Time-Varying Environmental and Polygenic Predictors of Substance Use Initiation in Youth: A Survival and Causal Modeling Study in the ABCD Cohort

Early substance use initiation is associated with later substance use disorders, but the relative contributions of environmental, behavioral, and genetic factors during adolescence remain unclear. We analyzed 2,366 participants of European genetic ancestry from the Adolescent Brain Cognitive Development Study. Four outcomes were examined through four years of follow-up: initiation of alcohol, nicotine, cannabis, and any substance use. Time-varying Cox models screened predictors, followed by LASSO-selected multivariable Cox models adjusted for age, sex, ancestry principal components, and study site. Marginal structural models evaluated selected predictors.
Environmental and behavioral factors were the strongest and most consistent predictors, including youth rule-breaking, impulsivity, parental alcohol-related problems, financial adversity, family context, phone use, negative life events, peer or romantic experiences, sleep, caffeine exposure, and parental monitoring. Polygenic risk scores for alcohol, cannabis, nicotine, and substance use disorder showed weaker and less consistent associations. Although some appeared in screening models, none remained robust after correction, multivariable selection, or causal modeling. In marginal structural models, youth rule-breaking was consistently associated with all four outcomes. Other outcome-specific signals included sensation seeking, lack of planning, parental alcohol-related problems, phone use, sleep duration, and parental monitoring.
Early substance use initiation was more strongly associated with dynamic environmental, behavioral, family, and psychosocial factors than with common-variant genetic liability. These findings highlight modifiable developmental pathways and support prevention strategies focused on proximal behavioral and environmental risk contexts.