), alternative reinforcement (44-item questionnaire) and use of alcohol, marijuana and combustible cigarettes during the past 6 months (yes/no) and the past 30 days (nine-level ordinal response based on days used in past 30 days).


RESULTS
Significant associations of wave 1 conduct problems with wave 3 marijuana use during the past 6 months (β = 0.25) and past 30 days (β = 0.26) were mediated by wave 2 diminished alternative reinforcement (βindirect effect : 6 months = 0.013, 30 days = 0.017, Ps < 0.001). Associations of conduct problems with alcohol or combustible cigarette use were not mediated by alternative reinforcement. All associations did not differ by sex and socio-economic status.


CONCLUSIONS
Diminished alternative reinforcement may be a modifiable mechanism linking early adolescent conduct problems and subsequent marijuana use that could be targeted in prevention programs to offset the adverse health and social sequelae associated with comorbid conduct problems and marijuana use in early-mid adolescence.
['Khoddam|Rubin|R|', 'Cho|Junhan|J|', 'Jackson|Nicholas J|NJ|', 'Leventhal|Adam M|AM|0000-0002-3539-7656']
D000293:Adolescent D000294:Adolescent Behavior D000073865:Cigarette Smoking D019955:Conduct Disorder D005260:Female D006801:Humans D008137:Longitudinal Studies D008297:Male D000074609:Marijuana Use D012054:Reinforcement, Psychology D000066608:Underage Drinking D014481:United States
alternative reinforcers conduct problems substance use Adolescents alcohol marijuana cigarette behavioral economics