Moderators of the association between peer and target adolescent substance use

Early Adolescent Friendship Selection Based on Externalizing Behavior: the Moderating Role of Pubertal Development. The SNARE Study

This study examined friendship (de-)selection processes in early adolescence. Pubertal development was examined as a potential moderator. It was expected that pubertal development would be associated with an increased tendency for adolescents to select their friends based on their similarities in externalizing behavior engagement (i.e., delinquency, alcohol use, and tobacco use). Data were used from the first three waves of the SNARE (Social Network Analysis of Risk behavior in Early adolescence) study (N = 1144; 50 % boys; M_age = 12.7; SD = 0.47), including students who entered the first year of secondary school. The hypothesis was tested using Stochastic Actor-Based Modeling in SIENA. While taking the network structure into account, and controlling for peer influence effects, the results supported this hypothesis. Early adolescents with higher pubertal development were as likely as their peers to select friends based on similarity in externalizing behavior and especially likely to remain friends with peers who had a similar level of externalizing behavior, and thus break friendship ties with dissimilar friends in this respect. As early adolescents are actively engaged in reorganizing their social context, adolescents with a higher pubertal development are especially likely to lose friendships with peers who do not engage in externalizing behavior, thus losing an important source of adaptive social control (i.e., friends who do not engage in externalizing behavior).

Peer drug use and adolescent polysubstance use: Do parenting and school factors moderate this association?

AIMS

This study examined the association between peer drug use and adolescent polysubstance use, and investigated if this association was moderated by parenting and/or school factors.

METHODS

The sample consisted of 9966 participants (mean age=14.3; 49.34% males) randomly selected from secondary schools in Victoria, Australia. Three 30-day polysubstance use profiles were derived from latent class analysis - no drug use (47.7%), mainly alcohol use (44.1%) and polysubstance use (8.2%). These profiles were then regressed on peer's drug use, family conflict, parental monitoring, parental disapproval of drug use, school commitment, reward for prosocial involvement in school and academic failure, and the interactions between peer's drug use and each of the parenting and school variables.

RESULTS

Relative to non-users, peer's drug use was strongly associated with polysubstance use (OR=30.91, p<0.001), and this association was moderated by parental disapproval of drug use (OR=0.46, p<0.001). This indicated that high level of parental disapproval may mitigate the negative influence of drug using peers. School commitment and parental monitoring were significantly associated with reduced likelihood of polysubstance use (p<0.05), but they did not moderate the relationship between peer drug use and adolescent polysubstance use. All analyses were adjusted for key demographic factors such as age, gender, areas of residence, birth place and family affluence.

CONCLUSION

Reinforcing parent disapproval of drug use may be an important strategy in reducing adolescent substance use. Parents may need to be more integrated into mainstream prevention programs.

Substance Misuse and Substance use Disorders: Why do they Matter in Healthcare?

This paper first introduces important conceptual and practical distinctions among three key terms: substance "use," "misuse," and "disorders" (including addiction), and goes on to describe and quantify the important health and social problems associated with these terms. National survey data are presented to summarize the prevalence and varied costs associated with misuse of alcohol, illegal drugs, and prescribed medications in the United States. With this as background, the paper then describes historical views, perspectives, and efforts to deal with substance misuse problems in the United States and discusses how basic, clinical, and health service research, combined with recent changes in healthcare legislation and financing, have set the stage for a more effective, comprehensive public health approach.

Internalizing Symptoms, Peer Substance Use, and Substance Use Initiation

This study used longitudinal survey and social network data covering sixth through ninth grades to test whether internalizing symptoms make early adolescents more prone to (1) exposure to and (2) influence by substance-using peers. Random effects regressions revealed that increases in symptoms were significantly associated with increases in the proportion of friends who used cigarettes, alcohol, and marijuana; some associations weakened across grades. Event history models revealed that the effect of friends' smoking on smoking initiation decreased as internalizing symptoms increased; symptoms did not moderate the effects of friends' alcohol and marijuana use on alcohol and marijuana use initiation. These findings counter the influence hypothesis of the co-occurrence of internalizing symptoms with substance use and partly support the exposure hypothesis.

Risky substance use and peer pressure in Swiss young men: Test of moderation effects

BACKGROUND

Peer pressure (PP) toward misconduct is a well-known risk factor for substance use. However, the way it interacts with social factors and the associations of the aspects of PP other than PP toward misconduct have been understudied. This study examined the associations of three aspects of PP with risky substance use and tested whether the associations of PP toward misconduct were moderated by social factors.

METHOD

A representative sample of 5,680 young Swiss males completed a questionnaire assessing risky alcohol, cigarette, and cannabis use, PP toward misconduct, toward peer involvement, and toward peer conformity, as well as social support (SS) and neighbourhood cohesion. Multinomial logistic regression models were used.

RESULTS

PP toward misconduct was positively associated with all substance use outcomes. The PP toward misconduct-risky alcohol use association was stronger in individuals reporting high than in those reporting low levels of PP toward peer involvement, SS, and neighbourhood cohesion. The PP toward misconduct-risky cannabis use association was stronger in individuals reporting high than in those reporting low levels of SS and neighbourhood cohesion. The PP toward misconduct-smoking association was stronger in individuals reporting high than in those reporting low levels of PP toward peer involvement.

CONCLUSIONS

The risk for substance use associated with PP toward misconduct varies as a function of social factors. Being well connected with others (high level of PP toward peer involvement and SS), and living in a cohesive neighbourhood may amplify the risk for risky substance use associated with PP toward misconduct.

Identification of Key Items Regarding Personality, Environment, and Life Events to Assess Risk and Resilience Factors for Harmful Alcohol Drinking in Adolescents

AIMS

Alcohol misuse often develops during adolescence involving interacting factors deriving from personality, environment and life events that can be assessed with well-established instruments. However, for specific research purposes, involving the assessment of large data sets, it may be beneficial having a short tool of key items representing the most important risk factors.

METHODS

We identified a set of key items from standard questionnaires assessed in about 2000 adolescents. In our longitudinal study we identified important items on personality, environment, and life events explaining alcohol drinking behaviour at the age of 14 years and the increase of alcohol consumption 2 years later.

RESULTS

The key items explained 33.4% of variance in alcohol drinking behaviour (vs. 34.8% for original battery) and can be completed in six minutes.

CONCLUSIONS

Our item list represents a powerful easy-to-use tool for the examination of alcohol drinking behaviour in adolescents.

Hispanic/Latino Adolescents' Alcohol Use: Influence of Family Structure, Perceived Peer Norms, and Family Members' Alcohol Use

BACKGROUND

Family structure and value system among Hispanic/Latino population are changing. However, very few studies are examining the combination of the influence of family structure, parental and sibling alcohol use, perceived peer norms about drinking, and alcohol use among Hispanic/Latino adolescents.

PURPOSE

This study examined the associations among family structure parental and sibling substance use, perceived peer norm toward drinking and alcohol use among a sample of adolescents in the US.

METHODS

We assessed cross-sectional data from a 2010 study of 1,523 high school students from a school district in Los Angeles. Logistic regression analyses were conducted using SPSS 23.

RESULTS

Our results indicate that family structure was not significantly associated with adolescents' alcohol use. Having family members' who consumed alcohol, perception of close friends' attitudes toward drinking, and perceived drinking prevalence among peers increased the likelihood of drinking.

DISCUSSION

Findings suggest that alcohol use behaviors of members of the family unit, perception of drinking prevalence among peers, and perception of friends attitude to drinking (not their actual drinking behavior) increased the likelihood of drinking.

TRANSLATION TO HEALTH EDUCATION PRACTICE

We call Health Education Specialists develop awareness programs targeted at correcting adolescents' normative perceptions towards alcohol use prevalence among their peers.

The interaction between temperament and the family environment in adolescent substance use and externalizing behaviors: Support for diathesis-stress or differential susceptibility?

Both individual and environmental factors predict externalizing behaviors and substance use (EB-SU); however, different patterns of interaction among these factors may have different implications. This review first examines how temperament and the family environment interact in the prediction of adolescent EB-SU. Second, studies are reviewed according to two theoretical models: (1) diathesis-stress, i.e., certain individual characteristics are linked to vulnerability and later problems in adverse environments; (2) differential susceptibility, i.e., these characteristics are linked to susceptibility, predicting problems in adverse environments, but also better than average outcomes in good environments. Fourteen studies focusing on the prediction of EB-SU at ages 12-18 were selected through a literature search. Results showed that certain temperament traits (high levels of impulsivity and disinhibition; low levels of effortful control, negative affect, fearfulness and shyness), hereby designated as "adventurous" disposition, were associated with higher levels of EB-SU in adverse family environments. Some studies also showed that children with "adventurous" temperament traits in positive environments had the lowest levels of EB-SU. This suggests that prevention of EB-SU might target family factors such as parenting and focus on children with "adventurous" temperament traits. Further, studies that supported the differential susceptibility model were those assessing temperament and the family environment in childhood and studies that supported the diathesis-stress model assessed these variables in adolescence. It is thus possible that some of these "adventurous" temperament traits, with regard to EB-SU, would be indicators of susceptibility to both enriched and adverse environments in childhood but no longer in adolescence, when they would only be indicators of vulnerability to adverse environments.

A Study of Motives for Tobacco and Alcohol Use Among High School Students in Hungary

Motives may be an important influence for substance use among youth. The goal of this research was to study the relation of social, self-enhancement, boredom relief and affect regulation motives to smoking and drinking in a sample of Eastern European high school students and to examine variation in the effects of these motives by gender. Our sample involved 500 students (ages 14-20 years) from three high schools in a large city in Hungary. Multiple logistic regression analyses examined the relation between motives and substance user status. Social motives were significantly related to both smoking and drinking (except for boys' smoking). Affect regulation motives were a significant predictor of smoking; in addition, boredom relief was a significant motive for smoking among boys. Mother's educational level was inversely related to youth substance use, whereas father's education was positively related to alcohol use among girls. School-based prevention programs should include cognitive education and social skills training to counter perceived benefits of substance use. Further research is needed to clarify the relation of alcohol use to parental education.

Drinking and driving among Italian adolescents: Trends over seven years (2007-2013)

In recent years, increasing attention has been paid to the issue of driving under the influence of alcohol (DUI), especially among young people. The aims of the present study were (1) to analyse the trends of DUI, riding with a driver under influence of alcohol (RWDUI) and alcohol-related road crashes (A-rC) in a nationally representative sample of students in the period 2007-2013, (2) to assess how different drinking patterns were associated with DUI and RWDUI, (3) to evaluate other influential factors (such as gender, older siblings' and friends' behaviour with alcohol) on DUI and RWDUI. Data were drawn from the cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) carried out annually in Italy. The sample size ranged from 25,555 to 40,390 students (15-19 years old). Results were stratified for students <18 years and ≥18 years old. Although a significant decreasing trend for alcohol consumption was observed only in the younger group, a significant decrease in DUI [APC (annual percent change) -9.7 in the younger and -6.4 in the older group] and in RWDUI (APC -6.7 in the younger and -4.8 in the older group) was detected. A significant decreasing trend of A-rC was observed only in the older group (APC -3.4). Three specific drinking patterns were identified: "Drinking to Excess" (DE), "Drinking with Intoxication" (DI) and "Drinking but Not to Excess" (DNE). In both age groups, the DE pattern significantly increased the likelihood of DUI, whereas the DI pattern was negatively associated, and the DNE pattern was not associated. Different results were found for RWDUI: the DE and DI patterns where significantly associated with RWDUI, whereas the DNE pattern was negatively associated. Overall, illegal substance use, parental monitoring, peers' and siblings' influence were associated with DUI and RWDUI. The change in behaviour towards DUI and RWDUI suggests a cumulative effectiveness of current alcohol policies, although further actions (greater attention to social context, law enforcement, and promotion of good practice) are needed to substantially reduce alcohol-related crashes.

Why young people's substance use matters for global health

During puberty, when young people are completing their education, transitioning into employment, and forming longer-term intimate relationships, a shift in emotional regulation and an increase in risky behaviour, including substance use, is seen. This Series paper considers the potential effects of alcohol, tobacco, and illicit drug use during this period on: social, psychological, and health outcomes in adolescence and young adulthood; role transitions, and later health and social outcomes of regular substance use initiated in adolescence; and the offspring of young people who use substances. We sourced consistent support for causal relations between substance use and outcomes and evidence of biological plausibility from different but complementary research designs. Many adverse health and social outcomes have been associated with different types of substance use. The major challenge lies in deciding which are causal. Furthermore, qualitatively different harms are associated with different substances, differences in life stage when these harms occur, and the quality of evidence for different substances and health outcomes varies substantially. The preponderance of evidence comes from a few high-income countries, thus whether the same social and health outcomes would occur in other countries and cultures is unclear. Nonetheless, the number of harms that are causally related to substance use in young people warrant high-quality research design interventions to prevent or ameliorate these harms.

Adolescent drinking, social identity, and parenting for safety: Perspectives from Australian adolescents and parents

We explored young people and parents' views on adolescent drinking and safety in the locations where drinking may occur. Focus groups with adolescents and parents showed that many believed adolescent drinking and drunkenness is normative. Younger adolescents had more negative views of adolescent drinkers than their older peers. Adolescent drinking occurred in private settings and parents made decisions about allowing their adolescent children to attend social events based on the level of safety attributed to the location. If adolescent drinking was likely then home was the preferred location as it provided scope for risk minimisation. Positive portrayals of non-drinking adolescents and information to assist parents' decision-making are needed.

Role of parenting styles in adolescent substance use: results from a Swedish longitudinal cohort study

OBJECTIVE

Adolescent substance use is an area of concern because early substance use is associated with a higher risk of adverse outcomes. Parenting style, defined as the general style of parenting, as well as substance-specific parenting practices may influence children's substance use behaviour. The present study aims to probe the impact of parenting style on adolescent substance use.

METHOD

A cohort of 1268 adolescents (48% girls), aged 12-13 years at baseline, from 21 junior high schools was assessed in the first semester of junior high school, and then again in the last semester of the 9th grade, 32 months later. Parenting style, operationalised as a fourfold classification of parenting styles, including established risk factors for adolescent substance use, were measured at baseline.

RESULTS

Neglectful parenting style was associated with worse substance use outcomes across all substances. After adjusting for other proximal risk factors in multivariate analyses, parenting style was found to be unrelated to substance use outcomes with one exception: authoritative parenting style was associated with less frequent drinking. Association with deviant peers, delinquent behaviour, provision of alcohol by parents, and previous use of other substances were associated with substance use outcomes at follow-up.

CONCLUSIONS

The results of the present study indicate that parenting style may be less important for adolescent substance use outcomes than what has previously been assumed, and that association with deviant peers and delinquent behaviour may be more important for adolescent substance use outcomes than general parenting style.

What's love got to do with it? Adolescent romantic networks and substance use

This study examined how romantic aspiration network characteristics at the individual level (in-degree and out-degree) are associated with substance use (i.e. smoking and drinking) among a cross-sectional sample of US adolescents (10th grade, n = 1523) from 4 high schools in Los Angeles. Findings highlighted that, with an increase in out-degree (romantic aspiration nominations made), adolescents in our sample were less likely (OR = .824, CI = .688-.986, p < .05) to report smoking in the past 30 days. Additionally, with an increase in in-degree (romantic aspiration nominations received), adolescents were more likely (OR = 1.186, CI = 1.04-1.36, p < .05) to report drinking in the past 30 days. We conclude that romantic aspirations/relations influence adolescents' substance use behaviour (i.e. smoking and drinking alcohol), particularly because of the intensity of such relationships and the desire to please or be acceptable to the other person. Moreover, understanding adolescents' aspirations/relations can be useful for the development of intervention/prevention programmes to target adolescents' substance use.

Internet Use and Adolescent Binge Drinking: Findings from the Monitoring the Future Study

OBJECTIVE

To investigate the relation between Internet use and binge drinking during early and middle adolescence.

METHODS

This is a cross-sectional study of a sub-sample of 8^th and 10^th graders from the Monitoring the Future (MtF) study, which annually surveys a nationally representative sample of U.S. youth on their attitudes, behaviors, and values. This study includes data from 21,170 8^th and 24,362 10^th graders who participated between 2007 and 2012 and were asked questions about Internet use and binge drinking.

RESULTS

In fully adjusted models, we found a dose response relation between hours of recreational Internet use (i.e. outside work or school) and binge drinking which was stronger for 8^th than 10^th graders. Compared to <1 h of Internet use per week, odds ratios estimates for 1-5 h/week, 6-19 h/week, and 20 or more h/week were 1.24 (99% CI: 0.85, 1.82), 1.83 (1.28, 2.61), and 2.78 (1.99, 3.87) for 8^th graders, respectively. For 10^th graders, this same association was attenuated [estimated OR=1.06 (99% CI: 0.96, 1.16); 1.20 (1.03, 1.40); and 1.30 (1.07, 1.58), respectively].

CONCLUSIONS

Drawing on a nationally representative sample of U.S. youth, we find a significant, dose-response relation between Internet use and binge drinking. This relation was stronger in 8^th graders versus 10^th graders. Given that alcohol is the most abused substance among adolescents and binge drinking confers many health risks, longitudinal studies designed to examine the mediators of this relation are necessary to inform binge drinking prevention strategies, which may have greater impact if targeted at younger adolescents.

Moderation, mediation - or even both? School climate and the association between peer and adolescent alcohol use

INTRODUCTION

Ample studies discuss the enhancing effects of peer drinking on student alcohol use. In addition, there is vast research on school climate impact on student alcohol use. Though these two areas are intertwined for most young adolescents, it is heretofore not completely clear, in what way these characteristics functionally interact and affect drinking behavior.

METHODS

In a longitudinal study, we analyzed a sample of 2490 German adolescents (Mage=13.32, SD=0.57, range=8-13) from 5th (fall 2010) to 8th (fall 2013) grade. We discerned mediating (class climate) and moderating (school organization variables) functions of school on the association between peer and adolescent alcohol use, and finally combined them in direct effect moderated mediation models for a variety of outcomes (lifetime alcohol use, frequency and amount of drinking, binge drinking), adjusting for possible confounders.

RESULTS

Class climate mediated a small significant part of the association between peer and adolescent alcohol use (1.8-2.4%), with the exception of lifetime drinking. Student-teacher ratio and percentage of at-risk students significantly moderated the peer-adolescent association, with the latter having an enhancing and the first having a buffering effect.

CONCLUSIONS

School life serves as an important context of adolescent development and as such, seems to have direct and indirect effects on behavior and health. Future research should pay attention to differentiating effects of school climate and include both forms of operationalization when analyzing school effects on student behavior.

Differential susceptibility to environmental influences: Interactions between child temperament and parenting in adolescent alcohol use

Temperament and parental practices (PP) are important predictors of adolescent alcohol use (AU); however, less is known about how they combine to increase or decrease risk of AU. This study examined whether age 6 temperament (i.e., impulsivity and inhibitory control) interacted with age 6 coercive PP and/or age 14 parental monitoring to predict AU at 15 years among 209 adolescents. Results showed that low parental monitoring was associated with more frequent AU and that coercive PP interacted with impulsivity to predict AU. This interaction was examined as a function of two models that were not studied before in the prediction of AU: the diathesis-stress model (i.e., impulsive children are more "vulnerable" to adverse PP than those with an easy temperament); and the differential susceptibility model (i.e., impulsive children are also more likely to benefit from good PP). Results supported the differential susceptibility model by showing that impulsive children were not only at higher risk for AU when combined with high coercive PP but also benefit from the absence of coercive PP. This supports the suggestion that the conception of certain temperament characteristics, or in this case impulsivity, as a "vulnerability" for adolescent AU, may need revision because it misrepresents the malleability it may imply.

The Role of Self-Control and Early Adolescents' Friendships in the Development of Externalizing Behavior: The SNARE Study

This social network study investigated the moderating role of self-control in the association between friendship and the development of externalizing behavior: Antisocial behavior, alcohol use, tobacco use. Previous studies have shown inconsistent findings, and did not control for possible friendship network or selection effects. We tested two complementary hypotheses: (1) That early-adolescents with low self-control develop externalizing behavior regardless of their friends' behavior, or (2) as a result of being influenced by their friends' externalizing behavior to a greater extent. Hypotheses were investigated using data from the SNARE (Social Network Analysis of Risk behavior in Early adolescence) study (N = 1144, 50 % boys, M age 12.7, SD = 0.47). We controlled for selection effects and the network structure, using a data-analysis package called SIENA. The main findings indicate that personal low self-control and friends' externalizing behaviors both predict early adolescents' increasing externalizing behaviors, but they do so independently. Therefore, interventions should focus on all early adolescents' with a lower self-control, rather than focus on those adolescents with a lower self-control who also have friends who engage in externalizing behavior.

Prevalence, patterns, associated factors and severity of substance use among psychotic patients in southern Thailand

Co-occurring substance use in psychotic patients causes many subsequences including increased illness severity, decreased medication compliance, higher relapse rates, more hospitalizations, and legal problems. We aim to investigate the prevalence, patterns, associated factors and severity of substance use risk among psychotic patients in southern Thailand. Psychotic out-patients were screened with the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) for their history of substance use in the past three months and categorized as None-to-Low Risk (NLR) or Moderate-to-High Risk (MHR) levels. Multivariate logistic regression was used to examine the associated factors of substance use risk-level. The associations between substance use risk-level and emotional and behavioural symptoms, functional status and family functional status were examined using multivariate linear regression analysis. Of 663 participants screened, 322 (48.6%) used at least one substance in the past three months. Tobacco was the most common substance used (47.2%). The factors associated with a higher risk of any substance use were male gender, young age group, low level of education, being employed and being diagnosed with schizophrenia. A higher number of emotional and behavioural symptoms was significantly associated with higher substance use risk-level. In conclusion, the prevalence of substance use in psychotic patients was high and associated with their emotional and behavioural symptoms. Recommendations for implementation of screening and early intervention programs of substance-related problems in psychotic patients are important for preventing unwanted outcomes.

Catechol-O-methyltransferase gene methylation and substance use in adolescents: the TRAILS study

Substance use often starts in adolescence and poses a major problem for society and individual health. The dopamine system plays a role in substance use, and catechol-O-methyltransferase (COMT) is an important enzyme that degrades dopamine. The Val(108/158) Met polymorphism modulates COMT activity and thus dopamine levels, and has been linked to substance use. COMT gene methylation, on the other hand, may affect expression and thus indirectly COMT activity. We investigated whether methylation of the COMT gene was associated with adolescents' substance use. Furthermore, we explored whether the COMT Val(108/158) Met polymorphism interacts with COMT gene methylation in association with substance use. In 463 adolescents (mean age=16, 50.8% girls), substance use (cigarette smoking, alcohol and cannabis use) was assessed with self-report questionnaires. From blood samples, COMT Val(108/158) Met genotype and methylation rates of membrane bound (MB) and soluble (S) COMT promoters were assessed. MB-COMT promoter methylation was associated with non-daily smoking [odds ratio (OR)=1.82, P=0.03], but not with daily smoking (OR=1.20, P=0.34), MB-COMT promoter methylation was not associated with alcohol use. Adolescents with the Met/Met genotype and high rates of MB-COMT promoter methylation were less likely to be high-frequent cannabis users than adolescents with the Val/Val or Val/Met genotype. S-COMT promoter methylation was not associated with substance use. These results indicate that there is an association between substance use and COMT gene methylation. Although this association is complex, combining genetic and epigenetic variation of the COMT gene may be helpful in further elucidating the influence of the dopamine system on substance use in adolescence.