Social network effects in alcohol consumption among adolescents

Examining associations between brain morphology in late childhood and early alcohol or tobacco use initiation in adolescence: Findings from a large prospective cohort

A prominent challenge in understanding neural consequences of substance use involves disentangling predispositional risk factors from resulting consequences of substance use. Existing literature has identified pre-existing brain variations as vulnerability markers for substance use throughout adolescence. As early initiation of use is an important predictor for later substance use problems, we examined whether pre-existing brain variations are associated with early initiation of use. In the Generation R Study, a prospective population-based cohort, brain morphology (gray matter volume, cortical thickness and surface area) was assessed at ages 10 and 14 using neuroimaging. In the second wave, participants reported on alcohol and tobacco use initiation. From a base study population (N = 3019), we examined the longitudinal (N = 2218) and cross-sectional (N = 1817) association between brain morphology of frontolimbic regions of interest known to be associated with substance use risk, and very early (age < 13) alcohol/tobacco use initiation. Additionally, longitudinal and cross-sectional associations were examined with a brain surface-based approach. Models were adjusted for age at neuroimaging, sex and relevant sociodemographic factors. No associations were found between brain morphology (ages 10 and 14) and early alcohol/tobacco use initiation (<13 years). Sex-specific analyses suggested a cross-sectional association between smaller brain volume and early initiated tobacco use in girls. Our findings are important for interpreting studies examining neural consequences of substance use in the general population. Future longitudinal studies are needed to specify whether these findings can be extended to initiation and continuation of alcohol/tobacco use in later stages of adolescence.

Obesity contagion among classmates: Children's relation with each other regarding weight status, physical activity, and dietary intake

A series of influential articles suggests that obesity may spread between couples, siblings, and close friends via an obesity contagion phenomenon. Classmates, as important structural equivalents in one's social network, may experience obesity contagion. However, this has rarely been examined. Anthropometric measurements, questionnaire surveys, and geographic information were collected from 3670 children from 26 schools in Northeast China. We found that classmates were positively related in terms of body mass index (BMI), body fat, physical activity, and intake of vegetables, fruits, fast food, snacks, and sugar-sweetened beverages. One standard deviation (SD) increase in classmates' mean BMI and percentage body fat was associated with 0.19 SD higher individual BMI (95% confidence interval [CI]: 0.00, 0.39) and 0.31 SD higher percentage body fat (95% CI: 0.13, 0.48). Coefficients ranged from 0.48 to 0.76 in models for physical activity, and the dietary intake of vegetables, fruit, fast food, snacks, and sugar-sweetened beverages. Children's BMI and body fat were more strongly associated with the maximum and minimum body fat levels of their same-sex classmates than with those of their general classmates. Their dietary intake and physical activity were more strongly associated with the mean/median levels of their general classmates than with those of their same-sex classmates. This study suggests that children's BMI, body fat, physical activity, and dietary intake may be related to those of their classmates. Modeling healthy behaviors in the classroom may help children develop habits that support achieving and maintaining a healthy weight. Future interventions should consider the inclusion of classmates as a social network strategy for obesity prevention.

Dynamic social network analysis of a brief alcohol intervention trial in heavy-drinking college students shows spillover effects

BACKGROUND

Heavy-drinking college students tend to have close social networks, and there is theoretical and empirical support for the idea that behavior change can spread through those networks via close ties. The objective of this research was to determine whether intervention-induced behavior change in a subset of heavy drinkers in a sociometric (whole) college class-year social network is transmitted to other heavy drinkers in the network, resulting in reduced behavioral risk and change in network ties.

METHODS

We conducted a controlled trial in which most of a first-year college class (N = 1236; 56.9% female) was enrolled, with alcohol use and social network ties measured early in each of three semesters. Following a baseline assessment, the network was divided into two groups, brief motivational intervention (BMI) and natural history control (NHC) according to dormitory residence location. A subset of heavy drinkers in each group was selected, and those in the BMI group received an in-person intervention.

RESULTS

Using stochastic actor-oriented modeling, we found a significant tendency for participants in the BMI group to shed ties with individuals with similar drinking behaviors between the first and second semesters, relative to the NHC group. Furthermore, heavy drinkers with reciprocal ties to intervention recipients in the BMI group showed a significant reduction in drinks per week.

CONCLUSIONS

Individual alcohol interventions appear to have effects both on behavior and network connections among individuals who did not receive the intervention. Continued research is needed to identify the optimal conditions for the diffusion of behavior change.

Prevalence of probable substance use disorders among children in Ugandan health facilities

BACKGROUND

Globally, there is a concerning surge in the prevalence of substance use among adolescents and children, creating a substantial public health problem. Despite the magnitude of this issue, accessing healthcare explicitly for substance use remains challenging, even though many substance users frequently visit healthcare institutions for other health-related issues. To address this gap, proactive screening for substance use disorders has emerged as a critical strategy for identifying and engaging patients at risk of substance use. The purpose of this study was to investigate the prevalence of probable alcohol and other substance use disorders, and associated factors, among children aged 6 to 17 years old attending health facilities in Mbale, Uganda.

METHODS

We conducted a health facility cross-sectional study, involving 854 children aged 6-17 years. The prevalence of probable alcohol and other substance use disorders was assessed using a validated Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. Univariable and multivariable modified Poisson regression analyses were performed using STATA 15 software.

RESULTS

The overall prevalence of probable alcohol use disorders (AUD) and other substance use disorders (SUD) was 27.8% (95% CI 1.24-1.31) while that of probable AUD alone was 25.3% (95% CI 1.22-1.28). Peer substance use (APR = 1.24, 95% CI 1.10-1.32), sibling substance use (APR = 1.14, 95% CI 1.06-1.23), catholic caregiver religion (APR = 1.07 95% CI 1.01-1.13), caregiver income of more than $128 (APR = 0.90, 95% CI 0.82-0.98), having no parental reprimand for substance use (APR = 1.05, 95% CI 1.01-1.10) and having no knowledge of how to decline an offer to use substances (APR = 1.06, 95% CI 1.01-1.12) were found to be significantly associated with probable AUD/SUD.

CONCLUSIONS

Our findings suggest a high prevalence of probable AUD and SUD among children and adolescents visiting healthcare facilities for other conditions, along with a strong link between AUD and SUD prevalence and social factors. The implication for our healthcare system is to actively screen for and treat these conditions at primary healthcare facilities.

Effect of household toilet accessibility on physical health of ethnic minority adolescents: a longitudinal study from the China Education Panel Survey 2013 and 2014

BACKGROUND

Accessing household toilets is vital for adolescent health during crucial stages of growth and development; however, some ethnic minority families in China lack toilets. The relationship between household toilet accessibility and the physical health of adolescents in China's ethnic minority areas has been underexamined.

METHODS

Using two waves of data from the China Education Panel Survey (2013 and 2014), this study explored the effect of household toilet accessibility on Chinese ethnic minority adolescents' physical health. The sample consisted of 576 ethnic minority adolescents with an average age of approximately 13 years. To test the health effect of household toilet accessibility on ethnic minority adolescents, a fixed effects ordinary least squares model and difference-in-differences combined with propensity score matching method were used.

RESULTS

The results of the fixed effects model and difference-in-differences combined with propensity score matching showed a significant and positive effect of household toilet accessibility on adolescents' physical health. The heterogeneity analysis indicated that among the toilet types of soil cesspits, cement cesspits, squat toilets, and flush toilets, the flush toilets were proven to be the most efficient in improving adolescents' physical health. Moreover, the family living arrangement was proven to play a moderating role in the effect of household toilet accessibility on the physical health of ethnic minority adolescents. The average marginal effects of household toilet accessibility on the physical health of ethnic minority adolescents who lived without parents were more evident and significant than those who lived with their parents.

CONCLUSION

Promoting household toilet accessibility in China's ethnic minority areas is essential for improving adolescents' health. Moreover, having a household toilet is not sufficient, the quality and dignity of household toilets are also important.

Social media use and alcohol consumption among students in Uganda: a cross sectional study

Background

Globally, alcohol use significantly contributes to the disease burden. Alcohol consumption in Uganda is related to several health consequences among young people, including university students. Social media is commonly used by students to share academic information and create social networks. Among young people in high-income countries, previous studies have also shown that social media use can have negative health outcomes related to alcohol use, and associated problems. To date, similar studies conducted in low- and middle-income countries are largely missing.

Objective

To assess the prevalence of and associations between social media use and alcohol consumption among university students in Uganda.

Method

This was a cross-sectional study among 996 undergraduate students at Makerere University. Data were collected using a questionnaire. Alcohol use in the previous 12 months was the dependent variable. The independent variable was social media use categorised as general use, alcohol-related use, and social media lurking/passive participation. Multinomial logistic regression was used to assess associations. Crude and adjusted odds ratios were reported.

Results

Nearly all students (97%) used social media and 39% reported alcohol use. Regular alcohol use was significantly associated with moderate (OR = 2.22, CI: 1.35–3.66) and high level general social media use (OR = 2.45, CI: 1.43–4.20). Regular alcohol use was also associated with alcohol-related social media (OR = 6.46, CI: 4.04–10.30), and alcohol-related lurking (OR = 4.59, CI: 2.84–7.39). Similar, although weaker associations were identified for occasional alcohol use.

Conclusions

Approximately four in ten students reported alcohol use in the past year, and almost all students used social media. Alcohol-related social media use was associated with occasional and regular alcohol use, with stronger associations for regular use. These findings may guide further research and present an opportunity for potential alcohol control interventions to improve health among young populations in low- and middle-income countries.

Consumo e exposição a bebidas alcoólicas entre adolescentes brasileiros

Objetivo: analisar os indicadores referentes ao consumo de álcool entre escolares brasileiros de 13 a 17 anos em 2015 e 2019. Método: estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar (PeNSE), realizadas em 2015 e 2019. Foram analisados os indicadores referentes ao consumo de álcool estratificados por sexo, faixa etária e dependência administrativa, sendo estimadas as prevalências e os respectivos intervalos de 95% de confiança (IC95%). Resultados: observou-se estabilidade nas prevalências de experimentação de bebida alcoólica alguma vez na vida, 61,4% (IC95%: 59,3;63,6) em 2015 e 63,3% (IC95%: 62,6;64,0) em 2019; o uso de álcool nos últimos 30 dias também se mostrou estável 29,3% (IC95%: 27,6;31,2) 2015 e 28,1% (IC95%: 27,3;28,8) em 2019; experimentação de álcool com 13 anos ou menos aumentou de 30,6% (IC95%: 28,7;32,6) em 2015 para 34,6% (IC95%: 33,8;35,3) em 2019; sofrer embriaguez na vida passou de 27,2% (IC95%: 25,4;28,9) em 2015 para 47,0% (IC95%: 46.0;47.9) em 2019; ter problemas com amigos devido ao consumo de álcool  aumentou de 9,3% (IC95%: 8,4;10,2) em 2015, para 15,7% (IC95%: 15,1;16,2) em 2019. Amigos que consomem álcool reduziu de 49,2% (IC95% 47,1;51,3) para 43,9% (IC95%: 43,0;44,7). Conclusão: evidenciou-se a precocidade da exposição ao álcool e grande magnitude desse fenômeno, o que expõe grande parcela dos adolescentes brasileiros a uma elevada carga evitável de morbimortalidade decorrente do álcool.

Causal Inference for Social Network Data

We describe semiparametric estimation and inference for causal effects using observational data from a single social network. Our asymptotic results are the first to allow for dependence of each observation on a growing number of other units as sample size increases. In addition, while previous methods have implicitly permitted only one of two possible sources of dependence among social network observations, we allow for both dependence due to transmission of information across network ties and for dependence due to latent similarities among nodes sharing ties. We propose new causal effects that are specifically of interest in social network settings, such as interventions on network ties and network structure. We use our methods to reanalyze an influential and controversial study that estimated causal peer effects of obesity using social network data from the Framingham Heart Study; after accounting for network structure we find no evidence for causal peer effects.

Adolescent alcohol initiation: Context of close friendships and the role of trust

PURPOSE

Adolescent initiation of drinking and intoxication is associated with concurrent and later problems among adolescents. This study explores the mechanisms by which the context of close friendships is important to adolescents' decisions to initiate drinking and heavy alcohol use.

METHODS

In-depth face-to-face qualitative interviews were conducted online with 50 adolescents (12-16 years) who reported lifetime drinking. These semi-structured interviews allowed adolescents to describe their first experiences with drinking, reflecting on their social and environmental contexts, decision-making process, and expectations. We conducted a thematic analysis of the narratives, which revealed the nuances of social relationships and trusting peers and their impacts on alcohol use initiation patterns.

RESULTS

In contrast to common perceptions of peer pressure, youth described decision-making about alcohol that was influenced by feelings of safety and security produced by close relationships. Specifically, social relationships, especially the presence of close friends, influenced decisions to initiate alcohol use.

CONCLUSION

Results of this study suggest that close peer relationships enhanced feelings of safety even while engaging in risky behaviors. These results suggest the importance of understanding the complex relationships between social contexts, close friendships, and perceived trust and can inform future research and interventions on alcohol prevention or delayed initiation among adolescents.

The Effects of Social Network and Institutional Embeddedness on Household Consumption: Evidence from China Household Finance Survey

Consumer behavior is embedded in a certain social structure and social networks, and the scale and density of household social networks will be likely to affect consumption expenditure. To explore the impact of social networks and institutional embeddedness on household consumption, this study constructs a model of consumption influencing factors, and devises an empirical study using the data of China Household Finance Survey (CHFS). The results show some innovation. (1) The impact of household social networks on total household consumption is significant. A 1% increase in social networks spending boosts household consumption spending by 0.364%. (2) The institutional embeddedness will affect household consumption. Every 1% increase of social security account balance (the proxy variable of institutional embeddedness) can boost household consumption by 0.196%. This proves that the social insurance institution can enhance consumer confidence and promote current consumption growth. (3) The results of the robustness test confirmed that even after replacing the dependent variable with “the proportion of developmental consumption in total household consumption,” the influence of social networks and institutional embeddedness on consumption is still significant. Using the variable “communication expenses” instead of “gift income and expenditure” as the proxy variable of social networks, the estimation result is still robust. (4) Social networks have a significant influence on all types of household consumption except medical care consumption, but the degree of influence is different. Further discussion revealed that the estimation results are different for different regions in China, but the coefficients of core independent variables are not significantly different. This conclusion is different from people’s intuition, which holds that people in regions with low economic development rely more on social communication and spend more on social communication to maintain a certain social status. The conclusion of this paper is of great significance for formulating policies and institutions affecting residents’ consumption.

Parent/caregiver attitudes, motivations and behaviours in relation to alcohol use among offspring aged 13-18 years: a qualitative study

BACKGROUND

Parental alcohol consumption and alcohol-related behaviour play a critical role in shaping adolescent alcohol use, but comparatively little is known about the perspectives of parents regarding adolescent alcohol use from qualitative studies in England. This study aimed to explore parental views and attitudes towards alcohol use during adolescence, among their offspring and among young people in general.

METHODS

Twenty-three parents (21 mothers, 2 fathers) of children aged 13-18 years were recruited via schools, workplaces and community settings, predominantly in the West of England (n = 19) between 2017 and 2018. Data were collected via in-depth one-to-one interviews and analysed thematically, using an inductive, constructionist approach.

RESULTS

Five major themes were identified in the data: (1) the parental alcohol environment, (2) balance and acceptance, (3) influences of the parental approach, (4) boundaries and parental monitoring, and (5) wider influences shaping young people's behaviour. Overall, parents were aware of the risks and consequences of alcohol use and the wide range of influences shaping drinking behaviour, and expressed broad disapproval of alcohol use among young people. However, adolescent alcohol use was viewed as inevitable, and set within a context of a tolerant drinking culture. Many parents therefore chose a balanced and reluctantly accepting approach. This approach was determined by weighing disapproval of drinking against consistency with wider culture and parental behaviour, support for autonomy of the child, and avoidance of social sanctions. Parents' responses were also determined by a desire to protect the parent-child relationship, maintain an open, communicative and trusting relationship, and ultimately limit risk and minimise harm. Various boundaries and strategies were employed to this end, including care around role modelling, gradual introductions to alcohol, boundaried provision, clear risk reduction messaging and parental monitoring.

CONCLUSIONS

Parents employ a range of mechanisms to reduce alcohol-related risk and to balance harms of alcohol use among their offspring against adolescent behavioural norms. A downward shift in community consumption and changing socio-cultural norms could alter the accepting context in which parents are required to navigate adolescent alcohol use.

The role of social network support in treatment outcomes for medication for opioid use disorder: A systematic review

BACKGROUND

Social connections can lead to contagion of healthy behaviors. Successful treatment of patients with opioid use disorder may lay in rebuilding social networks. Strong social networks of support can reinforce the benefits of medication treatments that are the current standard of care and the most effective tool physicians have to fight the opioid epidemic.

METHODS

The research team conducted a systematic review of electronic research databases, specialist journals and grey literature up to August 2020 to identify randomized controlled trials of social network support in patient populations receiving medication for opioid use disorder (MOUD). The research team placed the studies into a framework of dynamic social networks, examining the role of networks before MOUD treatment is initiated, during the treatment, and in the long-term following the treatment. The research team analyzed the results across three sources of social network support: partner relationships, family, and peer networks.

RESULTS

Of 5193 articles screened, eight studies were identified as meeting inclusion criteria. Five studies indicated that social network support had a statistically significant effect on improved MOUD treatment outcomes. We find the strongest support for the positive impact of family social network support.

CONCLUSIONS

Social networks significantly shape effectiveness of opioid use disorder treatments. While negative social ties reinforce addiction, positive social support networks can amplify the benefits of medication treatments. Targeted interventions to improve treatment outcomes can be designed and added to MOUD treatment with their effects evaluated in improving patients' odds of recovery from opioid use disorder and reversing the rising trend in opioid deaths.

A Mobile Peer Intervention for Preventing Mental Health and Substance Use Problems in Adolescents: Protocol for a Randomized Controlled Trial (The Mind Your Mate Study)

Background

Anxiety, mood, and substance use disorders have significant social and economic impacts, which are largely attributable to their early age of onset and chronic disabling course. Therefore, it is critical to intervene early to prevent chronic and debilitating trajectories.

Objective

This paper describes the study protocol of a CONSORT (Consolidated Standards of Reporting Trials)-compliant randomized controlled trial for evaluating the effectiveness of the Mind your Mate program, a mobile health (mHealth) peer intervention that aims to prevent mental health (focusing on anxiety and depression) and substance use problems in adolescents.

Methods

Participants will consist of approximately 840 year 9 or year 10 students (60 students per grade per school) from 14 New South Wales high schools in Sydney, Australia. Schools will be recruited from a random selection of independent and public schools across the New South Wales Greater Sydney Area by using publicly available contact details. The intervention will consist of 1 introductory classroom lesson and a downloadable mobile app that will be available for use for 12 months. Schools will be randomly allocated to receive either the mHealth peer intervention or a waitlist control (health education as usual). All students will be given web-based self-assessments at baseline and at 6- and 12-month follow-ups. The primary outcomes of the trial will be the self-reported use of alcohol and drugs, anxiety and depression symptoms, knowledge about mental health and substance use, motives for not drinking, and willingness to seek help. Secondary outcomes will include positive well-being, the quality of life, and the impact of the COVID-19 pandemic. Analyses will be conducted using mixed-effects linear regression analyses for normally distributed data and mixed-effects logistic regression analyses for categorical data.

Results

The Mind your Mate study was funded by an Australian Rotary Health Bruce Edwards Postdoctoral Research Fellowship from 2019 to 2022. Some of the development costs for the Mind your Mate intervention came from a seed funding grant from the Brain and Mind Centre of the University of Sydney. The enrollment of schools began in July 2020; 12 of 14 schools were enrolled at the time of submission. Baseline assessments are currently underway, and the first results are expected to be submitted for publication in 2022.

Conclusions

The Mind your Mate study will generate vital new knowledge about the effectiveness of a peer support prevention strategy in real-world settings for the most common mental disorders in youth. If effective, this intervention will constitute a scalable, low-cost prevention strategy that has significant potential to reduce the impact of mental and substance use disorders.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12620000753954; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379738&isReview=true

International Registered Report Identifier (IRRID)

DERR1-10.2196/26796

An open trial investigation of Treatnet Family among adolescents with substance use problems

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Treatnet Family (TF) had a positive significant impact in reducing alcohol use.

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After participating in the TF, the adolescents were engaged with significantly fewer friends who consumed substances and participated in antisocial behaviours.

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The two most reported life events (i.e., “got in a lot of arguments or fights” and “had problems with drugs or alcohol”) before the intervention were significantly decreased at the follow-up assessment.

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Based on parent’s/family member’s reports, there was a significant decrease in mental health problems across time.

Introduction

Studies that used evidence-based family therapies have demonstrated significant effects in reducing adolescent drug use and delinquent behaviours, and in reducing comorbid mental health problems. However, almost all these studies were conducted in high-income countries. The overall aim of the present study was to explore the effect of United Nations Office on Drugs and Crime’s (UNODC) Treatnet Family (TF) in reducing substance consumption, drug-related activities, reducing mental health problems, and in improving family interaction among adolescents with substance-use problems.

Method

Nineteen adolescents who had been referred to a community counselling clinic because of substance-use problems and their parents/family members participated in TF. They completed a set of questionnaires to measure substance use, family functioning, mental health problems, and life events at pre-, post-intervention as well as at a one month-follow-up assessment.

Results

TF had a positive significant impact in reducing alcohol use among adolescents with substance-use problems. The number of adolescents who smoked cigarettes and marijuana, and used amphetamines reduced across time. After participating in TF, the adolescents were involved with significantly fewer friends who consumed substances and participated in antisocial behaviours. Furthermore, parent/family member reported a significant decrease in mental health problems, and positive changes in adolescent’s behaviours.

Conclusion

The TF had a positive impact in reducing alcohol consumption and problems related to substance consumption among adolescents with substance-use problems when delivered by practitioners in routine community settings.

Peer influence in adolescent drinking behavior: A meta-analysis of stochastic actor-based modeling studies

Objectives

To measure the effects of peer influence and peer selection on drinking behavior in adolescence through a rigorous statistical approach designed to unravel these interrelated processes.

Methods

We conducted systematic searches of electronic databases, thesis collections and conference proceedings to identify studies that used longitudinal network design and stochastic actor-oriented modeling to analyze drinking behavior in adolescents. Parameter estimates collected from individual studies were analyzed using multilevel random-effects models.

Results

We identified 26 articles eligible for meta-analysis. Meta-analyses for different specifications of the peer influence effect were conducted separately. The peer influence effect was positive for every specification: for average similarity (avSim) mean log odds ratio was 1.27 with 95% confidence interval [0.04; 2.49]; for total similarity (totSim) 0.46 (95% CI = [0.44; 0.48]), and for average alter (avAlt) 0.70 (95% CI = [-0.01; 1.41]). The peer selection effect (simX) was also positive: 0.46 (95% CI = [0.28; 0.63]). Conversion log odds ratio values to Cohen’s d gives estimates from 0.25 to 0.70, which is considered as medium to large effect.

Conclusions

Advances in methodology for social network analysis have made it possible to accurately estimate peer influence effects free from peer selection effects. More research is necessary to clarify the roles of age, gender, and individual susceptibility on the changing behavior of adolescents under the influence of their peers. Understanding the effects of peer influence should inform practitioners and policy makers to design and deliver more effective prevention programs.

Gender Differences in the Prediction of Alcohol Intoxication among Adolescents

BACKGROUND

Alcohol is one of the most commonly consumed substances in adolescence and can lead to many (mental) health problems. This study aimed to examine social determinants related to family, peers and school achievement as risk factors for alcohol intoxication (AI) among adolescents and to examine whether these risk factors differ in their prediction of AI concerning potential gender differences.

METHODS

The data used in this study were obtained from the cross-sectional "European School Survey Project on Alcohol and Other Drugs" and involved 2558 participants who were turning 16 in the year of the research. Multinomial and binary logistic regressions were performed for each AI indicator (lifetime, in the last 12 months, in the last 30 days and heavy episodic drinking (HED) in the last 30 days) in relation to gender.

RESULTS

School achievement, parental knowledge, peer pressure (for alcohol consumption and for AI) were found to be consistent predictors for varying AI among adolescents. High school achievement was found to be a protective factor for all AI indicators explored in our study, regardless of gender. Peer pressure made a more pronounced contribution to AI experience among boys, while parental knowledge demonstrated a more protective nature with regards to AI among girls.

CONCLUSION

Overall, results indicate that social determinants as predictors of AI among adolescents are consistent across various AI indicators and confirm gender specific predictors for AI. These findings indicate the possible benefit of involving parents in preventive programs and of using a gender perspective regarding observed differences.

Maternal education and infant health gradient: New answers to old questions

By using data from the National Vital Statistics System, this study provides an in-depth investigation of the well-documented mother's education- infant health gradient. The study allows for differential relationship between mother's education and infant health outcomes across localities based on income status by using birthweight and low birthweight as health measures. The results show that mother's education- infant birthweight relationship is more concentrated at relatively poor geographic areas. This can partially be explained by increases in utilization of health services among educated mothers residing in poorer areas compared to mothers with lower levels of education. Although the magnitude of education-health gradient has decreased in recent years, the gradient is still more pronounced in poorer localities. Access to health care during pregnancy, measured by adequacy of care, has improved particularly among less educated mothers living in poorer areas. However, smoking participation during pregnancy has declined substantially among less educated mothers across all geographic localities in recent years. Additionally, mother's education-infant health gradient is similar across black and white race groups.

Qualitative exploration of the intersection between social influences and cultural norms in relation to the development of alcohol use behaviour during adolescence

OBJECTIVES

Few contemporary studies have examined peer and social drivers of alcohol use during mid-adolescence. We sought to explore young people's perspectives on socio-cultural influences relating to alcohol use behaviour during this period.

DESIGN

Qualitative research study.

METHODS

Semi-structured one-to-one (n=25), paired (n=4) or triad (n=1) interviews and one focus group (n=6) were conducted with 30 young people aged 14 to 15 (13 males, 17 females) recruited from 4 schools, and 12 participants (aged 14 to 18, 8 males, 4 females) recruited from two youth groups in an urban centre in the West of England. Nineteen participants abstained from alcohol use, 9 were occasional or moderate drinkers and 14 drank alcohol more regularly. Interviews were audio-recorded, transcribed verbatim and analysed thematically using NVivo V.10, through a lens of social influence and social norms theories.

RESULTS

Alcohol consumption was associated with being cool, mature and popular, while enabling escape from reality and boosting confidence and enjoyment. Positive expectancies, alongside opportunity, contributed to motivating initiation, but social influences were paramount, with participants describing a need to 'fit in' with friends to avoid social exclusion. Such influences positioned drinking at parties as a normative social practice, providing opportunities for social learning and the strengthening of peer norms. Social media presented young people with positive alcohol-associated depictions of social status, enjoyment and maturity. This intersection of influences and norms generated a pressurised environment and a sense of unease around resisting pressures, which could elicit stigmatising insults.

CONCLUSIONS

Cultural norms, social influences and social media intersect to create a pressurised environment around alcohol use during mid-adolescence, driving the escalation in the prevalence of excessive consumption at this stage. New interventions need to address normative influences to enable the prevention of excessive alcohol use during adolescence.

Peer social network processes and adolescent health behaviors: A systematic review

Research has highlighted the importance of peers for determining health behaviors in adolescents, yet these behaviors have typically been investigated in isolation. We need to understand common network processes operating across health behaviors collectively, in order to discern how social network processes impact health behaviors. Thus, this systematic review of studies investigated adolescent peer social networks and health behaviors. A search of six databases (CINAHL, Education Resources Information Centre, Embase, International Bibliography of the Social Sciences, Medline and PsycINFO) identified 55 eligible studies. The mean age of the participants was 15.1 years (range 13-18; 51.1% female). Study samples ranged from 143 to 20,745 participants. Studies investigated drinking (31%), smoking (22%), both drinking and smoking (13%) substance use (18%), physical activity (9%) and diet or weight management (7%). Study design was largely longitudinal (n = 41, 73%) and cross-sectional (n = 14, 25%). All studies were set in school and all but one study focused on school-based friendship networks. The Newcastle-Ottawa Scale was used to assess risk of bias: studies were assessed as good (51%), fair (16%) or poor (33%). The synthesis of results revolved around two network behavior patterns: 1) health behavior similarity within a social network, driven by homophilic social selection and/or social influence, and 2) popularity: health behavior engagement in relation to changes in social status; or network popularity predicting health behaviors. Adolescents in denser networks had statistically significant lower levels of harmful behavior (n = 2/2, 100%). Findings suggest that social network processes are important factors in adolescent health behaviors.

Determinants of harmful use of alcohol among urban slum dwelling adults in Kenya

BACKGROUND

Harmful alcohol use is a public health problem associated with negative health and socio-economic impacts. However, patterns and dynamics of alcohol use among slum-dwellers in Kenya are poorly understood.

OBJECTIVE

To establish determinants of harmful alcohol use among adults in an urban slum setting in Kenya.

MATERIALS AND METHODS

Cross-sectional study involving a consecutively selected sample (N=215) from Githurai, in Nairobi. A pre-tested questionnaire that captured data on socio-demographics, drinking patterns, type, reasons, initiator, and support system.

RESULTS

Of the respondents, those above 31 years, married, separated/divorced/widowed, of high education, earning above 50 USD, and from dysfunctional families consumed more alcohol. Low earners consumed (p < 0.05) unrecorded while high earners drank (p< 0.001) recorded alcohol. Adults from families with a drinking father and sibling consumed more alcohol (p=0.001). Single, low educational attainment/earners, and those in dysfunctional families (p <0.05) drank due to stress and reported alcohol-related problems. Young, unmarried, and casual laborers were introduced (p < 0.05) to alcohol by friends.

CONCLUSION

Socio-demographic, economic, familial, social interactions, and stress are associated with harmful alcohol use among adults from slums calling for interventions targeting these factors.

The Association Between Social Media Use and Hazardous Alcohol Use Among Youths: A Four-Country Study

Aims

To examine the continuing role of daily popular social media use in youth hazardous alcohol consumption in four countries across continents.

Methods

A web-based survey was given to youths aged 15–25 in the USA (n = 1212), South Korea (n = 1192), Finland (n = 1200) and Spain (n = 1212). Hazardous alcohol use (alcohol use disorders identification test-C) was the dependent variable. Main independent variables measured daily use of different social media services. Controls included compulsive Internet use, offline belonging, psychological distress, impulsivity, risk-taking, age and gender. Linear regression models and mediation analyses with bootstrapping were done for each country.

Results

Daily use of Facebook and Instagram was associated with higher hazardous alcohol use among youths in Finland, South Korea and Spain. Daily instant messaging was related to higher hazardous alcohol use among South Korean and Finnish youths. Daily YouTube use was associated with higher hazardous alcohol use among youths in South Korea, but lower hazardous alcohol use among youths in the USA and Finland. Daily Twitter use was related to lower hazardous drinking among youths in Finland but higher hazardous drinking among youths in Spain. The mediation analyses revealed that uploading pictures to social media is a possible facilitator of social media-related hazardous alcohol use among youths in the USA and Spain.

Conclusion

Certain social media platforms might inspire and/or attract hazardously drinking youths, contributing to the growing opportunities for social media interventions.

Using social network analysis to examine alcohol use among adults: A systematic review

Background

Alcohol use and abuse constitute a major public health problem and identifying their determinants is a priority. Social network analysis can indicate how characteristics of social networks are related to individual health behaviors. A growing number of studies have used social network analysis to examine how social network characteristics influence adult alcohol consumption, but this literature has never been systematically reviewed and summarized. The current paper systematically reviews empirical studies that used social network analysis to assess the influence of social network characteristics on drinking behaviors in adults.

Methods

A literature search of PubMed/MEDLINE, EMBASE, PsycINFO and Web of Science databases and a review of the reference lists of retrieved articles was conducted in March 2019. Two reviewers independently screened 5,510 non-duplicate records, and further screened the full text of 150 articles to determine their eligibility for inclusion. Seventeen articles were judged eligible and included.

Results

Most studies were conducted among young adults (mean age<30), in university settings or follow up visits with adolescent networks moving into adulthood. The objectives and methods of the included studies were heterogeneous. All included studies reported a statistically significant association between a social network characteristic and an alcohol consumption-related outcome. Social network members drinking behaviors were associated with participants’ drinking behaviors in multiple ways.

Discussion

In young adults, among whom the majority of identified studies were conducted, with whom they socialize and how they socialize appears to be associated with alcohol consumption; this was observed across methodologies and settings. We still know very little about the relationship of social networks to drinking in older age groups, and in populations most impacted by alcohol. As social networks appear to play a role in the consumption of alcohol in young adulthood, interventions that utilize social networks to help reduce harmful alcohol consumption should be considered.

Peer influence in adolescent drinking behaviour: a protocol for systematic review and meta-analysis of stochastic actor-based modeling studies

INTRODUCTION

Alcohol consumption is a considerable public health problem that is especially harmful to young people. To develop effective prevention programmes targeted at adolescents, it is important to understand the social mechanisms triggering alcohol consumption. Among such mechanisms, peer influence plays an important role. The effects of peer influence are very difficult to evaluate because of the entanglement with social selection, that is, a tendency of people to befriend others with similar behaviour. The recently developed stochastic actor-oriented models (SAOM) approach is designed to disentangle social influence from social selection. The aim of this study is to conduct a systematic review and meta-analysis of studies employing SAOM methodology to evaluate the effects of social influence on adolescent drinking behaviour.

METHODS AND ANALYSIS

In order to analyse the co-evolution of alcohol consumption and adolescent friendship networks, we will collect articles that use SAOM methodology through systematic electronic searches in Web of Science, Scopus, PubMed, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials), EBSCOhost (MEDLINE, SocINDEX, Academic Source, ERIC), ProQuest (ProQuest Dissertations and Theses Global), PsycINFO (PsycNET), Excerpta Medica database (Embase) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). We will collect the literature from academic journals, dissertations/theses, reports and conference materials. Three reviewers will retrieve and independently assess potentially relevant material in terms of whether they comply with prespecified criteria. Subsequently, we will summarise the results of the studies in a systematic review. If a sufficient number of studies can be found, SAOM quantitative results will be extracted and meta-analysed. The project will go from 1 December 2018 to 1 December 2019.

ETHICS AND DISSEMINATION

Ethical approval will not be required as our work is based on published studies. A list of all the studies included in this work will be available for review. We plan dissemination in a peer-reviewed international scientific journal and through conference presentations. Our review will highlight the peer effect of peers in adolescent drinking behaviour and provide guidance for developing effective prevention and intervention programmes. We expect it to be informative for policy and practice, decision-making as well as for further research in public health and sociology of adolescents.

PROSPERO REGISTRATION NUMBER

CRD42019119836.

Content, perceptions and impact of alcoholic drink promotions in nightlife venues that are targeted towards students

Background

Binge drinking is generally considered socially acceptable for students across Western culture. Social norms within the student population have meant that excessive drinking plays a key role in socialising and reinforcing peer group identity. Research has highlighted the United Kingdom (UK) as having elevated levels of alcohol consumption especially within the student population, and the role that drink promotions have in influencing consumption practices. This paper considers promotions of alcoholic drinks in UK nightlife venues and student perceptions of these promotions. Bourdieu's concepts of social and cultural capital are applied to the findings.

Method

Content analysis of social media posts by nightlife venues (n = 12), observations of nightlife venues (n = 20) and semi-structured focus groups and paired interviews with 32 undergraduate students, from one city in the North West of England.

Results

Nightlife venues target promotions of alcoholic drinks at students through social media, advertisements throughout nightlife venues, and by promoters outside of venues. These promotions will often influence the course of a night out in terms of venues visited and the drinks consumed. Alcohol holds importance within mainstream student culture; it plays a key role in achieving cultural capital and is a means for students to obtain social capital through the creation of shared experiences, which are key for those who are new to university.

Conclusions

Nightlife venues will target alcoholic drink promotions at students and will use the notion of creating a shared experience as part of this targeted promotion. This contributes to the overall social and cultural capital that alcohol holds within the student population. This is an important consideration for alcohol policy - it demonstrates how prevention activities need to take into consideration the importance of shared experiences for the students; alternatives to excessive alcohol consumption need to offer a similar opportunity.

Social identity and drinking: Dissecting social networks and implications for novel interventions

Drinking among young adults has been consistently associated with perceptions of prevalence and approval of varying levels of drinking among broadly defined similar others (e.g. other female college students). Few works have considered influences in terms of actual group members comprising individuals' social networks. We proposed two overlapping groups would differentially influence drinking (important others; drinking buddies; and members of both groups). Furthermore, we expected that specific individuals (e.g. romantic partners and family members) would be associated with less drinking. Data were provided from 372 drinkers who logged daily drinking and the presence of network members on MTurk. Results indicated consistent support for the number of network members present as a predictor of the number of drinks consumed per drinking day, regardless of member characteristics. Only important others who were not drinkers and romantic partners failed to demonstrate unique positive associations with drinks per drinking day.

Adolescents' Social Norms across Family, Peer, and School Settings: Linking Social Norm Profiles to Adolescent Risky Health Behaviors

Social norms around adolescent risky health behaviors have been often studied in separate developmental settings (e.g., family norms, peer norms), and little is known regarding the overall patterns of social norms across contexts and how they influence adolescent risky health behaviors. This study explored profiles of social norms around risky health behaviors across family, peer, and school settings, using data from 11,086 adolescents (50% female; 49% White, 22% Black, 18% Latinx, 8% Asian American, 3% other race/ethnicities) in the National Longitudinal Study of Adolescent to Adult Health. Five profiles of social norms around risky health behaviors emerged. Only a small portion of the sample experienced either congruent-restrictive (6%) or congruent-permissive (10%) social norms across settings. The majority experienced incongruent social norms, including the developmentally normative-low risk (39%), developmentally normative-high risk (40%), and resilient (5%) profiles. Adolescents with the congruent-restrictive profile and developmentally normative-low risk profiles exhibited the least risky health behaviors over time, followed by those with the resilient profile, and adolescents with the developmentally normative-high risk and the congruent-permissive profile exhibited the greatest risky health behaviors over time. Each profile was associated with unique developmental, socio-demographic, and psychosocial characteristics. The findings highlighted the complexity of social norms across contexts and the developmental versus risky natures of these social norm profiles.

Problematic alcohol use and depression in secondary school students in Miri, Malaysia

BACKGROUND

Alcohol consumption in the under-aged is one of the main concerns regarding Malaysian adolescents. There is no previous study on problematic alcohol use (PAU) in adolescents in Sarawak. The aim of this study was to determine the prevalence of PAU, its associated variables and its relationship with depression.

METHODS

This was a cross-sectional study. A total of 327 secondary school students completed the Alcohol Use Disorder Identification Test and Children's Depression Inventory, and a sociodemographic questionnaire. Binary and multivariable logistic regression were used to examine the relationship between the different variables.

RESULTS

A total of 42.2% of adolescents had PAU. Urban adolescents had a higher prevalence compared with rural adolescents (OR, 1.612; 95% CI: 1.036-2.508 P = 0.034). Female adolescents (56.8%) and Bumiputera Sarawak adolescents (76.8%) comprised a large proportion of the respondents with PAU. Cultural norm (78.3%) and curiosity (68.1%) were the two main reasons for PAU. Only family history of alcohol use (OR, 2.273; 95% CI: 1.013-5.107; P = 0.047), ever consumed alcohol (OR, 57.585; 95% CI: 21.885-151.525; P < 0.001) and ever consumed beer (OR, 2.564; 95% CI: 1.032-6.372; P = 0.043) were significantly associated with PAU. The prevalence of depression was 21.4%. A significant relationship between PAU and depression was seen (OR, 2.557; 95% CI: 1.479-4.420; P = 0.001).

CONCLUSION

There is a high prevalence of PAU in adolescents in Miri, Malaysia. More effort is needed to implement policies for this vulnerable group, with collaboration between agencies to ensure their mental and physical wellbeing and prevent a negative impact later. Clinicians should be more vigilant in detecting depression in adolescents with PAU to enable early intervention.

Social influences normalize gambling-related harm among higher risk gamblers

BACKGROUND AND AIMS

Social influences are key drivers of gambling, and can begin in youth through parental modeling and facilitation. Over time, social influence from friends and colleagues also becomes important. Social network analysis provides a method to measure the combined nature of these social influences. This study aimed to compare social influences across gambling risk groups, by examining key characteristics of the social networks, among Australian adults.

METHODS

A total of 784 respondents (egos) reported their demographics, gambling behavior and gambling risk, as well as those of the 20 most influential people in their lives (alters). Egos also reported the strength of the connection between themselves and each of their alters, and between each pair of alters. Data were analyzed using egocentric social network analysis approaches.

RESULTS

Egos in higher risk groups reported more alters who gamble, including a higher proportion experiencing gambling-related harm. Relationship strength indicated that egos in higher risk groups tended to feel closer to their alters, regardless of whether the alter gambles or not. Network density (interconnectedness between alters) was greater for egos in higher risk groups.

DISCUSSION AND CONCLUSIONS

The findings indicate that both gambling behavior and gambling-related harm are normalized through social connections. Greater interconnectedness in the networks of higher risk gamblers indicates difficulties in reducing or removing these influences. The findings indicate limitations of individualised interventions, and instead highlight the important role of changing norms within society, which can be transmitted throughout these networks.

Self-Persuasion on Facebook Increases Alcohol Risk Perception

In this experiment, we examined if participating in a Facebook group by generating antialcohol arguments (self-persuasion) is more effective than reading antialcohol posts of others (direct persuasion) in changing alcohol consumption, risk perception, and attitudes. In addition, it was examined if submitting posts moderated these effects. Participants logged into their Facebook account and joined a group that contained posts with antialcohol arguments. They either generated their own arguments with or without posting them, or read those present in the group with or without posting that they had read them. Next, participants rated movie clips in a 30-minute ad libitum drinking session in dyads, and their alcohol consumption was measured. Finally, measures of alcohol risk perception and attitudes were completed. Results show that generating antialcohol arguments-regardless of whether they are posted online-is effective in increasing alcohol risk perception but does not affect immediate alcohol consumption.

Generational Peers and Alcohol Misuse

This study investigates the influence of generational peers on alcohol misuse among immigrant youth. We derive hypotheses from sociological theories of generations regarding race/ethnicity, gender, and immigrant generation and test these hypotheses using a measure that accounts for the proportion of peers within a given peer network that are of the same immigrant generation. Results show that generational ties decreased the odds of alcohol misuse for immigrants and that these effects depend partly on race/ethnicity and gender. We conclude that generational ties play a meaningful role in the health and well-being of immigrant youth, and discuss possible future avenues for research on immigrant generational peers.

An exploration of adolescents' decisions to abstain or refrain from alcohol consumption in Australian social settings: a qualitative systematic review

BACKGROUND

A significant number of Australian adolescents consume alcohol, with almost two thirds of them doing so at risky levels. This is continuing to increase despite recent National Health and Medical Research Council (NHMRC) guidelines stipulating that no alcohol is the safest option. Measures initiated to reduce and prevent alcohol consumption by adolescents have limited effectiveness. Consumption of alcohol by Australian adolescents is a national concern because of the deleterious effects of alcohol consumption on adolescents' social, physical and neurological development, as well as other short- and long-term health risks, and the negative impact of alcohol-related violence and injury on the community. Understanding adolescents' decisions to abstain or refrain from alcohol consumption may provide valuable insights to assist in dealing with this significant social and health issue, more particularly about the mechanisms used by adolescents or their ability to make decisions about resisting or abstaining from alcohol consumption when exposed to alcohol in their social setting(s).

OBJECTIVES

The review aimed to synthesize the best available qualitative evidence on the decisions made or mechanisms used by adolescents who abstain or refrain from consuming alcohol in any social setting where alcohol is available.

INCLUSION CRITERIA

Adolescents aged between 14 and 19 years who reside in Australia.The phenomenon of interest was abstinence from or resistance to alcohol consumption when exposed to alcohol in social situations.This review considered studies that focused on qualitative data, including, but not limited to,designs such as phenomenology, grounded theory, action research and exploratory studies.

SEARCH STRATEGY

A three-step search strategy was used. An initial search to identify keywords only was undertaken in Medline and CINAHL. This was followed by an expanded search using all identified keywords and index terms specific to each included database. The reference lists of included papers were then searched for any other relevant studies.

METHODOLOGICAL QUALITY

No studies met the inclusion criteria sufficiently to progress to critical appraisal.

DATA EXTRACTION

No studies progressed to data extraction.

DATA SYNTHESIS

Data synthesis was not undertaken as no study met the inclusion criteria.

RESULTS

Although a number of studies retrieved indicated they had qualitative elements to their studies, the qualitative data was not reported.

CONCLUSIONS

Although a number of studies met some aspects of the inclusion criteria there was insufficient reporting of the phenomenon of interest. Due to the lack of studies meeting the inclusion criteria, no conclusions can be drawn for clinical practice. A lack of qualitative data on this topic has been identified. Thus there is a great need for qualitative research to understand and know more about what enables an adolescent to abstain or refrain from consumption in order to inform or formulate effective interventions, policies or plans to prevent or reduce the volume of alcohol consumed by Australian adolescents.

Predictors and the distal outcome of general Internet use: The identification of children's developmental trajectories

This study examined the predictors and distal outcome in relation to the frequency of online activities and investigated the presence of prototypical trajectories following different patterns of general Internet use over 5 years. The data set consisted of a nationally representative sample of 2,840 fourth graders (M_age  = 9.86 years) in South Korea at baseline. Analyses revealed rank-order stability in general Internet use with four latent classes: high stable (5.8%), high quadratic (20.3%), moderate stable (32.7%), and low stable (41.2%). Youth with higher levels of perceived parental monitoring knowledge, friendship closeness, and depressed mood at baseline were more likely to belong to the high stable class, while girls were more likely to be in the high quadratic or moderate stable classes relative to the low stable class. The high stable class had the greatest odds of reporting alcohol use at grade eight, whereas the low stable class had the lowest odds. Statement of contribution What is already known on this subject? Internet usage increases as children progress through to early adolescence and then levels off Longitudinal data have shown that adolescents' greater Internet use is predictive of their higher levels of drinking What does this study add? To explore different developmental pathways of Internet use in relation to its antecedents and distal outcome Early adolescents who spend more time on the Internet have a greater chance of starting to drink The interindividual rank-order stability of general Internet usage exists at least before late childhood.

Characteristics of influential peers in the eyes of secondary school students: a mixed method study

Aim It is the aim of this study to explore the characteristics of influential peers identified by schoolmates, and the mechanism by which they exert their influence on their peers.

BACKGROUND

Adolescent crowds are a salient influence on the health-risk behaviors of peers, contributing to adolescent substance use such as drinking alcohol, smoking cigarettes, and taking drugs.

METHODS

A mixed method study. Three schools granted us access to students and those who had been nominated as influential by their peers. The students were asked to nominate and indicated the characteristics of peers whom they considered influential in a quantitative study. Those peers whom they considered influential were invited to take part in focus group interviews. A total of six focus group interviews were conducted, comprised of two groups from each school, with an average of seven participants in each group. Findings Students considered caring and friendliness (91.0%), being a buddy (88.5%), and entertaining/humor (86.8%) as the top three characteristics of influential peers. The interviews revealed that the students believed that they are influential because of their cheerfulness and humor, considerateness, ability to communicate, popularity and sociability, sincerity and trustworthiness, and because they possess the characteristics of a leader. They also believed that their power to influence came about through their helpfulness, accommodation, and the closeness of their relationships. Their influence was manifested in both positive and negative ways on the academic pursuits and health-risk behaviors of their peers. In order to engage at-risk students in health promotion programs, it is important to identify their influential peers, and to understand how adolescent friends may help one another to resist behaviors that pose a risk to their health.

Among friends: a qualitative exploration of the role of peers in young people's alcohol use using Bourdieu's concepts of habitus, field and capital

Drinking is viewed by young people as a predominantly social activity which provides an opportunity for entertainment and bonding with friends. Using Bourdieu's concepts of habitus, field and capital, this article explores young people's attitudes and beliefs around alcohol use, influences on behaviour, and the role of peers, with a view to informing the development of preventive interventions. Semi-structured interviews were conducted with 28 young people aged 18-20 in the south west of England. We describe how friends were integral in drinking experiences, and drinking with friends was equated with fun and enjoyment. In this way, the desire for social and symbolic capital appeared to be a key motivator for adolescent drinking. Critically, however, wider cultural norms played the predominant role in shaping behaviour, via the internalisation of widely accepted practice and the subsequent externalisation of norms through the habitus. Applying Bourdieu's theory suggests that population-level interventions that regulate alcohol consumption, and thus disrupt the field, are likely to facilitate behaviour change among young people by driving a response in habitus.

Youth Exposure to Alcohol Advertising in National Magazines in the United States, 2001-2011

OBJECTIVES

To update public health surveillance of alcohol advertising to underage populations by assessing alcohol industry compliance with their voluntary guidelines for US magazine advertisements from 2001 to 2011.

METHODS

Using advertising industry standard sources The Nielsen Company and MediaMark, we evaluated youth exposure to alcohol advertising, and relative advertising exposure of youths versus adults, in 168 national magazines.

RESULTS

From 2001 to 2011, magazine alcohol advertising seen by youths declined by 62.9%, from 5.4 billion impressions (single person seeing a single advertisement) to 2.0 billion impressions. Most alcohol advertising (65.1% of ads) was for spirits (e.g., vodka, whiskey). Since 2008, alcohol companies achieved 100% compliance with their limited guidelines. However, youths were overexposed to magazine advertising relative to adults on average 73% of the time.

CONCLUSIONS

Despite improving compliance with placement guidelines in national editions of the 168 measured magazines, most youth exposure to magazine alcohol advertising exceeded adult exposure, per capita. If alcohol companies adopted stricter guidelines based on public health risk assessments, youths would not be overexposed to alcohol advertising in magazines.

The Interaction of Ethanol Ingestion and Social Interaction with an Intoxicated Peer on the Odor-Mediated Response to the Drug in Adolescent Rats

BACKGROUND

Using a social transmission of food preference paradigm in rats, we previously demonstrated that ethanol (EtOH) exposure during adolescence, as either an observer (interaction with an intoxicated conspecific) or demonstrator (intragastric infusion with EtOH), altered the reflexive odor-mediated responses to the drug. The 2 modes of exposure were equivalent in the magnitude of their effects. Human adolescents, however, are likely to experience the drug in a social setting as both an EtOH observer and demonstrator. That is, both interacting with an intoxicated peer and experiencing EtOH's postingestive consequences in conjunction with hematogenic olfaction. Therefore, we tested whether combined adolescent exposure as both an observer and demonstrator differed from either form of individual experience.

METHODS

Beginning on postnatal day (P) 29, naïve rats received EtOH or water exposures in a social interaction paradigm as either an observer, a demonstrator, or combined experience (where each animal in the interaction was, itself, an observer and demonstrator). Exposures occurred 4 times, once every 48 hours. On P37, the reflexive behavioral response to EtOH odor was tested, using whole-body plethysmography.

RESULTS

The odor-mediated responses of adolescent EtOH observers, demonstrators, and combined exposure animals all significantly differed from controls. Compared to controls, however, the magnitude of the behavioral effect was greatest in the combined exposure animals. Moreover, combined exposure as both an EtOH observer and demonstrator significantly differed from either form of individual EtOH experience.

CONCLUSIONS

EtOH's component chemosensory qualities are known to be central contributors to its acceptance and increases in the acceptability of EtOH's odor, resulting from a social transmission experience, are predictive of enhanced EtOH avidity in adolescence. Our findings demonstrate that combined exposure as an observer and demonstrator, within a socially relevant framework, may represent a higher risk scenario for increased EtOH avidity in adolescence (and by extension adult persistence) as compared to the individual effects of direct ingestion or social experience with the drug.

A qualitative investigation of the role of the family in structuring young people's alcohol use

BACKGROUND

Few qualitative studies have investigated young people's perspectives around influences on substance use. We aimed to examine young people's understandings, attitudes and experiences around alcohol, tobacco and cannabis use and factors influencing substance use behaviour.

METHODS

Qualitative interview study involving 28 young people (13 males and 15 females) aged 18-20 years, recruited purposively on the basis of substance use, who were participating in the Avon Longitudinal Study of Parents and Children. Interviews were conducted at participants' homes or at local cafés. Audio data were transcribed verbatim, systematically coded and analysed inductively using a constant comparative approach.

RESULTS

Parental attitudes and behaviours and the nature of communication emerged as critical factors structuring young people's alcohol use. Initiation of alcohol use was frequently mediated by parents early in adolescence, with the home recounted as a primary site of early drinking experiences. Later in adolescence, young people perceived a more permissive stance towards alcohol use, with broad acceptance of high levels of consumption and recognition of drinking as a cultural norm during adolescence. In contrast, young people reported a more prohibitive and discouraging stance from their parents towards tobacco and cannabis use, and the use of these substances appeared to be of greater parental concern.

CONCLUSIONS

Interventions involving parents or guardians have a critical role to play in the prevention of harms arising from alcohol use during adolescence. However, such interventions are needed in conjunction with individual, school, community and environmental interventions to shift cultural norms across the population and to facilitate effective prevention.

Teen Alcohol Use and Social Networks: The Contributions of Friend Influence and Friendship Selection

Background

We evaluated the contributions of teen alcohol use to the formation and continuation of new and existing friendships while in turn estimating the influence of friend drinking on individuals’ regular use and heavy drinking.

Method

Longitudinal network analysis was used to assess the mutual influences between teen drinking and social networks among adolescents in two large Add Health schools where full network data was collected three times. Friendship processes were disaggregated into the formation of new friendships and the continuation of existing friendships in a joint model isolating friendship selection and friend influences.

Results

Friends have a modest influence on one another when selection is controlled. Selection is more complicated than prior studies suggest, and is only related to new friendships and not their duration in the largest school. Alcohol use predicts decreasing popularity in some cases, and popularity does not predict alcohol consumption.

Conclusion

Intervention efforts should continue pursuing strategies that mitigate negative peer influences. The development of socializing opportunities that facilitate relationship opportunities to select on healthy behaviors also appears promising. Future work preventing teen substance use should incorporate longitudinal network assessments to determine whether programs promote protective peer relationships in addition to how treatment effects diffuse through social networks.

Social housing conditions and oxytocin and vasopressin receptors contribute to ethanol conditioned social preference in female mice

Social behavior modulates response to alcohol. Because oxytocin (OXT) and vasopressin (AVP) contribute to rewarding social behavior, the present study utilized a genetic strategy to determine whether OXT and AVP receptors (OXTR, AVPR1a) are essential for female mice to demonstrate a conditioned social preference for ethanol. The study compared wild-type (WT) and knock-out (KO) females lacking either Oxtr or Avpr1a in a conditioned social preference (CSP) test. KO females and WT females from Het-Het crosses were pair-housed: KO and WT(ko). WT females from Het-WT crosses were pair-housed: WT(wt). Test mice received 2g/kg ethanol or saline ip, and were paired four times each with one stimulus female (CS-) after saline, and with another female (CS+) following ethanol. After pairing, the time spent with CS+ and CS- females was measured. WT(wt) females showed conditioned preference for the CS+ female paired with ethanol, demonstrated by greater interaction time (p<0.05). In both KO lines, ethanol significantly reduced interaction with the CS+ female (p<0.05), and there was no change in interaction for WT(ko) females. Response to odors by habituation-dishabituation was unaffected in both KO lines, and the response to a hypnotic dose of ethanol also was the same as in WT mice. However, anxiety, measured as time on the open arms of the elevated plus maze, was reduced in KO(Oxtr) females compared with WT(wt). The results suggest that Oxtr and Avpr1a are required for conditioned effects of an ethanol-associated social stimulus. The lack of CSP in WT(ko) females suggests that the quality of social interactions during postnatal and postweaning life may modulate development and expression of normal social responses.

US adolescents' friendship networks and health risk behaviors: a systematic review of studies using social network analysis and Add Health data

Background. Documented trends in health-related risk behaviors among US adolescents have remained high over time. Studies indicate relationships among mutual friends are a major influence on adolescents' risky behaviors. Social Network Analysis (SNA) can help understand friendship ties affecting individual adolescents' engagement in these behaviors. Moreover, a systematic literature review can synthesize findings from a range of studies using SNA, as well as assess these studies' methodological quality. Review findings also can help health educators and promoters develop more effective programs. Objective. This review systematically examined studies of the influence of friendship networks on adolescents' risk behaviors, which utilized SNA and the Add Health data (a nationally representative sample). Methods. We employed the Matrix Method to synthesize and evaluate 15 published studies that met our inclusion and exclusion criteria, retrieved from the Add Health website and 3 major databases (Medline, Eric, and PsycINFO). Moreover, we assigned each study a methodological quality score (MQS). Results. In all studies, friendship networks among adolescents promoted their risky behaviors, including drinking alcohol, smoking, sexual intercourse, and marijuana use. The average MQS was 4.6, an indicator of methodological rigor (scale: 1-9). Conclusion. Better understanding of risky behaviors influenced by friends can be useful for health educators and promoters, as programs targeting friendships might be more effective. Additionally, the overall MQ of these reviewed studies was good, as average scores fell above the scale's mid-point.

The relationship between population-level exposure to alcohol advertising on television and brand-specific consumption among underage youth in the US

AIMS

We investigated the population-level relationship between exposure to brand-specific advertising and brand-specific alcohol use among US youth.

METHODS

We conducted an internet survey of a national sample of 1031 youth, ages 13-20, who had consumed alcohol in the past 30 days. We ascertained all of the alcohol brands respondents consumed in the past 30 days, as well as which of 20 popular television shows they had viewed during that time period. Using a negative binomial regression model, we examined the relationship between aggregated brand-specific exposure to alcohol advertising on the 20 television shows [ad stock, measured in gross rating points (GRPs)] and youth brand-consumption prevalence, while controlling for the average price and overall market share of each brand.

RESULTS

Brands with advertising exposure on the 20 television shows had a consumption prevalence about four times higher than brands not advertising on those shows. Brand-level advertising elasticity of demand varied by exposure level, with higher elasticity in the lower exposure range. The estimated advertising elasticity of 0.63 in the lower exposure range indicates that for each 1% increase in advertising exposure, a brand's youth consumption prevalence increases by 0.63%.

CONCLUSIONS

At the population level, underage youths' exposure to brand-specific advertising was a significant predictor of the consumption prevalence of that brand, independent of each brand's price and overall market share. The non-linearity of the observed relationship suggests that youth advertising exposure may need to be lowered substantially in order to decrease consumption of the most heavily advertised brands.