Friends or foes: social anxiety, peer affiliation, and drinking in middle school

Anxiety as a Moderator of the Relationship Between Deviant Peer Association and Substance Use: Does the Specific Dimension of Anxiety Matter?

Deviant peer association has been identified as a risk factor for substance use. Anxiety has been examined as a moderator of this relationship in a limited capacity. Despite this, investigations of specific dimensions of anxiety as moderators of this relationship remain understudied. This study examined three dimensions of anxiety as moderators: physiological anxiety, worry/oversensitivity anxiety, and social concerns/concentration anxiety. The Pathways to Desistance data were used in analyses. Ordered logistic regression models were used to assess relationships of interest for three substance use outcomes: heavy episodic drinking, marijuana use, and cigarette use. Findings indicated that social concerns/concentration anxiety moderated the relationship between deviant peer association and marijuana use, but, contrary to predictions, a protective effect at higher levels of this form of anxiety was observed. Worry/oversensitivity anxiety also appeared to exert a significant and negative direct effect on all three substance use outcomes. Implications are discussed.

Clarifying the Relation between Social Interaction Anxiety and Cannabis Use: Personality as a Distinguishing Factor

Background: Individuals with social interaction anxiety, a facet of social anxiety disorder, are heterogeneous with respect to approaching or avoiding risky behaviors, including substance use. Additionally, the relation between social anxiety and cannabis use frequency has been inconsistent in the literature. Objective: The present study aimed to clarify the relation between social interaction anxiety and cannabis use by examining the effects of personality traits known to differentially predict substance use, including sensation seeking, emotion dysregulation, urgency, behavioral approach, and behavioral inhibition. Methods: We explored heterogeneity in social interaction anxiety using finite mixture modeling to discern profiles differing in mean scores on measures of social interaction anxiety and personality. We then examined how profiles differed in their likelihood of cannabis use. Results: The profile with low social interaction anxiety and high scores on personality measures was the most likely to use cannabis at all time periods. Two profiles with high social interaction anxiety scores were discerned. Between these two profiles, the profile with the highest levels of social interaction anxiety and most measured personality traits was more likely to use cannabis across all measured time periods. The profile with the high social interaction anxiety and low scores on personality measures was the least likely to use cannabis. Conclusions: Results of the present study identified personality traits most associated with increased risk of cannabis use for people high and low in social interaction anxiety, including facets of emotion regulation, urgency, and sensation seeking.

Understanding health decision making: An exploration of homophily

The phenomenon of homophily first was described in Lazarsfeld and Merton's classic 1954 friendship analysis as a tendency for friendships to form between those who are alike in some respect. Although theories of decision making address a host of factors that affect the process, the influence of individuals with homophilic ties remains unaccounted for and unexplained. The purpose of this paper is to review theories relevant to decision making and describe what is known about the relationship between homophily and health care decision making. Further, we provide new evidence suggesting the influence of homophily on decision making in results from a randomized, multi-center clinical trial of American men with localized prostate cancer. A diverse sample of 293 men with a new diagnosis of localized prostate cancer reported relevant personal factors influencing the care management decision before randomization to a decision aid or usual care, between 2013 and 2015. Among these personal factors were the level of influence or importance ascribed to various individuals at the time of the treatment decision. One month later, participants reported how prepared they were for decision making. 123 men (42%) reported friends and/or coworkers as information sources, of which 65 (53%) indicated that friends and/or coworkers influenced the care decision. Men who reported friends/coworkers as information sources had significantly higher one-month preparation scores. Our review of decision making theories and practical applicability suggests the influence of homophilic relationships manifests in health care decision making. Faced with a list of options to manage health conditions, decision makers turn to known individuals in their environments, particularly those individuals with whom the decision maker can identify. Clinicians may solicit information from patients about influential others and explain how that support fits into the health decision at hand without dishonoring the importance of the homophilic relationship.

Internalizing Symptoms, Peer Substance Use, and Substance Use Initiation

This study used longitudinal survey and social network data covering sixth through ninth grades to test whether internalizing symptoms make early adolescents more prone to (1) exposure to and (2) influence by substance-using peers. Random effects regressions revealed that increases in symptoms were significantly associated with increases in the proportion of friends who used cigarettes, alcohol, and marijuana; some associations weakened across grades. Event history models revealed that the effect of friends' smoking on smoking initiation decreased as internalizing symptoms increased; symptoms did not moderate the effects of friends' alcohol and marijuana use on alcohol and marijuana use initiation. These findings counter the influence hypothesis of the co-occurrence of internalizing symptoms with substance use and partly support the exposure hypothesis.

Risk and protective factors associated with adolescent girls' substance use: Data from a nationwide Facebook sample

BACKGROUND

Despite overall reductions in teenage substance use, adolescent girls' rates of substance use remain unacceptably high. This article examines whether girls' substance use is associated with general risk and protective factors (goal setting, problem solving, refusal skills, peer use, and self-efficacy) and gender-specific risk and protective factors (communication style, coping skills, self-esteem, body image, perceived stress, anxiety, and depression).

METHODS

Cross-sectional data were collected in 2013 via online surveys from a nationwide sample of adolescent girls (N = 788), aged 13 and 14 years, who were recruited through Facebook.

RESULTS

In multivariate analyses, controlling for correlates of adolescent substance use, 11 of the 13 general and gender-specific risk and protective factors were consistently associated with past-month alcohol, cigarette, and other drug use in the expected direction; past-month marijuana use was associated with 8 of the 13 factors. Refusal skills, peer use, coping, and depressive mood were most consistently and strongly associated with substance use.

CONCLUSIONS

Substance abuse prevention programs targeting adolescent girls should focus on such general risk and protective factors as problem solving, refusal skills, peer influences, and self-efficacy, as well as such gender-specific risk and protective factors as communication style, coping, self-esteem, body image, perceived stress, and mood management.

Cognitive, emotion control, and motor performance of adolescents in the NCANDA study: Contributions from alcohol consumption, age, sex, ethnicity, and family history of addiction

OBJECTIVE

To investigate development of cognitive and motor functions in healthy adolescents and to explore whether hazardous drinking affects the normal developmental course of those functions.

METHOD

Participants were 831 adolescents recruited across 5 United States sites of the National Consortium on Alcohol and NeuroDevelopment in Adolescence 692 met criteria for no/low alcohol exposure, and 139 exceeded drinking thresholds. Cross-sectional, baseline data were collected with computerized and traditional neuropsychological tests assessing 8 functional domains expressed as composite scores. General additive modeling evaluated factors potentially modulating performance (age, sex, ethnicity, socioeconomic status, and pubertal developmental stage).

RESULTS

Older no/low-drinking participants achieved better scores than younger ones on 5 accuracy composites (general ability, abstraction, attention, emotion, and balance). Speeded responses for attention, motor speed, and general ability were sensitive to age and pubertal development. The exceeds-threshold group (accounting for age, sex, and other demographic factors) performed significantly below the no/low-drinking group on balance accuracy and on general ability, attention, episodic memory, emotion, and motor speed scores and showed evidence for faster speed at the expense of accuracy. Delay Discounting performance was consistent with poor impulse control in the younger no/low drinkers and in exceeds-threshold drinkers regardless of age.

CONCLUSIONS

Higher achievement with older age and pubertal stage in general ability, abstraction, attention, emotion, and balance suggests continued functional development through adolescence, possibly supported by concurrently maturing frontal, limbic, and cerebellar brain systems. Determination of whether low scores by the exceeds-threshold group resulted from drinking or from other preexisting factors requires longitudinal study. (PsycINFO Database Record

Early adolescent symptoms of social phobia prospectively predict alcohol use

OBJECTIVE

The current study examined whether social phobia (SP) symptoms in early adolescence prospectively predicted alcohol use through middle adolescence in a community sample of youth.

METHOD

Data from an ongoing longitudinal study (N = 277) of mechanisms of HIV-related risk behaviors in youth were used to assess the extent to which SP symptoms in early adolescence (mean [SD] age = 11.00 years [0.81]) would predict alcohol use across five annual assessment waves. Adolescents completed measures of SP symptoms, depressive symptoms, and alcohol use at each wave.

RESULTS

Higher SP symptoms at baseline predicted higher average odds of alcohol consumption during subsequent waves but did not significantly predict an increase in the odds of alcohol use as a function of time. Within a lagged model, SP symptoms measured at a prior assessment point (1 year earlier) predicted greater odds of drinking alcohol at the following assessment point. Importantly, alcohol use did not significantly predict SP symptoms over time. These results suggest that early SP symptoms are an important risk factor for increased odds of subsequent alcohol use.

CONCLUSIONS

The present findings highlight that elevated SP symptoms place adolescents at risk for early alcohol use. Early interventions targeting SP symptoms may be crucial for the prevention of problematic alcohol use in early to mid-adolescence. Implications for prevention and treatment approaches are discussed.

When you see it, let it be: Urgency, mindfulness and adolescent substance use

The emotion-based domains of impulsivity, positive and negative urgency, are facets that have garnered attention due to their associations with substance use, and mindfulness based strategies have shown promise in reducing substance use in adults. The aim of the current study was to examine relations among urgency, mindfulness, and substance use in adolescence. Cross-sectional data were collected from students (N=1,051) at a large, private high school in the Pacific Northwest. Both positive and negative urgency were uniquely associated with greater likelihood of lifetime and current alcohol use; only positive urgency predicted lifetime marijuana use. Mindfulness was associated with a lower likelihood of lifetime alcohol or marijuana use. Interactions between urgency and mindfulness were not supported. Our findings highlight the need to explore relations among baseline mindfulness, skills based mindfulness, and personality in adolescent alcohol and other drug use.

Moderators of the association between peer and target adolescent substance use

Associating with substance using peers is generally considered as one of the most important predictors of adolescent substance use. However, peer association does not affect all adolescents in the same way. To better understand when and under what conditions peer association is most linked with adolescent substance use (SU), this review focuses on the factors that may operate as moderators of this association. The review highlighted several potential moderators reflecting adolescents' individual characteristics (e.g., pubertal status, genes and personality), peer and parental factors (e.g., nature of relationships and parental monitoring), and contextual factors (e.g., peer, school and neighborhood context). As peer association is a broad concept, important methodological aspects were also addressed in order to illustrate how they can potentially bias interpretation. Taking these into account, we suggest that, while the effects of some moderators are clear (e.g., parental monitoring and sensation seeking), others are less straightforward (e.g., neighborhood) and need to be further examined. This review also provides recommendations for addressing different methodological concerns in the study of moderators, including: the use of longitudinal and experimental studies and the use of mediated moderation. These will be key for developing theory and effective prevention.

Cannabis use behaviors and social anxiety: the roles of perceived descriptive and injunctive social norms

OBJECTIVE

Individuals with greater social anxiety are particularly vulnerable to cannabis-related impairment. Descriptive norms (beliefs about others' use) and injunctive norms (beliefs regarding others' approval of risky use) may be particularly relevant to cannabis-related behaviors among socially anxious persons if they use cannabis for fear of evaluation for deviating from what they believe to be normative behaviors. Yet, little research has examined the impact of these social norms on the relationships between social anxiety and cannabis use behaviors.

METHOD

The current study investigated whether the relationships of social anxiety to cannabis use and use-related problems varied as a function of social norms. The sample comprised 230 (63.0% female) current cannabis-using undergraduates.

RESULTS

Injunctive norms (regarding parents, not friends) moderated the relationship between social anxiety and cannabis-related problem severity. Post hoc probing indicated that among participants with higher (but not lower) social anxiety, those with greater norm endorsement reported the most severe impairment. Injunctive norms (parents) also moderated the relationship between social anxiety and cannabis use frequency such that those with higher social anxiety and lower norm endorsement used cannabis less frequently. Descriptive norms did not moderate the relationship between social anxiety and cannabis use frequency.

CONCLUSIONS

Socially anxious cannabis users appear to be especially influenced by beliefs regarding parents' approval of risky cannabis use. Results underscore the importance of considering reference groups and the specific types of norms in understanding factors related to cannabis use behaviors among this vulnerable population.

Cumulative and recent psychiatric symptoms as predictors of substance use onset: does timing matter?

AIMS

We examined two questions about the relationship between conduct disorder (CD), depression and anxiety symptoms and substance use onset: (i) what is the relative influence of recent and more chronic psychiatric symptoms on alcohol and marijuana use initiation and (ii) are there sensitive developmental periods when psychiatric symptoms have a stronger influence on substance use initiation?

DESIGN

Secondary analysis of longitudinal data from the Pittsburgh Youth Study, a cohort study of boys followed annually from 7 to 19 years of age.

SETTING

Recruitment occurred in public schools in Pittsburgh, Pennsylvania, USA.

PARTICIPANTS

A total of 503 boys.

MEASUREMENTS

The primary outcomes were age of alcohol and marijuana use onset. Discrete-time hazard models were used to determine whether (i) recent (prior year); and (ii) cumulative (from age 7 until 2 years prior to substance use onset) psychiatric symptoms were associated with substance use onset.

FINDINGS

Recent anxiety symptoms [hazard ratio (HR) = 1.10, 95% confidence interval (CI) = 1.03-1.17], recent (HR = 1.59, 95% CI = 1.35-1.87), cumulative (HR = 1.45, 95% CI = 1.03-2.03) CD symptoms, and cumulative depression symptoms (HR = 1.04, 95% CI = 1.01-1.08) were associated with earlier alcohol use onset. Recent (HR = 1.39, 95% CI = 1.22-1.58) and cumulative CD symptoms (HR = 1.38, 95% CI = 1.02-1.85) were associated with marijuana use onset. Recent anxiety symptoms were only associated with alcohol use onset among black participants.

CONCLUSIONS

Timing matters in the relationship between psychiatric symptoms and substance use onset in childhood and adolescence, and the psychiatric predictors of onset are substance-specific. There is no single sensitive developmental period for the influence of psychiatric symptoms on alcohol and marijuana use initiation.

Onset to First Alcohol Use in Early Adolescence: A Network Diffusion Model

A novel version of Snijders's stochastic actor-based modeling (SABM) framework is applied to model the diffusion of first alcohol use through middle school-wide longitudinal networks of early adolescents, aged approximately 11-14 years. Models couple a standard SABM for friendship network evolution with a proportional hazard model for first alcohol use. Meta-analysis of individual models for 12 schools found significant effects for friendship selection based on the same alcohol use status, and for an increased rate of onset to first use based on exposure to already-onset peers. Onset rate was greater at higher grades and among participants who spent more unsupervised time with friends. Neither selection nor exposure effects interacted with grade, adult supervision, or gender.

Alcohol and Other Drug Use in Middle School: The Interplay of Gender, Peer Victimization, and Supportive Social Relationships

The current study examined the impact of supportive social relationships (i.e., teacher support, adult support, school relatedness) and peer victimization on middle school students' substance use. Over 3,000 middle school students reported on alcohol, cigarette, and marijuana use, supportive social relationships, and instances in which they were the victim of aggressive behavior. Mixed-effects logit regression analyses revealed complementary patterns of results across types of substances. Students who perceived high levels of social support were less likely to report alcohol and drug use initiation, particularly at low levels of peer victimization. Gender moderated the negative effect of peer victimization, with highly victimized boys most likely to report alcohol, cigarette, and marijuana use. Results indicated a complex interplay of social influences and moderating variables in predicting early onset alcohol and other drug use, one that researchers should consider when studying adolescents' decisions to use alcohol and other drugs.

A biopsychosocial model of social anxiety and substance use

Emerging prospective work suggests that individuals with social anxiety disorder (SAD) may be at particular risk for developing substance use disorders (SUD). Yet, little is known about why this may be so. Most research has utilized existing theories of substance use (e.g. tension reduction-based theories) to understand SAD-SUD relations. However, these theories do not address why individuals with social anxiety, in particular, experience such high rates of substance-related problems. A possible explanation may lie in the nature of social anxiety itself, which is characterized not only by chronically elevated negative affective states, but by low positive affect, fear of scrutiny, and social avoidance. These aspects of social anxiety may work in concert to place these especially vulnerable individuals at risk for SUD. The current paper presents a biopsychosocial model of SAD-SUD comorbidity that focuses on several specific facets of social anxiety that may be especially related to SUD risk. The utility of this model is evaluated via a review of the literature on the relations between SAD and substance-related behaviors.

Social Anxiety and Onset of Drinking in Early Adolescence

The present study examines several types of social anxiety that may be associated with the onset of alcohol use in middle school students, and whether the relationship differs by sex and grade. Students in the seventh and eighth grades (N = 2621) completed the Social Anxiety Scale for Adolescents and a measure of lifetime drinking via school-wide surveys. Distinct aspects of social anxiety were associated with higher and lower rates of onset of alcohol use. A high level of fear of negative evaluation was associated with drinking initiation in boys and girls, while girls who reported no social anxiety or distress in new situations were more likely than other groups to have started drinking by early adolescence. Youth with either very low or very high levels of generalized anxiety had higher rates of drinking than youth with scores in between. These findings suggest that the relationship between social anxiety and initiation of alcohol use is complex and varies by type of anxiety symptomatology.

The peer context and the development of the perpetration of adolescent dating violence

The peer context is a central focus in research on adolescent risk behaviors but few studies have investigated the role of the peer context in the perpetration of adolescent dating violence. This longitudinal study examined between-subjects and within-person contemporaneous and lagged effects of peer attributes, measured with social network analyses, on trajectories of dating violence perpetration and determined if effects varied by grade and/or sex of the adolescent. Data are from adolescents who participated in a five-wave panel study beginning when they were in 7 through 9th grade and ending when they were in 10 through 12th grade (n = 3,412); half were male, 40.5 % were white, 49.9 % were black and 10.4 % were of another race/ethnicity. Significant between-subjects effects indicate that adolescents who typically have friends who use dating violence, and girls who are typically high in social status, are at increased risk for using dating violence throughout adolescence. Adolescents who typically have high quality friendships and girls who typically have friends with pro-social beliefs are at decreased risk for using dating violence throughout adolescence. Significant within-person contemporaneous effects indicate that both boys and girls reported lower levels of dating violence than usual at times when they had more friends with pro-social beliefs, and reported higher levels of dating violence than usual at times when they had higher social status. None of the lagged effects were significant and none of the effects varied across grade. These findings suggest that the peer context plays an important role in the development of the perpetration of adolescent dating violence.

Association between binge drinking, type of friends and gender: a cross-sectional study among Brazilian adolescents

BACKGROUND

Hazardous drinking among adolescents is a major public health concern. The purpose of this study was to examine the prevalence of binge drinking/alcohol consumption and its association with different types of friendship networks, gender and socioeconomic status among students in Belo Horizonte, Minas Gerais, Brazil.

METHODS

We conducted a cross-sectional study on a representative random sample of 891 adolescents (41% male, aged 15-19 years) from public and private schools in 2009-2010. Information on friendship networks and binge drinking was collected using two validated self-administered questionnaires: the Integrated Questionnaire for the Measurement of Social Capital and the first 3 items in the Alcohol Use Disorders Identification Test (AUDIT C). We used the area-based Social Vulnerability Index (SVI), mother and father's educational background, and the type of school to assess socioeconomic status. The chi-squared test was used to examine the associations between sample characteristics or the type of friends and binge drinking (p-values <0.05 were considered statistically significant). Ordinal logistic regression was used to estimate the association between binge drinking and the independent variables.

RESULTS

A total of 321 (36%) adolescents reported binge drinking (5 or more drinks in one occasion), and among them, 233 (26.2%) adolescents reported binge drinking less than monthly to monthly, and 88 (9.9%) weekly to daily. Binge drinking was associated with being male (OR = 1.52, 95% CI 1.01-2.28) and with living in a low vulnerability area (having the best housing conditions, schooling, income, jobs, legal assistance and health) (OR = 1.66, 95% CI 1.05-2.62). Students who reported that their closest friends were from school (as opposed to friends from church) had an increased risk of binge drinking (OR = 3.55, 95% CI 1.91-5.87). In analyses stratified by gender, the association was significant only among the female students.

CONCLUSIONS

The prevalence of binge drinking was high in this sample of Brazilian adolescents, and gender, low social vulnerability and friendship network were associated with binge drinking.

The role of academic motivation in high school students' current and lifetime alcohol consumption: adopting a self-determination theory perspective

OBJECTIVE

The current study investigated the relationship between different types of academic motives-specifically, intrinsic motivation, introjected regulation, and external regulation-and high school students' current and lifetime alcohol consumption.

METHOD

One thousand sixty-seven high school students completed measures of academic motivation, other school-related factors, and lifetime and current alcohol consumption.

RESULTS

Using structural equation modeling, different types of motivation and school-related factors were differentially related to student drinking. Specifically, intrinsic motivation was negatively related to lifetime and current alcohol consumption. External regulation, on the other hand, was positively associated with current drinking. Grade point average was the only school-related factor related to student alcohol use.

CONCLUSIONS

These findings suggest that motivation is an important construct to consider in predicting students' alcohol use, even when other more commonly studied educational variables are considered. In addition, it supports the adoption of a motivation framework that considers different types of motivation in understanding the relationship between academic motivation and alcohol use. Suggestions for incorporating the self-determination model of motivation into studies of alcohol and substance use, as well as potential impacts on intervention efforts, are discussed. In particular, it may be important to foster only certain types of motivation, rather than all types of academically-focused motives, in efforts to deter alcohol use.

To drink or not to drink: motives and expectancies for use and nonuse in adolescence

Drinking motives have a prominent role in cognitive models of adolescent and adult alcohol decision-making (Cooper, Russell, Skinner, & Windle, 1992; Cooper, 1994). The complementary construct of motivation not to drink has received less attention (Epler, Sher & Piasecki, 2009). We examined how abstinence motives interacted with drinking motives and alcohol expectancies to predict alcohol consumption in samples of US high school students (N>2500). Nondrinking motives predicted lower rates of lifetime and current alcohol use. Motives not to drink interacted with specific drinking motives, like social and coping motives, and alcohol expectancies to predict certain aspects of drinking behavior. For example, motives not to drink had the greatest impact on youth with weaker social motivations. Findings highlight the distinction between motives not to drink and other alcohol-related cognitions in predicting adolescent alcohol consumption. This work not only supports the utility of this construct in developing models of youth alcohol-related decision-making but also has implications for prevention programming.