Rural Community Characteristics, Economic Hardship, and Peer and Parental Influences in Early Adolescent Alcohol Use

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.

Neighborhood structural characteristics, perceived neighborhood environment, and problem behaviors among at-risk adolescents

Neighborhood environment has been linked to behavioral outcomes in adolescence. The current study examined two potential mediators (i.e., perceived social capital, perceived neighborhood disorder) in the association between neighborhood structural characteristics (i.e., neighborhood disorganization) and problem behaviors (i.e., externalizing behavior, substance use) among at-risk adolescents with prenatal substance exposure. The study sample included 350 15-year-old adolescents recruited at birth. Adolescents' addresses were linked to census tract data. Neighborhood structural characteristics were not directly associated with adolescent problem behaviors in the presence of perceived social capital and neighborhood disorder. Greater neighborhood disorganization was associated with lower levels of perceived social capital, which was related to greater perceived neighborhood disorder, and then problem behaviors. The findings suggest that community practice needs to focus on subjective perceptions of neighborhoods when developing intervention programs on problem behaviors among at-risk adolescents.

Community Awareness of Outreach Efforts to Reduce Underage Drinking on California Indian Reservations

We report an evaluation of a combined individual- and community-level treatment and prevention effort to reduce underage drinking by American Indian (AI) youths on rural California Indian reservations. The interventions included: brief motivational interviewing and psychoeducation for Tribal youths, restricting alcohol sales to minors in alcohol sales outlets, and community mobilization and awareness activities. Surveys were collected from 120 adults and 74 teens to evaluate the awareness and effectiveness of the interventions. A high proportion of adult (93%) and youth (96%) respondents endorsed being aware of one or more of the intervention activities, and 88% of adults and 71% of youth felt the program impacted the community in a positive way. Eighty-four percent of adults and 63% of youth agreed that as a result of the activities that they decided to take action to reduce teen drinking in their community. Being aware of more of the intervention activities significantly increased the odds of taking action to change drinking behaviors. This study documents that a significant proportion of the community was aware of the intervention efforts and that awareness caused them to take action to reduce underage drinking. Such efforts may benefit other AI/AN communities seeking to reduce underage drinking.

School and town factors associated with risky alcohol consumption among Catalan adolescents

Risky alcohol consumption among adolescents has health and social consequences. Evidence identifying the school context that determines alcohol consumption among rural and urban adolescents is lacking. This study aimed to describe the contextual school and town factors determining risky alcohol consumption among rural and urban 10th-grade adolescents (15-17 years old) from Catalonia (northeastern Spain). The study had a cross-sectional design. Cluster sampling with the class as the sampling unit was used, and a total of 1268 10th-grade adolescents from Catalonia nested in 26 high schools participated in the study. A computerized and self-administrated questionnaire was used to collect individual variables. Contextual variables were collected from the Catalan police registers, geocoded sources, and governmental internet databases, and by aggregation of answers from the self-administrated questionnaire. The prevalence of risky alcohol consumption was calculated, and a multilevel Poisson regression analysis with robust variance was conducted with data from adolescents nested within high schools. The results show that risky alcohol consumption is higher among rural adolescents (59.3%) than among urban youth (51.1%) (p < 0.005). Positive expectancies, drunkenness of siblings and friends, and most of the variables indicating accessibility are associated with risky alcohol consumption at the individual level. At the contextual level, the sports center rate and the high school's percentage of risky student alcohol consumption are strongly associated with individual risky alcohol consumption. The town environment (rural or urban), the unemployment rate, and the number of pubs and nightclubs lost their significance after adjustment by the individual and mediating variables. In conclusion, individual factors, such as the influence of drinking patterns of siblings and friends, and more alcohol access opportunities, are associated with adolescents' risky alcohol consumption. The associated contextual factors are the sports center rate and the percentage of risky classmate alcohol consumers. Interventions targeting adolescents should focus at community and high school levels, trying to reduce adolescents' accessibility to alcohol.

Frightening or Foolish? Gendered Perceptions of Public Intoxication Among Youths and Adults in Norway and Finland

Background: What people define as acceptable alcohol use may differ between social situations and depend upon on who is drinking as well as who is evaluating the situation. Objective: The aim of the study was to explore how Norwegian and Finnish youth and adults perceived the acceptability of situations involving public intoxication and how gender and alcohol's harm to others were made relevant in their reflections. Methods: We conducted eight focus groups among adolescents (N = 44) and eight among adults (N = 38), using photos and stories of drinking situations as stimuli for the discussions. Results: Youths' and adults' perceptions of public intoxication were characterized by ambivalence: negative evaluations were often nuanced and negotiated while positive evaluations typically were followed up with reservations. To some extent, their evaluations depended upon the gender and age of the drinker. Although a norm of gender equality was emphasized, women were typically criticized for their looks and for foolish behavior when drunk, while drunk men were often perceived as frightening. Age was a prominent dimension in evaluations of the acceptability of women's alcohol use, while it was seldom mentioned when discussing intoxicated men. Youths seemed to have somewhat more restrictive attitudes towards public intoxication than adults, reflecting perhaps how they related to the situations with more general conceptions of drinking and harms from drinking, picked up from public debate or from school. Conclusion: Perceptions of alcohol's harm to others were clearly gendered, in that intoxicated men were seen as frightening while women were seen as foolish.

Prevention of Underage Drinking on California Indian Reservations Using Individual- and Community-Level Approaches

OBJECTIVES

To evaluate combined individual- and community-level interventions to reduce underage drinking by American Indian/Alaska Native (AI/AN) youths on rural California Indian reservations.

METHODS

Individual-level interventions included brief motivational interviewing and psychoeducation for Tribal youths. Community-level interventions included community mobilization and awareness activities, as well as restricting alcohol sales to minors. To test effects, we compared 7 waves of California Healthy Kids Survey data (2002-2015) for 9th- and 11th-grade AI/AN and non-AI/AN students in intervention area schools with California AI/AN students outside the intervention area (n = 617, n = 33 469, and n = 976, respectively).

RESULTS

Pre- to postintervention mean past 30-day drinking frequency declined among current drinkers in the intervention group (8.4-6.3 days) relative to comparison groups. Similarly, heavy episodic drinking frequency among current drinkers declined in the intervention group (7.0-4.8 days) versus the comparison groups.

CONCLUSIONS

This study documented significant, sustained past 30-day drinking or heavy episodic drinking frequency reductions among AI/AN 9th- and 11th-grade current drinkers in rural California Indian reservation communities exposed to multilevel interventions. Public Health Implications. Multilevel community-partnered interventions can effectively reduce underage alcohol use in this population.

Associations of the Neighborhood Environment With Substance Use: A Cross-sectional Investigation Among Patients in Compulsory Drug Detention Centers in Thailand

Objectives

To identify the associations of characteristics of the neighborhood environment with substance abuse among clients receiving treatment for drug abuse in Thailand.

Methods

A cross-sectional study was conducted of 1128 drug addicts from 28 neighborhoods who were receiving treatment at all 7 compulsory drug detention centers in Thailand. A trained interviewer conducted structured interviews with the subjects about substance use and the perceived neighborhood environment in their community. A multilevel logistic regression model was applied to estimate the effects of the neighborhood environment on substance use.

Results

The majority of participants, 53.8% only used methamphetamine pills, 31.3% used other illicit drugs as well as methamphetamine pills, and 14.9% used an illicit drug other than methamphetamine. Three neighborhood characteristics were associated with substance use. A 1-unit increase in the perceived neighborhood cohesion score was associated with a 15% reduction in methamphetamine pill use and an 11% reduction of the use of both methamphetamine pills and another illicit drug. Conversely, a 1-unit increase in perceived neighborhood crime predicted 19 and 14% increases in the use of methamphetamine pills and the use of both methamphetamine pills and another illicit drug, respectively. In addition, a 1-unit increase in the scores for stigma surrounding addiction corresponded to a 25% increase of the use of methamphetamine pills and a 12% increase in the use of both methamphetamine pills and another illicit drug.

Conclusions

Substance use among drug addicts was influenced by characteristics of the neighborhood environment. Therefore, prevention and intervention strategies should be designed based on a consideration of the impact of neighborhood context on substance use behaviors.

The role of neighborhood disadvantage, physical disorder, and collective efficacy in adolescent alcohol use: a multilevel path analysis

Research into the salient exposures which explain neighborhood variation in adolescent alcohol use remains inconclusive. The Social Disorganization Theory suggests that neighborhood-level disadvantage may reduce collective efficacy to control adolescent risky behavior. Collective perceptions of physical disorder are also implicated in this neighborhood pathway. Drawing on data from a nationally-representative survey of urban high school students in New Zealand, multilevel path analysis was used to estimate the direct and mediating effects of neighborhood disadvantage, physical disorder, and collective efficacy on current drinking, frequency of binge drinking, and typical quantity of alcohol consumed. The findings supported an indirect pathway from disadvantage to binge drinking and high typical quantities in young adolescents (<16 years), mediated by physical disorder and reduced collective efficacy. Collective efficacy was not associated with current drinking in young adolescents. An opposing indirect effect was evident among older adolescents (≥16 years), whereby collective efficacy was positively associated with drinking outcomes. Implications for future research are discussed.

Residential environments, alcohol advertising, and initiation and continuation of alcohol consumption among adolescents in urban Taiwan: A prospective multilevel study

Background

Research indicates that place characteristics and the media environment are important contextual determinants of underage drinking behaviors in Western countries, but it is unknown whether these exposures influence adolescent alcohol consumption outside Western contexts, including in Asia׳s emerging global alcohol markets. Guided by the social ecological framework, we prospectively investigated the influences of place characteristics and alcohol advertising on initiation and continuation of alcohol consumption among adolescents in Taipei, Taiwan.

Methods

Data on individual-level characteristics, including alcohol use behaviors and perceived exposure to alcohol advertising, were obtained from two waves of a longitudinal school-based study through a stratified probability sampling method in 2010 (Grade 7/Grade 8, aged 13-14 years old) and 2011-2012 (Grade 9, aged 15 years old) from 1795 adolescents residing in 22 of 41 districts in Taipei. Data on district-level characteristics were drawn from administrative sources and Google Street View virtual audit to describe districts where adolescents lived at baseline. Hierarchical generalized linear models tested hypotheses about the associations of place characteristics and perceived alcohol advertising with underage drinking, with stratification by baseline lifetime alcohol consumption.

Results

Among alcohol-naïve adolescents, lower district-level economic disadvantage, a higher proportion of betel nut kiosks (a relatively unregulated alcohol source) compared to off-premises alcohol outlets, and exposure to television-based alcohol advertising predicted increased likelihood of alcohol initiation at one-year follow-up. Among alcohol-experienced adolescents, greater spatial access to off-premises alcohol outlets, and lower access to metro rapid transportation (MRT) and to temples were found to predict a subsequent increased likelihood of continued alcohol use. Parental drinking moderated the relationship between district-level violent crime and initiation of alcohol consumption.

Conclusions

These findings suggest that local social economic status, alcohol access, and institutional resource and individual media exposure affect underage drinking behaviors in Taiwan. We discuss potential public health implications for place-based interventions. Future research on place, media, and adolescent alcohol consumption in Asian contexts is warranted.

Adolescent Susceptibility to Peer Influence in Sexual Situations

PURPOSE

One consistent predictor of adolescents' engagement in sexual risk behavior is their belief that peers are engaging in similar behavior; however, not all youth are equally susceptible to these peer influence effects. Understanding individual differences in susceptibility to peer influence is critical to identifying adolescents at risk for negative health outcomes. The purpose of this project was to identify predictors of susceptibility to peer influence using a novel performance-based measure of sexual risk taking.

METHODS

Participants were 300 early adolescents (Mage = 12.6 years; 53% female; 44% Caucasian) who completed (1) a pretest assessment of demographics, sexual attitudes, and hypothetical scenarios measuring the likelihood of engaging in sexual risk behavior and (2) a subsequent experimental procedure that simulated an Internet chat room in which youth believed that they were communicating with peers regarding these same hypothetical scenarios. In reality, these "peers" were computer-programmed e-confederates. Changes in responses to the sexual scenarios in the private pretest versus during the public chat room provided a performance-based measure of peer influence susceptibility.

RESULTS

In total, 78% of youth provided more risky responses in the chat room than those in pretest. The most robust predictor of this change was gender, with boys significantly more susceptible to peer influence than girls. Significant interactions also were noted, with greater susceptibility among boys with later pubertal development and African-American boys.

CONCLUSIONS

Results confirm that not all youth are equally susceptible to peer influence. Consistent with sexual script theory, boys evidence greater susceptibility to social pressure regarding sexual behavior than girls.

Collective efficacy, alcohol outlet density, and young men's alcohol use in rural South Africa

Alcohol use contributes to morbidity and mortality in developing countries by increasing the risk of trauma and disease, including alcohol dependence. Limited research addresses determinants of alcohol use beyond the individual level in sub-Saharan Africa. We test the association of community collective efficacy and alcohol outlet density with young men's drinking in a cross-sectional, locally representative survey conducted in rural northeast South Africa. Informal social control and cohesion show protective associations with men's heavy drinking, while alcohol outlet density is associated with more potential problem drinking. These findings provide initial support for intervening at the community level to promote alcohol reduction.

A systematic review of the influence of community level social factors on alcohol use

PURPOSE

To explore evidence on the influence of community level social factors on alcohol use among adults and adolescents.

METHODS AND RESULTS

Major bibliographic databases were searched for quantitative studies meeting inclusion criteria. After screening, narrative synthesis and a quality review were applied. Forty-eight studies met the eligibility criteria. While the findings were inconclusive for associations between alcohol use and deprivation, poverty, income, unemployment, social disorder and crime, there was some indication that social capital characteristics were protective.

CONCLUSIONS

Social capital has a potentially important association with reducing alcohol use. Further studies are required to better understand social influences on alcohol use.

The role of economic strain on adolescent delinquency: a microsocial process model

The current study examines the role of economic strain as a moderator of the microsocial processes influencing younger siblings' delinquency (externalizing behavior and substance use) in a longitudinal design. The younger siblings (122 younger brothers and 122 younger sisters) were from 244 families with same-sex biological siblings. Structural equation modeling was utilized to examine a process model whereby mothers' harsh/inconsistent parenting and older sibling delinquency influence younger siblings' delinquent behavior via sibling aggression and delinquent peer affiliation. Findings suggest that indirect mechanisms vary as a function of economic strain, with sibling aggression having a stronger, more detrimental effect on adolescent delinquency in economically strained families. Data suggest that familial economic conditions contextualize the relative roles of parenting, sibling, and peer processes in the transmission of risk to adolescent delinquency.