Predicting transitions in low and high levels of risk behavior from early to middle adolescence: the TRAILS study

Mental health and risk behaviors among secondary school students: A study on ethnic minorities

BACKGROUND

Mental health disorders are highly correlated with risk behaviors. The objective of the present study is to examine the relationship between risk behaviors and mental health among school-going students with a focus on ethnic minorities.

METHODS

The National Health and Morbidity Survey (NHMS) 2017 (n = 8230) was used for analyses. It was a nationwide survey conducted in Malaysia. The dependent variables were measured by three risk behaviors (cigarette smoking, alcohol drinking and use of illicit drugs). Probit regressions were utilized to examine the effect of mental health on the probability of smoking, drinking and using illicit drugs. Demographic and lifestyle factors were used as the control variables. Truancy was identified as a mediating variable.

RESULTS

Anxiety, depression and suicidal ideation affected cigarette smoking, alcohol drinking and use of illicit drugs through mediation of truancy. After controlling for demographic and lifestyle factors, students with anxiety, depression and suicidal ideation were more likely to smoke, drink and use illicit drugs compared with their peers without any mental health disorders. Furthermore, the likelihood of consuming cigarettes, alcohol and illicit drugs was found to be higher among students who played truant than those who did not.

CONCLUSION

Mental health plays an important role in determining participation in risk behaviors among ethnic minority students in Malaysia. Public health administrators and schools have to be aware that students who suffer from mental health disorders are likely to indulge in risk behaviors.

Factors associated with risk behaviors in adolescence: a systematic review

OBJECTIVE

Understanding the distal (≤ 6 years of age) and proximal (between 6 years of age and early adolescence) factors in adolescent risk behavior is important for preventing and reducing morbidity and mortality in this population. This study sought to investigate the factors associated with the following adolescent risk behaviors: i) aggressiveness and violence, ii) tobacco, alcohol, and illicit substance use, iii) depressive behavior and self-harm (including suicidal ideation and attempts), iv) sexual risk behavior, and v) multiple risk behavior.

METHODS

A systematic review was conducted to identify longitudinal studies that examined factors associated with adolescent risk behaviors. The PubMed, PsycINFO, and LILACS databases were searched.

RESULTS

Of the 249 included studies, 23% reported distal risk factors, while the remaining reported proximal risk factors. Risk factors were related to sociodemographic characteristics (neighborhood, school, and peers), family patterns, and the presence of other adolescent risk behaviors.

CONCLUSION

Distal and proximal factors in adolescent risk behavior that are not exclusively socioeconomic, familial, environmental, or social should be explored more thoroughly.

Evaluation of a program targeting sports coaches as deliverers of health-promoting messages to at-risk youth: Assessing feasibility using a realist-informed approach

Unequal access to health promotion resources and early prevention services is a major determinant of health inequity among youth. Initiatives that improve the access to and adoption of health promotion messages are important undertakings, e.g., sport. Sport-for-development (SFD) programs are seen as valuable delivery tools, in which coaches are used as change agents to increase health awareness and behavior among at-risk youth. The delivery of such messages requires specific knowledge and skills that can be attained through training; however, the effectiveness of such training requires assessment. In this study, we evaluated the feasibility of such a training program for SFD coaches using process evaluation from a realist perspective, and views from multiple stakeholders, among other sources. We also clarified the inner workings of the training and investigated how context shaped the training outcomes. Increased health awareness and a sense of responsibility from acting as a role model for at-risk youth were among the perceived training outcomes. Building a safe environment for learning, engagement, and bonds of trust increased the confidence to learn, and resulted in a sense of critical self-reflection and self-development of SFD coaches towards health and prevention messages. Importantly, the unique situations (or context) of SFD coaches and SFD in general presented challenging variables, e.g., a precarious life history or living conditions, mental health issues, or low educational skills, that hampered the impact of the mechanisms put in place by the training. Here, we present a process in which the development of the ‘right mind-set,’ engagement and bonds of trust, in combination with the right settings are key elements for SFD coaches to learn how to convey health-promoting messages and take responsibility as role models for at-risk youth.

Prescription Opioid Misuse and Risky Adolescent Behavior

OBJECTIVES

Misuse of opioid medications (ie, using opioids differently than how a doctor prescribed the medication) is common among US adolescents and associated with preventable health consequences (eg, severe respiratory depression, seizures, heart failure, and death).¹ New guidelines and recommendations have made providers more attuned to overprescribing and more vigilant about screening for opioid misuse.² We hypothesized that youth who misused prescription opioids were more likely to report engaging in a broad range of other risky behaviors.

METHODS

We used the Centers for Disease Control and Prevention's 2017 Youth Risk Behavior Surveillance Survey (n = 14 765), a cross-sectional, nationally representative survey of high school students. Students were sampled by using a 3-stage random cluster design. We conducted weighted logistic regressions to determine the strength of the association between our independent variable, ever misusing prescription opioids, and 22 dependent variables in the following categories: risky driving behaviors (4 variables), violent behaviors (3 variables), risky sexual behaviors (4 variables), substance use (10 variables), and suicide attempt (1 variable).

RESULTS

In 2017, 14% of US adolescents reported ever misusing opioids. Those who misused prescription opioids were significantly more likely to have engaged in all 22 risky behaviors (adjusted odds ratios ranged from 2.0 to 22.3; P < .0001 for all tests) compared with other adolescents.

CONCLUSIONS

Adolescents reporting ever misusing prescription opioids were more likely to have engaged in a broad range of risky behaviors. Health care providers screening for prescription opioid misuse may be ideally positioned to identify these high-risk youth and initiate early interventions.

Unique developmental trajectories of risk behaviors in adolescence and associated outcomes in young adulthood

This study aimed at assessing developmental trajectories of risk behaviors from adolescence into young adulthood and their associations with outcomes in young adulthood (i.e. education, employment). Data of the TRacking Adolescents’ Individual Lives Survey (TRAILS) including 2,149 participants (mean age = 13.6, SD = 0.5, 51% girls) were used to examine the development of alcohol, cannabis, smoking, and externalizing behavior. The results showed that the associations between these risk behaviors varied with age, and revealed varying developmental patterns throughout adolescence. Most notably alcohol use did not covary strongly with the other risk behaviors. The often assumed peak in risk behavior in adolescence was only found in a small group, and only for alcohol (7.4%) and cannabis use (3.4%), but not for smoking or externalizing behavior. Most adolescents revealed only low involvement in risk behavior, with the largest differences between low and high trajectories emerging in late adolescence (> 19 years). Clustering of risk behavior throughout adolescence is rather the exception than the rule and depends on age and type of risk behavior. Differences in risk behavior between individuals become the largest in late adolescence, possibly influencing successful transition into adulthood visible in educational attainment and employment.

Health Promotion in Socially Vulnerable Youth: Sports as a Powerful Vehicle?

Community sport has emerged in the past decades and uses sports as a lever to improve health and well-being among socially disadvantaged youth. Despite this premise, we do not know whether and to what extent health promotion aims are achieved within community sports practice. Measurable actions are needed, but it can be hard for researchers or practitioners to know how to approach this. This study aimed at developing a health-promoting intervention targeting youth attending community sports. To this aim, we used a planned approach for intervention design within a community-based participatory research design. The result is a group-based program promoting health-supportive behavior among community sport coaches, as we found coaches to be quintessential in fostering motivation toward health behavior change in vulnerable youth attending community sports. The design of such a complex intervention is difficult, yet tractable, when using a planned approach. Of importance, community engagement was the core of our work and we provide the reader with detailed examples on the combined use of participatory research and planned intervention design. This article provides an exemplar of how to approach the development of a health-promoting intervention in hard-to-reach populations.

Prospective Effects of Parenting on Substance Use and Problems Across Asian/Pacific Islander and European American Youth: Tests of Moderated Mediation

OBJECTIVE

Parental warmth and knowledge are protective factors against substance use, whereas parental psychological control is a risk factor. However, the interpretation of parenting and its effects on developmental outcomes may vary cross-culturally. This study examined direct and indirect effects of three parenting dimensions on substance use across Asian/Pacific Islander (API) and European Americans.

METHOD

A community sample of 97 API and 255 European Americans were followed from Grades 6 to 12. Participants reported on parenting in Grade 7, academic achievement and externalizing behaviors in Grades 7 and 8, and substance use behaviors in Grades 7, 9, and 12.

RESULTS

Direct effects of parenting were not moderated by race. Overall, mother psychological control was a risk factor for substance use problems in Grade 9, whereas father knowledge was protective against alcohol use in Grade 9, substance use problems in Grades 9 and 12, and alcohol dependence in Grade 12. Moderated mediation analyses indicated significant mediational links among European Americans only: Mother knowledge predicted fewer externalizing problems in Grade 8, which in turn predicted fewer substance use problems in Grades 9 and 12. Father warmth predicted better academic achievement in Grade 8, which in turn predicted fewer substance use problems in Grades 9 and 12, as well as alcohol and marijuana dependence in Grade 12.

CONCLUSIONS

Better academic achievement and fewer externalizing behaviors explain how positive parenting reduces substance use risk among European Americans. Promoting father knowledge of adolescents' whereabouts can reduce substance use risk among both European and API Americans.

Music Preferences, Friendship, and Externalizing Behavior in Early Adolescence: A SIENA Examination of the Music Marker Theory Using the SNARE Study

Music Marker Theory posits that music is relevant for the structuring of peer groups and that rock, urban, or dance music preferences relate to externalizing behavior. The present study tested these hypotheses, by investigating the role of music preference similarity in friendship selection and the development of externalizing behavior, while taking the effects of friends’ externalizing behavior into account. 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. Two hypotheses were tested. First, adolescents were expected to select friends based both on a similarity in externalizing behavior and music genre preference. Second, a preference for rock, urban, or dance, music types was expected to predict the development of externalizing behavior, even when taking friends’ influence on externalizing behavior into account. Stochastic Actor-Based Modeling indicated that adolescents select their friends based on both externalizing behavior and highbrow music preference. Moreover, both friends’ externalizing behavior and a preference for dance music predicted the development of externalizing behavior. Intervention programs might focus on adolescents with dance music preferences.

Comportamentos de risco em adolescentes que vivem em diferentes contextos: Família e institucionalização

<p>Este estudo investigou o engajamento em comportamentos de risco e fatores associados em adolescentes que vivem em diferentes contextos. Participaram 945 adolescentes de ambos os sexos com idades entre 11 e 19 anos. Adolescentes que vivem com suas famílias adotam menos comportamentos de risco e contam com um ambiente mais favorável ao desenvolvimento. Adolescentes acolhidos institucionalmente vivenciaram mais violência intrafamiliar, percebem mais negativamente a relação com a família, apresentam autoestima mais baixa e mais comportamento suicida, adolescentes que estavam cumprindo medida socioeducativa vivenciaram mais eventos estressores e apresentaram mais comportamento antissocial, uso de substâncias e comportamento sexual de risco. É necessário valorizar a convivência familiar e fortalecer instituições de atendimento.</p>

Adolescent tobacco use practices and user profiles in a mature Swedish moist snuff (snus) market: Results from a school-based cross-sectional study

AIMS

The aim of this work was to study the diversity of tobacco use among Norwegian adolescent tobacco users and to investigate how different user groups compared with each other in terms of lifestyle and risk correlates. Swedish moist snuff (snus) use has increased dramatically in Norway over the last few years and is now more prevalent than smoking in younger age groups.

METHODS

The participants were 736 15-year-old tobacco users obtained from a large school-based cross-sectional survey (response rate 73%). Leisure time activity and risk behaviour factors were extracted by principal components analysis. Associations between tobacco use, leisure activities, risk behaviours, alcohol use and sex were studied bivariately and by logistic regression.

RESULTS

In total, 41.5% of the tobacco users were dual users (smokers and snus users). Problem behaviour and risk-taking lifestyles were associated with tobacco use frequency and high-frequency dual use, with a low risk profile for all types of occasional users (snus, cigarettes or dual users), a medium risk profile for all types of daily single-product users, including those who occasionally used the other product (i.e. dual users) and a high-risk profile for those who used both products daily (daily dual users).

CONCLUSIONS

Fragmented use patterns in adolescence undermine the dichotomy often applied between smokers and snus users. For associations with lifestyle and risk correlates, use frequency and high-frequency dual use seem to be more important than the choice of product.

Variáveis pessoais e contextuais associadas a comportamentos de risco em adolescentes

RESUMO Objetivo Este estudo investigou o engajamento de adolescentes brasileiros em comportamentos de risco (uso de substâncias, comportamento sexual de risco, comportamento antissocial e comportamento suicida), buscando identificar os fatores de risco e proteção pessoais e contextuais mais associados com esses comportamentos. Métodos Participaram 1.332 adolescentes de 12 a 19 anos (M = 15,68; DP = 1,60), de ambos os sexos. Resultados O engajamento em comportamentos de risco variou em função da idade e do sexo, e o uso de substâncias foi o tipo de comportamento de risco mais prevalente entre os que foram investigados. Os fatores significativamente associados à adoção desses comportamentos foram violência intra- e extrafamiliar, ter amigos próximos ou familiares que usam drogas, eventos estressores e elevado nível de autoeficácia; enquanto os fatores que se mostraram protetores foram elevado nível de autoestima, expectativas positivas quanto ao futuro e percepção de positividade nas relações com família, escola, religião e comunidade. Conclusão O estudo permitiu identificar algumas características da manifestação de comportamentos de risco na adolescência, com destaque para a prevalência mais alta do uso de substâncias e a coocorrência de diferentes tipos de comportamentos de risco. Dentre os fatores de risco mais associados com o engajamento em comportamentos de risco, destacaram-se a presença de eventos estressores ao longo da vida e a proximidade com amigos que usam drogas. A partir disso, sugere-se investir na minimização de fatores de risco e na potencialização de fatores protetivos para a promoção do desenvolvimento saudável durante a adolescência.

Longitudinal patterns and predictors of multiple health risk behaviors among adolescents: The TRAILS study

BACKGROUND

Most studies on multiple health risk behaviors among adolescents have cross-sectionally studied a limited number of health behaviors or determinants.

PURPOSE

To examine the prevalence, longitudinal patterns and predictors of individual and multiple health risk behaviors among adolescents.

METHODS

Eight health risk behaviors (no regular consumption of fruit, vegetables or breakfast, overweight or obesity, physical inactivity, smoking, alcohol use and cannabis use) were assessed in a prospective population study (second and third wave). Participants were assessed in three waves between ages 10 and 17 (2001-2008; n=2230). Multiple linear regression was used to assess the influence of gender, self-control, parental health risk behaviors, parental monitoring and socioeconomic factors on the number of health risk behaviors adjusted for preceding multiple health risk behaviors (analysis: 2013-2014).

RESULTS

Rates of >5 health risk behaviors were high: 3.6% at age 13.5 and 10.2% at age 16. Smoking at age 13.5 was frequently associated with health risk behaviors at age 16. No regular consumption of fruit, vegetables and breakfast, overweight or obesity, physical inactivity and smoking predicted the co-occurrence of health risk behaviors at follow-up. Significant predictors of the development of multiple health risk behaviors were adolescents' levels of self-control, socioeconomic status and maternal smoking.

CONCLUSIONS

Multiple health risk behaviors are common among adolescents. Individual and social factors predict changes in multiple health risk behaviors, showing that prevention targeting multiple risk behaviors is needed. Special attention should be paid to adolescents with low self-control and families with low socioeconomic status or a mother who smokes.

Characteristics of Child Maltreatment and Adolescent Marijuana Use: A Prospective Study

There has been increasing acceptance of marijuana use in the United States in recent years, and rates among adolescents have risen. At the same time, marijuana use during adolescence has been linked to an array of health and social problems. Maltreated children are at risk for marijuana use, but the relationships among characteristics of maltreatment and marijuana use are unclear. In this article, we examine how the type and the extent of maltreatment are related to the level of adolescent marijuana use. Data analyses were conducted on a subsample of maltreated adolescents (n = 702) from the Longitudinal Studies of Child Abuse and Neglect project. Approximately half the sample had used marijuana, and maltreatment was associated with its use. Multivariate regression models showed that being male, extensive maltreatment, and peer marijuana use were associated with heavy use of marijuana. These findings suggest the importance of comprehensively assessing children's maltreatment experiences and their peers' drug use to help prevent or address possible marijuana use in these high-risk adolescents.

Psychosocial Adjustment in School-age Girls With a Family History of Breast Cancer

OBJECTIVE

Understanding how young girls respond to growing up with breast cancer family histories is critical given expansion of genetic testing and breast cancer messaging. We examined the impact of breast cancer family history on psychosocial adjustment and health behaviors among >800 girls in the multicenter LEGACY Girls Study.

METHODS

Girls aged 6 to 13 years with a family history of breast cancer or familial BRCA1/2 mutation (BCFH+), peers without a family history (BCFH-), and their biological mothers completed assessments of psychosocial adjustment (maternal report for 6- to 13-year-olds, self-report for 10- to 13-year-olds), breast cancer-specific distress, perceived risk of breast cancer, and health behaviors (10- to 13-year-olds).

RESULTS

BCFH+ girls had better general psychosocial adjustment than BCFH- peers by maternal report. Psychosocial adjustment and health behaviors did not differ significantly by self-report among 10- to 13-year-old girls. BCFH+ girls reported higher breast cancer-specific distress (P = .001) and were more likely to report themselves at increased breast cancer risk than BCFH- peers (38.4% vs 13.7%, P < .001), although many girls were unsure of their risk. In multivariable analyses, higher daughter anxiety was associated with higher maternal anxiety and poorer family communication. Higher daughter breast cancer-specific distress was associated with higher maternal breast cancer-specific distress.

CONCLUSIONS

Although growing up in a family at risk for breast cancer does not negatively affect general psychosocial adjustment among preadolescent girls, those from breast cancer risk families experience greater breast cancer-specific distress. Interventions to address daughter and mother breast cancer concerns and responses to genetic or familial risk might improve psychosocial outcomes of teen daughters.

Multiple substance use patterns in adolescents-A multilevel latent class analysis

BACKGROUND

Multiple substance use among adolescents is associated with a number of negative consequences. Therefore, we aim to investigate multiple substance use patterns among young adolescents and identify possible multilevel predictors.

METHODS

We analyzed a longitudinal sample of 2490 German students (51% male; Mage=13.32, SD=0.57) at 45 schools in four German states (Bremen, Hesse, North Rhine-Westphalia, Schleswig-Holstein), who completed two assessments in fall, 2010 and fall, 2013. We conducted multilevel latent class analysis for follow-up data on a variety of outcomes, and tested our final 3-class-model for possible baseline predictors. Follow-up substance use measures included lifetime use, current use, and amount of substance for cigarettes and alcohol. Baseline covariates comprised age, gender, socio-economic status, bullying, victimization, peer and parental use, type of school, and health certification of school.

RESULTS

We identified three latent classes: non-users (n=1541; 61.9%), experimenters (n=722; 29.0%), and multiusers (n=227; 9.1%). Experimental consumption was predicted by higher baseline age (OR=1.71; 1.31-2.24), paternal drinking (OR=2.89; 1.23-6.79), and school type (OR=2.57; 1.83-3.61), while multiuse was predicted by peer smoking (OR=2.94; 1.80-4.80) and drinking (OR=2.13; 1.32-3.44), maternal drinking (OR=6.26; 2.02-19.43), bullying (OR=1.69; 1.15-2.48), higher age (OR=1.92; 1.40-2.62), and school type (OR=4.76; 2.75-8.24) compared to the non-users class.

CONCLUSIONS

Prevention and further research on multiple substance use need to concentrate on social influence models and behavior-related interventions, especially at schools without a college-preparatory track.