Social influences as explanations for substance use differences among Asian-American and European-American adolescents

The Role of Socialization Contexts on Adolescent Substance Use across Racial and Ethnic Groups

Purpose of Review

This review summarizes theories and empirical work regarding socialization contexts contributing to substance use across marginalized adolescents. Future directions and recommendations to minimize the perpetuation of racial stereotypes are provided.

Recent Findings

Neighborhoods high in social cohesion may offset substance use risk. Promoting school connectedness via increased support from teachers and peers could reduce school-based discrimination and enhance feelings of belongingness. The influence of peers on substance use engagement largely differs across racial groups and level of acculturation. Family cultural values emphasizing respect, obedience, and collectivism offer protection from substance use.

Summary

Despite lower prevalence rates of adolescent substance use within racial/ethnic groups, rates of negative consequences due to substances are far greater compared to White adolescents. Transcultural factors (e.g., strong family ties), as well as culture-specific factors, should be leveraged to delay the onset of substance use and prevent negative sequelae resulting from substance use initiation.

How peer influence shapes value computation in moral decision-making

Moral behavior is susceptible to peer influence. How does information from peers influence moral preferences? We used drift-diffusion modeling to show that peer influence changes the value of moral behavior by prioritizing the choice attributes that align with peers' goals. Study 1 (N = 100; preregistered) showed that participants accurately inferred the goals of prosocial and antisocial peers when observing their moral decisions. In Study 2 (N = 68), participants made moral decisions before and after observing the decisions of a prosocial or antisocial peer. Peer observation caused participants' own preferences to resemble those of their peers. This peer influence effect on value computation manifested as an increased weight on choice attributes promoting the peers' goals that occurred independently from peer influence on initial choice bias. Participants' self-reported awareness of influence tracked more closely with computational measures of prosocial than antisocial influence. Our findings have implications for bolstering and blocking the effects of prosocial and antisocial influence on moral behavior.

Can the Health Belief Model and moral responsibility explain influenza vaccination uptake among nurses?

AIMS

The aim of this study was to examine the prevalence and the factors associated with influenza vaccination among nurses in Hong Kong based on the Health Belief Model. The role of moral responsibility was also examined.

BACKGROUND

Influenza vaccination is the most effective way to prevent influenza infection. Nurses are recommended to receive influenza vaccination annually. However, the rate of vaccination among nurses in Hong Kong is low.

DESIGN

A cross-sectional study.

METHOD

A survey was conducted among 214 nurses between January - March 2017.

RESULT

The prevalence of having ever received influenza vaccination, having received influenza vaccination in the last influenza season and having intention to receive influenza vaccination in the coming influenza season were 64.5%, 29.0% and 23.3% respectively. Results from multiple stepwise logistic regressions showed that perceived benefits of influenza vaccination and having received recommendations from colleagues were associated with higher chances of having ever received influenza vaccination. Perceived susceptibility of influenza, perceived benefits of influenza vaccination and perceived moral responsibility were associated with higher chances of having received influenza vaccination in the last influenza season, whereas perceived barriers of influenza vaccination were associated with lower chances. Furthermore, perceived susceptibility of influenza and perceived benefits of influenza vaccination were associated with higher chances of having the intention to receive influenza vaccination in the coming influenza season, whereas perceived barriers were associated with lower chances. The moderating effect of perceived moral responsibility was not significant.

CONCLUSION

Health promotion should make use of the Health Belief Model and increase moral responsibility to increase influenza vaccination rate among nurses.

Ethnic Differences in Cigarette Use Trajectories and Health, Psychosocial, and Academic Outcomes

PURPOSE

Cigarette smoking among youth is associated with poorer health and psychosocial outcomes. However, few studies address how smoking may differentially relate to the emergence of disparities in functioning across races/ethnicities over adolescence.

METHODS

Youth (n = 2,509) were surveyed eight times from ages 11 to 18. We measured cigarette use, academic and social functioning, mental and physical health, and delinquency. Sequelae of change models controlled for sociodemographic factors, and tested whether intercept and slope for smoking trajectories were associated with outcomes at the end of high school, and examined racial/ethnic differences in outcomes assuming similar smoking trajectories across groups.

RESULTS

Youth were 45% Hispanic, 20% Asian, 20% white, 10% multiethnic, 2% black, and 1% other ethnicities. Higher average probability of smoking and steeper slopes of smoking trajectories were associated with poorer outcomes in multiple domains. Controlling for smoking trajectories, we observed the following disparities (vs. white youth; all p's < .05): black, Hispanic, and multiethnic youth reported lower academic performance; Asian, black, and multiethnic youth reported higher academic unpreparedness; Asian and multiethnic youth reported poorer mental health; Asian, Hispanic, and multiethnic youth reported poorer physical health; and Asian youth reported higher delinquency and poorer social functioning.

CONCLUSIONS

Statistically adjusting for similar smoking trajectories, racial/ethnic minority youth demonstrated poorer outcomes in multiple domains compared with white peers. Smoking may be a particularly robust marker for risk of negative outcomes in racial/ethnic minority youth. Screening for cigarette use and intervening on smoking and associated risk behaviors among minority youth may help reduce disparities in functioning.

Ethno-specific preferences of cigarette smoking and smoking initiation among Canadian immigrants - a multi-level analysis

BACKGROUND

Cigarette smoking is the leading cause of preventable morbidity and mortality worldwide. Over the last decade, increased immigration has significantly shifted Canada's demographic profile. According to a 2011 National Household Survey, approximately 20.6% of the Canadian population was immigrants, the highest among the G8 countries. It is estimated that by 2031, one-in-three Canadian's will be an immigrant. This study examined the ethno-specific preference of cigarette smoking and smoking initiation among Canadian immigrants.

METHODS

This study used data from the 2013 to 2014 combined cycles of the Canadian Community Health Survey. This was a nationally generalizable, telephone-based survey that included a total of 130,000 respondents, aged 12 years or older. Ethnic differences in the preference of cigarette use among Canadian immigrant groups were determined. A three-level mixed effects logistic regression model was used to estimate the effect of ethnicity on the likelihood of smoking initiation after migration to Canada.

RESULTS

In our study, 82% of respondents were native-born Canadians (one group), while the rest were immigrants (six groups=18%). Results of the logistic regression analysis revealed statistically significant differences in the number of cigarettes smoked daily (P=0.0001), age of smoking onset (P=0.0001), and smoking initiation (P=0.0001) between Canadian-born and immigrant participants. Immigrant smokers in Canada were significantly more likely to be younger, single, Caucasian, females with high income and post-secondary education (P=0.0001).

CONCLUSION

The results of our study suggest that Caucasian female immigrants in Canada initiated smoking at a younger age and smoked more cigarettes than any other immigrant group or native-born Canadians. This is a particularly interesting finding as Caucasian female immigrants may not be considered a vulnerable or at-risk population. To be effective, tobacco strategies specifically tailored for this overlooked population would require increased awareness, culturally appropriate initiatives, and gender-specific interventions.

Psychoactive Substance Use among Methadone Maintenance Therapy Clients in China

A proportion of methadone maintenance therapy (MMT) clients in China shifted their substance use habit from opiate to psychoactive substances. The objective of this study was to examine the pattern and associated factors of psychoactive substance use among MMT clients. The study was conducted among 2,448 clients from 68 MMT clinics of China. The type and frequency of psychoactive substance use were self-reported. About 38.1% (N=933) of the participants reported psychoactive substance use in lifetime, and 6.5% (N=158) in the previous 30 days. The most commonly used psychoactive substances were sedative/hypnotic/antidiarrheal agent and amphetamine. Psychoactive substance use in the past 30 days was correlated with younger age, recent heroin use, having psychoactive substance using friend(s), and depressive symptoms. The finding suggested that urinalysis of psychoactive substances should be routinely administered in the MMT clinics. Young clients, concurrent heroin users, and clients with depressive symptoms deserve more screening and intervention efforts.

The Effects of Low Self-Control and Delinquent Peers on Alcohol, Tobacco, and Drug Use in a Sample of Saudi Arabian Youth

A considerable amount of research has examined patterns of substance use and the potential explanations of it among samples from the United States and other industrialized nations. To date, however, no research has explored these issues in a sample of Saudi Arabian youth. The current study addressed this gap in the literature and examined the lifetime use of drugs, alcohol, and tobacco among Saudi Arabian youth. We also examined whether key measures from social learning theory and low self-control theory were able to account for patterns of usage. Data drawn from a sample of nearly 500 youth residing in Jeddah, Saudi Arabia, were used. Analysis of the data revealed that 12.7% of youth had smoked cigarettes at least 1 time, 2.6% had consumed alcohol at least once, and 3.0% had used illegal drugs. Moreover, the results of rare-events logistic regression revealed that a measure of delinquent peers was the strongest and most consistent predictor of substance use, while a measure of low self-control was unrelated (or related in a direction opposite to that which was predicted) to the measures of substance use.

Are Dimensions of Parenting Differentially Linked to Substance Use Across Caucasian and Asian American College Students?

BACKGROUND

Parental warmth and autonomy granting are commonly thought of as protective factors against substance use among Caucasians. However, limited research has examined whether associations between parenting dimensions and substance use outcomes are the same or different among Asian Americans.

METHOD

A final analytic sample of 839 college students was used to test whether race (Caucasian vs. Asian American) moderated the relations between parenting dimensions and substance use outcomes across Caucasians and Asian Americans. We utilized the Parental Bonding Instrument (Parker, Tupling, & Brown, 1979) to measure maternal and paternal warmth, encouragement of behavioral freedom, and denial of psychological autonomy.

RESULTS

Multivariate regression models controlling for covariates including age, gender, and paternal education indicated four significant parenting by race interactions on alcohol problems and/or marijuana use. Specifically, maternal warmth was inversely associated with both alcohol problems and marijuana use among Caucasians but not among Asian Americans. Both maternal and paternal denial of psychological autonomy were positively associated with alcohol problems among Caucasians but not among Asian Americans.

CONCLUSIONS

Consistent with emerging cross-cultural research, the associations between parenting dimensions and substance use behaviors observed in Caucasian populations may not be readily generalized to Asian Americans. These findings highlight the importance of considering different parenting dimensions in understanding substance use etiology among Asian Americans. Future research should use longitudinal data to replicate these findings across development and seek to identify other parenting dimensions that may be more relevant for Asian American youth.

Change in Adolescents’ Alcohol-Use Patterns, From Non-Drinking to Non-Heavy Drinking or Heavy Drinking

This study examined risk and protective factors at work when adolescents change from a non-drinking alcohol-use pattern to either non-heavy drinking or heavy drinking. Using a sample of 1,725 non-drinkers extracted from the National Longitudinal Study of Adolescent to Adult Health, we conducted multinomial logistic regression and found that likelihood of change from non-drinking to non-heavy drinking was associated positively with safe neighborhood, female, peers’ drinking, emotional maltreatment, and delinquent behaviors. We found a negative association between such likelihood and being African American. We found that likelihood of change from non-drinking to heavy drinking was associated positively with peers’ drinking, depressive feelings, drug use, and repeating a grade(s) at school. We found a negative association between such likelihood and having a married mother, being African American or some other non-Hispanic minority ethnicity, and maternal supervision. Implications for intervention and future research are discussed.

A comparison of Cambodian-American adolescent substance use behavior to national and local norms

INTRODUCTION

This study was designed to compare rates of alcohol, marijuana, and cigarette use in Cambodian-American adolescents with norms from nationally- and regionally-representative peers.

METHODS

Substance use data from 439 10th grade Cambodian-American adolescents in Long Beach, California were compared to grade- and gender-matched nationally representative data from the Monitoring the Future study and data from the California Healthy Kids Survey of students within the same school district.

RESULTS

Overall, the Cambodian-American youth were less likely than nationally- and regionally-representative youth to use alcohol, marijuana, and cigarettes. Specifically, relative to estimates obtained for the general population and students attending school in the same school district, Cambodian-American youth were significantly less likely to use alcohol and marijuana. Cambodian-American youth were also less likely than youth in the general population to smoke cigarettes, but did not differ statistically from youth within their same school district.

CONCLUSIONS

As a group, Cambodian-American youth may not be at especially high risk for substance use. As is the case with virtually all populations, some individuals within the Cambodian-American group are likely to have more difficulty than others with substance use concerns. Thus, additional research is needed to identify factors that might help to identify high users with potential service needs.

Two-year outcomes of a randomized, family-based substance use prevention trial for Asian American adolescent girls

Asian Americans have been largely ignored in the prevention outcome literature. In this study, we tested a parent-child program with a sample of Asian American adolescent girls and their mothers, and evaluated the program's efficacy on decreasing girls' substance use and modifying risk and protective factors at individual, family, and peer levels. A total of 108 Asian American mother-daughter dyads recruited through online advertisements and from community service agencies were randomly assigned to an intervention arm (n = 56) or to a test-only control arm (n = 52). The intervention consisted of a nine-session substance abuse prevention program, delivered entirely online. Guided by family interaction theory, the prevention program aimed to strengthen the quality of girls' relationships with their mothers while increasing girls' resilience to resist substance use. Intent-to-treat analyses showed that at 2-year follow-up, intervention-arm dyads had significantly higher levels of mother-daughter closeness, mother-daughter communication, maternal monitoring, and family rules against substance use compared with the control-arm dyads. Intervention-arm girls also showed sustained improvement in self-efficacy and refusal skills and had lower intentions to use substances in the future. Most important, intervention-arm girls reported fewer instances of alcohol and marijuana use and prescription drug misuse relative to the control-arm girls. The study suggests that a culturally generic, family-based prevention program was efficacious in enhancing parent-child relationships, improving girls' resiliency, and preventing substance use behaviors among Asian American girls.

Religiosity and substance use among Asian American college students: moderated effects of race and acculturation

BACKGROUND

Religiosity is a well-established protective factor against substance use among Caucasians, but limited research has examined its role among Asian Americans. The purposes of this study were (1) to examine whether the associations between religiosity and substance use outcomes differed across Caucasians and Asian Americans, and (2) to test whether acculturation moderated the associations between religiosity and substance use outcomes among Asian Americans.

METHOD

We utilized a large and diverse cross-sectional sample of 839 college students to test whether race moderated the associations between religiosity and substance use outcomes (Study 1). We then replicated and extended our findings in a separate college sample of 340 Asian Americans, and examined the moderating role of acculturation on the associations between religiosity and substance use outcomes (Study 2).

RESULTS

Controlling for age, gender, and paternal education, religiosity was protective against alcohol use, alcohol problems, and marijuana use among Caucasians but was unrelated to these outcomes among Asian Americans in Study 1. In Study 2, religiosity was protective against alcohol problems only at high levels of acculturation. Moreover, religiosity was protective against marijuana use at both high and mean levels of acculturation, but not at low levels of acculturation.

CONCLUSIONS

The protective effects of religiosity on alcohol use and problems varied across Caucasian and Asian American college students, and religiosity protected against alcohol problems and marijuana use only among more acculturated Asian Americans. These findings underscore the need to examine culturally-specific correlates of substance use outcomes among Asian Americans.

Neighborhood context and substance use disorders: a comparative analysis of racial and ethnic groups in the United States

BACKGROUND

There is evidence that ethnic/racial minorities are conferred differential risk for substance use problems based on where they live. Despite a burgeoning of research focusing on the role of neighborhood characteristics on health, limited findings are available on substance use. Our study uses nationally representative data (N=13,837) to examine: (1) what neighborhood characteristics are associated with risk of substance use disorders?; (2) do the associations between neighborhood characteristics and substance use disorders remain after adjusting for individual-level factors?; and (3) do neighborhood characteristics associated with substance use disorders differ by race/ethnicity after adjusting for individual-level factors?

METHODS

Data were drawn from the Collaborative Psychiatric Epidemiology Studies (CPES-Geocode file) with 836 census tracts. Analyses included African Americans, Asians, Caribbean Blacks, Latinos, and non-Latino whites. Separate logistic regression models were fitted for any past-year substance use disorder, alcohol use disorder, and drug use disorder.

RESULTS

Living in more affluent and residentially unstable census tracts was associated with decreased risk of past-year substance use disorder, even after adjusting for individual-level factors. However, when we investigated the interaction of race/ethnicity and census latent factors with past-year substance use disorders, we found different associations for the different racial/ethnic groups. We also found different associations between neighborhood affluence, residential instability and any past-year substance use and alcohol disorders by nativity.

CONCLUSIONS

Characteristics of the environment might represent differential risk for substance disorders depending on a person's ethnicity/race and nativity status.

Ecstasy use and associated risk factors among Asian-American youth: findings from a national survey

This study examined ecstasy use and associated risk and protective factors among Asian American youth. Data from 996 Asian American adolescents and 1,108 Asian American young adults were used. Ecstasy use was relatively common among Asian American youth. Among adolescents, it was associated with older age, poor parent-child communication, having been approached by drug sellers, living in a metropolitan area, and positive attitudes toward substance use. Among Asian American young adults, it was associated with having been born in the United States, having been approached by drug sellers, criminal justice system involvement, and positive attitudes toward substance use. Implications for designing substance use prevention/intervention programs for this minority group are discussed.

Bullying and discrimination experiences among Korean-American adolescents

The bullying experiences of Korean-American adolescents (N = 295) were explored in relation to discrimination and mental health outcomes. Bullying experiences were assessed by the Bully Survey (Swearer, 2005), discrimination by the Perceived Ethnic and Racial Discrimination Scale (Way, 1997) and depression by the Center for Epidemiological Studies - Depression Scale (CES-D). Those who reported being bullied (31.5%) as well as those who reported both being bullied and bullying others (15.9%) experienced a higher level of depression, which was elevated beyond the clinically significant level of CES-D. The results of a LISREL model suggest that the experiences of bullying among Korean/Asian-American adolescents and their related mental health issues need to be addressed in a comprehensive context of their discrimination experiences, acculturation, family and school environments.

Incapacitated rape and alcohol use in White and Asian American college women

This study examined the role of Asian ethnicity as a moderator of drinking outcomes associated with alcohol-related sexual assault (incapacitated rape). Participants were 5,467 Asian American and White college women. Results found the overall MANOVA for ethnicity and incapacitated rape (IR) interactions to be significant. Asian American participants with no history of IR had fewer drinking problems than White American participants with no history of IR. Asian American participants with IR histories had more drinking problems than White Americans with IR histories. Findings indicate Asian Americans who experience IR may be at increased risk for negative alcohol outcomes.

Characteristics of Asian and Pacific Islanders admitted to U.S. drug treatment programs in 2005

OBJECTIVE

We determined how Asian and Pacific Islanders (APIs) differ from clients from other ethnic groups in regard to drug use and admissions to drug treatment programs.

METHODS

We used national survey and treatment admissions data to characterize drug problems and first-time adult admissions to publicly funded drug treatment programs in the U.S. in 2005.

RESULTS

APIs accounted for 1.9% of illicit drug use in U.S. adults and for 1.3% of adult clients entering drug treatment for the first time. Compared with other ethnic groups, APIs were significantly more likely to be entering treatment for the first time. Stimulants were the primary drug problem for 57.3% of API first-time treatment clients, a significantly greater proportion than other ethnic groups. This figure had increased from 45.3% in 2001, significantly greater than the increase among Caucasian or African American clients. API first-time admissions had used drugs less frequently (13.6 days in the prior 30 days), began drug use at a slightly older age (mean = 20.7 years), and had a shorter period between start of use and first admission (mean = 9.4 years) than other racial/ethnic groups.

CONCLUSION

Stimulant use was the predominant problem of API clients entering treatment for the first time. APIs were underrepresented in the treatment system relative to their share of the population with drug problems. Diverse groups were aggregated to form the API category. Information on APIs needs to be disaggregated to develop more culturally appropriate and effective treatment.

Differential effects of acculturation on drinking behavior in Chinese- and Korean-American college students

OBJECTIVE

Recent evidence suggests increasing rates of alcohol use and related disorders among Asian-American young adults. Relatively little research has focused on this group, and few studies have examined heterogeneity in drinking prevalence and correlates across Asian subgroups. This study examined interactive effects of ethnicity, acculturation, and gender on drinking behavior among Asian-American undergraduates.

METHOD

Participants were 112 Chinese Americans and 108 Korean Americans (mean age = 19.2 years, 61% female) who completed measures of alcohol use, acculturation, and demographic factors. Multivariate analyses examined drinking behavior (defined as quantity, frequency, and duration) as a function of ethnicity, gender, and acculturation.

RESULTS

Overall, Korean ethnicity predicted increased drinking, and acculturation predicted decreased drinking. However, acculturation interacted with ethnicity such that its influence was protective for Korean Americans and negligible for Chinese Americans.

CONCLUSIONS

Previous research implicates acculturation as a risk factor for drinking among Asian Americans, but the current findings suggest that protective effects may also exist. Results also indicate that Korean ethnicity is a risk factor particularly in the context of low acculturation. These findings illustrate the need to consider ethnic subgroup differences in drinking rates and in risk and protective factors for alcohol use among Asian Americans.

Alcohol expectancies, drinking refusal self-efficacy and drinking behaviour in Asian and Australian students

The effects of alcohol expectancies (AE) and drinking refusal self-efficacy (DRSE) in predicting alcohol consumption in Caucasians has been well studied. However, the role of AE and DRSE in Asian students is still not well understood. This study reported on this using Caucasian (n=98) and Asian (n=92) student samples. Participants completed the Alcohol Use Disorder Identification Test (AUDIT) to measure their hazardous alcohol consumption, and the drinking expectancy profile (DEP) to assess their alcohol related expectancies and ability to resist drinking in certain situations. Results showed that Caucasians reported significantly higher confidence, higher sexual interest, and higher tension reduction expectancies than Asians. Conversely, Asians significantly expected cognitive enhancement and negative consequences more than Caucasians. Relative to Caucasians, the Asian sample also reported that they would be more able to refuse alcohol when under social pressure. Results from regression analyses showed that for the Caucasian sample, AE, DRSE and their interactions were significant predictors of alcohol consumption. For the Asian group, the only significant effect to emerge was that DRSE was negatively related to alcohol consumption. The clinical implications of the differential pattern of results between the samples are discussed in terms of self-efficacy and negative consequences of alcohol consumption, especially when dealing with university aged individuals.

Psychosocial, cultural and genetic influences on alcohol use in Asian American youth

OBJECTIVE

Environmental and cultural factors, as well as a genetic variant of the aldehyde dehydrogenase gene (the ALDH2*2 allele) have been identified as correlates of alcohol use among Asian Americans. However, concurrent examination of these variables has been rare. The present study assessed parental alcohol use, acculturation and ALDH2 gene status in relation to lifetime, current and heavy episodic drinking among Chinese and Korean American undergraduates.

METHOD

Participants (N = 428, 51% women; 52% Chinese American, age 18-19 years) were first-year college students in a longitudinal study of substance use initiation and progression. Data were collected via structured interview and self-report, and participants provided a blood sample for genotyping at the ALDH2 locus.

RESULTS

Gender, parental alcohol use and acculturation significantly predicted drinking behavior. However, none of the hypothesized moderating relationships were significant. In contrast with previous studies, ALDH2 gene status was not associated with alcohol use.

CONCLUSIONS

Results indicate that although the variables examined influence alcohol use, moderating effects were not observed in the present sample of Asian American college students. Findings further suggest that the established association of ALDH2 status and drinking behavior in Asians may not be evident in late adolescence. It is possible that ALDH2 status is associated with alcohol consumption only following initiation and increased drinking experience.

Ethno-specific patterns of adolescent tobacco use and the mediating role of acculturation, peer smoking, and sibling smoking

AIMS

The objectives of this study are to identify the relationship between ethnic identity and tobacco use, and to examine the mediating effects of peer and sibling smoking and acculturation.

DESIGN AND MEASUREMENTS

Data were drawn from a cross-sectional survey of 3400 Toronto students, sampled from 30 schools between 1998 and 2000. Primary ethnic identity was based on adolescents' self-identification of their ethnic heritage condensed to 12 groups for analysis. Tobacco use was measured as a dichotomy, predicting non-smoking in the past year. Multivariate logistic regression models were employed to test for baseline differences in non-smoking by ethnic identity. Subsequent models adjusted for controls (age, gender, social class, religious attendance, educational achievement) and introduced mediators.

FINDINGS

Results indicated that smoking varied among adolescents of differing ethnic identities. Adolescents of western European, eastern European and southern European ethnicity were considerably less likely to be non-smokers, while Chinese, South Asian and East Indian and West Indian youth were more inclined to be non-smokers. The discrepancies in rates of non-smoking among western European and South Asian and East Indian adolescents were explained by a combination of peer and sibling smoking and acculturation; among southern European and eastern European youth via peer and sibling smoking; and by neither peer and sibling smoking nor acculturation for Chinese and West Indian youth.

CONCLUSIONS

This paper demonstrates that disparities in tobacco use among certain ethnic groups can be explained by peer and sibling smoking and acculturation; however, for other ethnic groups, knowledge of the processes that account for differences in tobacco use remains less clear.

From adolescence to young adulthood: racial/ethnic disparities in smoking

OBJECTIVES

We used data gathered from 6259 youths between the ages of 13 and 23 years to compare trends in smoking among 4 racial/ethnic groups.

METHODS

We weighted trend data to represent baseline respondent characteristics and evaluated these data with linear contrasts derived from multiple regression analyses.

RESULTS

Although African Americans exhibited higher initiation rates than Whites, they exhibited consistently lower rates of regular smoking than both Whites and Hispanics. This seeming anomaly was explained by African Americans' lower rates of transition to regular smoking and greater tendency to quit. Racial/ethnic disparities were accounted for by differences in pro-smoking influences.

CONCLUSIONS

Reducing racial/ethnic disparities in smoking may require reducing differences in the psychosocial factors that encourage smoking.

Ethnic variation in drinking, drug use, and sexual behavior among adolescents in Hawaii

This study examined ethnic differences in substance use and sexual behavior and whether drinking and drug use constitute risk factors for unsafe sexual practices among Native Hawaiian (NH), Caucasian, and Asian/Pacific Islander (API) high school students in Hawaii. A secondary data analysis of the Youth Risk Behavior Survey (1997 and 1999) using a representative sample of 2,657 students in 9-12 grades was performed. Chi-square tests for bivariate associations and multivariate regression analyses were conducted to identify predictors. NHs were more sexually active, initiated sex earlier, and tended to have multiple partners. Alcohol lifetime use was higher in NH, Caucasians, and males. NHs were more likely to initiate drinking by age 12 and engage more in episodic drinking. Non-episodic or episodic drinkers and students who use drugs were at risk to engage in sexual activity, have multiple partners, and use alcohol/drugs during sex. Risk was two times higher for substance use during sex if drinking was initiated at age 10 or younger compared to 15 years or older. Compared to abstainers, the risk doubled for lifetime multiple partners if drinking was initiated at ages 13-14. Overall, females were more sexually active. Because drinking was associated with sexual initiation and risky behavior, adverse effects of alcohol must be addressed in programs targeting underage drinking, thus helping youth delay or minimize sexual activity and prevent other associated problems. Intervention efforts should enhance life skills that endorse abstinence from alcohol and drug use.

Explaining racial/ethnic differences in smoking during the transition to adulthood

Using data from a longitudinal panel of nearly 3000 adolescents to predict current smoking among young adults, we test whether adding variables that tap prior social bonds and influences to the model eliminates race/ethnicity as a significant predictor of current smoking. At age 23, African Americans and Asians exhibited substantially lower rates of current smoking than Whites and Hispanics. Controlling for social influences during high school, particularly exposure to siblings and friends who smoked plus parental disapproval of smoking, accounted for these differences. Social bonding variables, in contrast, had a limited mediating effect. Interventions aimed at decreasing adolescent vulnerability to prosmoking influences, reducing overall levels of peer cigarette use, and helping parents better convey their disapproval of smoking should help curb young adult smoking and diminish racial/ethnic differences in tobacco use.

Substance use, self-esteem, and depression among Asian American adolescents

The relationship of self-esteem and depression with alcohol, tobacco, and other drug (ATOD) use was tested in a California statewide sample of more than 4,300 Asian American high school students comprising five subgroups: Chinese, Japanese, Korean, Filipino, and Vietnamese. Estimated prevalence rates of alcohol, tobacco, and marijuana use among males and females from these Asian American subgroups are presented. Correlations revealed that cigarette, alcohol, and marijuana use were generally more related to high depression and low self-esteem in females than in males. Logistic regression analysis with only the female subjects investigated whether the relationship between the psychological variables and ATOD use was maintained even after controlling for traditionally important constructs in ATOD use (grade level in school, born in the United States, ethnicity, and ATOD use by friends). These results indicated that for females, depression was significantly related to alcohol and tobacco use, but self-esteem was not. Neither self-esteem nor depression was a significant contributor to marijuana use. Issues related to the application of these results are discussed.

Association of language spoken at home with health and school issues among Asian American adolescents

The study examined the association of language spoken at home with the school and health risks and behaviors of Asian American adolescents. Using the United States component of the 1997-1998 World Health Organization Study of Health Behavior in School Children, bivariate and multiple logistic regression analyses were conducted of records for Asian children to explore the relationship between language spoken at home and outcome variables regarding health behaviors, psychosocial and school risk factors, and parental factors. Compared to those who usually speak English at home, adolescents who usually speak another language, or who speak two languages equally, face a greater risk for health risk factors, psychosocial and school risk factors, and parental risk factors. Not speaking English at home was associated with higher health risks, including not wearing seat belts and bicycle helmets; higher psychosocial and school risk factors, including feeling that they do not belong at school, difficulty making new friends, and lacking confidence; and higher parental risks, including reporting that parents were not ready to help them or willing to talk to teachers. Adolescents less acculturated to the United States experience a variety of physical and psychosocial risks. School-based interventions such as early identification and outreach, needs assessment, and counseling and support services should be provided to immigrant students and their families.