Sensation seeking predicts established smoking and binge drinking in adolescents.

QUESTION Question: Can sensation seeking be used to predict binge drinking and established smoking among adolescents and target adolescents for substance use interventions? Patients: 6522 adolescents aged 10–14 years at baseline, contacted by random digit dial telephone survey. Comparing the age, sex and census region of the participants, and income groupings of their parents with the US 2000 Census data confi rmed that the participants were a representative sample. Ethnicity was 62% white, 18.2% Hispanic and 13.6% black. Setting: Telephone survey, USA; recruitment June to October 2003. Test: Sensation seeking was measured using a four-item scale: thrill seeking, adventure seeking, boredom susceptibility and intensity seeking. Scores for individual items ranged from one to four and were summed across items (total scores 4–16). Receiver operating characteristics (ROC) curves were used to analyse effectiveness of sensation seeking as a predictor of binge drinking and established smoking. Diagnostic standard: Participant report of binge drinking or established smoking at 24 months. Participants were surveyed three times at 8-month intervals. If 24-month data was not available, data from the 16- or 8-month assessments was used. At each time point participants were asked if they had ever had more than fi ve drinks within a couple of hours; answering yes indicated binge drinking. Participants were asked how many cigarettes they had smoked in their lifetime, with more than 100 indicating an established smoker. Outcomes: Area under receiver operating curve (AROC), sensitivity and specifi city, false positive and false negative rates. METHODS Design: Cohort study. MAIN RESULTS 5834 participants had one or more follow-up assessments and were used in the analyses. Retention was 71% at 24 months (n=4575). At baseline, 3.4% (n=200) adolescents were binge drinkers, and 0.55% were established smokers (n=32). Among the non-binge drinkers at baseline, binge drinking was reported at follow-up interviews by 12.7% (n=717). Among non-established smokers at baseline, established smoking was reported by 2.5% (n=144). Mean sensation seeking score at baseline was 8.0 (SD 2.5), and median sensation seeking score was 7.0. A cut-off level at the median score of 7 would identify 52% of the population at risk. A cut-off of 9 would identify 25%, and a cut-off of 11 would identify 9% of the population at risk. Sensation seeking at baseline was a moderately good predictor of binge drinking at follow-up (AROC 0.71, 95% CI 0.69 to 0.73). Sensation seeking at baseline was a better predictor of established smoking at follow-up (AROC 0.80, 95% CI 0.76 to 0.83). For binge drinking, using a cut-off of 1 SD above the mean, 16% of the population would be identifi ed for intervention and would include approximately one-third of future binge drinkers (sensitivity 31%, false positive rate 12%). Half the population would be identifi ed using a median split cut-off and would include 77% of future binge drinkers (false positive rate 46%). For established smoking, using a cut-off of 1 SD above the mean would identify approximately 50% of future smokers (sensitivity 53%, false positive rate 14%). Using a median split cut-off would include 92% of future smokers (false positive rate 50%). CONCLUSIONS Sensation seeking is an effective predictor of established smoking and a moderately effective predictor of binge drinking in adolescents.