Preventing Youth Suicide: A Review of School-Based Practices and How Social-Emotional Learning Fits Into Comprehensive Efforts

Schools in the United States increasingly incorporate social-emotional learning (SEL) as a part of comprehensive youth suicide prevention programs in schools. We reviewed the literature to investigate the inclusion of SEL in youth suicide prevention efforts. We identified several known risk factors to youth suicide, namely, hopelessness, anxiety, substance use, and child sexual abuse, then cross-walked that review to SEL competencies shown to mitigate each of those known risk factors. We found all SEL competencies, to some extent, across all the evidence-based, school-based youth suicide prevention programs we identified. Further, we found that all five SEL competencies are shown directly to address and mitigate the major, known risk factors for youth suicide. These findings suggest that SEL can play a productive role in upstream youth suicide prevention. State-level policy makers and school administrators should consider the inclusion of evidence-based SEL in efforts to address youth suicide prevention.

Age of Initiation of Dual Tobacco Use and Binge Drinking among Youth (12-17 Years Old): Findings from the Population Assessment of Tobacco and Health (PATH) Study

Earlier exposure to binge drinking and tobacco use is associated with higher odds of substance use disorders. Using national youth data from the PATH study, we prospectively estimate the age of initiating past 30-day use of (1) cigarettes, e-cigarettes, and binge drinking, and (2) cigarettes, cigarillos, and binge drinking. Cox proportional hazard models were used to estimate differences in the age of initiation by sex, race/ethnicity, and previous use of other tobacco products. By age 21, 4.4% (95% CI: 3.7-5.2) and 2.0% (95% CI: 1.2-2.8) of youth reported initiation of past 30-day use outcomes (1) and (2), respectively. After controlling for sex and previous use of other tobacco products, statistically significant differences in the age of initiation by race/ethnicity were found for each outcome: Hispanic and non-Hispanic Black youth were less likely than non-Hispanic White youth to initiate past 30-day use of both outcomes (1) and (2) at earlier ages. Although the initiation of both outcomes remained relatively low by age 21, these incidences represent 1.56 million and 700,000 youth, respectively. This study provides the public with evidence to identify the particular ages at which education campaigns may be most effective to prevent youth from initiating these three substances. Further research is needed to estimate the age of initiation of other dual tobacco use patterns with binge drinking.

Correlates of Awareness and Use of Heated Tobacco Products in a Sample of US Young Adults in 2018-2019

INTRODUCTION

Tobacco companies have devoted increased resources in recent years to developing and marketing heated tobacco products (HTPs) as alternatives to combustible products like cigarettes. However, little is known about correlates of awareness and use of these products in American young adults.

METHODS

Two thousand four hundred ninety-seven young adults (mean age = 21.6) completed survey items on HTP awareness and lifetime use in 2018-2019. Logistic regression models compared young adults who were (1) unaware of HTPs (reference group) with those who were, (2) aware of HTPs, and (3) had ever used HTPs on demographic, tobacco, and other substance use characteristics. Among current smokers, these groups were compared on cigarette use, dependence, and readiness to quit.

RESULTS

Approximately 12% of respondents (n = 293) were aware of HTPs, and 5% (n = 134) reported lifetime HTP use. Controlling for demographics, HTP awareness and use were both associated with greater use of all types of tobacco products, number of different tobacco products, and use of marijuana and other drugs. Among current smokers, HTP awareness and use correlated with heavier cigarette consumption, greater dependence, and past-month marijuana use, but not with recent quit attempts or thinking about quitting cigarettes.

CONCLUSIONS

Awareness and use of HTPs among young adults were associated with greater use of tobacco products and other substances and, among current smokers, with greater cigarette dependence (but not cessation-related factors). As these products become increasingly available in the United States, additional surveillance and monitoring activities are needed to better understand use patterns, consequences, and reasons for using HTPs.

IMPLICATIONS

Few studies have examined factors associated with awareness and use of heated tobacco products (HTPs) among US young adults. HTP awareness and lifetime use correlated with a range of factors, including male gender, white race/ethnicity, and tobacco and other substance use. Lifetime use of HTPs was low (5%); most lifetime HTP users reported history of other tobacco use, but a sizeable minority (14%) reported no other tobacco product use history. Among current cigarette smokers, cigarette dependence, poly-tobacco use, and marijuana use-but not cigarette cessation attempts or contemplation-were associated with greater likelihood of awareness and use of HTPs.

Facilitating Change in Drinking Cognitions and Behaviors Among Three Immigrant Generations of Latinx Youth Through a School-Based Intervention: Findings From a Multi-Site Clinical Trial

Latinx youth experience disparities in the availability of and participation in evidence-based interventions to reduce hazardous alcohol use. The aim of this secondary data analysis was to examine whether Project Options, a brief, evidence-based alcohol use intervention was beneficial for Latinx participants. A total of 331 first-, second-, and third-generation immigrant Latina and Latino youth who participated in a multi-site, hybrid effectiveness/efficacy clinical trial of the intervention were selected for analyses. Mixed-effects growth models tested changes in drinking cognitions (i.e., perception of peer drinking, intention to drink next month, alcohol use and cessation expectancies) and behaviors (i.e., number of past-month drinking days, average number of drinks per occasion, and maximum number of drinks per occasion) across three time points (i.e., baseline, 4-weeks, and 12-weeks). Consistent with prior Project Options studies, participants with more drinking experience reported greater decreases in perception of peer drinking, intentions to drink next month, and all drinking behaviors than those with less experience. While no changes were observed in expectancies, first-generation participants endorsed lower positive use expectancies than second- and third-generation youth as well as more favorable cessation expectancies than third-generation teens. In concert with prior studies demonstrating the intervention's success in recruitment and retention of Latinx participants, results suggest that Project Options might be a promising school-based intervention for Latinx youth. This intervention has the potential to reach adolescents who might otherwise not participate in traditional programming and help decrease disparities in availability of evidence-based practices for Latinx youth.

Greater risk for frequent marijuana use and problems among young adult marijuana users with a medical marijuana card

BACKGROUND

This study compared young adults with and without a medical marijuana (MM) recommendation from a provider ("MM card") on their developmental trajectories of frequent marijuana use and marijuana-related problems in young adulthood.

METHODS

The analytic sample consists of young adult past month marijuana users (N = 671) who were part of a larger, diverse, and predominantly California cohort. Analyses are based on data from seven surveys completed from ages 13-19.

RESULTS

At age 19, 28% of participants reported having an MM card to legally purchase marijuana from an MM dispensary. A multiple group latent growth model indicated that young adults who had an MM card showed steeper increases in frequent marijuana use (i.e., 20-30 days of use in the past month) from ages 13-19 compared to young adults who did not have an MM card. Logistic regression models that matched MM cardholders and non-MM cardholders on individual sociodemographic characteristics found that MM cardholders were more likely to report marijuana negative consequences, selling marijuana/hashish, and driving under the influence of marijuana in the past year. In addition, MM cardholders were more likely to have tried cutting down or quitting in the past 3-months.

CONCLUSIONS

Among young adult marijuana users, those with an MM card had a higher risk profile for marijuana use and related problems compared to those without an MM card. Given expanding state legalization of MM, this issue warrants further attention.

New Zealand adolescents' concerns about their alcohol use and access to services: Associations with ethnicity and other factors

Using a national survey of 8,500 New Zealand high school students, we investigated adolescents' concerns about their drinking, associated factors including help-seeking preferences and access to health care services, and how these varied by ethnicity and level of socioeconomic deprivation. Approximately 23.9% of the 3,704 current drinkers reported concerns (i.e., being worried about their drinking and/or having tried to cut down). Regression analyses revealed that Māori and Pacific youth were more likely than their New Zealand European peers to be concerned about their drinking. Concerned drinkers were more likely than nonconcerned drinkers to report hazardous drinking behaviors and alcohol-related problems, but these associations varied by age, ethnicity, and socioeconomic deprivation. Help-seeking preferences differed strongly by ethnicity. Concerned drinkers, and Māori and Pacific drinkers, were more likely to report difficulties accessing health care and alcohol and drug services. The factors associated with adolescents' drinking concerns and paradoxical difficulties accessing health care highlight the importance of engaging adolescents in developing responsive and equitable services.

Impact of Perceived Risk and Friend Influence on Alcohol and Marijuana Use Among Students

We performed a secondary analysis of Adolescent Health Risk Behavior Survey data ( N = 937), examining associations between lifetime alcohol and marijuana use with intrapersonal (i.e., risk perceptions) and interpersonal (e.g., peer approval and behavior) factors. Multinomial and binary logistic regression analyses contend students reporting lifetime alcohol use-compared to students who had never used alcohol or marijuana-perceived lower alcohol risk ( p < .001), higher friend drinking approval ( p < .001), and greater friend drinking ( p = .003). Using both alcohol and marijuana in one's life was associated with being in public schools ( p = .010), higher grade levels ( p = .001), lower perceived alcohol ( p = .011) and marijuana use risk ( p = .003), higher friend approval of alcohol ( p < .001) and marijuana use ( p < .001), and believed more friends used alcohol ( p < .001). Compared to lifetime alcohol only, perceived friend academic performance decreased the risk of lifetime alcohol and marijuana use ( p = .043). Findings are beneficial to school nurses with students experiencing effects associated with substance use.

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

DISCUSSION

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

TRANSLATION TO HEALTH EDUCATION PRACTICE

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

Cumulative Stress and Substance Use From Early Adolescence to Emerging Adulthood

Building on models of the stress process, this study examined the consequences for binge alcohol use, marijuana use, and other illicit substance use of cumulative levels of stressful life events using data from the Family Health Study (FHS), an 8-year panel data set ( N = 840). The results of a latent trajectory analysis indicated a positive association between cumulative stressors and involvement in substance use during this period of the life course, especially among early adolescent users. However, there were no identifiable effects on adolescent-limited users. Implications of the results for theory and policy are discussed.

Gender differences in the developmental trajectories of multiple substance use and the effect of nicotine and marijuana use on heavy drinking in a high-risk sample

BACKGROUND

Heavy drinking is highly comorbid with nicotine and marijuana use among young adults. Yet, our knowledge about the longitudinal effects of nicotine and marijuana use (including onset timing and quantity/frequency) on heavy drinking and whether the effects vary by gender is very limited. This study aims to characterize gender-specific developmental trajectories of multiple substance use and to examine gender differences in the effects of nicotine and marijuana use on heavy drinking.

METHODS

We conducted secondary analysis on 8 waves of data from 850 high-risk youth who were recruited as ninth graders with low GPA in an economically disadvantaged school district in the Midwest and were followed up annually to young adulthood. Onset ages and quantity/frequency of multiple substance use were assessed by a self-report questionnaire at each wave. The time-varying effect model and linear mixed model were adopted for statistical analysis.

RESULTS

Males' levels of heavy drinking, nicotine use, and marijuana use tended to grow persistently from adolescence to emerging adulthood. Females, on the other hand, only gradually increased their nicotine use across time while maintaining low levels of heavy drinking and marijuana use. Controlling for the early onset status of alcohol use, early onset statuses of nicotine use and marijuana use both added additional risk for heavy drinking; late onset marijuana users were also at higher risk for heavy drinking than nonusers of marijuana. Controlling for substance use onset statuses, higher quantity/frequency of nicotine and marijuana use both contributed to more involvement in heavy drinking. We also found that the effect of nicotine use quantity on heavy drinking was greater among males.

CONCLUSIONS

Our study demonstrates the longitudinal effects of onset timing and quantity/frequency of nicotine and marijuana use on heavy drinking. Our analysis of gender differences also identifies female youth's nicotine use and male youth's co-use of nicotine and alcohol as two important areas for future prevention and intervention work.

Binge Drinking

Alcohol is the substance most frequently abused by children and adolescents in the United States, and its use is associated with the leading causes of death and serious injury at this age (ie, motor vehicle accidents, homicides, and suicides). Among youth who drink, the proportion who drink heavily is higher than among adult drinkers, increasing from approximately 50% in those 12 to 14 years of age to 72% among those 18 to 20 years of age. In this clinical report, the definition, epidemiology, and risk factors for binge drinking; the neurobiology of intoxication, blackouts, and hangovers; genetic considerations;and adverse outcomes are discussed. The report offers guidance for the pediatrician. As with any high-risk behavior, prevention plays a more important role than later intervention and has been shown to be more effective. In the pediatric office setting, it is important to ask every adolescent about alcohol use.

Alcohol and marijuana use in middle school: comparing solitary and social-only users

PURPOSE

Middle school students with a history of solitary substance use are at elevated risk for substance problems by young adulthood. Understanding how these students differ from social-only users on substance use behaviors and consequences, normative beliefs, social influences, and attitudes can inform efforts to reduce solitary use and its related negative consequences.

METHODS

Sixth- to seventh-grade students completed an in-school survey. We compared those with a history of solitary versus social-only alcohol use (n = 202 and n = 616, respectively) and marijuana use (n = 92 and n = 208, respectively) on a range of substance use-related characteristics.

RESULTS

Any solitary use was reported by 25% of lifetime alcohol users and 31% of lifetime marijuana users. Those with a history of solitary use of either substance were more likely to hold positive expectancies about their use but also reported more negative consequences during the past year. Solitary users tended to have greater exposure to substance-using peers and more difficulty resisting offers to use. Compared with social-only drinkers, those with a history of solitary drinking perceived that more of their peers were alcohol users. Significant group differences were not found on negative outcome expectancies or attempts to cut down on substance use.

CONCLUSIONS

Solitary use is an important, yet, overlooked problem among middle school students who have just begun drinking or using marijuana. Results suggest that positive expectancies, peer influences, resistance self-efficacy, and normative beliefs may be important areas to target in reducing solitary use and the risk it poses for problematic use in young adulthood.

Does diversity matter? The need for longitudinal research on adolescent alcohol and drug use trajectories

The existing research aimed at understanding alcohol and drug (AOD) use patterns from early to late adolescence typically does not examine samples with substantial racial and ethnic diversity. This is a critical research gap because studies have suggested that non-white adolescents often have worse health outcomes compared to white adolescents, even with less AOD use. In this paper, we discuss the need for future research on this topic, given demographic shifts in the racial and ethnic composition of the USA. We also outline how this research can provide information on what periods might be most relevant for each racial/ethnic group, and suggest measures that epidemiological studies on early substance use should assess to capture the underlying cultural, acculturation, psychosocial, and contextual factors that explain racial/ethnic differences in AOD trajectories.

[SURPS French version validation in a Quebec adolescent population]

OBJECTIVE

The Substance Use Risk Profile Scale (SURPS) has been developed to screen personality risk factors for substance abuse. This scale assesses 4 high-risk personality traits using a 23-item, self-report questionnaire. SURPS helps guiding targeted approaches to prevention of substance abuse and misuse. It has been validated in the United Kingdom, English Canada, Sri Lanka, and China. This study aims to validate this scale in a sample of French-speaking adolescents from Quebec as well as its sensitivity in a clinical sample of adolescents.

METHOD

Two hundred two 15-year-old youths from a community sample completed a French version of SURPS as well as other measures of personality and substance use. This study reports the internal consistency and concurrent validity of the scale, as well as a factor analysis of items. Further, 40 youths (mean age 15.7 years) from a clinical population completed SURPS and their scores were compared with those of the community sample.

RESULTS

SURPS French translation has good internal consistency and demonstrated a 4-factor structure very similar to the original scale. The 4 subscales show good concurrent validity, and 3 of the subscales were found to correlate with measures of substance use. Finally, 95% of the clinical sample was identified at high risk for substance misuse according to SURPS cut-off scores.

CONCLUSION

SURPS French translation seems to be a valid and sensitive scale that can be used in a French-speaking adolescent population from Quebec.

Longitudinal trajectories of posttraumatic stress disorder symptoms and binge drinking among adolescent girls: the role of sexual victimization

PURPOSE

Many studies have documented associations among sexual victimization (SV), posttraumatic stress disorder (PTSD) symptoms, and alcohol use; however, few have examined these associations longitudinally among adolescents. The present study evaluated the effect of SV on the longitudinal trajectory of PTSD symptoms and binge drinking (BD) among adolescent girls, a population known to have high rates of SV and alcohol use.

METHODS

Participants (N = 1,808 at wave 1) completed interviews regarding PTSD symptoms, BD, and SV experiences over approximately 3 years.

RESULTS

Multilevel modeling revealed decreases in PTSD symptoms over the course of the study; however, compared with nonvictims, adolescents who were sexually victimized reported greater PTSD symptoms at wave 1 and maintained higher levels of PTSD symptoms over the course of the study after controlling for age. SV reported during the study also predicted an acute increase in PTSD symptoms at that occasion. BD increased significantly over the course of the study; however, SV did not predict initial BD or increases over time. SV reported during the study was associated with acute increases in BD at that occasion, although this effect diminished when participants reporting substance-involved rape were excluded.

CONCLUSIONS

SV was associated with immediate and long-lasting elevations in PTSD symptoms, but not with initial or lasting elevations in BD over time, suggesting that adolescent victims have yet to develop problematic patterns of alcohol use to cope with SV. However, SV was associated with acute increases in PTSD symptoms and BD, suggesting a need for BD interventions to reduce alcohol-related SV.

Structural, concurrent, and predictive validity of the Substance Use Risk Profile Scale in early adolescence

A brief personality risk profile (23 items), the Substance Use Risk Profile Scale was tested for concurrent and predictive validity for substance use in 1139 adolescents (grades 8-10) from a mid-sized city in western Canada. The SURPS was administered in two waves of a longitudinal study separated by 12 months (2003-04). As expected, four subscales were supported by confirmatory factor and metric invariance analysis. In regression analysis, three subscales, hopelessness, impulsivity, and sensation seeking, were positively related to current and future use; while one, anxiety sensitivity, was negatively related. Findings suggest clinical utility for screening adolescents at risk for substance use.

Adolescent alcohol use trajectories: Predictors and subsequent problems

This study aimed at identifying different alcohol drinking trajectories in early to late adolescence. We also examined whether certain factors predicted membership of a specific trajectory and to what extent trajectory membership was linked to later negative consequences. Data were drawn from a longitudinal cohort study starting with 1923 adolescents including all seventh grade students in six school districts in Stockholm, Sweden 2001 (age 14), with follow-up in 2002, 2003, and 2006 (age 19). Cluster- and multinomial logistic regression analyses revealed four developmental pathways: low, gradually increasing, high, and suddenly increasing consumption. "High consumers" and "sudden increasers" reported higher levels of alcohol consumption, heavy episodic drinking, and alcohol-related problems both at age 14-16 and at age 19. The "gradual increasers" were more likely to smoke cigarettes, have easy access to alcohol, visit youth recreation centres, have friends who drink, and report a poorer health, compared to the "low consumer/abstainer group". "High consumers" were more likely to have drinking peers than both "low consumers/abstainers" and "gradual increasers".

Binge drinking in African American males from adolescence to young adulthood: the protective influence of religiosity, family connectedness, and close friends' substance use

We examined the contribution of culturally relevant protective factors (i.e., adolescent religiosity, family connectedness, and perceived close friends' substance use) to the probability of young adult binge drinking among African American males. Participants (n = 1,599) drawn from the National Longitudinal Study of Adolescent Health were high school age adolescents (14-18 years, M = 16) at Wave 1 and young adults (18-26, M = 22) at Wave 3. Adolescent binge drinking was associated with all three protective factors. Perceived close friends' substance use in adolescence was a protective factor in later binge drinking during young adulthood, and was moderated by age such that the effect was stronger for younger adolescents. Implications for culturally relevant research and prevention are discussed.

Binge drinking in childhood and adolescence: epidemiology, consequences, and interventions

BACKGROUND

Episodic excessive alcohol consumption ("binge drinking") among children and adolescents has become a serious public health problem in Germany and is associated with a variety of risks.

METHODS

Selective literature search of the Ovid Medline database from 1998 to 2008.

RESULTS

Episodic excessive alcohol consumption is associated not only with somatic complications, but also with traffic accidents and other types of accident, violent behavior, and suicide. The more frequently a child or adolescent drinks to excess, and the younger he or she is, the greater is the risk of developing an alcohol-related disorder (alcohol misuse or dependence syndrome). In the USA, brief motivational interventions have been shown to have a small to medium-sized beneficial effect in reducing further binge drinking and its complications.

CONCLUSIONS

The intervention HaLT ("Stop," also an acronym for Hart am Limit--"near the limit") is performed in a number of regions in Germany. Further types of brief motivating intervention should be developed and evaluated to prevent the development of alcohol-related disorders, where indicated, in children and adolescents that engage in binge drinking.

A review of similarities between domain-specific determinants of four health behaviors among adolescents

Schools are overloaded with health promotion programs that, altogether, focus on a broad array of behavioral domains, including substance abuse, sexuality and nutrition. Although the specific content of programs varies according to the domain focus, programs usually address similar concepts: knowledge, attitudinal beliefs, social influences and skills. This apparent conceptual overlap between behaviors and programs provides opportunities for a transfer-oriented approach which will stimulate students to apply the knowledge and skills they have learned in one domain (e.g. skills for resisting tobacco use) to other domains (e.g. alcohol, sex). A requirement for such an approach is that behaviors share at least some determinants. This review addresses this issue by examining similarities between domain-specific determinants of smoking, drinking, safe sex and healthy nutrition among adolescents. Recent empirical studies and reviews were examined. The results show that the following determinants are relevant to all four behaviors: beliefs about immediate gratification and social advantages, peer norms, peer and parental modeling and refusal self-efficacy. Several other determinants have been found to relate to at least two behaviors, e.g. health risk beliefs and parental norms. These results can be used for the development of a transfer-oriented school health promotion curriculum.

A developmental perspective on alcohol and youths 16 to 20 years of age

Late adolescence (ie, 16-20 years of age) is a period characterized by escalation of drinking and alcohol use problems for many and by the onset of an alcohol use disorder for some. This heightened period of vulnerability is a joint consequence of the continuity of risk from earlier developmental stages and the unique neurologic, cognitive, and social changes that occur in late adolescence. We review the normative neurologic, cognitive, and social changes that typically occur in late adolescence, and we discuss the evidence for the impact of these transitions on individual drinking trajectories. We also describe evidence linking alcohol abuse in late adolescence with neurologic damage and social impairments, and we discuss whether these are the bases for the association of adolescent drinking with increased risks of mental health, substance abuse, and social problems in adulthood. Finally, we discuss both the challenges and successes in the treatment and prevention of adolescent drinking problems.

Project CHAT: a brief motivational substance abuse intervention for teens in primary care

Many adolescents use alcohol and drugs (AODs); however, most do not seek help because of stigma or confidentiality concerns. Providing services in settings that teens frequent may decrease barriers. We examined the feasibility of adapting a brief motivational intervention (MI) for high-risk adolescents (age 12-18 years) in a primary care (PC) setting by conducting small feedback sessions with adolescents, parents, and clinic staff, and pilot testing the MI with adolescents. Findings from feedback sessions indicated that clinic staff thought teens would not talk about AOD use. In contrast, adolescents reported that they would talk about their AOD use; however, they were afraid of being judged. Parents were also concerned that the PC provider might be judgmental. Feedback from the MI pilot indicated that teens were willing to talk about their AOD use and indicated readiness to change. Findings suggest that providing a brief MI in a PC setting is a viable approach for working with high-risk youth.

Escalation and initiation of younger adolescents' substance use: the impact of perceived peer use

PURPOSE

The middle school years are peak years for substance use initiation. The current study assessed the impact of peer influence on both initiation and escalation of cigarette, alcohol, and marijuana use among sixth, seventh, and eighth graders.

METHODS

Youth (n = 974; 45% male) were surveyed twice over an academic year and reported on their personal substance use and their perception of peer substance use. The sample ranged in age from 10 to 15 years at Time 1 (M age = 11.95) and was 44% White, 26% Latino, 7% Asian American/Pacific Islander, 4% African American, and 14% mixed ethnic origin.

RESULTS

Hierarchical regressions examined whether personal and perceived peer substance use predicted later substance involvement, and logistic regressions assessed whether Time 1 perceived peer and personal use of other substances discriminated between initiates and noninitiates. After controlling for personal substance use, perceived peer alcohol use predicted both increased alcohol and marijuana use, and perceived peer marijuana use predicted increased alcohol use. Only perceived peer alcohol use was associated with initiation of alcohol, and both perceived peer alcohol and marijuana use predicted onset of marijuana use.

CONCLUSIONS

Results highlight the importance of perceived peer use in predicting both onset and escalation of use and suggest utilizing a multifaceted prevention approach that targets multiple substances.

Disentangling gender and age effects on risky single occasion drinking during adolescence

OBJECTIVES

To determine the association between adolescent risky single occasion drinking (RSOD) and gender, age, and the relative age position of students within their class.

METHOD

A cross-sectional national representative sample of 7088 from 8th to 10th graders in Switzerland (mean age 14.6; SD = 0.94) as part of the ESPAD international study was analysed using hierarchical linear modelling.

RESULTS

Being male, older than the class average and a member of older classes (on average) was associated with a higher RSOD frequency. Additionally, interactions between student and class level were found. The higher the mean class age the greater the difference in RSOD between boys and girls, and the lower the impact on RSOD of the relative age position in a class.

CONCLUSIONS

In early and mid-adolescence, prevention efforts should try to impede the modelling of alcohol use of older classmates, whereas in late adolescence gender-specific motives for RSOD should be taken into account.

Clustering of Health-Related Behaviors and Their Determinants: Possible Consequences for School Health Interventions

Characterizing school health promotion is its category-by-category approach, in which each separate health-related behavior is addressed independently. Such an approach creates a risk that extra-curricular activities become overloaded, and that teaching staff are distracted by continuous innovations. Within the health promotion sector there are thus increasing calls for an integrative approach to health-related behaviors. However, a meaningful integrative approach to different lifestyles will be possible only if there is some clustering of individual health-related behaviors and if health-related behaviors have a minimum number of determinants in common. This systematic review aims to identify to what extent the four health-related behaviors smoking, alcohol abuse, safe sex and healthy nutrition cluster; and how their determinants are associated. Potentially modifiable determinants that offer clues for an integrative approach of school health-promotion programs are identified. Besides, the direction in which health educators should look for a more efficient instructional design is indicated.

Factors that impact adolescents' intentions to utilize alcohol-related prevention services

The current study is the first to examine factors that may be associated with middle school students' intentions to use alcohol-related prevention services. Youth (N = 1506; 46% male; 11-14 years old) completed surveys on their intentions to use alcohol-related services, beliefs about services, previous use of services, and substance use. Students who reported stronger positive beliefs reported greater intentions to use services. Girls, younger students, and whites also reported stronger interest in using services than boys, older students, and youth of mixed ethnicity, respectively. Adolescents who reported current use of substances were less willing to use prevention services. Current research highlights the importance of creating prevention services for this age group that are developmentally relevant and that focus on features that will attract youth, such as utilizing an interactive discussion format. Beginning to understand what motivates adolescents to seek help can facilitate the creation of better prevention programs.

Developmental considerations for substance use interventions from middle school through college

This article summarizes a symposium organized by Dr. Elizabeth D'Amico and presented at the 2004 Annual Meeting of the Research Society on Alcoholism in Vancouver, Canada. The four presentations illustrate the importance of creating substance use interventions that are developmentally appropriate for youth. They represent innovative approaches to working with preteens, teenagers, and young adults. Dr. D'Amico's paper describes her research on the development of a voluntary brief intervention targeting alcohol use among middle school students. Findings indicated that by using school and community input, she was able to obtain a diverse a sample of youth across grades, sex, ethnicity, and substance use status. Dr. Ellickson's paper describes her research on Project ALERT, a school-based prevention program for middle school youth. Her findings indicate that Project ALERT worked for students at all levels of risk (low, moderate, and high) and for all students combined. Dr. Wagner's Teen Intervention Project was a randomized clinical trial to test the efficacy of a standardized Student Assistance Program for treating middle and high school students with alcohol and other drug problems. The study provided a unique opportunity to begin to examine how development may impact response to an alcohol or other drug intervention. Dr. Turrisi's paper examined processes underlying the nature of the effects of a parent intervention on college student drinking tendencies. Findings suggested that the parent intervention seems to have its impact on student drinking by reducing the influence of negative communications and decreasing the susceptibility of influences from closest friends. Dr. Kim Fromme provided concluding remarks.

A randomized controlled trial of an emergency department-based interactive computer program to prevent alcohol misuse among injured adolescents

STUDY OBJECTIVE

To determine whether an emergency department (ED)-based laptop computer intervention reduces the normative age-related increase in alcohol misuse compared with standard of care.

METHODS

This was a randomized controlled trial conducted from October 11, 1999, to April 14, 2001, in a community teaching hospital and university medical center. Subjects were aged 14 to 18 years and with a minor injury. Controls and intervention participants completed a computer-based questionnaire. Intervention participants also completed a laptop-based interactive computer program to affect alcohol misuse. Main outcome measures were Alcohol Misuse Index (Amidx) and binge-drinking episodes. Follow-up occurred by telephone at 3 and 12 months. Analysis included repeated-measures analysis of variance (alpha=0.05; power 0.80; effect size 0.10).

RESULTS

Three hundred twenty-nine participants were randomized to the intervention group, and 326 participants were randomized to the control group. Two hundred ninety-five (89.7%) intervention subjects and 285 (87.4%) control subjects completed 3- and 12-month follow-ups. For intervention and control groups, respectively, mean age was 16.0 and 15.9 years and men composed 66.8% and 66.3% of the groups; Amidx scores were 2.2 and 2.0; binge-drinking episodes were 1.2 and 1.0. Outcomes for intervention and control, respectively, were Amidx (3 months) 1.5 and 1.4; Amidx (12 months) 1.8 and 2.1; binge drinking (3 months) 0.9 and 0.8; and binge drinking (12 months) 1.4 and 1.2. Overall, there were no significant effects (effect size 0.04). No detrimental effects were noted. Subgroup analysis suggested that the intervention may have an effect among subjects with experience drinking and driving (5% of the sample).

CONCLUSION

The intervention was not effective in decreasing alcohol misuse among the study population. Further research will be required to determine effectiveness among the subgroup of adolescent minor injury patients who have experience drinking and driving.

Impact of consent procedures on reported levels of adolescent alcohol use

This study examined sample bias related to parental consent procedures in school-based survey research on alcohol-related behavior. Alcohol prevalence and severity of use estimates from a high school student survey using traditional-active parental consent (N = 1,429) were compared with estimates from 2 student surveys using alternative parental consent procedures (passive consent; N = 2,210 and N = 3,231). Traditional-active parental consent procedures resulted in underrepresentation of lifetime drinkers. Furthermore, traditional-active parental consent procedures resulted in lower levels of high-risk drinking, and this bias was most evident for Caucasians and both boys and girls. Findings accentuate the need for administrators, policymakers, and researchers to consider the impact consent procedure related bias may have on results and interpretation of findings from school-based substance use research.

Characteristics of binge drinkers in Europe

Binge drinking has been shown to be associated with considerable social harm and disease burden. This review aims to give an overview from a European perspective of the socio-demographical, individual, and social factors that affect binge drinking and to identify effective interventions to reduce binge drinking. To this end, a computer-assisted search of relevant articles was conducted. Results showed that males tended to binge drinking more frequently than females. Binge drinking was most prevalent among adolescents and young adults, and prevalence levelled off later in life. Socio-economic conditions seemed to have an effect on binge drinking, independent of their effects on the volume of alcohol consumed. The early onset of binge drinking was associated with a history of drinking in the family, but pathways into adulthood are less clear. Binge drinking often co-occurred with other substance use. Motives for binge drinking included both social camaraderie and tension reduction. Which aspect prevails may vary according to the type of binge drinker, but to date has not been satisfactorily explained. Binge drinkers were not likely to know enough about or be aware of the potential risks of bingeing. Pressure from peers was one of the strongest influencing factors for binge drinking and seemed to outweigh parental influences, especially from late adolescence onwards. Binge drinking also varied according to both the predominant adult and adolescent drinking culture with more binge drinking in the northern and middle parts of Europe compared to the southern parts. Thus, a variety of socio-demographical, individual, and social characteristics associated with binge drinking have been identified. However, knowledge in this area is limited, as most research has been conducted among particular groups in specific situations, in particular North American college students. More research in Europe is urgently needed, as results from other cultural backgrounds are difficult to generalize.

Treatment of alcohol use disorders in adolescents

The treatment of alcohol use disorders (AUDs) in adolescents is a very important issue in the field of substance use disorders; however, it is a complex and understudied area in which there are limited data concerning evidence-based treatment. The authors first briefly review the epidemiology of AUDs in adolescents, describe existing guidelines for the treatment of such disorders in adolescent patients, and consider differences between AUDs as they present in adolescents and adults. In the next section of the paper, the authors review the assessment and diagnosis of AUDs in adolescents and consider how findings from such assessments will influence subsequent treatment planning. They also describe prognostic factors (e.g., family issues, socioeconomic factors, psychiatric comorbidity, gender, ability to form a therapeutic alliance) that may affect treatment outcome and need to be considered in treatment selection. The various settings in which adolescent AUDs may be treated and the types of patients and situations for which each is most appropriate are described. The second half of the article focuses on the treatment of adolescents with AUDs. The authors describe techniques for establishing abstinence and then preventing subsequent relapse. Although there is an interest in the use of medications (e.g., naltrexone) to treat AUDs in this population, there are unfortunately few if any data concerning the use of these agents in adolescent patients. More data are available concerning psychosocial treatments. The authors describe a variety of psychosocial modalities that have been tested in adolescents, including individual psychotherapy (e.g., interpersonal therapy, cognitive-behavioral therapy, motivational enhancement therapy), group therapies, 12 step/self-help programs, family therapy, skills training for parents, and psychoeducation. The authors then consider the importance of targeting comorbid psychiatric conditions, especially anxiety and depression, in the treatment of AUDs in adolescents. The authors stress the importance of being aware that adolescents with AUDs are at increased risk for violence against self or others and suicide. They also note that practitioners who work with adolescents with AUDs often need to deal with forensic issues (e.g., DUI charges).

More Canadian students drink but American students drink more: comparing college alcohol use in two countries

AIMS

To compare alcohol use among US and Canadian college students.

DESIGN

Results of the 1999 College Alcohol Study and the 1998 Canadian Campus Survey are compared.

SETTING

One hundred and nineteen nationally representative US 4-year colleges and universities in 40 states and 16 nationally representative Canadian 4-year universities.

PARTICIPANTS

Randomly selected students under 25 years (12 344 US and 6729 Canadian).

MEASUREMENTS

Self-reports of alcohol use and heavy alcohol use.

FINDINGS

The prevalence of life-time and past year alcohol use is significantly higher among Canadian students than US students (92% versus 86%, 87% versus 81%). The prevalence of heavy alcohol use (typically consuming five or more drinks in a row for males/four or more for females) among past-year and past-week drinkers is significantly higher among US students than Canadian students (41% versus 35%, 54% versus 42%). In both countries older [corrected] students and students living at home with their parents are less likely to be heavy drinkers; students who report first drunkenness before the age of 16 are more likely to be heavy drinkers in college.

CONCLUSION

Programs aimed at students' heavy alcohol use should target freshman at entry or earlier. Since students living with their parents are less likely to be heavy drinkers, parents may play a potentially important role in prevention efforts. The patterns of drinking in both countries may be influenced by the legal minimum drinking age. However, the relationship is complex and must be viewed in the context of other variables such as chronological age.

Brief prevention for adolescent risk-taking behavior

AIMS

Despite widespread prevention efforts to decrease adolescent risk-taking, substance use and driving after drinking (DD) are prevalent in the United States. The current study compared the efficacy of an abbreviated version of Drug Abuse and Resistance Education (DARE-A) to a new Risk Skills Training Program (RSTP).

DESIGN

Adolescent participation in drinking, drug use, DD and riding with a drunk driver was examined longitudinally. After baseline assessments, adolescents were randomly assigned to the RSTP. DARE-A or a no intervention control group and then completed 2-month post-test and 6-month follow-up assessments.

SETTING

Adolescents attended a mid-sized suburban high school.

PARTICIPANTS

The sample (N = 300) was comprised of 58% females and the age range was 14-19 years.

INTERVENTION

The RSTP was developed to target several risk behaviors and to examine the feasibility of conducting a brief personalized prevention program in a group setting. DARE-A focused on increasing knowledge and understanding the deleterious effects of substance use.

MEASUREMENTS

Risk-taking behavior, perception of peer risk-taking and positive and negative alcohol expectancies were assessed.

FINDINGS

RSTP participants decreased participation in several risk behaviors at post-test, but reductions were not maintained at 6-month follow-up. The control and DARE-A groups increased their positive and decreased their negative alcohol expectancies. The control group increased their alcohol consumption.

CONCLUSIONS

Results suggest that a brief, personalized, group prevention program is a feasible approach to reducing adolescent risk-taking. Strategies must be developed to solidify these positive changes so that they are longer-lasting.