Multiplex congruity: friendship networks and perceived popularity as correlates of adolescent alcohol use

The Social Processes of Excessive Online Gaming Homophily: Peer Selection or Influence?

Adolescents who befriend online game using peers may be at risk for initiated and continued excessive game use (online gaming use homophily). The present article examined how adolescents' severity of online gaming use related to their friends' online gaming behavior bi-directionally across a semester (peer selection or peer influence effect). Students from two universities completed three waves of online surveys within four and a half months (N = 3079; 33.6% female; Mage = 19.16; SD = 0.97). Random-intercepts, Cross-Lagged Panel Model (RI-CLPM) analyses revealed that peer selection and peer influence both promote online gaming use homophily in adolescents' friendship groups. Furthermore, participants were more likely to form new friendships with peers exhibiting similar online gaming behavior as their behavior, subsequently reinforcing their online gaming use behaviors within these relationships. These social processes may exhibit a time lag among girls, which needs to be confirmed through longer-term follow-up. In general, findings suggest that effective prevention programs targeting excessive online gaming should not only focus on promoting social influence skills but also consider the structure of peer environments.

Associations of Content Domain-Specific Possible Selves with Adolescent Drinking Behaviors

Alcohol use ranks as one of the most prevalent health-risk behaviors among Taiwanese adolescents. Possible selves-personalized future-oriented cognitions about the self-are significant motivators of one's actions, which may potentially influence adolescent drinking behavior. This study aimed to estimate the content domain-specific possible selves and their associations with drinking behaviors among Taiwanese adolescents. A total of 225 Taiwanese seventh and eighth graders from a public junior high school were recruited. An anonymous self-reported questionnaire was used to collect data during two time-points at six-month intervals. Results showed that having a "physical appearance" related hoped-for possible self and a "friendship" related feared possible self was associated with adolescent alcohol use after six months. Whereas, having the "physical appearance" related hoped-for and feared possible selves were associated with alcohol problems, at both, baseline and six months later. Future studies could clarify the meaning behind "physical appearance" related possible selves.

Injection network drivers of HIV prevention service utilization among people who inject drugs: results of a community-based sociometric network cohort in New Delhi, India

INTRODUCTION

Injection drug networks may influence their network members' health-seeking behaviours. Using data from a sociometric injecting partner network of people who inject drugs (PWID) in New Delhi, India, we assessed the role of injecting partner (alter) behaviours on individual engagement in HIV prevention services.

METHODS

We enumerated injecting partner linkages among 2512 PWID using coupon referrals and biometric data from November 2017 to March 2020. Participants completed interviewer-administered questionnaires and provided information on injection behaviours, injecting partners, HIV/hepatitis C (HCV) testing and service engagement. Multilevel multiple-membership models (MMMM) evaluated individual PWID HIV testing, medication for opioid use disorder (MOUD) and syringe service engagement as a function of alter attributes, accounting for membership across multiple ego-networks. Logistic regression models assessed parallel associations among socially proximal injecting peers, defined as PWID ≤3 path length from ego.

RESULTS

Median age was 26 years; 99% were male. PWID had median 2 injecting partners and 8 socially proximal peers; 14% reported HIV testing, 33% accessed MOUD and 13% used syringe services 6 months prior. In MMMM analyses, PWID with ≥1 versus 0 injecting partners who received HIV testing were significantly more likely to report HIV testing (adjusted odds ratio [aOR]: 2.27, 95% confidence interval [CI]: 1.68-3.16), MOUD (aOR: 1.99, 95% CI: 1.60-2.53) and syringe service use (aOR: 1.66, 95% CI: 1.21-2.39). We observed similar findings for individual MOUD and syringe service use. Having ≥1 versus 0 HIV-positive partners was associated with decreased HIV testing and MOUD but increased syringe service use (aOR: 1.54, 95% CI: 1.09-2.17). PWID with ≥1 versus 0 socially proximal peers who used non-sterile injection equipment reported increased HIV testing (aOR: 1.39, 95% CI: 1.01-1.92), MOUD (aOR: 1.40, 95% CI: 1.10-1.77) and syringe service use (aOR: 1.82, 95% CI: 1.23-2.68).

CONCLUSIONS

We found differential associative relationships between individual HIV prevention service engagement and the health or risk behaviours of direct and indirect alters. Characterizing network exposure beyond direct injecting partnerships provided important context on possible mechanisms of behavioural influence. Findings could be leveraged to design peer-based interventions that promote network diffusion of health-seeking behaviours.

Socio-economic inequalities in smoking and drinking in adolescence: Assessment of social network dynamics

AIMS

We investigated whether (1) adolescents selected friends with a similar socio-economic status (SES), (2) smoking and alcohol consumption spread in networks and (3) the exclusion of non-smokers or non-drinkers differed between SES groups.

DESIGN

This was a longitudinal study using stochastic actor-oriented models to analyze complete social network data over three waves.

SETTING

Eight Hungarian secondary schools with socio-economically diverse classes took part.

PARTICIPANTS

This study comprised 232 adolescents aged between 14 and 15 years in the first wave.

MEASUREMENTS

Self-reported smoking behavior, alcohol consumption behavior and friendship ties were measured. SES was measured based upon entitlement to an income-tested regular child protection benefit.

FINDINGS

Non-low-SES adolescents were most likely to form friendships with peers from their own SES group [odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.02-1.11]. Adolescents adjusted their smoking behavior (OR = 24.05, 95% CI = 1.27-454.86) but not their alcohol consumption (OR = 1.65, 95% CI = 0.62-4.39) to follow the behavior of their friends. Smokers did not differ from non-smokers in the likelihood of receiving a friendship nomination (OR = 0.98, 95% CI = 0.87-1.10), regardless of their SES. Alcohol consumers received significantly more friendship nominations than non-consumers (OR = 1.16, 95% CI = 1.01-1.33), but this association was not significantly different according to SES.

CONCLUSIONS

Hungarian adolescents appear to prefer friendships within their own socio-economic status group, and smoking and alcohol consumption spread within those friendship networks. Socio-economic groups do not differ in the extent to which they encourage smoking or alcohol consumption.

Understanding factors associated with firearm possession: Examining differences between male and female adolescents and emerging adults seeking emergency department care

Firearm possession increases the likelihood of hospital visits among adolescents and emerging adults for both males and females. To better inform prevention practices, we examine data among adolescents and emerging adults (A/EAs; ages 16 to 29) presenting to an urban emergency department for any reason to understand the differences in firearm possession between males and females (N = 1312; 29.6% male; 50.5% Black). Regression identified firearm possession correlates, such as male sex (AOR = 2.26), firearm attitudes (AOR = 1.23), peer firearm possession (AOR = 9.84), and community violence exposure (AOR = 1.02). When stratified by sex (e.g., male vs female), regression results yielded differences in correlates for firearm possession: in males, peer firearm possession (AOR = 8.96) were significant, and in females, firearm attitudes (AOR = 1.33) and peer firearm possession (AOR = 11.24) were significant. An interaction between sex and firearm attitudes demonstrated that firearm attitudes were differentially associated with firearm possession between female and male A/EAs (AOR = 1.28). Overall, we found that females are more likely to endorse retaliatory firearm attitudes, and both males and females are highly influenced by their perception of peer firearm possession. These results help inform prevention strategies across multiple settings, especially for hospital-based violence interventions, and suggest that tailored approaches addressing differences between male and female A/EAs are appropriate when addressing firearm violence and injury risk among A/EAs.

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.

Being Popular or Having Popular Friends, Which Is Better? A Longitudinal Social Network Analysis of Depressive Symptoms among Chinese Adolescents under Major Chronic Stress

Background: Previous studies have found that adolescents’ depressive symptoms are influenced by social networks in a stressful context, especially focusing on the processes of social selection and social influence. The current study aimed to explore the coevolution of sociometric popularity and depressive symptoms among adolescents suffering from the stress attached to the Chinese gaokao. Methods: The analytical sample comprised 1062 Chinese adolescents who were under significant pressure to return to school for an additional year (returnees) to prepare for college entrance examinations. Students were assessed for depressive symptoms and asked to nominate up to five friends within their classes across four waves (six months). We employed stochastic actor-oriented models to investigate the interdependent relationships between popularity and depressive symptoms. Results: Adolescents’ depressive symptoms negatively predicted future friendship popularity in this stressful situation, but not vice versa. The results of this study also highlighted the importance of friends’ popularity, indicating that adolescents who nominated popular peers as friends tended to subsequently have lower depressive symptoms. Conclusion: These findings suggested that friends’ popularity may serve as a protective factor against depressive symptoms under major chronic stress. Network-based interventions may have practical implications for reducing depressive symptoms under major chronic stress.

Perceived friendship and binge drinking in young adults: A study of the Human Connectome Project data

BACKGROUND

Peer influences figure prominently in young adult binge drinking. Women have trended to show a level of alcohol use on par with men during the last decades. It would be of interest to investigate the neural processes of social cognition that may underlie binge drinking and the potential sex differences.

METHODS

Here, we examined the data of the Human Connectome Project where we identified a total of 175 binge drinkers (125 men) and 285 non-binge drinkers (97 men) performing a social cognition task during brain imaging. We analyzed the imaging data with published routines and evaluated the results at a corrected threshold.

RESULTS

Both male and female binge relative to non-binge drinkers showed higher perceived friendship. Binge relative to non-binge drinkers demonstrated diminished activations in the anterior medial orbitofrontal cortex (amOFC) during perception of social vs. random interaction, with a more prominent effect size in women. Further, whole-brain regression identified activity of the right posterior insula (rPI) in negative correlation with perceived friendship score in non-binge drinking women. Post-hoc analyses showed significant correlation of rPI activity with perceived friendship, amOFC activity, and a summary measure of alcohol use severity identified by principal component analysis, across all subjects. Mediation and path analysis demonstrated a significant model: amOFC activity → rPI activity → perceived friendship → severity of alcohol use.

CONCLUSIONS

These findings support peer influences on binge drinking and suggest neural correlates that may relate altered social cognitive processing to alcohol misuse in young adults.

What is(n't) a friend? Dimensions of the friendship concept among adolescents

Much research in network analysis of adolescent friendships assumes that friendships represent liking and social interaction, friendships are directed, and friendships are equivalent to one another. This study investigates the meaning of friendship for eight diverse cohorts of sixth graders. Analysis of focus group and survey data suggests that these adolescents construe friendship as a multidimensional role relation composed primarily of relational norms, expectations for mutual behavior. Their friendship definitions may also include mutual liking and interaction, and other structural expectations such as reciprocity, homophily, and transitivity. Lastly, boys and girls weight these dimensions differently in defining friendship.

Comparing targeting strategies for network-based adolescent drinking interventions: A simulation approach

Public health researchers and social scientists highlight the promise of network-based strategies to inform and enhance interventions that curb risky adolescent health behaviors. However, we currently lack an understanding of how different variants of network-based interventions shape the distribution of targeted behaviors. The current project considers the effectiveness of five targeting strategies that are designed to have differential impacts on the health of program participants versus non-participants. Using simulations that are empirically-grounded in 28 observed school-based networks from the PROSPER study, we evaluate how these approaches shape long-term alcohol use for intervention participants and non-participants, separately, and consider whether contextual factors moderate their success. Findings suggest that enrolling well-connected adolescents results in the lowest drinking levels for non-participants, while strategies that target groups of friends excel at protecting participants from harmful influences. These trends become increasingly pronounced in contexts characterized by higher levels of peer influence.

Social Network Research contribution to evaluating process in a feasibility study of a peer-led and school-based sexual health intervention

There is growing interest in social network-based programmes to improve health, but rigorous methods using Social Network research to evaluate the process of these interventions is less well developed. Using data from the "STis And Sexual Health" (STASH) feasibility trial of a school-based, peer-led intervention on sexual health prevention, we illustrate how network data analysis results can address key components of process evaluations for complex interventions-implementation, mechanisms of impacts, and context. STASH trained students as Peer Supporters (PS) to diffuse sexual health messages though face-to-face interactions and online Facebook (FB) groups. We applied a Multilevel Exponential Random Graph modelling approach to analyse the interdependence between offline friendship relationships and online FB ties and how these different relationships align. Our results suggest that the creation of online FB communities mirrored offline adolescent groups, demonstrating fidelity of intervention delivery. Data on informal friendship networks related to student's individual characteristics (i.e., demographics, sexual health knowledge and adherence to norms, which were included for STASH), contributed to an understanding of the social relational 'building' mechanisms that sustain tie-formation. This knowledge could assist the selection of opinion leaders, improving identification of influential peers situated in optimal network positions. This work provides a novel contribution to understanding how to integrate network research with the process evaluation of a network intervention.

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.

Social Interaction With an Alcohol-Intoxicated or Cocaine-Injected Peer Selectively Alters Social Behaviors and Drinking in Adolescent Male and Female Rats

BACKGROUND

Drinking alcohol is facilitated by social interactions with peers, especially during adolescence. The importance of peer social influences during adolescence on alcohol and substance use has recently received more attention. We have shown that social interaction with an alcohol-intoxicated peer influences adolescent alcohol drinking differently in male and female rats using the demonstrator-observer paradigm. The present set of experiments analyzed the social interaction session to determine changes in social behaviors and subsequent alcohol drinking in adolescent male and female rats.

METHODS

Specifically, in Experiment 1, we determined whether specific social behaviors were altered during interaction with an alcohol-intoxicated demonstrator administered 1.5 g/kg ethanol (EtOH) and assessed changes in EtOH intake in adolescent observers. Experiment 2 examined changes in voluntary saccharin consumption to determine whether social interaction with an alcohol-intoxicated demonstrator administered 1.5 g/kg EtOH altered consumption of a palatable solution. In Experiment 3, we administered saline, and a low (5 mg/kg) or high (20 mg/kg) dose of cocaine to the demonstrator and assessed changes in the adolescent observers to determine whether social interaction with a "drugged" peer altered social behaviors and voluntary EtOH intake.

RESULTS

We showed that social interaction with an alcohol-intoxicated demonstrator administered 1.5 g/kg EtOH (i) decreased social play and increased social investigation and social contact in adolescent male and female observers, (ii) did not alter nonsocial behaviors, (iii) did not alter saccharin consumption, and (iv) increased voluntary EtOH intake in adolescent female but not male observers. When the peer was injected with cocaine, (i) social play was dose-dependently decreased, (ii) there were no changes in other social or nonsocial behaviors, and (iii) voluntary EtOH intake in adolescent male and female observers was unaffected.

CONCLUSIONS

The present results are consistent and extend our previous work, showing that social interaction with an alcohol-intoxicated peer selectively alters social behaviors and alcohol drinking in adolescent rats. Females appear to be more sensitive to the elevating effects of social interaction on voluntary EtOH consumption.

Social identity differentiation predicts commitment to sobriety and wellbeing in residents of therapeutic communities

RATIONALE

Therapeutic communities (TC) for alcohol and other drug treatment rely strongly on social factors as agents of recovery; an approach known as 'community-as-method'. This study adopted a social identity approach in examining the relative strength of participants' recovery group identity and substance using group identity at admission (T1) and after six months (T2) in a TC.

OBJECTIVES

Were to investigate whether identity differentiation - the extent to which respondents see themselves more as belonging to recovery groups than belonging to substance using groups - (a) is related to individuals' primary substance of concern (i.e., amphetamine type stimulants; alcohol; other drugs), and (b) predicts positive indicators of recovery six months after entering a therapeutic community.

METHOD

Adults (N = 307) entering one of five Australian therapeutic communities (TC) completed measures of identification (user, recovery), commitment to sobriety, psychological distress, and personal wellbeing.

RESULTS

Participants' endorsement of the user and recovery identity at T1 and T2 did not differ as a function of primary substance of concern. User identity diminished over the six months while recovery identity remained high, regardless of primary drug category. Identity differentiation measured at T2 accounted for 20-25% variance in commitment to sobriety and wellbeing, after accounting for participant demographics, addiction severity, and T1 identity variables.

CONCLUSIONS

These findings highlight the importance of the relative strength of recovery over substance use related identities in supporting recovery indicators and the central role of the TC in supporting this trajectory.

Overlooked Threats to Respondent Driven Sampling Estimators: Peer Recruitment Reality, Degree Measures, and Random Selection Assumption

Intensive sociometric network data were collected from a typical respondent driven sample (RDS) of 528 people who inject drugs residing in Hartford, Connecticut in 2012-2013. This rich dataset enabled us to analyze a large number of unobserved network nodes and ties for the purpose of assessing common assumptions underlying RDS estimators. Results show that several assumptions central to RDS estimators, such as random selection, enrollment probability proportional to degree, and recruitment occurring over recruiter's network ties, were violated. These problems stem from an overly simplistic conceptualization of peer recruitment processes and dynamics. We found nearly half of participants were recruited via coupon redistribution on the street. Non-uniform patterns occurred in multiple recruitment stages related to both recruiter behavior (choosing and reaching alters, passing coupons, etc.) and recruit behavior (accepting/rejecting coupons, failing to enter study, passing coupons to others). Some factors associated with these patterns were also associated with HIV risk.

Who's Got the Booze? The Role of Access to Alcohol in the Relations Between Social Status and Individual Use

OBJECTIVE

The findings of previous research that examined relationships between popularity and alcohol use in adolescents have been mixed, and few hypotheses have proposed mechanisms for this relationship. The current study expands on previous literature (a) by examining a possible mechanism that can explain the relation between popularity and alcohol use (home access to alcohol) and (b) by using another sociometric measure ("betweenness"), beyond popularity, that may relate more to home alcohol access.

METHOD

Using network-level data from adolescents in 9th-11th grades in eight schools within two in-home waves of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined two sociometric measures of social status: popularity (number of schoolmates who nominated participants as a friend) and betweenness (level of ties participants have to multiple social subgroups within a network).

RESULTS

Betweenness, but not popularity, related to later alcohol use. Having home access to alcohol positively related to later alcohol use, and having friends with home access to alcohol negatively related to later alcohol use. Alcohol access was also related to later sociometric status. Friends' alcohol access negatively related to later betweenness, and personal alcohol access moderated other pathways predicting betweenness.

CONCLUSIONS

Betweenness appears to play a unique role in the association between social status and alcohol use in adolescent social networks. This is potentially tied to specific ways in which adolescents may be able to access alcohol (through home or through friends with access at home). More research is necessary to examine the ways in which multiple sociometric statuses relate to the contexts in which adolescents access and use alcohol.

Popularity Breeds Contempt: The Evolution of Reputational Dislike Relations and Friendships in High School

In this study, we examined the dynamics of the perception of "dislike" ties (reputational dislike) among adolescents within the contexts of friendship, perceived popularity, substance use, and Facebook use. Survey data were collected from a longitudinal sample of 238 adolescents from the 11th and 12th grades in one California high school. We estimated stochastic actor-based network dynamic models, using reports of reputational dislike, friendships, and perceived popularity, to identify factors associated with the maintenance and generation reputational dislike ties. The results showed that high-status adolescents and more frequent Facebook users tended to become perceived as or stay disliked by their peers over time. There was a tendency for friendships to promote the creation and maintenance of reputational disliking but not vice versa. Adolescents tended to perceive others as disliked when their friends also perceived them as disliked. There was no evidence that either cigarette smoking or drinking alcohol affected reputational dislike dynamics. This study highlights the important role that the hierarchical peer system, online peer context, and friendships play in driving information diffusion of negative peer relations among adolescents.

The Influence of Social Network Characteristics on Peer Clustering in Smoking: A Two-Wave Panel Study of 19- and 23-Year-Old Swedes

OBJECTIVES

The present study examines how the composition of social networks and perceived relationship content influence peer clustering in smoking, and how the association changes during the transition from late adolescence to early adulthood.

METHODS

The analysis was based on a Swedish two-wave survey sample comprising ego-centric network data. Respondents were 19 years old in the initial wave, and 23 when the follow-up sample was conducted. 17,227 ego-alter dyads were included in the analyses, which corresponds to an average response rate of 48.7 percent. Random effects logistic regression models were performed to calculate gender-specific average marginal effects of social network characteristics on smoking.

RESULTS

The association of egos' and alters' smoking behavior was confirmed and found to be stronger when correlated in the female sample. For females, the associations decreased between age 19 and 23. Interactions between network characteristics and peer clustering in smoking showed that intense social interactions with smokers increase egos' smoking probability. The influence of network structures on peer clustering in smoking decreased during the transition from late adolescence to early adulthood.

CONCLUSIONS

The study confirmed peer clustering in smoking and revealed that females' smoking behavior in particular is determined by social interactions. Female smokers' propensity to interact with other smokers was found to be associated with the quality of peer relationships, frequent social interactions, and network density. The influence of social networks on peer clustering in smoking decreased during the transition from late adolescence to early adulthood.

Multiplex crack smoking and sexual networks: associations between network members' incarceration and HIV risks among high-risk MSM

This study examined HIV risks in the multiplex crack-smoking and sexual networks of incarcerated drug-using men who have sex with men (MSM) and their associates. We estimated the associations between the network members' incarceration, self-reported HIV infection, and trading sex for money. Our analytic sample consisted of 508 crack-smoking or sexual partnerships of 273 high-risk MSM. Network members were specified by (1) crack smoking and sexual behavior or (2) crack smoking only. Longer incarceration of the crack-smoking and sexual network members was associated with self-reported HIV infection (AOR = 1.61, p < 0.05), which extended up to one's partners' partners' partners (AOR = 1.63, p < 0.05). Similar results were found for trading sex (AOR = 2.77, p < 0.05). The findings of the study call for the development of a system-level HIV intervention among former incarcerated MSM and their associates.

Social isolation, drunkenness, and cigarette use among adolescents

INTRODUCTION

This study compares isolated to sociable youth to investigate the relations between different network types of social isolation and alcohol and cigarette use.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health we developed a network measure that includes various types of social isolation. Types of social isolation were operationalized as socially avoidant, actively isolated, and socially disinterested, with sociable youth as the reference category. Random effects ordinal logit models were fit to estimate the association between different types of social isolation and drunkenness and cigarette use.

RESULTS

Different types of social isolation had varying effects on drunkenness and cigarette use. On the one hand, socially disinterested youth were at an increased risk for drunkenness and cigarette use. On the other hand, socially avoidant youth had lower odds of drunkenness and no significant differences in cigarette use when compared to sociable youth. Actively isolated youth showed no differences in drunkenness and cigarette use.

CONCLUSIONS

The role played by marginalized social positions in youth substance use is an important yet overlooked problem. This study can contribute to better targeted and more effective health behavior prevention efforts for vulnerable adolescents.