With friends like these…: Peer delinquency influences across age cohorts on smoking, alcohol and illegal substance use

Perceptions of mental health services among the children who are in conflict with the law in Jammu and Kashmir

Background: Due to the Jammu and Kashmir conflict, many teenagers are involved in disputes with the law. The conflict made generations suffer for decades. Such children made the mobs; being involved in life-threatening situations and the risk they confront develop psychiatric disorders. As a result of the various tense conditions when applied in multiple anti-social activities, aberrant children sent to correctional homes have to encounter numerous psychological disorders. Aim: The motive of the study is to explore the level of awareness, availability of services, stigma and obstacles to seeking assistance. Method: Due to the open-ended interview questions and a small sample size of 15 respondents, this study employed a qualitative methodology - a thematic analysis was done. Results: The findings revealed that, although the stigma is not publicly acknowledged, children who break the law and seek mental health services (MHS) are stigmatised. It was also shown that minor offenders fear that when they receive services provided by the staff of the observation home (OH), there will be a violation of their privacy and fear unforeseen repercussions. Conclusion: Collaborative action must proactively raise appropriate awareness to lessen the stigma linked with mental health problems, especially regarding MHS among these teenagers.

A Person-centered Approach to Violence Exposure in Postwar Colombian Youth: Demographic Covariates and Positive Youth Development Outcomes

While the negative impact of extensive exposure to community violence and armed conflict is known, less emphasis has been focused on outcomes supportive of resilience. It is critical to begin exploring these constructs to both promote healing from decades-long conflict and to inform targeted interventions that focus on positive youth development in contexts of adversity. This study thus utilized a person-centered approach to estimate violence exposure profiles among 3,443 Colombian youth to explore what demographic covariates and positive youth development outcomes, such as school engagement, hope, goals, social competence, future expectations, and barriers to education were associated with each violence exposure profile. Four profiles emerged: a low exposure profile, a high community violence profile, a some combined exposure profile, and a high combined exposure profile, each with various levels of community violence witnessing and victimization as well as armed conflict exposure. Demographic covariance results showed older, urban, male youth were more likely to be in the high violence exposure profiles compared to the low exposure group. Youth in the high combined exposure profile were more likely to have lower hope, educational expectations, and social competence compared to the low exposure group. Findings highlight that a person-centered approach provides a more multidimensional view of adolescent violence exposure. Demographic differences suggested the importance of tailoring violence prevention initiatives to the local context. Finally, results concerning positive youth development outcomes suggest that resiliency-oriented constructs, which can be instrumental toward youth's postwar healing and growth, should be emphasized among populations who experience high levels of co-occurring exposure.

Developmental Cascade Effects of Maternal Depression on Offspring Substance Use Across Adolescence: Pathway Through Mother-Child Relationship Quality and Peer Deviancy

There is evidence that maternal depression can disrupt adolescent social development and trigger a risk cascade to adolescent substance use that involves poor quality mother-child relationships (Lovejoy et al., 2000) and affiliation with deviant peers (Visser et al., 2012). However, relatively little work has considered maternal depression as a catalyst for this risk pathway to adolescent substance use. The current study aims to clarify whether maternal depression has cascading effects to adolescent substance use through related developmental systems. Using structural equation modeling and bootstrapping for testing indirect effects, we tested the prospective association between maternal depression and middle adolescent substance use and whether poor mother-child relationship quality and peer deviancy mediated this relationship. We controlled for a variety of important cofounding variables. The sample included N = 338 adolescents (57% female; predominantly non-Hispanic Caucasian (83.14%) or African American (8.88%)) and mothers drawn from a larger nine-year longitudinal study of adolescent substance use. Data from wave 1 through wave 6 of the longitudinal project were utilized. The average age of adolescents was 11.6, 12.6, 13.6, 14.6, 15.5, and 16.6 at W1-W6, respectively. The indirect effect from maternal depression to substance use was supported (ab = 0.03, 95% CI [0.002, 0.07]). Findings emphasize that future work should more closely examine how maternal depression operates in developmental cascade models of adolescent substance use.

Effects of Risk Perception and Accessibility on Cannabis Use among Young Population in Spain: Findings from the 2016 National Survey (ESTUDES)

BackgroundCannabis use in the young population has undergone a significant increase in Europe. Empirical assessments of individual and contextual mediating variables in relation to cannabis use are informative for prevention actions and have yet to be conducted in Spain. Objectives: This study used the 2016 National Survey on Drug Use in Secondary Education in Spain (ESTUDES) to inform on potentially relevant cannabis prevention targets. We examined individual variables (sex, age, and cannabis risk perception), past 30-day legal and illicit substance use, substance-free activities, and contextual factors (perceived accessibility to cannabis) associated to past 30-day cannabis use. Methods: Data were drawn from 35,369 adolescents (% females: 50.1). Structural equation modeling (SEM) was implemented to identify predictors of cannabis use, and indirect paths were tested via bootstrapping to examine the mediating effects of cannabis risk perception and accessibility. Results: Demographics (male sex, higher age), and past 30-day tobacco, alcohol, and illicit substance use were associated with past 30-day cannabis use. Frequency of past-year engagement in hobbies and reading did also predict past 30-day cannabis use. The mediators worked on most of the relationships examined, except for hobbies and illegal substance use in the case of accessibility and reading and hobbies in the case of risk perception. Conclusions/importance: Cannabis use is more likely to emerge in the event of low risk perception and high accessibility. Lower frequency of past year reading and higher engagement in some hobbies that are often carried out alone represent risk factors, which could potentially influence prevention programs.

Detachment, peer pressure, and age of first substance use as gateways to later substance use

BACKGROUND

Prior research using psychosocial developmental models have identified emotional detachment from family and susceptibility to peer pressure as predictors of adolescent substance use. Despite mixed support for the gateway hypothesis, less is known about how these psychosocial developmental factors facilitate adolescent substance use. The purpose of this study was to examine how age of first substance use, emotional detachment from parents, and susceptibility to peer pressure influence the progression from alcohol, marijuana, and tobacco use to other illicit substance use (e.g., cocaine, hallucinogens).

METHOD

Data (N = 5792) were collected from high school students across seven semesters. Latent growth curve modeling was used to examine how age of first use of alcohol, marijuana, and tobacco predicted initial levels and changes in emotional detachment, peer pressure, and other illicit substance use.

RESULTS

Earlier age of first use of alcohol, marijuana, and tobacco predicted detachment, peer pressure, and a greater likelihood of initial use of other illicit substances. More initial emotional detachment was associated with increases in other illicit substance use. Earlier ages of first use of alcohol, marijuana, and tobacco had indirect effects on initial use of other illicit substances through initial emotional detachment.

CONCLUSION

Emotional detachment from parents and peer pressure impact the likelihood of other illicit substance use across the high school years. Prevention programs may benefit by focusing on delaying the onset of first use of substance use and by preventing emotional detachment from parents and peer pressure.

Experiences of parents with an adolescent abusing substances admitted to a mental health institution in Giyani, South Africa

BACKGROUND

Substance abuse by adolescents may be a problem that contributes to their mental illness. Substance abuse does affect not only the individual who is abusing it but also friends, family and the whole community. The adolescent abusing substances may be mentally unstable and have unpredictable behaviour. There is no research on the experiences of parents with adolescents abusing substances in Giyani, South Africa.

OBJECTIVE

The purpose of the study was to explore and describe the experiences of parents with adolescents abusing substances admitted to a mental health institution in Giyani.

METHOD

A qualitative, exploratory, descriptive and contextual research design was used. Data were collected by means of conducting individual, in-depth, phenomenological interviews, observations and field notes. The following central question was asked to the participants: 'How is it for you to have an adolescent who is abusing substances'. Data were analysed by using a thematic method of coding. An independent coder analysed data together with the researcher, and consensus was reached.

RESULTS

Four themes emerged from the data: parents experienced uncontrolled thoughts regarding their adolescent abusing substances, not being able to control their adolescent abusing substances through discipline, negative feelings regarding their adolescent abusing substances and negative consequences regarding their adolescents abusing substances.

CONCLUSION

From the study result, it is clear that parents with adolescent abusing substances need professional assistance and support as evidenced by the challenges faced in terms of promoting, maintaining and restoring their mental health. Psychiatric nurses should take responsibility to educate the community about substance abuse, for example offering school health programmes. Further research studies can also be conducted in other villages to gain a greater understanding of those parents' experiences with an adolescent abusing substances.

Estimating the influence of adolescent delinquent behavior on adult health using sibling fixed effects

Despite the well-established link between juvenile delinquency and socioeconomic attainment in adulthood, less is known about whether engagement in delinquent behavior during adolescence shapes adult health outcomes. This study examines the association between juvenile delinquency and adult physical and mental health, and whether this association is confounded by unobserved family heterogeneity. Moreover, this study explores the potential underlying mechanisms through which juvenile delinquency shapes adult physical and mental health. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) 1994-1995 (Wave 1) and 2007-2008 (Wave 4), we adopted a sibling fixed effect approach to account for genetic factors, family environment, and childhood social contexts such as school and neighborhood effects. The conventional OLS results show that engagement in delinquent behavior during adolescence strongly predicts higher levels of Framingham cardiovascular disease (CVD) risk score and depressive symptoms in adulthood. Once we account for family-specific heterogeneity, however, the point estimates of the associations of delinquency with CVD risk score and depressive symptoms are attenuated by 33% and 45%, respectively. Despite this attenuation, the association of juvenile delinquency with adult health is robust: a one standard-deviation increase in juvenile delinquency is associated with approximately 8 and 6 percent of one standard-deviation increases in CVD risk and depressive symptoms, respectively. Our mediation analyses suggest that a combination of several mediating pathways jointly explain the association between juvenile delinquency with adult health. The most consistent and significant mediating pathways connecting juvenile delinquency to both physical and mental health included disruption in student-teacher relationship, smoking, criminal justice contact, and educational attainment. Moreover, while binge drinking explained part of the association between delinquency and CVD risk score, student-friend relationship partially mediated the association with depression.

Social Media Interventions for Risky Drinking Among Adolescents and Emerging Adults: Protocol for a Randomized Controlled Trial

BACKGROUND

Despite intervention efforts to date, the prevalence of risky drinking among adolescents and emerging adults remains high, increasing the risk for health consequences and the development of alcohol use disorders. Peer influences are particularly salient among this age group, including via social media. Thus, the development of efficacious early interventions for youth, delivered with a broad reach via trained peers on social media, could have an important role in addressing risky drinking and concomitant drug use.

OBJECTIVE

This paper describes the protocol of a randomized controlled trial (RCT) testing the efficacy of a social media intervention among adolescents and emerging adults who meet the criteria for risky drinking (using the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]), delivered with and without financial incentives for participation, compared with an attention placebo control condition (ie, entertaining social media content), on alcohol consumption and consequences.

METHODS

This RCT involved recruiting 955 youths (aged 16-24 years) via advertisements on Facebook and Instagram to self-administer a brief web-based screening survey. Those screening positive for past 3-month risky drinking (AUDIT-C positive: ages 16-17 years: ≥3 females and ≥4 males; and ages 18-24 years: ≥4 females and ≥5 males) were eligible for the RCT. After providing consent (a waiver of parental consent was obtained for minors), participants completed a web-based baseline survey and several verification procedures, including a selfie photo matched to Facebook profile photos. Participants were then randomized to join invitation-only secret Facebook groups, which were not searchable or viewable by parents, friends, or anyone not recruited by the study. The 3 conditions were social media intervention with incentives, social media intervention without incentives (SMI), and attention placebo control. Each condition lasted 8 weeks and consisted of bachelor's-level and master's-level therapist electronic coaches posting relevant content and responding to participants' posts in a manner consistent with Motivational Interviewing. Participants in the control condition and SMI condition did not receive payments but were blind to condition assignment between these 2 conditions. Follow-ups are ongoing and occur at 3, 6, and 12 months poststart of the groups.

RESULTS

We enrolled 955 participants over 10 waves of recruitment who screened positive for risky drinking into the RCT.

CONCLUSIONS

The findings of this study will provide the critical next step in delivering early alcohol interventions to the youth, capitalizing on social media platforms, which could have significant public health impact by altering alcohol use trajectories of adolescents and emerging adults engaged in risky drinking.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02809586; https://clinicaltrials.gov/ct2/show/NCT02809586.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/16688.

Declining alcohol consumption among adolescents and schools in Stockholm, 2010-2016

Aims:

The principle aim of this study was to investigate changes in alcohol consumption among adolescents in Stockholm from 2010 to 2016. A further aim was to investigate whether there are divergent or similar trends in alcohol consumption among elementary schools in Stockholm from 2010 to 2016 and, if there are diverging trends, to examine how the differences might be explained.

Methods:

Data were analysed using multilevel mixed effects linear regression, in which individual students represented one level and schools the second level.

Data:

Student-level data were derived from the Stockholm School Survey for the years 2010, 2012, 2014 and 2016 (n = 15481). School-level data (n = 132) were derived from registries of the Swedish National Agency for Education.

Results:

The results showed that there was an almost 45% decline in total alcohol consumption among ninth-grade students in Stockholm between 2010 and 2016. The decline was similar among all analysed consumption groups. Two factors were found to statistically explain some of the general decline: more restrictive parental attitudes towards alcohol and, more importantly, decreasing alcohol consumption among the students’ peers. The downward trends among schools between 2010 and 2016 were universal but not identical, but when parental attitudes towards alcohol and peers’ alcohol behaviour were controlled for, the diverging school trends in alcohol consumption were considerably more equal.

Conclusions:

School constitutes a social context for the student of which both parents and peers are important parts, and the diverging changes may be due to the norms and behaviours, influenced by parents and peers, characterising these schools.

Reports of perceived racial discrimination among African American children predict negative affect and smoking behavior in adulthood: A sensitive period hypothesis

We examined the prospective relations between a cultural risk factor, perceived racial discrimination (PRD), and subsequent negative affect and health behavior (smoking) in a panel of 889 African American children (part of the Family and Community Health Study). Cultural moderators (protective factors) of these relations were also examined. PRD was assessed six times from ages 10.5 (Wave 1) to 24.5 (Wave 6), and negative affect (anger and depressive symptoms) was assessed at Wave 2 (age 12.5) and Wave 6 (age 24.5). Results indicated that Wave 1 PRD predicted Wave 6 smoking, controlling for multiple factors related to smoking and/or PRD, including smoking at age 15.5. Structural equation models indicated that these relations between Wave 1 PRD and smoking were mediated by both early and later negative affect. The models also indicated that Wave 1 PRD had a direct impact on Wave 6 anger (assessed 14 years later), controlling for the effects of PRD on early affect. Cultural socialization was associated with lower rates of adolescent smoking, and it buffered the relation between PRD and Wave 6 anger. The impact of early PRD experiences along with suggestions for culturally informed interventions and preventive interventions that might buffer against early PRD effects are discussed.

Alcohol and Marijuana use in Undergraduate Males: Between- and Within-Person Associations with Interpersonal Conflict

BACKGROUND

Among college students, interpersonal conflict with others is a common, yet stressful negative interpersonal experience. Research suggests that drinking episodes may contribute to the occurrence of conflict. Marijuana use, independently or in conjunction with alcohol, may also influence the likelihood of subsequent conflict.

OBJECTIVES

We considered the temporal effects of independent and simultaneous alcohol and marijuana use episodes on the occurrence of interpersonal conflict. Use of multilevel modeling allowed us to distinguish the within-person effects of substance use from between-person differences in frequency of use.

METHODS

Within a sample of 427 college freshman males over 56 days of daily reports, we examined the independent and interactive effects of episodes of alcohol and marijuana on the odds of conflict within the next 1-, 2-, 3-, and 4 hours.

RESULTS

Multilevel modeling analyses showed that drinking episodes increased the likelihood of conflict occurring within the next 1, 2, 3, and 4 hours. Marijuana had weaker positive effects, significant only within the 2 hour window. There were no alcohol by marijuana interaction effects in any analysis.

CONCLUSIONS/IMPORTANCE

Both marijuana and alcohol independently increased the likelihood of interpersonal conflict; however, the marijuana effect appeared less robust. As marijuana use becomes more normative and accessible for college students, it is important to understand the extent to which marijuana use results in negative consequences and the contexts under which these effects unfold.

An Examination of Parental and Peer Influence on Substance Use and Criminal Offending During the Transition from Adolescence to Adulthood

Although peer behavior and parent-child-conflict have been associated with adolescent and young adults' behavior, prior studies have not adequately controlled for selection effects and other confounders, or examined whether associations change across the transition to adulthood or by race. Using annual data from young men followed from 17-26, within-individual change models examined whether substance use or offending increased in the year after boys began affiliating with friends who engaged in substance use/offending and/or experienced increased parent-son-conflict. Moderation analyses tested whether associations varied by age or race. Alcohol use, marijuana use, and offending (Black participants only) increased in the year after boys began affiliating with more peers who engaged in similar behaviors. Associations were strongest during adolescence for substance use. Parent-son conflict was not associated with the outcomes. Findings underscore the importance of developmental and racialized differences in understanding the role of social influences on young men's substance use and offending.

Racial/Ethnic Differences in Cigarette Use Trends in the United States among Multiracial and Other Youth, 1994-2008

Tobacco use among the multiracial population is grossly underresearched. This study explored the cigarette-smoking trends of multiracial individuals over time in comparison with monoracial individuals and assessed the relationship between cigarette smoking and factors at the individual, family, peer, school, and state levels. This study used data collected by the National Longitudinal Study of Adolescents and Adult Health from 1994 to 2008. This study examined a subsample of 9,421 respondents who self-identified as Black, Asian, American Indian, Hispanic, White, or multiracial. Generalized estimating equations were used to analyze the population-level data. Findings suggest that multiracial individuals reported high rates of cigarette use over time. The most consistent correlates of cigarette use were family factors, peer cigarette use, and school policies that prohibit staff from smoking on school premises. Additional research is needed to identify the correlates and causes of cigarette use among multiracial adolescents and young adults.

Exploring Relationships Between Delinquent Peer Groups, Participation in Delinquency, Substance Abuse, and Injecting Drug Use Among the Incarcerated: Findings From a National Sample of State and Federal Inmates in the United States

The following study assesses the relationship between affiliating with delinquent peer groups, participation in delinquency, and several substance misuse and injecting drug use outcomes in a nationally representative sample of inmates in state and federal facilities in the United States. After controlling for potential confounders, affiliating with peers who engaged in deviant behaviors and participation in delinquency was associated with onset of alcohol and illicit drug use, substance dependence, alcohol dependence, types of substances used, and injecting drug use outcomes. Inmates who began engaging in delinquency at older ages reported initiating drug and alcohol use at older ages, and were less likely to meet the criteria for drug abuse or dependence, less likely to use substances daily or near daily, and less likely to report having ever injected or shared syringes. The implications of these findings for substance abuse, HIV, and crime prevention interventions are discussed.

Liquor licences issued to Australian schools

Background

Children’s positive socialisation to alcohol is associated with early initiation of drinking and alcohol-related harm in adult life. Internationally, there have been reports of adults’ alcohol consumption at school events in the presence of children. The aim of this research was to identify the conditions under which Australian schools are required to apply for a liquor licence and the associated prevalence of liquor licences for these events where children were likely to be present.

Methods

A document review was conducted to examine temporary liquor licensing legislation. Quantitative analysis was used to examine relevant licensing data. Coding criteria was developed to determine school type, student year levels and the likely presence of children.

Results

Four jurisdictions provided data on 1817 relevant licences. The average annual licences/100 schools was highest amongst Independent schools followed by Catholic and public (government) schools. The rates were highest in Queensland and Victoria where children were present at 61% and 32% of events respectively.

Conclusions

While there are legislative differences across jurisdictions, the prevalence of adults’ alcohol use at school events in the presence of children may reflect the various education department policies and principals’ and school communities’ beliefs and attitudes. Licences are not required for all events where liquor is consumed so the prevalence of adults’ use of alcohol at school events is likely to be higher than our analyses imply. Such practices may undermine teaching about alcohol use in the school curriculum and health promotion efforts to develop alcohol-free events when children are present.

Blackouts among male and female youth seeking emergency department care

BACKGROUND

Alcohol-related blackouts are a common consequence of heavy drinking, and these blackouts pose risk for injury and other adverse health outcomes.

OBJECTIVE

To examine the prevalence and correlates of blackouts among underage drinkers.

METHODS

Youth (ages 14-20) presenting to a suburban Emergency Department (ED) completed screening surveys. Among those reporting past-year alcohol consumption, we examined past 3-month blackouts in relation to: background characteristics (e.g., demographics, fraternity/sorority involvement), substance use, sexual risk behaviors and incapacitated sexual assault (unaware/unable to consent due to alcohol/drugs), forced sexual assault, positive depression screening, and reason for ED visit (injury vs. medical).

RESULTS

In total, 2,300 past-year drinkers participated: 58% female, 75% Caucasian, and mean age = 18.4. Regarding past 3-month blackouts, 72.7% reported none, 19.3% reported monthly or less, and 8% reported monthly or more. Multivariate cumulative logit regression indicated that blackout frequency was positively associated with: college involvement in Greek life, alcohol use severity, prescription drug misuse, marijuana, screening positive for depression, incapacitated sexual assault, and a gender by alcohol use severity interaction.

CONCLUSION

With one-quarter of this clinical sample reporting recent blackouts, as well as the association between blackout frequency and health risk behaviors and other outcomes, findings underscore the need for programs focusing on substance use, depression, and preventing sexual assault. Interventions should also address poly-substance use and drinking motives. Although findings highlight how college students in Greek life may be at high risk for blackouts, many participants not in college also reported blackouts, suggesting that interventions in other settings are also needed.

Patterns of health-related behaviours among adolescents: a cross-sectional study based on the National Survey of School Health Brazil 2012

OBJECTIVES

The aim of this study was to analyse the clustering of multiple health-related behaviours among adolescents and describe which socio-demographic characteristics are associated with these patterns.

DESIGN

Cross-sectional study.

SETTING

Brazilian schools assessed by the National Survey of School Health (PeNSE, 2012).

PARTICIPANTS

104 109 Brazilian ninth-grade students from public and private schools (response rate=82.7%).

METHODS

Exploratory and confirmatory factor analyses were performed to identify behaviour clustering and linear regression models were used to identify socio-demographic characteristics associated with each one of these behaviour patterns.

RESULTS

We identified a good fit model with three behaviour patterns. The first was labelled 'problem-behaviour' and included aggressive behaviour, alcohol consumption, smoking, drug use and unsafe sex; the second was labelled 'health-compromising diet and sedentary behaviours' and included unhealthy food indicators and sedentary behaviour; and the third was labelled 'health-promoting diet and physical activity' and included healthy food indicators and physical activity. No differences in behaviour patterns were found between genders. The problem-behaviour pattern was associated with male gender, older age, more developed region (socially and economically) and public schools (compared with private). The 'health-compromising diet and sedentary behaviours' pattern was associated with female gender, older age, mothers with higher education level and more developed region. The 'health-promoting diet and physical activity' pattern was associated with male gender and mothers with higher education level.

CONCLUSIONS

Three health-related behaviour patterns were found among Brazilian adolescents. Interventions to decrease those negative patterns should take into account how these behaviours cluster together and the individuals most at risk.

Differential Effects of Neighborhood Type on Adolescent Alcohol Use in New Zealand

Identifying neighborhood typologies associated with adolescent alcohol use can inform the development of harm reduction strategies. Utilizing data from a nationally representative youth survey (n = 4267) in New Zealand, latent class analysis was used to categorize neighborhood types (defined by 10 demographic, social and environmental indicators) to investigate their association with alcohol consumption and related harm. Three neighborhood types were distinguished: (1) "high outlet density and economic deprivation" (30 % of all neighborhoods); (2) "high deprivation, social disorganization, and unsafe" (38 %); and (3) "higher income, safe, and socially organized" (32 %). Significant ethnic variation was evident between neighborhood types. There was an age-group interaction in the main effects with significant associations between neighborhood type and drinking measures and harm most apparent among younger adolescents (<16 years), as described next. Compared to students residing in "higher income, safe, and socially organized" neighborhoods, the frequency of binge drinking and high typical consumption was significantly higher in students residing in "high outlet density and economic deprivation" and "high deprivation, social disorganization, and unsafe", with students residing in "high outlet density and economic deprivation" also experiencing higher levels of alcohol-related harm. The findings that neighborhoods characterized by high deprivation and alcohol outlet density and low social organization and perceptions of safety were associated with risky drinking patterns and harm, specifically among young adolescents, underscores the importance of adopting a developmental approach to the study of contextual effects on adolescents.

Selection and Socialization Effects in Early Adolescent Alcohol Use: A Propensity Score Analysis

The robust correlation between peer and adolescent alcohol use (AU) has been taken as evidence for both socialization and selection processes in the etiology of adolescent AU. Accumulating evidence from studies using a diverse range of methodological and statistical approaches suggests that both processes are involved. A major challenge in testing whether peer AU predicts an adolescent's drinking (socialization) or whether an adolescent's drinking predicts peer AU (selection) is the myriad of potentially confounding factors that might lead to an overestimation of socialization and selection effects. After creating AU transition groups based on peer and adolescent AU across two waves (N = 765; age = 10-15; 53% female), we test whether transitions into AU by adolescents and peers predict later peer and adolescent AU respectively, using (1) propensity score analysis to balance transition groups on 26 potential confounds, (2) a longitudinal design with three waves to establish temporal precedence, and (3) both adolescent (target) and peer self-report of peer AU to disentangle effects attributable to shared reporter bias. Both selection and socialization were supported using both peer self-report of AU and adolescent-report of peer AU. Although cross-sectional analyses suggested peer self-reported models were associated with smaller effects than perceived peer AU, longitudinal analyses suggest a similar sized effect across reporter of peer AU for both selection and socialization. The implications of these findings for the etiology and treatment of adolescent AU are discussed.

Multiple Levels of Influence That Impact Youth Tobacco Use

OBJECTIVE

Multiple levels of influence interplay to impact youth tobacco use. We work towards understanding important policy and environmental strategies that are associated with youth tobacco use behaviors.

METHODS

We utilized data from participants of the Monitoring the Future (MTF) study and linked national data from multiple sources to assess correlates of youth tobacco use behaviors across individual, family, school, community, and state-level policy influences.

RESULTS

Higher cigarette prices had the strongest association with youth tobacco use behaviors. Demographic and socio-economic characteristics at the individual, familial, and community/school-levels were associated with youth tobacco use behaviors.

CONCLUSIONS

In the present study, we confirm that higher cigarette prices could help to reduce youth tobacco use behaviors. Several states are still lagging behind in terms of their low cigarette tax and they should enact tax policies to reduce youth tobacco use.

Principals' reports of adults' alcohol use in Australian secondary schools

BACKGROUND

Schools provide opportunities for parents and the wider community to connect and support the physical and emotional wellbeing of their children. Schools therefore have the potential to play a role in the socialisation of alcohol use through school policies and practices regarding consumption of alcohol by adults at school events in the presence of children.

METHODS

This survey was undertaken to a) compare the extent to which alcohol is used at secondary school events, when children are present, in the states of New South Wales (NSW) and Victoria (VIC), Australia; b) describe principals' level of agreement with these practices; c) their awareness of state policies on this issue; and d) the predictors of such events. A random sample of secondary schools, stratified to represent metropolitan and non-metropolitan schools were invited to participate. Bivariate and multivariate analysis were conducted with p values < 0.05 considered significant.

RESULTS

A total of 241 (43%) schools consented to participate in the study. Fifteen percent of participating NSW schools and 57% of VIC schools held at least one event in which alcohol was consumed by adults in the presence of children in the year before the survey. Of the 100 reported events, 78% were Year 12 graduation dinners, and 18% were debutante balls. Compared to NSW principals, VIC principals were significantly more likely to agree with the use of alcohol at these events; significantly less likely to be aware of their state education department policy on this issue; have a policy at their own school or support policy that prohibits alcohol use at such events; and less likely to report having enough information to make decisions about this.

CONCLUSIONS

There is a growing focus on adults' use of alcohol at school events when children are present. Schools can play an important role in educating and socialising children about alcohol via both the curriculum and policies regarding adults' alcohol use at school events. Findings from this study suggest education department and school-based policies that prohibit or restrict the use of alcohol, are significant predictors of adults' alcohol use at school events when children are present.

What Social Bonds have the Greatest Influence on Patterns of Substance Use among Child-Welfare-Involved Youth?

Child-welfare-involved youth may lack protective social bonds that could reduce their risk of substance use. We investigated whether caregiver, school, or peer bonds predict distinct patterns of substance use among child-welfare-involved youth. The sample included 720 participants in the National Survey of Child and Adolescent Well-Being II. Latent class analysis (LCA) and the three-step approach to incorporate indicator variables onto the latent classes were used. We found the following classes: (1) severe polysubstance use; (2) moderate polysubstance use; and (3) low use. Youth bonded to primary caregivers were less likely to be severe polysubstance drug users, but caregiver bonds did not protect against moderate polysubstance use. School bonds protected against severe polysubstance and moderate polysubstance. Youth bonded to deviant peers were more likely to be in the severe polysubstance use and moderate polysubstance use classes. Interventions targeting child-welfare-involved youth need to account for social bonds' effect on substance use.

Predictors of substance use among young adults transitioning away from high school: a narrative review

BACKGROUND

Young adulthood has been shown to be a time of increased substance use. Yet, not enough is known about which factors contribute to initiation and progression of substance use among young adults specifically during the transition year away from high school.

OBJECTIVES

A narrative review was undertaken to increase understanding of the predictors of changes in use of tobacco, alcohol, cannabis, other illicit drugs, and mental health problems among young adults during the transition period after high school.

METHODS

A review of academic literature examining predictors of the use of tobacco, alcohol and cannabis, and co-morbidities (e.g., co-occurring substance use and/or mental health issues) among young adults transitioning from high school to post-secondary education or the workforce.

RESULTS

Twenty six studies were included in the review. The majority of the studies (19) examined substance use during the transition from high school to post-secondary settings. Seven studies examined substance use in post-secondary settings. The studies consistently found that substance use increases among young adults as they transition away from high school. During the transition away from high school, common predictors of substance use include substance use in high school, and peer influence. Common predictors of substance use in post-secondary education include previous substance use, peer influence, psychological factors and mental health issues. Conclusions/Importance: Further research on social contextual influences on substance use, mental health issues, gender differences and availability of substances during the transition period is needed to inform the development of new preventive interventions for this age group.

Temporal associations between substance use and delinquency among youth with a first time offense

OBJECTIVE

Substance use and delinquency among adolescents have been shown to be positively associated; however, the temporal relationship is not well understood. Examining the association between delinquency and substance use is especially relevant among adolescents with a first-time substance use related offense as they are at-risk for future problems.

METHOD

Data from 193 adolescents at time of diversion program entry and six months later was examined using cross-lagged path analysis to determine whether substance use and related consequences were associated with other types of delinquency across time.

RESULTS

Results demonstrated that delinquency at program entry was related to subsequent reports of heavy drinking and alcohol consequences, but not marijuana use or its consequences. In contrast, alcohol and marijuana use at program entry were not related to future reports of delinquency.

CONCLUSIONS

Findings emphasize the need to build in comprehensive assessments and interventions for youth with a first time offense in order to prevent further escalation of substance use and criminal behaviors.

Do risky friends change the efficacy of a primary care brief intervention for adolescent alcohol use?

PURPOSE

To determine if peer risk (having friends who drink or approve of drinking) modifies the effects of a computer-facilitated screening and provider brief advice (cSBA) intervention on adolescent alcohol use.

METHODS

We assessed the intervention effect using logistic regression modeling with generalized estimating equations on a sample of 2,092 adolescents. Effect modification by peer risk was analyzed separately for alcohol initiation (drinking at follow-up in baseline nondrinkers) and cessation (no drinking at follow-up in baseline drinkers) by testing an interaction term (treatment condition by peer risk). Interpretation of the interaction effect was further clarified by subsequent stratification by peer risk.

RESULTS

The intervention effect on alcohol cessation was significantly greater among those with peer risk (adjusted relative risk ratios; risk 1.44, 1.18-1.76 vs. no risk .98, .41-2.36) at 3 months' follow-up. There was no such finding for alcohol initiation.

CONCLUSIONS

Alcohol screening and brief provider counseling may differentially benefit adolescent drinkers with drinking friends.

Moderators of the association between peer and target adolescent substance use

Associating with substance using peers is generally considered as one of the most important predictors of adolescent substance use. However, peer association does not affect all adolescents in the same way. To better understand when and under what conditions peer association is most linked with adolescent substance use (SU), this review focuses on the factors that may operate as moderators of this association. The review highlighted several potential moderators reflecting adolescents' individual characteristics (e.g., pubertal status, genes and personality), peer and parental factors (e.g., nature of relationships and parental monitoring), and contextual factors (e.g., peer, school and neighborhood context). As peer association is a broad concept, important methodological aspects were also addressed in order to illustrate how they can potentially bias interpretation. Taking these into account, we suggest that, while the effects of some moderators are clear (e.g., parental monitoring and sensation seeking), others are less straightforward (e.g., neighborhood) and need to be further examined. This review also provides recommendations for addressing different methodological concerns in the study of moderators, including: the use of longitudinal and experimental studies and the use of mediated moderation. These will be key for developing theory and effective prevention.

Risky cognitions associated with adolescent alcohol misuse: moral disengagement, alcohol expectancies and perceived self-regulatory efficacy

AIM

To examine the longitudinal associations between moral disengagement, alcohol related expectancies, perceived self-regulatory efficacy and alcohol use amongst adolescents.

DESIGN AND PARTICIPANTS

A total of 367 students (mean age=13.1, SD=0.51; 65% male) from five schools across Sydney, Australia took part in this longitudinal study. Participants completed a self-report questionnaire at four time points across an 18 month period which assessed their alcohol use, levels of moral disengagement, alcohol related expectancies and perceived self-regulatory efficacy to resist peer pressure to engage in transgressive behaviours.

RESULTS

Over time, rates of binge drinking in the past three months significantly increased, but rates of drinking any alcohol in the past three months remained stable. As hypothesised, all three cognitions were independently and consistently associated with adolescent alcohol use and binge drinking over time, with the exception of perceived self-regulatory efficacy which was not associated with an increased risk of drinking any alcohol in the past three months when controlling for moral disengagement, alcohol expectancies, gender and age.

CONCLUSIONS

The current study is the first study to longitudinally map three distinct cognitive factors associated with adolescent alcohol use. Considering the alarming number of adolescents drinking at levels that place them at risk of significant harm, this study has provided important implications about cognitive factors that can be targeted to increase the accuracy of assessment and efficacy of prevention for alcohol misuse amongst adolescents.

The impact of media-related cognitions on children's substance use outcomes in the context of parental and peer substance use

Media-related cognitions are a unique influence on adolescents' substance use outcomes even after accounting for the powerful influence of parent and peers. This cross-sectional study expands upon prior research by investigating the impact of media-related cognitions on children's alcohol and tobacco outcomes in the context of parental and peer substance use. Six hundred forty-nine elementary school children (M = 9.4 years of age, SD = 1.1 years; 51 % female) completed self-report questionnaires. After accounting for peer and parental substance use, children's media-related cognitions were independently associated with three outcomes: preferences for alcohol-branded merchandise, moral beliefs about underage alcohol and tobacco use, and intentions to use alcohol and tobacco. Children's perceptions of the desirability and realism of alcohol and tobacco ads--and their similarity to and identification with these ads--predicted greater intentions to use. Desirability and identification with alcohol and tobacco ads were associated with stronger preferences for alcohol-branded merchandise, and understanding advertising's persuasive intent predicted weaker preferences. Media deconstruction skills predicted stronger beliefs that underage alcohol and tobacco use is wrong. Peer and parental substance use were associated with stronger substance-use intentions among children and weaker feelings that substance use is wrong. The findings highlight the role of media influence in contributing to youth substance use and the potential role of media literacy education in the early prevention of substance use.

The use of mental health services by adolescent smokers: a nationwide Israeli study

In this study, we aimed to evaluate the utilization of mental health services by adolescent smokers, the presence of untreated mental disorders in this young population and the associated emotional and behavioral difficulties. We performed a nationwide survey study of an Israeli representative sample of 906 adolescents and their mothers. Mental disorders were assessed using the Development and Well-Being Assessment (DAWBA) Inventory. Emotional and behavioral difficulties were evaluated using the Strengths and Difficulties Questionnaire (SDQ). Mental health services use and smoking habits were evaluated by relevant questionnaires. Adolescent smokers were using significantly more mental health services than non-smokers (79% vs. 63%, respectively, P<0.001), independently of their mental health status or ethnic group. Adolescent smokers also reported more emotional and behavioral difficulties in most areas (P<0.001), which are consistent with their mothers' reports, except in the area of peer relationships. The treatment gap for the smoking adolescents was 53% compared to 69% in the non-smokers (P<0.001). This is the first study characterizing the use of mental health services and the related emotional and behavioral difficulties in a nationally-representative sample of adolescents. The findings of a wide treatment gap and the rates of the associated emotional and behavioral difficulties are highly relevant to the psychiatric assessment and national treatment plans of adolescent smokers.

Do adolescent delinquency and problem drinking share psychosocial risk factors? A literature review

Despite the prevalence and damaging effects of adolescent problem drinking, relative to delinquency, far less research has focused on drinking using an integrated theoretical approach. The aim of the current research was to review existing literature on psychosocial risk factors for delinquency and problem drinking, and explore whether integrating elements of social learning theory with an established psychosocial control theory of delinquency could explain adolescent problem drinking. We reviewed 71 studies published post-1990 with particular focus on articles that empirically researched risk factors for adolescent problem drinking and delinquency in separate and concurrent studies and meta-analytic reviews. We found shared risk factors for adolescent delinquency and problem drinking that are encompassed by an extension of psychosocial control theory. The potential of an extended psychosocial control theory providing a parsimonious theoretical approach to explaining delinquency, problem drinking and other adolescent problem behaviours, along with suggestions for future investigations, is discussed.

Sequence of alcohol involvement from early onset to young adult alcohol abuse: differential predictors and moderation by family-focused preventive intervention

AIMS

This study tests risk factors for four dimensions of alcohol use in the sequence from (i) early onset prior to age 13 to (ii) adolescent alcohol use and (iii) alcohol problems to (iv) young adult alcohol abuse. It also examines whether family-focused preventive interventions buffer predictive relationships.

DESIGN

Data were from a randomized prevention trial extending from ages 11 to 21 years.

SETTING

Families of sixth graders enrolled in 33 rural schools in the Midwestern United States were invited to participate.

PARTICIPANTS

Families (n = 667) were pretested and assigned randomly to a control group (n = 208) or to family interventions (n = 459). The average age of participating youth was 11.3 years when the study began (52% female).

MEASUREMENTS

Questionnaire data were collected on alcohol dimensions during adolescence (early onset, alcohol use, alcohol problems) and young adulthood (alcohol abuse), and on risk factors in early adolescence (male gender, impulsive behaviors, aggression-hostility, peer deviance and parent problem drinking).

FINDINGS

Impulsive behaviors predicted early onset, peer deviance predicted alcohol use and parent problem drinking predicted alcohol problems (P < 0.05). Aggression-hostility and alcohol problems predicted alcohol abuse in the control group (P < 0.05), but not in the family interventions group (P > 0.05).

CONCLUSIONS

Different dimensions of alcohol use and problems from before age 13 to young adulthood are predicted by different risk factors. Family-focused preventive interventions can reduce the influence of some of these risk factors, including early adolescent aggression-hostility and late adolescent alcohol problems.

Emotional valence and context of social influences on drug abuse-related behavior in animal models of social stress and prosocial interaction

RATIONALE

Social factors are important determinants of drug dependence and relapse.

OBJECTIVES

We reviewed pre-clinical literature examining the role of social experiences from early life through the development of drug dependence and relapse, emphasizing two aspects of these experiences: (1) whether the social interaction is appetitive or aversive and (2) whether the social interaction occurs within or outside of the drug-taking context.

METHODS

The models reviewed include neonatal care, isolation, social defeat, chronic subordination, and prosocial interactions. We review results from these models in regard to effects on self-administration and conditioned place preference established with alcohol, psychostimulants, and opiates.

RESULTS

We suggest that in general, when the interactions occur outside of the drug-taking context, prosocial interactions are protective against drug abuse-related behaviors, whereas social stressors facilitate these behaviors. By contrast, positive or negative social interactions occurring within the drug-taking context may interact with other risk factors to enhance or inhibit these behaviors.

CONCLUSIONS

Despite differences in the nature and complexity of human social behavior compared to other species, the evolving animal literature provides useful models for understanding social influences on drug abuse-related behavior that will allow for research on the behavioral and biological mechanisms involved. The models have contributed to understanding social influences on initiation and maintenance of drug use, but more research is needed to understand social influences on drug relapse.

Predicting alcohol use across adolescence: relative strength of individual, family, peer, and contextual risk and protective factors

The current study examined developmental changes in the relative influence of risk and protective factors (RPFs) across individual, family, peer, school, and community domains on adolescent alcohol use. Using longitudinal data from two independent samples, multivariate cross-lagged models were used to estimate the unique influence of each RPF on subsequent changes in recent alcohol use between early to late adolescence. The results supported the hypothesis that the influence of Individual Risk would increase during this developmental period. However, less consistent evidence was found concerning developmental changes among the other domains. Whereas the influence arising from Family Protection diminished during adolescence, the influence of Family Risk, School Protection, and Community Protection did not vary. The influence of Peer Risk showed a nonlinear pattern across adolescence, peaking during the middle adolescent years. The results of this study support a developmental approach to adolescent alcohol use and emphasize the need for prevention strategies that account for these developmental changes.

The Association of Family and Peer Factors with Tobacco, Alcohol, and Marijuana Use Among Chilean adolescents in Neighborhood Context

Research on adolescent use of substances has long sought to understand the family factors that may be associated with use of different substances such as alcohol, tobacco, and marijuana. However, scant attention has been focused on these questions in Latin American contexts, despite growing concerns about substance use among Latin American youth. Using data from a sample of 866 Chilean youth, we examined the relationship of family and neighborhood factors with youth substance abuse. We found that in a Latin American context, access to substances is an important predictor of use, but that neighborhood effects differ for marijuana use as opposed to cigarettes or alcohol. Age of youth, family and peer relationships, and gender all play significant roles in substance use. The study findings provide additional evidence that the use of substances is complex, whereby individual, family, and community influences must be considered jointly to prevent or reduce substance use among adolescents.