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Identifying risk factors for substance use initiation is essential for understanding the etiology and natural history of SUD and to develop empirically\u2010based preventive interventions to reduce initiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Analyses were done on Wave 1 participants of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) (<jats:italic>n<\/jats:italic>\u2009=\u200943,093). Estimates of the cumulative probability of substance use initiation were obtained separately for nicotine, alcohol, cannabis, and cocaine. Survival analyses with time\u2010varying covariates were implemented to identify risk factors for substance initiation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The lifetime cumulative probabilities of substance initiation were 45.5% for nicotine, 82% for alcohol, 19.6% for cannabis, and 6.4% for cocaine. Among respondents with lifetime nicotine use, 50% had used it by age 15.3, whereas for alcohol, cannabis, and cocaine the respective ages were 17.8, 16.6, and 19.8. Previous use of another substance, being male, having a cluster B personality disorder, family history of SUD, and being separated, divorced, or widowed increased the risk of use of all the substances assessed, whereas social anxiety disorder and some personality disorders were associated with specific substances.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>Although the age of substance use initiation varies by substance, in more than 50% of cases initiation of use occurs in the first two decades of life. Although most risk factors for substance use initiation are common across substances, some are substance\u2010specific.<\/jats:p><\/jats:sec><jats:sec><jats:title>Scientific Significance<\/jats:title><jats:p>This information may help in the development of empirically\u2010based preventive interventions. (Am J Addict 2018;27:477\u2013484)<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajad.12764","type":"journal-article","created":{"date-parts":[[2018,8,8]],"date-time":"2018-08-08T05:01:27Z","timestamp":1533704487000},"page":"477-484","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Predictors of initiation of nicotine, alcohol, cannabis, and cocaine use: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)"],"prefix":"10.1111","volume":"27","author":[{"given":"Carlos","family":"Blanco","sequence":"first","affiliation":[{"name":"Department of Psychiatry New York State Psychiatric Institute\/Columbia University New York New York"},{"name":"Division of Epidemiology, Services, and Prevention Research National Institute on Drug Abuse Bethesda Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4968-3466","authenticated-orcid":false,"given":"Ludwing","family":"Fl\u00f3rez\u2010Salamanca","sequence":"additional","affiliation":[{"name":"Department of Psychiatry New York State Psychiatric Institute\/Columbia University New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Secades\u2010Villa","sequence":"additional","affiliation":[{"name":"Grupo de Investigacion en conductas adictivas Department of Psychology University of Oviedo Oviedo Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry New York State Psychiatric Institute\/Columbia University New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah S.","family":"Hasin","sequence":"additional","affiliation":[{"name":"Department of Psychiatry New York State Psychiatric Institute\/Columbia University New York New York"},{"name":"Department of Epidemiology Mailman School of Public Health Columbia University New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/09595230600944446"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2010.11.004"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2010.12.017"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2008.02173.x"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1015183927979"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291710001418"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/002214650905000105"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1010034912070"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0306-4603(02)00225-3"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2011.11.015"},{"key":"e_1_2_6_12_1","doi-asserted-by":"crossref","first-page":"e588","DOI":"10.4088\/JCP.11m07345","article-title":"A longitudinal investigation of the role of self\u2010medication in the development of comorbid mood and drug use disorders: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)","volume":"73","author":"Lazareck S","journal-title":"J Clin Psychiatry"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0376-8716(02)00224-7"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2010.03194.x"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.61.4.361"},{"key":"e_1_2_6_16_1","unstructured":"GrantBF DawsonDA HasinDS. 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