School-Level Longitudinal Predictors of Alcohol, Cigarette, and Marijuana Use

This study analyzed measures aggregated at the school level to identify key predictors of drinking alcohol, binge drinking, smoking cigarettes, and using marijuana. Using data collected from 6th through 12th grade students between 2011 and 2015, we identify school-level variables that predict school-level prevalence in the subsequent year. Data included prior year assessments of: (1) school-wide prevalence, (2) perceived ease of access to drugs, (3) perceived adult disapproval of drug use, (4) perceived peer disapproval of drug use, and (5) perceived prevalence of drug use. We regressed grade-level behaviors on predictor variables from the previous school year. In middle schools, prior grade prevalence and prior grade perceived norms were significant predictors of subsequent grade prevalence. For high schools, prior year prevalence, aggregated peer norms, and perceived ease of access predicted subsequent use. These analyses provide evidence that a school's culture is predictive of changes in prevalence over time.

Youth and young adult knowledge of and access to opioid harm reduction policies and interventions in North Carolina

Introduction

From 2019-2021, overdose deaths among youth and young adults ages 10-19 years of age residing in the United States increased by 109 %. We sought to examine the extent to which youth and young adults who have experience with substance use are aware of the harm reduction policies and interventions, including the statewide Good Samaritan Law (GSL), naloxone, and fentanyl test strips, and have access to naloxone and fentanyl test strips.

Methods

From December 2022 to February 2023, we conducted a cross-sectional telephone survey of individuals ages 12-25 years who resided in North Carolina (NC) (N=15,000). We assessed awareness of and access to harm reduction policies and interventions among participants who reported ever using heroin/fentanyl, diverted prescription medication, cocaine, methamphetamine, and hallucinogens (n=539). Logistic regression models were used to identify factors associated with awareness of and access to these policies and interventions.

Results

We found that 81.5 % of the sample of youth and young adults who reported ever use of substances were aware of NC's GSL, 80.0 % were aware of naloxone, 43.0 % perceived they had access to naloxone, 74.4 % were aware of fentanyl test strips, and 21.9 % perceived they had access to fentanyl test strips. There were individual and community-level characteristics associated with awareness of and perceived access to these harm reduction policies and interventions.

Conclusions

Efforts are needed to improve access to harm reduction interventions among youth and young adults as they are experiencing an increased risk of dying from opioid-involved overdoses.

Examining alcohol-related social norms among international and domestic students in the United States

OBJECTIVES

The purpose of the current study is to examine college student status (international vs. domestic) across alcohol social norms perception.

METHODS

Undergraduates (n = 3081) were recruited for the study. Most participants were female (69.9%) and White (98.2%), with the average age of participants was 19.97 (SD = 1.61). Approximately 17.3% (n = 534) of the students were international (i.e., nonresident alien who are in the US for a bachelor's degree). It is a cross-sectional study.

RESULTS

International students reported significantly lower social norms than domestic students. International students in later college years reported norms closer to domestic students. International women endorsed social norms at a higher level than international men.

CONCLUSIONS

Assimilation into U.S. drinking culture may be linked with increased support of drinking norms among International students. This study shows the importance of incorporating drinking norms prevention strategy and cultural diversity awareness training to increase international students' knowledge and prevent misconceptions. International students' social norms should be examined for future drinking interventions. Interventions for college drinking should target specific events and context with short-term increase in hazardous drinking behavior but long-lasting effects.

Subjective norms as a mediator between exposure to online alcohol and marijuana content and offline use among adolescents

INTRODUCTION

While adolescent substance use (SU) may be viewed as normative, SU can quickly escalate leading to consequences. Social media use may increase SU risk. Despite using social media to connect with others, adolescents also view depictions of glamorised SU by both peers and influential figures. Exposure to online alcohol and marijuana content may impact subjective norms (i.e., injunctive and descriptive) ultimately leading to increased offline SU. Data from a multi-wave project was collected to assess whether subjective norms-mediated associations between exposure to alcohol and marijuana content by peers and influential figures on Instagram and Snapchat and offline SU.

METHODS

At Wave 1, participants were 264 adolescents (Mage  = 14.91, 51% female, 86% White, 85% Hispanic/Latino/a/x).

RESULTS

Injunctive norms significantly mediated associations between exposure to alcohol content posted by peers and influential figures on Instagram and Snapchat and offline alcohol use. Injunctive norms significantly mediated associations between exposure to marijuana content posted by peers and influential figures on Instagram, and peers on Snapchat and offline marijuana use. Descriptive norms significantly mediated associations between exposure to alcohol content posted by peers on Instagram, as well as peers and influential figures on Snapchat and offline alcohol use.

DISCUSSION AND CONCLUSION

Increased exposure to online SU content was more consistently associated with injunctive norms rather than descriptive norms. Future research should examine which social media features (e.g., the like button) contribute to increased subjective norms. Overall, findings suggest that social media may strongly convey approval of SU behaviours rather than actual use.

Does Narrative Quality Matter During Implementation of a School-Based Prevention Intervention? A Test of Narrative Engagement Theory

Narratives play a powerful role in sharing meaning and making sense of experiences. Specifically, health narratives convey storylines, characters, and messages about health-related behaviors and provide audiences with models for healthy behaviors, prompting audiences' health-related reflections and decision-making. Narrative engagement theory (NET) explains how personal narratives can be integrated into interventions to promote health. This study utilizes NET to test direct and indirect effects of teachers' narrative quality on adolescent outcomes during a school-based substance use prevention intervention that includes narrative pedagogy and an implementation strategy. Observational coding of teacher narratives in video-recorded lessons along with self-report student surveys (N = 1,683) were subjected to path analysis. Findings showed significant direct effects of narrative quality on student engagement, norms (i.e. personal, best-friend injunctive, and descriptive norms), and substance use behavior. The analysis also yielded support for indirect effects of narrative quality on adolescent substance use behavior via student engagement, personal norms, and descriptive norms. Findings highlight important issues related to teacher-student interaction during implementation and contributes implications for adolescent substance use prevention research.

Reconciling multiple sources of influence: Longitudinal associations among perceived parent, closest friend, and popular peer injunctive norms and adolescent substance use

Prospective associations over a 5-year period were examined among perceived parent, closest friend, and popular peer injunctive norms and the onset and frequency of adolescent substance use within a diverse (53% female, 45.5% White non-Hispanic, 22.3% Hispanic, 21.5% Black, 1% Asian, and 6.4% another race) sample of 868 seventh- and eighth-grade adolescents from 2012 to 2017. Analyses revealed adolescents' substance use norms were more lenient than perceptions of their parents' and stricter than perceptions of their closest friends'. Stricter perceptions of parent and closest friend norms, but not popular peer norms, were significantly associated with a later onset of alcohol, marijuana, and cigarette use, and the magnitude of the effect of each source' on later substance use varied across development.

The association between objectively measured exposure to tobacco outlets and smoking cognitions: a study among non-smoking adolescents in four Dutch cities

AIMS

Exposure to tobacco products and advertising at the point of sale may be associated with pro-smoking cognitions. However, previous studies on this topic measured exposure based on self-report and did not include European countries. The aim of this study was to assess the association between objectively measured exposure to tobacco outlets and non-smoking adolescents' smoking attitudes, beliefs and norms.

DESIGN

This cross-sectional study combined survey data with Global Positioning Systems data using geographic information system.

SETTING

The four Dutch cities of Amsterdam, Eindhoven, Haarlem and Zwolle.

PARTICIPANTS

We retrieved data of 308 13 to 17-year-old non-smoking adolescents, mainly girls (61%), adolescents attending pre-university secondary education (71%) and without smoking friends (58%).

MEASUREMENTS

Exposure was measured with a smartphone app registering for 2 weeks how often participants were within 10 m of a tobacco outlet. We distinguished between outlets without visible tobacco promotion (i.e. supermarkets), with only internal visibility and with both internal and external visibility. Participants' reported smoking cognitions were dichotomised into pro-smoking or anti-smoking. We applied multi-level logistic regression analyses and adjusted for age, sex, educational level and smoking friends.

FINDINGS

On average, adolescents were exposed to 1.18 (SD = 1.23) tobacco outlets per day. Higher exposure to tobacco outlets was associated with higher odds of pro-smoking injunctive norm ( OR = 1.35, 95% CI = 1.04-1.75). Associations with attitude (OR = 1.12, 95% CI = 0.91-1.38), social beliefs (OR = 1.15, 95% CI = 0.93-1.43), health beliefs (OR = 1.18, 95% CI = 0.97-1.44) and descriptive norm (OR = 1.15, 95% CI = 0.91-1.44) were also positive, but non-significant. Overall, associations were strongest for outlets with internal visibility, for instance, for injunctive norm (OR = 1.37, 95% CI = 1.03-1.81).

CONCLUSIONS

Global Positioning Systems-measured exposure to tobacco outlets was associated with pro-smoking cognitions among non-smoking adolescents in the Netherlands.

Physical and Recreational Activities, Sedentary Screen Time, Time Spent with Parents and Drug Use in Adolescents

In a context in which sedentary screen time is on the rise and adolescents are less eager to engage in free-time activities, physical and recreational activities, although too often ignored, have proven to be an antidote for a large array of psychological and behavioral problems in adolescents, including drug use. The present study is a cross-sectional investigation of the association between physical and recreational activities, sedentary screen time, and time spent with parents and the intensity of drug use in adolescents. The participants were part of a representative sample of 2677 adolescents from Bucharest, Romania. The results indicate that vigorous physical and recreational activities, as well as time spent with parents, were negatively associated with an index of drug use (13 drugs), while screen time positively predicted the intensity of drug use. These findings raise the question of the involvement of parents and educational authorities in promoting healthy behaviors and good practices for the prevention of drug use and improving public adolescents' health.

Psychosocial Indicators of Adolescent Alcohol, Cigarette, and Marijuana Use: An Analysis of Normalized, Harmonized, and Pooled Data

We normalized, harmonized, and pooled 344,429 surveys collected from 106,470 research participants from 25 research studies that assessed past 30-day alcohol use, drunkenness, smoking cigarettes, using marijuana, and a host of psychosocial variables. After normalizing and harmonizing psychosocial measures, we completed analyses to examine the ability of psychosocial variables to serve as proxy indicators of use. Intentionality, peer descriptive normative beliefs, and age emerged as being of primary importance in indicating use. Additional variables - peer injunctive norms, beliefs about the positive and negative consequences of use, and attitudes - were also demonstrated to have the potential to serve as proxies in the assessment of substance use risk. There were developmental patterns in how intentionality and descriptive normative beliefs changed with age. Young adolescents had scores that are protective; they have positive intentionality and do not see the prevalence of alcohol and other drug use as widespread. These and other psychosocial variable's mean scores generally erode with age while the distribution of scores widens as youth grow older. The goal of analyses was to define age-related psychosocial profiles that can be used prospectively to estimate substance use risk. These profiles are useful in creating virtual control cases for evaluating disseminated prevention programs.

Sharing pro-marijuana messaging on social media: The moderating role of legislation

ObjectivesThis study investigates whether recreational marijuana legislation and perceived social norms (descriptive and injunctive) affect college students' propensity to share pro-marijuana messages. We examine which referent group (close friends, typical student, parents) most influence those norms. Participants: A sample of 343 college students participated in the study. Of these students, 214 were from Washington State, where recreational marijuana is legal, and 129 were from Wyoming, where recreational marijuana is illegal. Method: Data, from an online survey, were analyzed through PROCESS analyses. Results: College students in Washington State who believed a typical peer would want them to share pro-marijuana messaging were marginally more likely to share pro-marijuana messages than their counterparts in Wyoming. However, among students who thought a typical peer would not approve of them sharing pro-marijuana messaging, the opposite pattern emerged. Conclusion: Restrictive recreational marijuana legislation does not uniformly abate related message sharing on social media.

Social predictors of the transition from anomie to deviance in adolescence

Adolescence is a complicated, full of challenges and explorations period in life on the way to adulthood. The behaviour of adolescents is considerably re-configuring under the pressure of biological, psychological, and social transformations, and the internalization of community rules and values, as well as the adoption of desirable behaviours, is not always easy or successful. During adolescence, anomie can easily become an attractive status quo, but it can also evolve, however, relatively easy, to delinquency. This exploratory study, part of the Planet Youth project, is based on an analysis of 17 items from a questionnaire applied to a sample of 2,694 young people in Bucharest, Romania, in 2018, high schoolers in grades 9-11. The main objective of this approach was to assess the impact of some socio-cultural factors regarding school, family, peer group, and neighbourhood on the adoption of deviant and delinquent behaviours among Bucharest teenagers. For data analysis, two dependent variables were built by aggregating items in the questionnaire: the level of anomie (composed of 8 items) and deviant behaviour (composed of 17 items). As independent variables, 17 predictors composed from 67 questions from the questionnaire were used. The main results reflect a high level of anomie among the adolescents of Bucharest and a low level of deviance, and a weak link between these two variables. On the other hand, adolescent anomie and deviance are favoured by anger management, perceived peer attitudes to substance use and digital leisure, together with low parental surveillance.

Does parental permissiveness toward cigarette smoking and alcohol use influence illicit drug use among adolescents? A longitudinal study in seven European countries

PURPOSE

Adolescents' perceptions of parental norms may influence their substance use. The relationship between parental norms toward cigarette and alcohol use, and the use of illicit substances among their adolescent children is not sufficiently investigated. The purpose of this study was to analyze this relationship, including gender differences, using longitudinal data from a large population-based study.

METHODS

The present study analyzed longitudinal data from 3171 12- to 14-year-old students in 7 European countries allocated to the control arm of the European Drug Addiction Prevention trial. The impact of parental permissiveness toward cigarettes and alcohol use reported by the students at baseline on illicit drug use at 6-month follow-up was analyzed through multilevel logistic regression models, stratified by gender. Whether adolescents' own use of cigarette and alcohol mediated the association between parental norms and illicit drug use was tested through mediation models.

RESULTS

Parental permissive norms toward cigarette smoking and alcohol use at baseline predicted adolescents' illicit drug use at follow-up. The association was stronger among boys than among girls and was mediated by adolescents' own cigarette and alcohol use.

CONCLUSION

Perceived parental permissiveness toward the use of legal drugs predicted adolescents' use of illicit drugs, especially among boys. Parents should be made aware of the importance of norm setting, and supported in conveying clear messages of disapproval of all substances.

Majority and popularity effects on norm formation in adolescence

Personal norms consist of individuals' attitudes about the appropriateness of behaviour. These norms guide adolescents' behaviour in countless domains that are fundamental for their social functioning and well-being. Peers are known to have a marked influence on adolescent risk-taking and prosocial behaviour, but little is known about how peers shape personal norms underlying those behaviours. Here we show that adolescents' personal norms are decisively moulded by the norms of the majority and popular peers in their social network. Our experiment indicates that observing peer norms substantially impacts adolescents' normative evaluation of risk-taking and prosocial behaviours. The majority norm had a stronger impact than the norm of a single popular peer, and norm adjustments were largest when adolescents observed strong disapproval of risk-taking or strong approval of prosocial behaviour. Our study suggests that learning about peer norms likely promotes adolescents to hold views and values supporting socially desirable behaviour.

"Tell Me How Much Your Friends Consume"-Personal, Behavioral, Social, and Attitudinal Factors Associated with Alcohol and Cannabis Use among European School Students

BACKGROUND

Substance use in European adolescents remains a serious health concern. Assessing what affects adolescents' substance use is crucial for implementing effective prevention. This study aims to examine alcohol and cannabis use-related behavioral, social, and attitudinal variables that might directly be considered to guide prevention responses for adolescents.

METHODS

Cross-sectional data of 78,554 15-16-year-old school students from the 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD) from 26 European countries were analyzed. Self-reported drunkenness in the last 30 days and cannabis use in the last 12 months served as dependent variables. To investigate which factors are associated with risky substance use, multivariable logistic regressions were used.

RESULTS

17.7% of respondents reported drunkenness in the last 30 days, and 14.9% used cannabis in the last 12 months. The most important predictor for risky substance use was the perception that most/all of their friends engaged in substance use behavior, followed by lack of parental support, low personal adherence to rules, and low school performance.

CONCLUSION

Interventions addressing the perceived descriptive norms either directly or by changing environmental cues, opportunities, and regulations, as well as effective parenting and academic support may prevent and reduce risky substance use behavior among adolescents.

The Role of Engagement in Effective, Digital Prevention Interventions: the Function of Engagement in the REAL Media Substance Use Prevention Curriculum

Prevention curricula rely on audience engagement to effectively communicate their messages. However, to date, measurement of engagement has primarily focused on self-report that is often an indicator of liking or satisfaction. Emerging technologies for intervention delivery hold promise not only for additional engagement indicators but also for dissemination outside of traditional vehicles such as classroom delivery. The present study, grounded in the theory of active involvement (Greene 2013), explores the role of engagement (as measured by self-report, program analytics, and observation) with short-term substance use prevention outcomes such as self-efficacy to counter-argue and descriptive and injunctive norms. The study tracks 4-H youth (N = 310) engaged with a media literacy focused e-learning substance prevention curriculum, REAL media. Results indicate that self-reports of engagement predicted self-efficacy to counter-argue, but a program-analytic indicator of dosage predicted lower injunctive and descriptive norms, all at 3 months. The observational indicator was correlated with self-efficacy to counter-argue but not significant in the predictive models. The implications and directions for future research regarding how engagement is measured in prevention and included in studying program effects are discussed. Clinical trial: NCT03157700, May 2017.

Relevance of Athlete-Specific Psychosocial Factors in High School Student-Athlete Alcohol Consumption

Background: Research suggests that adolescent student-athletes are at heightened risk for alcohol consumption. The identification of unique, modifiable risk factors for alcohol use in this population is needed. Purpose/Objectives: Building on previous work highlighting the importance of each of athlete-specific drinking motives and alcohol expectancies, this study investigated whether athlete-specific psychosocial predictors optimize our ability to predict adolescent athlete alcohol consumption after accounting for general psychosocial predictors. Methods: Participants were 352 current high school student-athletes who completed a self-report questionnaire about their alcohol use attitudes, behaviors, and cognitions. Results: Hierarchical regression revealed that among the total sample, gender, class year, liquid courage/sociability, sexuality, and negative alcohol expectancies, and negative athletic-functioning alcohol expectancies predicted alcohol consumption. Among lifetime drinkers, gender, class year, enhancement motives, conformity motives (negative), negative athlete-functioning alcohol expectancies, and sport-related coping motives predicted alcohol consumption. Conclusions/Importance: Negative athletic-functioning alcohol expectancies and sport-related coping motives emerged as important, athlete-specific predictors of adolescent athlete alcohol use. These factors provide important opportunities for targeted prevention efforts.

The Association between Gender Role Attitudes and Alcohol Use among Early Adolescents in Shanghai, China

Adolescent alcohol use was a major social and public health concern given its negative impacts. Previous studies indicated gender role attitudes (GRA) were associated with alcohol use; however, few studies focused on early adolescents (10 to 14 years) and similar researches were not found in China. Objective: This study sought to explore the association between GRA and alcohol use among early adolescents. Methods: A cross-sectional study was conducted among students in grades six to eight across three public secondary schools in Shanghai, China. Data were collected by Computer-Assisted Self-Interview (CASI) questionnaire on mobile tablets. Alcohol use was measured by self-report, and six items with 5-point Likert-type options assessed the attitude toward traditional gender roles. The logistic regression model was adopted to examine the associations between GAR and alcohol use. Results: Totally 1,631 adolescents aged 10 to 14 years with 50.33% of boys included in this study. The mean score of GRA in drinkers was significantly higher than nondrinkers among boys (3.03 vs. 2.78, p < 0.001) but not girls (2.15 vs. 2.18, p = 0.499). After controlling the covariates of age, depression, peers' substance use, social cohesion, etc., we found that more traditional GRA was associated with a higher risk of alcohol use among boys (OR = 1.39, 95%CI: 1.11-1.75), whereas the association was not significant among girls (OR = 0.96, 95%CI: 0.74-1.24). Conclusions: Traditional GRA may increase the risk of alcohol use among early adolescent boys, suggesting that altering traditional GRA among this population group may help to prevent alcohol use.

Narrative Engagement and Interpersonal Communication about Substance Use on Adolescent Substance Use Behaviors: A Case Study of keepin' it REAL

The present study examined direct and indirect effects of adolescent narrative engagement on substance use behaviors via refusal self-efficacy. This study also tested moderation effects of communication about substance use with parents, siblings, and friends on substance use behaviors. Students in 8^th grade (N = 225) participated in surveys at two different time points. Path analyses revealed a positive association between identification with main characters and refusal self-efficacy as well as negative associations between refusal self-efficacy and the past 30-days substance use. Communication with parents and friends significantly moderated the relationship between refusal self-efficacy and the past 30-days substance use.

Understanding alcohol-specific antecedents among Chinese vocational school adolescents

BACKGROUND

Alcohol use among Chinese vocational school students is widespread and associated with many negative consequences. However, alcohol-specific antecedents for this population are understudied.

OBJECTIVES

The current study explored: (a) which alcohol-specific antecedents are the most salient predictors for alcohol use intentions, (b) whether any mediational relationships exist among these alcohol-specific antecedents, and (c) whether gender-based differences exist among these relationships.

METHODS

This study analyzed data from 1,230 vocational school adolescents in three Chinese cities. Survey data were analyzed using dominance analysis and structural equation modeling.

RESULTS

Personal norms were the most salient antecedents for alcohol use intentions, followed by injunctive norms from friends and parents, descriptive norms from friends and classmates, and positive belief about drinking. We observed a statistically significant mediational chain from descriptive norms to injunctive norms, and in turn to personal norms and positive beliefs, and finally to alcohol use intentions. Gender moderated some of the paths.

CONCLUSIONS

Alcohol use norms and beliefs among Chinese vocational school students have distinct predictive relationships with alcohol use intentions. Alcohol use prevention programs designed for this population need to address normative beliefs (descriptive, injunctive, and personal norms) and the perceived benefit of alcohol use.

Substance abuse among children

Substance abuse (SA) among children is a recognized challenge for policymakers and law enforcement and has life-threatening consequences owing to the impact on the children's development and the consequent increase in vulnerability. This work outlines several important issues related to SA among children: (1) SA prevalence including onset, common examples, extent, and spectrum of SA; (2) the presence of new psychoactive substances, which are rapidly spreading worldwide with limitations regarding their prevalence, detection, and interventions; (3) street children and their recruitment in drug supply; (4) SA and substance use disorder pathways, risk and protective factors for the development of SA; (5) SA consequences in the case of early initiation, including deaths; and (6) current preventive interventions for the pediatric population. In conclusion, this challenge requires consistent and unremitting attention in order to execute effective prevention programs with continuous re-evaluation of the situation.

Short term effects of the REAL media e-learning media literacy substance prevention curriculum: An RCT of adolescents disseminated through a community organization

BACKGROUND

The primary aim of this study was to evaluate the short-term effects of testing an e-learning program to reduce adolescent substance use and abuse. Early initiation of substance use is linked to a variety of negative outcomes, thus effective intervention programs are needed. One approach is to use media literacy to capitalize on adolescents' immersion with media in a variety of forms. We developed, implemented, and tested an engaging substance use prevention program by collaborating with a youth-oriented community partner (4-H).

METHODS

639 middle adolescents from nine U.S. states participated in an RCT of REAL media. Participants completed a series of online surveys and were randomized to use an online substance prevention program (REAL media) or serve as control (delayed program use). Self-report surveys were administered at three points in time. This short-term evaluation uses data from the pretest (Time 1) and short-term posttest three-month surveys, which measured demographics, self-efficacy to counterargue, and injunctive and descriptive substance use norms.

RESULTS

Participants who completed the REAL media program reported increased self-efficacy to counterargue and decreased positive injunctive norms compared to control participants who did not complete the program. No significant differences were observed for descriptive norms.

CONCLUSIONS

We found support for the REAL media program in changing key predictors of youth substance use demonstrating (1) the efficacy of media literacy interventions targeting adolescents and (2) that e-learning substance use prevention efforts can be adapted for and implemented through community organizations.

Power of the Peer and Parent: Gender Differences, Norms, and Nonmedical Prescription Opioid Use Among Adolescents in South Central Kentucky

This study examined risk factors of nonmedical prescription opioid use (NMPOU) among adolescents and how risk factors differ by gender. In the fall of 2017, adolescents attending 6th through 12th grades across 44 schools in 10 south central Kentucky counties were invited to participate in an anonymous, school-based survey. A total of 11,761 adolescents completed the survey. Logistic regression was conducted to examine the association between NMPOU and constructs of the Theory of Reasoned Action (i.e., attitudes and subjective norms), descriptive norms (i.e., peer use), and parental control of prescription medications in the home. There were 297 (2.7%) adolescents who reported NMPOU in the past 12 months. In the adjusted multivariate logistic regression model, for both males and females, the adolescents who perceived that more of their peers engaged in NMPOU were significantly more likely to endorse NMPOU, whereas male and female adolescents who perceived their peers disapproved of use were significantly less likely to report NMPOU. Parent disapproval was significantly associated with decreased NMPOU for females only. Moderated regression analyses revealed that gender moderated the relationship between parental disapproval and NMPOU. We found that during adolescence, NMPOU is influenced by peer norms for both genders and parental norms for females. These results indicate that prevention efforts should focus on changing adolescents' peer and parental norms related to NMPOU.

Normative Influences on the Role of Prescription Medicine Misuse among College Students in the United States

Prescription medicine misuse is a growing problem in college campuses across the US. The Center for Disease Control (CDC) recently declared that the problem has reached epidemic proportions and is leading to a significant loss of lives every day. Norms-based public health campaigns that have been used in the past to address substance abuse issues among college students have had mixed success rates. Using the theory of normative social behavior, this study argues that a lack of focus on relevant mediators and moderators could be responsible for the failure of previous norms-based campaigns. Specifically, we test and support the mediating influence of perceived outcome expectations and injunctive norms on the effect of descriptive norms on intentions to misuse prescription medicines. In addition, perceived self-efficacy and trait reactance moderated the role of descriptive norms on outcome variables. Theoretical and practical implications of the findings are discussed.

Risk and protective factors for opioid misuse in American Indian adolescents

BACKGROUND

American Indian (AI) youth have disproportionately high rates of both heroin and other opioid misuse and recently have seen a large increase in negative outcomes due to opioid misuse. To address the dearth of research on within-group risk factors for heroin and other opioid misuse in AI adolescents, the goal of the present study is to explore the influence of peer, family, and school factors on opioid use among AI youth.

METHODS

Participants (n = 3498, 49.5 % female, M_age = 14.8) were drawn from a large school-based sample of AI youth living on or near reservations, across six geographic regions, between 2009 and 2013. Participants completed a self-report questionnaire regarding substance use and related factors. Multilevel logistic regression was utilized to examine the role of peer, family, and school-related factors on past-month and lifetime heroin and other opioid misuse.

RESULTS

Greater peer substance use (OR = 1.14, p<0.001), lower family disapproval of use (OR = .98, p = 0.01), and lower school performance (OR = .90, p = 0.01) were associated with greater likelihood of lifetime opioid misuse. Greater peer substance use (OR = 1.05, p<0.001) and lower family disapproval of use (OR = .99, p = 0.04) were associated with greater likelihood of past month opioid misuse. Greater peer substance use was the only variable significantly related to greater likelihood of lifetime (OR = 1.15, p<0.001) or past month heroin use (OR = 1.02, p = 0.047).

CONCLUSIONS

Findings highlight the need for interventions and offer potential factors to consider in developing interventions for heroin and/or other opioid misuse among AI adolescents.

A Test of the Theory of Planned Behavior in the Prediction of Alcohol-Induced Blackout Intention and Frequency

BACKGROUND

This study examined the theory of planned behavior (TPB) as an explanatory model for alcohol-induced blackouts among college students. Blackouts are periods of time wherein individuals continue to function and engage in their social environment but do not remember it as a result of consuming large quantities of alcohol. Social cognitive factors posited within TPB, such as perceived norms and personal attitudes toward alcohol consumption, are reliable predictors of alcohol use and related problems. However, research to date has not examined these theoretical antecedents as predictors of alcohol-induced blackout.

METHODS

College students with a history of blackout (N = 384) completed a baseline survey, and a subsample (N = 120) completed a 1-month follow-up survey. Negative binomial mediation models were used to evaluate intentions to blackout as a mediator of the norms, attitudes, and self-efficacy to avoid blackout-blackout frequency association at baseline and 1-month follow-up.

RESULTS

Norms, attitudes, and self-efficacy to avoid blackout all significantly predicted blackout intentions at baseline, which in turn predicted more frequent blackouts both at baseline and at 1-month follow-up. Notably, blackout attitudes demonstrated both direct and indirect associations with blackout frequency.

CONCLUSIONS

Prospective analyses provided partial support for the TPB, with only attitudes and intentions demonstrating prospective associations with actual blackout frequency. Given the particularly strong association between blackout attitudes and frequency of blackouts, attitudes may represent an important and novel target for prevention and intervention efforts.

Do restrictive gender attitudes and norms influence physical and mental health during very young Adolescence? Evidence from Bangladesh and Ethiopia

Adolescence is seen as a window of opportunity for intervention but also as a time during which restrictive gender attitudes and norms become more salient. This increasingly gendered world has the potential to profoundly influence adolescents' capabilities, including their physical and mental health. Using quantitative data on 6,500 young adolescents (10-12) from the Gender and Adolescence: Global Evidence (GAGE) program, this paper analyses the association between restrictive gender attitudes (RGAs) at the individual level and restrictive gender norms (RGNs) at the community level and physical and mental health in Bangladesh and Ethiopia. We find significant associations between RGAs and RGNs and height-for-age z-scores, body mass index z-scores, self-reported health, adolescent hunger, psychological well-being, and self-esteem. We find no relationship between RGAs or RGNs and illness. We also find heterogeneity across country and urbanicity. We find surprisingly limited variation by gender, and the differences we do see point to important vulnerabilities for both boys and girls. Our results point to the powerful role that distal factors such as culture and beliefs, as manifested through RGAs and RGNs, can play in shaping health outcomes for both boys and girls and suggest important next steps for future research and policy.

Social and Situational Party Characteristics Associated With High-Intensity Alcohol Use Among Youth and Young Adults

BACKGROUND

Rates of high-intensity drinking, which is alcohol consumption that exceeds standard heavy drinking levels, have increased in recent years and peak in young adulthood. To identify modifiable environmental targets for prevention of high-intensity drinking, we identified characteristics of parties attended by youth and young adults that were associated with high-intensity drinking and the consequences of this excessive form of drinking.

METHODS

Data are from 15- to 20-year-old participants in an online survey (n = 2,442; 55.4% female, 74.8% White) who resided in 24 communities across 7 states that were a part of a community randomized intervention trial to reduce the incidence and consequences of underage drinking parties. We used multinomial logistic regression to predict level of drinking by 6 party characteristics (size, location, age and gender composition, supervision, others' drinking behavior), and to predict 6 consequences (hangover, not remember event, passed out, punished by parents, broke something/got in fight, and sex against will) from level of drinking. We tested study hypotheses in 2 models, one that used a single binge drinking threshold (below binge vs. at or above binge level) and one that additionally used a high-intensity drinking level (below binge, 1 to 2 times binge, 2+ times binge level).

RESULTS

We found that larger party size and a mostly male composition were unique predictors of high-intensity drinking when compared to those who consumed 1 to 2 times the binge drinking level. Odds of passing out, not remembering the drinking event, breaking/damaging property, or getting in a fight were more than double for high-intensity drinkers compared to standard binge level drinkers.

CONCLUSIONS

Results from this study indicate there are unique precursors and consequences of high-intensity alcohol consumption among youth and young adults. These environmental factors associated with high-risk drinking contexts can be used to develop prevention strategies to mitigate the harms associated with excessive alcohol consumption.

Social cohesion and peer acceptance predict student-athletes' attitudes toward health-risk behaviors: A within- and between-group investigation

OBJECTIVES

Collegiate student-athletes often engage in health-risk behaviors such as alcohol misuse and hazing, but the literature in this domain lacks evidence pertaining to how peers shape attitudes towards such behaviors. We investigated how peer acceptance and social cohesion relate to attitudes towards alcohol use, marijuana use, drinking and driving, playing through a concussion, performance enhancing substance use, and hazing.

DESIGN

Cross-sectional survey.

METHODS

Participants were 387 NCAA athletes from 23 intact teams. Multilevel modeling was used to examine the extent that health-risk attitudes clustered within teams and enabled us to disentangle individual-level and group-level effects of peer acceptance and social cohesion.

RESULTS

Intraclass correlation coefficients revealed that health-risk attitudes clustered within teams. At the individual-level, student-athletes who perceived higher levels of peer acceptance, relative to teammates, held riskier attitudes towards alcohol use, playing through a concussion, and hazing. Meanwhile, those who perceived higher levels of social cohesion relative to teammates held less risky attitudes towards playing through a concussion. At the group-level, teams with greater peer acceptance held less risky attitudes towards playing through a concussion, whereas teams with greater social cohesion held riskier attitudes toward playing through a concussion.

CONCLUSIONS

These data indicated that health-risk behaviors may cluster within teams, and that peer acceptance and cohesiveness are differentially associated with attitudes toward risky behavior. Given that peer influence is a multilevel phenomenon, it is prudent that prevention efforts leverage social processes within teams, while reducing pressures to engage in risky behaviors.

Sensation seeking to marijuana use: Exploring the mediating roles of risk appraisal and social norms

While studies have shown a robust association between sensation seeking (SS) and adolescent marijuana use, comparatively little is known about the mechanisms that potentially account for this association. The current study tests a theoretical model linking SS to marijuana use through risk appraisal and normative influences (i.e., perceived behavior and attitudes of others). Utilizing a nationally representative, cross-sectional sample of high school seniors (N = 2117), the current study finds risk appraisal and normative influences mediate the relationship between SS and marijuana use. Furthermore, perceptions of risk appear to be strongly influenced by proximal peer norms. These results indicate risk appraisal and normative processes may be key explanatory mechanisms in the association between SS and adolescent marijuana use. Theoretical and policy implications for this model are discussed.

Examining marianismo gender role attitudes, ethnic identity, mental health, and substance use in Mexican American early adolescent girls

Given the increased trend in substance use patterns among Latina adolescents in recent years, the need for research that identifies gender-specific and culturally relevant protective factors is essential in tailoring interventions. The current study examined the links between marianismo gender role attitudes, ethnic identity, and substance use abstinence among 277 low-income Mexican American early adolescent girls. Mental health was also examined as a potential moderator in these links. Results of linear regression analysis revealed that familismo, virtuous/chaste, and spiritual marianismo gender role attitudes were predictive of stronger ethnic identity; conversely, self-silencing marianismo attitudes were predictive of weaker ethnic identity. Second, results of hierarchical logistic regressions revealed that both virtuous/chaste marianismo gender role attitudes and mental health (low rates of psychological distress) were inversely linked with substance use; furthermore, they had a combined link that was related to even lower rates of substance use among participants. However, ethnic identity did not have a direct or moderating effect on substance use. Findings suggest that the promotion of positive components of marianismo and mental health may have a protective effect against early substance use in Mexican American early adolescent girls.

Dyadic and Group-Level Positive Friendship Characteristics and Susceptibility to Perceived Delinquent Peer Substance Use

Peer relations researchers have suggested that dyadic and peer group relationship characteristics may interact with each other to affect behavior. Building on prior work that has pitted the relative effects of dyadic and peer group relationship characteristics on susceptibility to peer influence, the present study sought to integrate dyadic and group characteristics into a moderational model by testing whether friendship quality and peer group identification together exacerbate risk for conforming to peer norms for substance use. This longitudinal study included 387 early adolescents assessed annually for 4 years. Participants completed measures of perceived peer delinquency, friendship quality, peer group identification, and substance use frequency. Results indicated that perceived peer delinquency had the strongest association with substance use for adolescents characterized by high friendship quality and high peer group identification. These findings highlight the importance of considering the joint effects of multiple peer relationship characteristics on susceptibility to peer influence.

The Relation between Descriptive Norms, Suicide Ideation, and Suicide Attempts among Adolescents

This study examined the relationship between adolescents' beliefs about the prevalence of youth suicide ideation (ideation descriptive norms) and suicide attempts (attempt descriptive norms) with self-reported suicide ideation and attempts. Descriptive norms, suicide ideation, and suicide attempts as well as gender, race/ethnicity, and exposure to family, peer, and others' suicide were assessed in 2,109 students at six suburban New York State high schools. After controlling for demographic variables and exposure to suicide, elevated ideation descriptive norms and attempt descriptive norms were associated with higher rates of suicide ideation and lifetime suicide attempts among adolescents. Adolescents who believed suicide ideation and attempts to be more widespread among peers (i.e., elevated ideation and attempt descriptive norms) were more likely to endorse suicide ideation and attempts. Correcting these descriptive norms may be a worthwhile goal for school-based suicide prevention programs.

With a little help from my friends? A longitudinal look at the role of peers versus friends on adolescent alcohol use

INTRODUCTION

Alcohol is the most commonly used substance by South African adolescents. Social norms play a key role in alcohol use, although distinctions are not always made between descriptive and injunctive norms and peer proximity. Additionally, little research identifies factors attenuating social norms, peer proximity, and alcohol use, such as one's ability to resist peer influence.

METHODS

The current study investigates the relationship between adolescent alcohol use in 9th Grade and descriptive peer and injunctive friend norms in 8th grade, the moderating role of resistance to peer influence, and sex differences. Data were from South African students (N = 3592; M_age = 14) participating in the HealthWise South Africa implementation quality trial.

RESULTS

Path model results indicated injunctive friend norms, but not peer norms, influenced alcohol use. Resistance to peer influence did not moderate relationships and group comparisons found no sex differences.

CONCLUSION

Findings suggest social proximity shapes influences of alcohol use. Despite a differing cultural context, findings were consistent with those from the United States, indicating social proximity is relevant cross-culturally.

Randomized effectiveness trial of a parent and youth combined intervention on the substance use norms of Latino middle school students

This article advances knowledge about the effectiveness of applying a community-based efficacious parenting intervention in parallel with an efficacious preadolescent intervention in changing substance abuse norms among preadolescent Latino youth. The study employed a longitudinal, randomized control group design comparing three groups: (1) Parent intervention combined with a Youth intervention: Parent/Youth; (2) Parent intervention without a Youth intervention: Parent Only; and (3) Treatment as usual: Comparison. In the comparison group, parents participated in a standard parenting program delivered by the community partner, and the youth received the usual drug use prevention programming offered in their schools. Data from both parents and youth at the19 participating schools were collected at pre-test, immediate post-test (4 months after pre-test), and two follow-up (8 & 20 months after the pre-test). The total sample includes 532 families (parent-child dyads). The parent-child dyads consisted of one parent and one youth ages 12-14. The retention rates for both parents and preadolescent were high across the different waves of data collection (79%-96%). Regression results of youth substance use norms were calculated based on three permutations of data: (a) original data, with no imputation and no propensity score matching; (b) imputed data but no propensity score matching; and (c) imputed data plus propensity score matching. Compared to the Comparison group, the Parent/Youth condition was the most effective in changing youth's norms, closely followed by the Parent Only condition. These findings make a significant contribution in advancing knowledge on family/youth substance use prevention for Latinos in a community environment. Although the study took place in a specific urban center in the Southwest US, its findings can be generalized to other urban communities of similar characteristics across the country.

Changes in peer norms as a mediator of reduction in adolescent alcohol use

Background: Evidence from college samples suggests that changes in peer norms (perception about peer use) mediate changes in alcohol use. There is relatively little intervention-based research in adolescents. Objectives: To investigate whether changes in peer norms mediate the relationship between a brief intervention to reduce alcohol use, and level of use; additionally, to determine whether any mediation effects differ by adolescent age. Methods: Eighty-four adolescents aged 14-18 (Mean = 16.49, SD = 1.00), presenting to school-based health centers with moderate to high risk alcohol use were randomized to receive an electronic screening and feedback tool (Check Yourself) in addition to their visit, or their visit alone. Check Yourself includes provision of normative feedback regarding adolescent alcohol use. Measures of self-reported alcohol use, and peer norms were collected at baseline and 2-month follow-up. Results: Changes in perceptions of the proportion of peers using alcohol significantly mediated the relationship between the intervention and all three alcohol outcomes (frequency, typical quantity, and maximum quantity) such that reductions in perceived peer use were associated with reduced use. Moderated mediation suggested that these effects were stronger for younger adolescents compared with older adolescents. Perceptions of the frequency and quantity of peer use were not significant mediators of alcohol use. Conclusions/Importance: Results suggest that integrating normative feedback regarding peer alcohol use is a promising approach in adolescent focused school interventions. They extend previous findings by suggesting that perceptions of the proportion of peers using may be particularly meaningful, and that effects may be more pronounced in younger adolescents.

The Implications of Cannabis Policy Changes in Washington on Adolescent Perception of Risk, Norms, Attitudes, and Substance Use

There is increasing interest in the effect of legalization (particularly recreational legalization) of cannabis on prevalence of use and related problems. However, there is no consensus about the impact of policy change on cannabis use, particularly among adolescents. Legalization may increase adolescent use through mediating factors such as perceived risk and normative beliefs regarding the use of cannabis. Washington State enacted Initiative 502 on December 2012, which legalized and taxed recreational cannabis for adults aged ⩾21 years. This paper used data from a randomized, controlled intervention trial for cannabis-using adolescents that was recruiting participants in Seattle before and after the policy change to evaluate the following goals: assess differences in substance use, problems, and symptomatology pre- and post-policy change; evaluate several proposed risk factors that may be associated with such differences; and describe participants’ understanding of the law and how this understanding may relate to rates of use. Analyses revealed no significant differences pre- to post-policy in rate of substance use. However, there were significant post-policy increases in problems and use disorder symptoms. Despite these differences, there were no significant increases in norms, attitudes, or perceptions of risk. Participants were able to answer most questions regarding policy changes correctly, indicating a good understanding of the policy. Results provided no evidence that policy change influenced heavy-using adolescents’ rates of use nor the proposed risk factors associated with problematic use patterns.

Role of social normative beliefs as a moderating factor in smoking intention among adolescent girls in Korea

In this study, we investigated the relationship between risk-taking tendency and smoking intention as moderated by social normative beliefs among Korean female adolescents. A cross-sectional study was conducted with 274 female adolescents in middle school. Multiple regression and simple slope analyses were employed to test the moderating effects of social normative beliefs regarding smoking on the relationship between risk-taking tendency and smoking intention. Results determined that risk-taking tendency, social normative beliefs regarding smoking, and their interaction were significant factors influencing smoking intention among adolescents. Risk-taking tendency was associated with greater smoking intention among adolescents, with higher than average social normative beliefs regarding smoking. However, risk-taking tendency was not significantly associated with smoking intention for adolescents with lower than average social normative beliefs regarding smoking. In conclusion, social normative beliefs regarding smoking moderated the relationship between risk-taking intention and smoking intention among Korean female adolescents. Unique sociocultural perceptions about smoking behaviors of adolescents need to be reflected in smoking-prevention and -cessation programs.

Investigating the Potential Impact of Social Talk on Prevention Through Social Networks: the Relationships Between Social Talk and Refusal Self-Efficacy and Norms

Interpersonal communication among participants plays an important role in the impact and effectiveness of prevention programs (Southwell & Yzer, Communication Theory 19:1-8, 2009). This study focused on adolescents' informal conversations about a prevention program, referred to as social talk, from a social network perspective. We provide both a conceptualization of social talk in relation to prevention programs and an operationalization of it by examining adolescents' social networks. Participants (N = 185) were eighth-grade students attending a middle school substance-abuse prevention program called keepin' it REAL (kiR). Participants engaged in both positive and negative social talk about kiR. Students with higher friendship indegree centrality were more likely to have greater positive social talk indegree centrality (r = .23 p < .01). These results indicated that youth considered as friends by most of their classmates were also reported as being positive in their comments with respect to kiR. Youth who talked positively about kiR tended to report personal anti-substance injunctive norms (b = 0.71, p < .05). On the other hand, youth who were nominated as negative social talkers by their peers appeared to have less personal anti-substance injunctive norms (b = -0.92, p < .05). Furthermore, youth who were more likely to talk negatively about kiR were less likely to perceive that their best friends (b = -1.66, p < .05) or most youth in their age (b = -1.49, p < .05) disapprove of substance use.

The influence of social norms on flu vaccination among African American and White adults

Adult influenza vaccination rates remain suboptimal, particularly among African Americans. Social norms may influence vaccination behavior, but little research has focused on influenza vaccine and almost no research has focused on racially-specific norms. This mixed methods investigation utilizes qualitative interviews and focus groups (n = 118) and national survey results (n = 1643) to assess both descriptive and subjective norms surrounding influenza vaccination. Qualitative results suggest a perceived descriptive norm that 'about half' of the population gets vaccinated. Participants describe differing norms by race and vaccine behavior. Quantitative results confirm a perceived descriptive norm that 40-60% of the population gets vaccinated. Both African Americans and Whites accurately identified race-specific vaccination rates relative to the general population. Individuals who report that a majority of people around them want them to be vaccinated were significantly more likely to be vaccinated, suggesting subjective norms are influential for both White and African American adults. While perceived descriptive norms are somewhat accurate (mirroring the actual influenza vaccination rate), emphasizing a suboptimal vaccination rate may not be beneficial. Health promotion efforts, particularly those targeting African Americans, may benefit from focusing on subjective norms and encouraging friends and family members to talk about the benefits of influenza vaccination.

Injunctive safety norms, young worker risk-taking behaviors, and workplace injuries

Injunctive safety norms (ISNs) refer to perceptions of others' expectations of one's safety-related conduct. Drawing on a sample of Canadian young workers (n=11,986;M age=17.90years; 55% males), we study the relationships among four sources of non-work-related (i.e., parents, siblings, friends, teachers), two sources of work-related (i.e., supervisors, co-workers) ISNs, young workers' self-reported work-related risk-taking behaviors, and workplace injuries. Structural equation modeling suggests that ISNs from parents, supervisors, and co-workers were related to less frequent work-related risk-taking behaviors, and with fewer workplace injuries via less frequent work-related risk-taking behaviors. In addition, ISNs from supervisors were directly associated with fewer workplace injuries. In contrast, ISNs from teachers and siblings were not associated with work-related risk-taking behaviors, but ISNs from siblings were associated with fewer work injuries. Finally, ISNs from friends were associated with more frequent work-related risk-taking and more frequent work injuries via more frequent work-related risk-taking. This study draws attention to the relative roles of non-work sources of social influence and provides some evidence of how ISNs might be related to young workers' work-related risk-taking behaviors and their workplace injuries. It also contributes to practice by suggesting specific interventions that parents, supervisors, and co-workers could undertake to reduce young workers' work-related risk-taking and workplace injuries, namely encouraging youth to be safe at work.

The Relative Influence of Injunctive and Descriptive Social Norms on Methamphetamine, Heroin, and Injection Drug Use Among Homeless Youths: The Impact of Different Referent Groups

The current study assessed the relative influence of both injunctive and descriptive norms in the context of different referent groups (i.e., family, street peers, home-based peers, and staff members) on past 30-day methamphetamine, heroin, and injection drug use behaviors of homeless youth. Cross-sectional data ( N = 911) were collected from three drop-in centers in Los Angeles, California. The study consisted of two parts: a social network interview and a computerized self-administered survey. Multivariate logistic regression models examined the association of objection to drug use from referent groups (injunctive norms; that is, street-based peers, home-based peers, relatives, staff members) and drug use of referent groups (descriptive norms) with youths’ substance use behaviors. Multivariate results indicated that the role of injunctive and descriptive norms varied across the three substance use behaviors and by referent group. Findings indicate the need to carefully consider the diversity of homeless youths’ networks in designing substance use interventions.