Adolescent females with a substance use disorder: affiliations with adult male sexual partners

Culture and Borderline Personality Disorder in India

The present paper discusses how cultural context can be used as an essential tool in the diagnosis of mental disorders as well as in segregating individuals with normal or abnormal personality functioning. Further, such information about the culture can be used to diagnose individuals specifically with borderline personality disorder (BPD). BPD is a mental illness marked by impulsivity and instability in interpersonal relationships, moods, and self-image. We discuss how culture shapes patterns of behavior in the individual with BPD. An extensive review of manifestation of BPD in eastern countries suggests that culture and social norms are the two crucial factors, which can differentiate normal and abnormal behavioral patterns in BPD. For example, the social norms shape and give directions to our interpersonal functioning, emotions are experienced within the cultural context and expressed accordingly, and self is a reflection and representation of one’s culture. Hence, these constructs of BPD (such as interpersonal functioning, emotions, and self) indicate that they are experienced differently in different cultures and vary on the continuum of normal to abnormal personality functioning. The cultural manifestation of BPD helps to understand the specific profile of the three constructs of BPD in an eastern culture like India. A synthesis of studies on prevalence, development, and symptom presentation of BPD in the Indian context is emphasized to support the personality functioning within the constructs of BPD. The literature review indicates that BPD research in India is based only on a few cases and a tiny sample of such patients. However, studies on BPD in the cultural context are minimal and incomprehensive. Hence, it suggests the importance of more empirical studies concerning the appropriate diagnosis of BPD within the cultural context of India.

Alcohol supply as a favour for a friend: Scenarios of alcohol supply to younger friends and siblings

ISSUES ADDRESSED

Adolescents under the legal purchase age primarily source their alcohol through social networks. This study assessed the provision context from the perspective of both underage recipients and their suppliers who were older peers and siblings.

METHODS

Interviewer-administered surveys were conducted with 590 risky-drinking (50 g alcohol per session, at least monthly) adolescents. Participants of legal purchase age (18- to 19-year-olds; n = 269) reported their provision to 16- to 17-year-olds under eight scenarios. Those aged 14-17 (n = 321) reported receipt of alcohol under the same scenarios plus two parental supply contexts.

RESULTS

Purchase-age participants reported supply: to an underage friend (67%), an acquaintance (44%) or a sibling (16%) to drink at the same party; to a friend (43%) or sibling (20%) to take to another party (20%) and to a stranger near a bottle shop (5%). Supply to a friend at the same party was more likely if money was exchanged (60% vs 40%; P < 0.001). Almost all (98%) 14- to 17-year-olds reported receiving alcohol from an adult (including 36% from a parent for consumption away from the parent), with a similar pattern of receipt scenarios as those reported by the 18- to 19-year-olds.

CONCLUSIONS

Provision of alcohol was more frequent with a friend than a sibling or stranger, in close environmental proximity, and if money was exchanged. SO WHAT?: As supply may be sensitive to monetary considerations, the incidence of underage receipt may be affected by community-wide pricing measures. Traditional alcohol availability regulations should be supplemented by strategies relating to the social nature of supply and demand.

Parental separation/divorce in childhood and partnership outcomes at age 30

BACKGROUND

Previous research has found that children exposed to separation/divorce may also experience relationship problems in adulthood. The aim of this investigation was to examine this issue in a birth cohort of over 900 New Zealand children studied to age 30.

METHODS

Data were gathered over the course of the Christchurch Health and Development Study (CHDS). The CHDS is a 30 year longitudinal study of a birth cohort of 1265 children born in Christchurch (NZ) in 1977. The data collected included the following: (a) timing and number of parental separations and divorces from birth to 15 years; (b) partnership outcomes (16-30 years) of the number of cohabiting/marriage partnerships; positive partner relations; negative partner relations; partner adjustment/conduct problems; and interpartner violence victimization and perpetration; and (c) potential covariate factors.

RESULTS

Study findings showed the presence of significant associations between childhood parental separations/divorces and number of cohabiting/marriage partnerships (16-30 years) (p < .001), negative partner relations (p = .021), extent of partner adjustment/conduct problems (p < .001), and perpetration of interpartner violence (p = .018). Childhood parental separation/divorce explained less than 2.5% of the variance in partnership outcomes. These associations were explained statistically by a series of covariate factors associated with childhood parental separation/divorce including parental history of illicit drug use, childhood sexual abuse, childhood conduct problems (7-9 years), interparental conflict and violence, childhood physical punishment/maltreatment, family socio-economic status at the child's birth, and parental history of criminality. Tests of gender interaction showed that the effect of childhood parental separations/divorces may be the same for males and females. Analysis of the number of childhood parental separations/divorces experienced into three age groups (birth to 5, 5-10 years and 10-15 years) yielded similar results.

CONCLUSIONS

These findings suggest that the general associations between childhood parental separation/divorce and partner relationships in adulthood reflect the consequences of various contextual factors that are associated with childhood parental separation.

Everyone says it's ok: adolescents' perceptions of peer, parent, and community alcohol norms, alcohol consumption, and alcohol-related consequences

An adolescent's perception of norms is related to her or his engagement in alcohol-related behaviors. Norms have different sources, such as parents, peers, and community. We explored how norms from different sources were simultaneously related to different alcohol-related behaviors (current drinking, drunkenness, heavy episodic drinking, driving under the influence or riding with a impaired driver, and alcohol-related nonviolent consequences) using data collected in 2004 from 6,958 adolescents from 68 communities in five states. Results revealed that parent, friend, and community norms were related to adolescents' alcohol-related behavior, but the strength of these impacts varied across behaviors. The pattern of results varied when the analysis relied on all adolescents or just those who had consumed alcohol in the last year.

Adolescent sexual activity and the development of delinquent behavior: the role of relationship context

Despite the well-established association between adolescent sexual activity and delinquent behavior, little research has examined the potential importance of relationship contexts in moderating this association. The current study used longitudinal, behavioral genetic data on 519 same-sex twin pairs (48.6% female) divided into two age cohorts (13-15 and 16-18 years olds) drawn from the National Longitudinal Study of Adolescent Health. Analyses tested whether adolescent sexual activity that occurred in romantic versus non-romantic relationships was associated with delinquency from adolescence to early adulthood, after controlling for genetic influences. Results indicated that, for both younger and older adolescents, common underlying genes influence both sexual behavior and delinquency. After controlling for these genetic influences, there was no within-twin pair association between sexual activity and delinquency in younger adolescents. In older adolescents, sexual activity that occurred in romantic relationships predicted lower levels of delinquency, both cross-sectionally and longitudinally, whereas sexual activity in non-romantic relationships predicted higher levels of delinquency. These results are consistent with emerging research that suggests that the psychological correlates of adolescent sexual activity may be moderated by the social context in which this activity occurs.

Prospective study of the association between neurobehavior disinhibition and peer environment on illegal drug use in boys and girls

BACKGROUND

Individual and contextual factors jointly participate in the onset and progression of substance abuse; however, the pattern of their relationship in males and females has not been systematically studied.

OBJECTIVES

Male and female children and adolescents were compared to determine the relative influence of individual susceptibility (neurobehavior disinhibition or ND) and social environment (deviancy in peers) on use of illegal drugs.

METHODS

Boys (N = 380) and girls (N = 127) were prospectively tracked from age 10-12 to age 16 to delineate the role of ND and peer deviancy on use of illegal drugs.

RESULTS

Girls exhibited lower ND scores than boys in childhood and were less inclined to affiliate with deviant peers. These differences were reduced or disappeared by mid-adolescence. In boys only, peer deviancy in childhood mediated the association between ND and illegal drug use at age 16. In both genders, peer deviancy in mid-adolescence mediated ND and substance abuse at age 16.

CONCLUSIONS

Individual and contextual risk factors promoting substance abuse are more salient at a younger age in boys compared to girls.

SCIENTIFIC SIGNIFICANCE

These results point to the need for earlier screening and intervention for boys.

Childhood sexual abuse and adolescent pregnancy: a meta-analytic update

OBJECTIVE

Recent increases in adolescent pregnancies have sparked a renewed impetus to identify risk factors, such as childhood sexual abuse (CSA), associated with adolescent pregnancy. Given mixed evidence regarding the strength of the relationship between CSA and adolescent pregnancy (Blinn-Pike, Berger, Dixon, Kuschel, & Kaplan, 2002), our objective was to provide an estimate of the effect size of this relationship using updated literature and meta-analytic techniques.

METHODS

Meta-analyses of 21 studies were conducted using a random effects model of binary outcomes to determine aggregate effect-size estimates controlling for study heterogeneity.

RESULTS

CSA significantly increased the odds of experiencing an adolescent pregnancy by 2.21-fold (95% CI: 1.94-2.51). A supplemental analysis suggested that 4.5 out of 10 pregnant adolescents may have a prior history of CSA.

CONCLUSIONS

CSA places females at increased risk for subsequent adolescent pregnancy. Addressing conditions associated with CSA might impact the overall adolescent pregnancy rate.

Age at first drink and the first incidence of adult-onset DSM-IV alcohol use disorders

BACKGROUND

Existing studies of the association between age at first drink (AFD) and the risk of alcohol use disorders (AUD) suffer from inconsistent levels of control and designs that may inflate associations by failure to control for duration of exposure to risk.

METHODS

This study examined associations between AFD (ages <15 and 15-17 vs. 18+ years) and first incidence of DSM-IV alcohol dependence, abuse, and specific AUD criteria over a 3-year follow-up in a longitudinal study of U.S. drinkers 18 years of age and older at baseline (n = 22,316), controlling for duration of exposure, family history, and a wide range of baseline and childhood risk factors.

RESULTS

After adjusting for all risk factors, the incidence of dependence was increased for AFD <15 years (OR = 1.38) and for women only with AFD at ages 15 to 17 (OR = 1.54). The incidence of abuse was increased at AFD <15 and 15 to 17 years (OR = 1.52 and 1.30, respectively). Most dependence criteria showed significant associations with AFD, but hazardous drinking and continued drinking despite interpersonal problems were the only abuse criteria to do so. All associations were nonsignificant after controlling for volume of consumption, except that AFD at all ages <18 combined was associated with a reduced likelihood of impaired control, and AFD at ages 15 to 17 was associated with lower odds of drinking more/longer than intended among heavy-volume drinkers. In a population of low-risk drinkers that excluded those with positive family histories, personality disorders, and childhood risk factors, there were strong associations between early AFD (<18) and the incidence of dependence (OR = 3.79) and continued drinking despite physical/psychological problems (OR = 2.71), but no association with incidence of abuse.

CONCLUSIONS

There is a robust association between AFD and the risk of AUD that appears to reflect willful rather than uncontrolled heavy drinking, consistent with misuse governed by poor decision-making and/or reward-processing skills associated with impaired executive cognitive function (ECF). Additional research is needed to determine causality in the role of impaired ECF, including longitudinal studies with samples of low-risk adolescents.

Detrimental Psychological Outcomes Associated with Early Pubertal Timing in Adolescent Girls

Though often discussed as though it were a discrete event, puberty comprises one segment of a larger developmental continuum and is notable for rapid transformation across a multitude of domains. Research suggests that an earlier rate of pubertal maturation in girls correlates with a number of detrimental outcomes compared with on-time or later maturation. The present review synthesizes the research on negative psychological sequelae of early pubertal timing in adolescent girls. Emphasis is on three theoretical perspectives by which precocious development is believed to affect the emergence of adverse outcomes: biological, psychosocial, and selection effects.

Pubertal maturation and the development of alcohol use and abuse

OBJECTIVE

To examine the impact of various aspects of puberty on risk of using alcohol and developing alcohol use disorder (AUD).

METHODS

Data come from the Great Smoky Mountains Study, a longitudinal study of a representative sample of 1420 youth aged 9-13 at recruitment. Participants were interviewed annually to age 16. A parent was also interviewed. Information was obtained about use of a range of drugs including alcohol, drug abuse and dependence, other psychiatric disorders, life events, and a wide range of family characteristics. Pubertal hormones were assayed annually from blood samples, and morphological development was assessed using a pictorial measure of Tanner stage.

RESULTS

Controlling for age, Tanner stage predicted alcohol use and AUD in both boys (OR 1.58, 95% CI 1.18-2.22) and girls (OR 1.62, 95% CI 1.17-2.23). The effect of morphological development was strongest in those who matured early. Early pubertal maturation predicted alcohol use in both sexes, and AUD in girls. The highest level of excess risk for alcohol use was seen in early maturing youth with conduct disorder and deviant peers. Lax supervision predicted alcohol use in early maturing girls, while poverty and family problems were predictive in early maturing boys.

CONCLUSIONS

Among the many biological, morphological, and social markers of increasing maturation, the visible signs of maturity are important triggers of alcohol use and AUD, especially when they occur early and in young people with conduct problems, deviant peers, problem families and inadequate parental supervision.

Developmentally appropriate sexual risk reduction interventions for adolescents: rationale, review of interventions, and recommendations for research and practice

BACKGROUND

Despite awareness of the need to design developmentally appropriate sexual risk reduction interventions for adolescents, limited information exists to identify the aspects of intervention design or content that make an intervention developmentally appropriate.

PURPOSE

(a) To clarify the rationale for designing developmentally appropriate interventions, (b) to review randomized controlled trials (RCTs) of adolescent sexual risk reduction interventions, (c) to identify developmentally appropriate strategies, (d) to examine the relationship between developmental appropriateness and sexual risk outcomes, and (e) to provide recommendations for research.

METHODS

The authors examined studies (n = 24) published before 2003 that evaluated a risk reduction intervention, sampled adolescents, used an RCT study design, and evaluated sexual behavior outcomes.

RESULTS

Content analysis indicated that the interventions tested were often tailored to the cognitive level of adolescents, as indicated by the use of exercises on decision making, goal setting and planning, and concrete explanation of abstract concepts. Interventions also addressed the social influences of risky sex such as peer norms and provided communication skills training. Overall, the interventions tested in RCTs were more effective in delaying the onset of sexual activity than in promoting abstinence among sexually active youth. Interventions with booster sessions were effective in reducing sexual risk behavior. The use of process measures, linked with developmental constructs, was rare. However, improvements in sexual communication skills and perceived norms for safer sex were associated with reductions in sexual risk outcomes.

CONCLUSIONS

Developmental transitions during adolescence influence sexual behavior and should be considered when developing and evaluating risk reduction interventions for youth. Future research should assess process measures of key developmental constructs as well as risk behavior and biological outcomes.