Longitudinal Test of Multiple Risk and Protective Factor Domains for Early Substance Use Onset: Implications for Primary Prevention Policy and Practice

Background: Primary prevention research rarely include measures for multiple risk and protective factor domains for youth alcohol, tobacco, and other drug (ATOD) use onset simultaneously within the same prospective study. The aim of this study is to test the simultaneous longitudinal relationships between risk and protective factors within these 5 domains and ATOD onset among early adolescents. Methods: Analyses are based on waves 1 to 6 from the Young Mountaineer Health Study cohort that was conducted every ~6 months over a 3-year period between 2020 and 2023 in 20 diverse schools in West Virginia in the United States. For the present analysis, 2916 sets of student data were included from all 6 waves. Longitudinal analyses were conducted using best linear unbiased predictors for all domain exposure variables across the 6 time points using high-performance linear mixed modeling in conjunction with logistic regression. Results: Risk and protective factors within the 5 exposure domains of parents/caregivers, peers, school, leisure time, and community were simultaneously related to odds of substance use onset among early adolescents. Conclusions: Our findings underscore the need for both basic and prevention research guided by systems-based approaches versus a focus on a limited set of etiological factors.