The early use of alcohol and tobacco: its relation to children's competence and parents' behavior

The moderating effects of alcohol use with and without parent permission on alcohol risk communication in early adolescence

The frequency of parental alcohol risk communication (ARC) is considered an integral component of socializing youth about alcohol, but the literature offers mixed findings on whether such communication is protective. Early adolescents' prior drinking experiences may moderate the effectiveness of ARC, but evidence for such an interaction is inconsistent. One limitation of this work considering prior drinking experience is that it has not distinguished drinking with versus without parental permission. Parents are one of the earliest sources of information about alcohol use and many parents view allowing adolescents to drink alcohol with permission as a harm reduction strategy, despite some work suggesting the opposite effect. Using a random effects multilevel regression, we tested the unique moderating effects of drinking with and without parental permission on the prospective association between alcohol risk communication and later drinking without parental permission. Adolescent and parent dyads completed 3 annual assessments (first assessment mean age = 12.6, 52% girls, 76% White/non-Hispanic). Results supported a three-way interaction. There was a modest protective effect of parental ARC on later adolescent drinking, but only for adolescents who had prior experience drinking both with and without parental permission. For all other combinations of prior drinking experience, parental communication was not prospectively related to later drinking. These results help clarify the mixed literature on alcohol communication and suggests that ARC may help reduce some of the risk associated with allowing youth to drink alcohol but only for youth who also have experience with alcohol outside of parental supervision.

Impact of Individual, Familial and Parental Factors on Adolescent Smoking in Turkey

The burden of adolescent cigarette smoking is substantial. We assess mothers’ and fathers’ attitudes and behaviours on adolescent smoking using a cross-sectional study of n = 707 adolescents. Associations between parental attitudes and behaviours in adolescent smoking were assessed using logistic regression separately for boys and girls. Occasional alcohol use by both parents increased odds of smoking once a day (OR = 2.44, 95% CI 1.26, 4.71, OR = 1.51, 95% CI 0.97, 2.35, respectively). Fathers smoking increased odds for girls (OR = 1.59, 95% CI 1.01, 2.52). A democratic mother decreased odds for boys (OR = 0.32, 95% CI 0.10, 0.93) whereas a protective, demanding mother increased the odds for girls (OR = 8.65, 95% CI 1.38, 54.22). Public health smoking prevention programs could support changing parental behaviours and attitudes in early years to address this burden in countries with authoritarian parenting styles.

Adolescent drug use initiation and transition into other drugs: A retrospective longitudinal examination across race/ethnicity

BACKGROUND

Understanding adolescent drug use mechanisms is critical for drug use prevention. Although some theories such as the gateway theory suggest that drug users gradually transition into using more addictive drugs, there is no consensus about such a hypothesis. One important factor that hinders the advancement of knowledge in this area is the scarcity of longitudinal studies examining the type of drugs adolescents initially use and the different pathways adolescents take to transition into using other drugs as they grow older.

METHODS

Using the pooled sample of adolescent dug users (14-17 years old; n = 10,644) from the National Survey on Drug Use and Health (2015-2018), we constructed longitudinal data on adolescents' illicit drug use history other than the use of tobacco and alcohol based on the age of drug initiation. This allowed us to investigate what drugs were initially used by adolescents, how the use of these drugs may have progressed into a new drug, and whether there were racial/ethnic differences in the initiation and progression. The retrospective longitudinal data analyses applied life table method and Cox regression models.

RESULTS

Two thirds of the adolescent drug users initiated their drug use trajectories with marijuana, one quarter with inhalants, and the remaining with hallucinogens, prescription drugs, and hard drugs. Adolescent drug users who initiated with different drugs showed unique trajectories to the use of a new drug. By year 8, the probability of using a new drug was about 40% and 70% to 80% for adolescents who initiated with inhalants and other drugs, respectively. The probability of using a new drug for adolescents who initiated with marijuana and inhalants accumulated stably over time, and its difference with that of other drug users diminished over time. The multivariate Cox regression models suggest the observed discrepancies generally held after controlling for covariates. There were also racial/ethnic differences in adolescent drug use initiation and progression, with Black/African American adolescents being the least likely to switch to the use of a new drug.

CONCLUSION

Adolescents' initial use of marijuana and inhalants may lead to substantial risks of using other drugs over time. It is therefore important to screen adolescent drug use comprehensively and provide early interventions to prevent an escalation to more detrimental drugs. The findings provide new evidence to support aspects of both the gateway and generalized risk drug use theories.

A review of psychosocial factors linked to adolescent substance use

PURPOSE

Informed by ecological theories and models of influence, this review discusses various psychosocial risk and protective factors that contribute to adolescent substance use behavior. Given typical patterns of substance use initiation during this developmental period, an emphasis is placed on alcohol, cigarette, and marijuana use.

FINDINGS

Consistent with bioecological theories, peers and parents tend to have the strongest effect on adolescent substance use behavior. Influences can be both direct, such as offers and availability to use substances, as well as indirect influences, such as the perception of substance use approval. Schools and neighborhoods also contribute to adolescent substance use behavior, but this effect is often less direct. Moreover, the effect of neighborhoods on adolescent behavior reflects both structural components (e.g., neighborhood racial composition, teacher-student ratios) in addition to social process (e.g., neighborhood social cohesion, school connectedness). A review of parallel studies conducted with animals is also provided.

SUMMARY

Adolescent substance use behavior does not occur in a vacuum. Investigations must encompass the relevant social ecologies that affect adolescent behavior, including family, peer, school, and neighborhood contexts to provide a more complete understanding of substance use etiology.

Perceptions of alcohol use among injury patients and their family members in Tanzanian society

Alcohol is one of the leading causes of death and disability worldwide. Rates of alcohol abuse in Moshi, Tanzania, are about 2.5 times higher than the Tanzanian average. We sought to qualitatively assess the perceptions of alcohol use among injury patients in Moshi, including availability, consumption patterns, abuse, and treatments. Participants were Emergency Department injury patients, their families, and community advisory board members. Participants were included if they were ≥18 years of age, a patient or patient's family member seeking care at the Kilimanjaro Christian Medical Center Emergency Department, Moshi, Tanzania, for an acute injury, clinically sober at the time of enrollment, medically stable, able to communicate in Swahili and consented to participate. Focus group discussions were audiotaped, transcribed, translated, and analyzed in parallel using an inductive thematic content analysis approach. Resultant themes were then reanalyzed to ensure internal homogeneity and external heterogeneity. Fourteen focus group discussions, with a total of 104 participants (40 patients, 50 family members, 14 community advisory board members), were conducted. Major themes resulting from the analysis included: 1) Early/repeated exposure; 2) Moderate use as a social norm with positive attributes; 3) Complications of abuse are widely stigmatized; and 4) Limited knowledge of availability of treatment. Our findings suggest that, among our unique injury population and their families, despite the normalization of alcohol-related behaviors, there is strong stigma toward complications stemming from excess alcohol use. Overall, resources for alcohol treatment and cessation, although broadly desired, are unknown to the injury population.

Associations between self-esteem and smoking and excessive alcohol consumption in the UK: A cross-sectional study using the BBC UK Lab database

Introduction

There is mixed evidence regarding the associations between self-esteem and smoking and excessive alcohol consumption. This study aimed to investigate whether self-esteem is associated with smoking status and alcohol consumption in a large sample of adults in the United Kingdom after adjusting for age, sex, socio-economic status and depressed mood.

Methods

Design: Cross-sectional correlational study conducted under the aegis of the British Broadcasting Corporation (BBC) between 2009 and 2013.Participants: 187,398 respondents (67.9% female) with a mean age of 32.82 years (SD = 12.41) providing complete data.Setting: UK.

Measures

Online self-report questionnaire. The outcomes were smoking status (current smoker, ever smoker) and alcohol consumption (current drinker, excessive drinker); the input variable was self-esteem measured using a Single Item Self-Esteem Scale; covariates were age, sex, SES, and depressed mood measured using a single item question.

Results

The odds of being an ever smoker and a current smoker were greater in people with lower self-esteem (AdjOR 0.97; 95% CI 0.95-0.99, Cohen's d = -0.02; and AdjOR 0.96; 95% CI 0.94-0.99, Cohen's d = -0.02 respectively). The odds of being a current drinker were lower in people with lower self-esteem (AdjOR 1.20, 95% CI 1.17-1.24, Cohen's d = 0.10) while being an excessive drinker was associated with lower self-esteem (β = -0.13, p < 0.001, F(5, 187392) = 997.14, p < 0.001, Cohen's d = 0.3).

Conclusions

Lower self-esteem appears to be positively associated with ever- and current smoking and excessive alcohol consumption and negatively associated with current alcohol consumption.

Adolescent Tobacco and Betel Nut Use in the US-Affiliated Pacific Islands: Evidence From Guam

PURPOSE

To determine the prevalence of, and the risk and protective factors associated with, tobacco product use among adolescents in Guam, a US-Affiliated Pacific Island (USAPI) territory. To examine disparities in risk and protective factors across indigenous and nonindigenous groups.

DESIGN

Quantitative; cross-sectional.

SETTING

Middle and high schools in Guam.

SAMPLE

The Global Youth Tobacco Survey sample included a representative sample of 2449 6th to 12th graders (71% response rate). Sample for the supplemental study included 670 middle school students (76% response rate across randomly selected classrooms).

MEASURES

Self-reported measures of lifetime and past 30-day tobacco and betel nut use, social competence, resistance self-efficacy, risk perceptions, friend and family tobacco product use, and ease of access to tobacco products.

ANALYSIS

Multilevel logistic regression and analysis of covariance.

RESULTS

The prevalence rates of current cigarette, smokeless tobacco, and e-cigarette use among middle school students were 8%, 8%, and 25%, respectively. Ability to resist social pressure to use tobacco/betel nut use was strongly associated with lower likelihood of tobacco (odds ratio [OR] = 0.76; 95% confidence interval [CI]: 0.68-0.84) and betel nut use (OR = 0.74; 95% CI: 0.67-0.82). Indigenous Pacific Islanders scored significantly lower on protective and higher on risk factors.

CONCLUSION

Tobacco product use rates among Guam middle school students appear to be 4 to 5 times higher than the US national average rates. There is an urgent need for developing tobacco and betel nut use prevention programs for USAPI youth that are tailored to the needs of indigenous Pacific Islanders.

Dimensions of the Parent-Child Relationship: Effects on Substance Use in Adolescence and Adulthood

BACKGROUND

Several studies have uncovered a relationship between parenting styles and the likelihood that adolescents use tobacco, alcohol or illegal drugs.

OBJECTIVES

This paper extends existing research in two ways. First, we consider a longer time-frame, investigating the relationship between parenting in adolescence and substance use in adulthood. Second, we explore the pathways by which this relationship is expressed, in particular the extent to which the relationships in question are mediated by age at first use and depression.

METHODS

Our analysis is based on data from the National Longitudinal Study of Adolescent Health (Add Health), N = 2954, and is conducted using structural equation modeling (SEM). We consider warmth and control as distinct dimensions of parenting, as well as a typology of parenting which combines the two dimensions.

RESULTS

Warmth is associated with reduced risks of problem substance use in adulthood, via reduced risks of early initiation and a lower risk of depression. Parental control also has a protective effect via reduced risks of early initiation, but this is offset by a detrimental effect on depression, particularly in the case of older adolescents. We also find that indulgent parenting is not associated with extra risk of any kind compared with the authoritative style, whereas authoritarian and neglectful styles are. Conclusions/Importance: The nexus of relationships which we uncover has implications for policy aimed at reducing substance use in the longer term, suggesting that initiatives to promote warm and responsive parenting may be most effective in reducing the risks of later substance use problems.

Exposure to drinking mediates the association between parental alcohol use and preteen alcohol use

OBJECTIVE

The aim of the present study was to test the link between exposure to parental alcohol use (i.e., preteens seeing their parents drinking) and preteen's alcohol use. Specifically, this study aimed to (a) replicate the association between parental alcohol use and preteen alcohol use and (b) test whether alcohol use exposure mediated this association.

METHOD

Families were recruited from five regions in the Netherlands from 104 schools that agreed to participate. Preteens (N = 755, M_age = 11.27, SD = 0.56, 45.8% boys) and their mothers (N = 755) participated in the study. Preteens reported lifetime alcohol use and parental alcohol use exposure. Mothers reported on alcohol use for both parents. Structural Equation Modelling was used to assess direct and mediated paths between parental alcohol use, preteen's exposure to alcohol use and preteen alcohol use in one model.

RESULTS

Unexpectedly, father's alcohol use was negatively associated (β = -0.121, p = .012) and mother's alcohol use was not associated (β = 0.056, p = .215) with preteen's alcohol use. A positive indirect effect emerged through alcohol use exposure, showing that exposure to father's alcohol use mediated the association between parent's and preteen's alcohol use (β = 0.064, p = .001). This effect was absent for mother's alcohol use (β = 0.026, p = .264). Gender differences were non-significant.

CONCLUSIONS

Parental alcohol exposure positively mediated the association of parental alcohol use with preteen's alcohol use. These effects were found for both boys and girls and were most robust for father's drinking. The findings might provide clues for preventive action, for example, by emphasizing that exposure should be restricted to prevent preteen's alcohol use.

How do tobacco power walls influence adolescents? A study of mediating mechanisms

OBJECTIVES

Tobacco power walls display hundreds of tobacco products and are known to be a key part of the impact of point-of-sale tobacco advertising on risk for smoking in adolescents. The current study examined factors that are hypothesized to mediate the effect of tobacco power wall exposure on adolescents' susceptibility for smoking in the future.

METHOD

Participants (N = 148) aged 11-17 years were invited to shop in the RAND StoreLab, a life-sized replica of a convenience store. They were randomized to 1 of 2 conditions: one in which the power wall was located in its typical position behind the cashier and the other in which it was hidden behind an opaque wall. Participants shopped in the RAND StoreLab and then completed measures of susceptibility for smoking in the future, perceived smoking norms, and perceived accessibility of cigarettes. Participants' movements in the store were electronically tracked.

RESULTS

Having the tobacco power wall behind the cashier increased adolescents' susceptibility for smoking in the future by 14.3% (total effect) compared with when the power wall was hidden (p = .01), and 14% of this effect was mediated by participants' perceived smoking norms. Time spent in front of the cashier and perceived accessibility of cigarettes did not play a role in the association between study condition and susceptibility for smoking in the future.

CONCLUSIONS

The tobacco power wall increases adolescents' smoking risk, and this effect is partly explained by the effect of the power wall on adolescents' perceptions of how normative smoking is. (PsycINFO Database Record

Early alcohol use with parental permission: Psychosocial characteristics and drinking in late adolescence

The earliest experiences with alcohol for many children occur in the family context with parental supervision. The current study examined individual and sociocultural characteristics associated with early (prior to age 13years) sipping and tasting alcohol with parental permission in two longitudinal community samples. Early sipping/tasting was also tested as a predictor of frequency and quantity of alcohol use, and alcohol-related problems seven years later in late adolescence. Early sipping/tasting with parental permission was associated with a sociocultural context supportive of alcohol use (e.g., parental alcohol use, permissive rules about alcohol use in the home, parental attitudes about underage drinking, perceived peer norms), adolescent sensation seeking and disinhibition (e.g., surgency, externalizing behavior) and appraisals of alcohol (negative outcome expectancies and negative implicit alcohol associations). Early sipping/tasting predicted increased frequency and quantity of alcohol consumption, and increased alcohol-related problems in late adolescence, even after controlling sociocultural and individual difference variables. Findings suggest that early sipping/tasting with parental permission is not benign and is a viable target for preventive interventions.

Child maltreatment and age of alcohol and marijuana initiation in high-risk youth

INTRODUCTION

Youth with a history of child maltreatment use substances and develop substance use disorders at rates above national averages. Thus far, no research has examined pathways from maltreatment to age of substance use initiation for maltreated youth. We examined the longitudinal impact of maltreatment in early childhood on age of alcohol and marijuana use initiation, and whether internalizing and externalizing behaviors at age 8 mediates the link between maltreatment and age of substance use initiation.

MATERIALS AND METHODS

Data were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) at ages 4, 8, 12, and 18. Maltreatment was assessed through reviews of administrative records and youth self-reports. Behavior problems were assessed with the Child Behavior Checklist. Age of substance use initiation was assessed with the Young Adult version of the Diagnostic Interview Schedule for Children.

RESULTS

Path analyses indicated mediated effects from a history of maltreatment to age at first alcohol and marijuana use through externalizing behaviors. Considering type of maltreatment, direct effects were found from physical abuse to age of alcohol initiation, and mediated effects were found from sexual abuse and neglect to initial age of alcohol and marijuana use through externalizing behaviors. Direct effects for marijuana use initiation and indirect effects through internalizing behavior problems were not significant for either substance.

CONCLUSIONS

Externalizing behavior is one pathway from childhood maltreatment to age of substance use initiation. Services for maltreated youth should incorporate substance use prevention, particularly among those with early externalizing problems.

Social context has differential effects on acquisition of nicotine self-administration in male and female rats

RATIONAL

Smoking typically begins during adolescence or early adulthood in a social context, yet the role of social context in animal models is poorly understood.

OBJECTIVES

The present study examined the effect of social context on acquisition of nicotine self-administration.

METHODS

Sixty-day-old male and female Sprague-Dawley rats were trained to press a lever for nicotine (0.015 mg/kg, IV) or saline infusions (males only) on a fixed ratio (FR1) schedule of reinforcement across nine sessions in duplex chambers that were conjoined with either a solid wall or a wall containing wire mesh creating a social context between rat dyads (social visual, auditory, and olfactory cues). In a subsequent experiment, sex differences and dose-dependent effects of nicotine [0 (saline), 0.015 or 0.03 mg/kg, IV] were directly compared in rats trained in the isolated or social context on a schedule progressing from FR1 to FR3. These rats were given 20 sessions followed by 3 extinction sessions.

RESULTS

We consistently found transient social facilitation of low-dose nicotine self-administration in males during the first session. However, across training overall, we found social suppression of nicotine intake that was most prominent in females during later sessions.

CONCLUSIONS

Collectively, these findings suggest that at the age of transition from adolescence to adulthood, a social context enhances the initial reinforcing effects of nicotine in males, but protects against nicotine intake during later sessions especially in females. These findings highlight the importance of sex and social context in studying neural mechanisms involved in initiation of nicotine use.

The assessment of status of tobacco smoking among urban primary schoolchildren in Madagascar

The prevalence of tobacco smoking among adolescents aged 13-15 years old in Madagascar was previously reported to be higher than the average in other African regions. A preventive approach is urgently needed to avoid the initiation of early tobacco smoking. Therefore, the aims of this study were to evaluate the status of tobacco smoking among primary schoolchildren in Madagascar and explore the factors associated with initiation of tobacco smoking in the young. This study was conducted in the Mahajanga region of Madagascar. Three primary schools in this region and children of both genders between the ages of nine to 12 years old were randomly selected and approached to participate in this study. A self-administered questionnaire modified from the Global Youth Tobacco Survey Core Questionnaire 2007 was used to assess the status of tobacco smoking among primary schoolchildren. A total of 150 schoolchildren (14.0%) declared that they had smoked tobacco, with 30% starting to smoke tobacco at the age of seven or younger. The prevalence of tobacco smoking was lower among schoolchildren with non-smoking parents (p < 0.001) or non-smoking close friends (p < 0.001). Furthermore, schoolchildren's antismoking intention (p < 0.001) and their knowledge about the harmfulness of tobacco (p = 0.009) had significant effects on the prevalence of tobacco smoking. The results of this study indicate that tobacco smoking among schoolchildren in Madagascar may be influenced by peers, or parents, as well as smoking intention and knowledge about the harmfulness of tobacco use.

Parental Style and Its Association With Substance Use in Argentinean Youth

BACKGROUND

In Europe and the United States, family relationships and parenting behavior can influence youth substance use, but less is known about their influence in Latin American countries.

OBJECTIVE

To explore whether parenting behavior is associated with substance use among Latin American youth.

METHODS

A cross-sectional, school-based survey of middle-school youth (n = 3172) in three Argentinian cities queried tobacco, alcohol, and drug use using items adapted from global youth surveys. Parenting behavior was assessed with previously validated items that tapped into demandingness and responsiveness, separately for mothers and fathers. Multilevel logistic regression models assessed associations between parenting behavior and substance use after adjusting for student characteristics, socioeconomic indicators, sensation seeking, and smoking amongst peers and family members.

RESULTS

Substance use prevalence was 10% for current smoking, 32% for current drinking alcohol, 17% for past 30-day binge drinking (≥5 drinks), and 8% for previous year illicit drug use (marijuana or cocaine). Greater maternal demandingness was independently associated with lower likelihood of current smoking (adjusted odds ratio [AOR] = 0.77; 95% confidence interval (CI): 0.64-0.92), current drinking (AOR = 0.81; 95% CI: 0.71-0.92), binge drinking (AOR = 0.77; 95% CI: 0.66-0.99, and drug use (AOR = 0.71; 95% CI: 0.61-0.83). No other parenting behavior were independently associated with substance use, except for paternal demandingness and binge drinking (AOR = 0.84; 95% CI: 0.74-0.97). For all outcomes, no interactions were found between parenting behavior and student gender.

CONCLUSIONS

Among Argentine adolescents, maternal demandingness was the strongest and most consistent correlate of substance use, regardless of adolescent substance use behavior or gender.

Intergenerational Roots of Early Onset Substance use

This study examines intergenerational continuity in drug use across three generations of respondents in the same family. The data are from the Rochester Intergenerational Study, an ongoing, prospective, multi-generational investigation using a community-based sample. Our findings indicate that there is intergenerational continuity in drug use for Generation 2, or G2 daughters, but not sons, of G1 mothers. Use by G3 is significantly influenced by both G2 mothers and G1 grandmothers. However, for children of G2 fathers, neither prior generation's substance use is significantly related to G3 use. There is some indication that the absence of an effect from G2 fathers to G3 drug use is due to the number of nonresident fathers in the sample.

Does High Self-Esteem Cause Better Performance, Interpersonal Success, Happiness, or Healthier Lifestyles?

Self-esteem has become a household word. Teachers, parents, therapists, and others have focused efforts on boosting self-esteem, on the assumption that high self-esteem will cause many positive outcomes and benefits—an assumption that is critically evaluated in this review.

Appraisal of the effects of self-esteem is complicated by several factors. Because many people with high self-esteem exaggerate their successes and good traits, we emphasize objective measures of outcomes. High self-esteem is also a heterogeneous category, encompassing people who frankly accept their good qualities along with narcissistic, defensive, and conceited individuals.

The modest correlations between self-esteem and school performance do not indicate that high self-esteem leads to good performance. Instead, high self-esteem is partly the result of good school performance. Efforts to boost the self-esteem of pupils have not been shown to improve academic performance and may sometimes be counterproductive. Job performance in adults is sometimes related to self-esteem, although the correlations vary widely, and the direction of causality has not been established. Occupational success may boost self-esteem rather than the reverse. Alternatively, self-esteem may be helpful only in some job contexts. Laboratory studies have generally failed to find that self-esteem causes good task performance, with the important exception that high self-esteem facilitates persistence after failure.

People high in self-esteem claim to be more likable and attractive, to have better relationships, and to make better impressions on others than people with low self-esteem, but objective measures disconfirm most of these beliefs. Narcissists are charming at first but tend to alienate others eventually. Self-esteem has not been shown to predict the quality or duration of relationships.

High self-esteem makes people more willing to speak up in groups and to criticize the group's approach. Leadership does not stem directly from self-esteem, but self-esteem may have indirect effects. Relative to people with low self-esteem, those with high self-esteem show stronger in-group favoritism, which may increase prejudice and discrimination.

Neither high nor low self-esteem is a direct cause of violence. Narcissism leads to increased aggression in retaliation for wounded pride. Low self-esteem may contribute to externalizing behavior and delinquency, although some studies have found that there are no effects or that the effect of self-esteem vanishes when other variables are controlled. The highest and lowest rates of cheating and bullying are found in different subcategories of high self-esteem.

Self-esteem has a strong relation to happiness. Although the research has not clearly established causation, we are persuaded that high self-esteem does lead to greater happiness. Low self-esteem is more likely than high to lead to depression under some circumstances. Some studies support the buffer hypothesis, which is that high self-esteem mitigates the effects of stress, but other studies come to the opposite conclusion, indicating that the negative effects of low self-esteem are mainly felt in good times. Still others find that high self-esteem leads to happier outcomes regardless of stress or other circumstances.

High self-esteem does not prevent children from smoking, drinking, taking drugs, or engaging in early sex. If anything, high self-esteem fosters experimentation, which may increase early sexual activity or drinking, but in general effects of self-esteem are negligible. One important exception is that high self-esteem reduces the chances of bulimia in females.

Overall, the benefits of high self-esteem fall into two categories: enhanced initiative and pleasant feelings. We have not found evidence that boosting self-esteem (by therapeutic interventions or school programs) causes benefits. Our findings do not support continued widespread efforts to boost self-esteem in the hope that it will by itself foster improved outcomes. In view of the heterogeneity of high self-esteem, indiscriminate praise might just as easily promote narcissism, with its less desirable consequences. Instead, we recommend using praise to boost self-esteem as a reward for socially desirable behavior and self-improvement.

A Parenting Program to Promote an Alcohol-Free Childhood: Influence on Parents' Readiness to Prevent Child Sipping

OBJECTIVE

This study reports effects of a parenting program to increase parents' readiness to socialize their children against early alcohol use.

METHOD

A two-group randomized controlled trial was conducted with a nonprobability sample of 816 mothers. Participants were recruited from school districts located primarily in North Carolina and completed telephone interviews at baseline and 6 and 18 months after delivery of a parenting program to the treatment group mothers. Mothers reported on psychological indicators of readiness to prevent child alcohol use (e.g., attitude toward child sipping) and on parenting behaviors with potential to prevent such use (e.g., setting rules about child sipping). Multivariate analysis of variance models tested program effects on composite sets of psychological and behavioral outcomes; step-down analysis identified the individual outcomes driving overall program effects. Moderation of program effects by mother's alcohol use, established beliefs about the consequences of child sipping, educational attainment, and race/ethnicity was tested.

RESULTS

The program had significant overall effects on each composite set of psychological and behavioral outcomes. Effects on psychological outcomes were moderated by mother's alcohol use, beliefs about the consequences of child sipping, and educational attainment; effects on the behavioral outcomes were moderated by mother's race/ethnicity.

CONCLUSIONS

The parenting program had favorable, sustained effects on targeted outcomes intended to increase parental readiness to socialize children against early alcohol use. Mothers expected to be least receptive to the program-those who, at baseline, believed that allowing children to sip alcohol can have beneficial consequences-were most changed by it.

Drug-Resistance Strategies of Early Adolescents in Mexico: Gender Differences in the Influence of Drug Offers and Relationship to the Offeror

To address increases in substance use among Mexican adolescents, particularly females, US prevention programs are being adapted to the Mexican cultural context. Understanding how responses to substance offers by Mexican adolescents are shaped by gender and relationships to those making offers is an important step in the adaptation process. Using data from Guadalajara, Mexico middle schools (N = 431), this pilot study tested for gender differences in the use of several drug resistance strategies commonly taught in US substance abuse prevention interventions. Results indicated that the drug-resistance strategies of Mexican early adolescents differ by gender, type of substance offered, and the youth's relationship to the offeror. Contrary to previous research on older Mexican adolescents, in this sample, females received more substance offers from age peers than males did, and employed a wider repertoire of drug-resistance strategies, including active strategies such as direct refusals. Gender differences in use of the strategies persisted after controlling for number of offers received. There were gender differences in the conditional effects of greater exposure to offers. A larger volume of alcohol and cigarette offers predicted females' use of direct strategies more strongly than for males, but less strongly than males for marijuana offers. Females' use of drug resistance strategies was more strongly associated with offers from family adults, siblings, and cousins, while males' use of strategies was predicted more strongly by offers from nonfamily adults. Interpretations and prevention implications are discussed in light of changing gender norms in Mexico and gendered patterns of substance use.

The Relationship Between Peer, Parent, and Grandparent Norms and Intentions to Use Substances for Urban American Indian Youth

Peer, parent, and grandparent norms may be a protective factor for American Indian (AI) youth intentions to use substances, but little research has explored these influences on urban AI youth. Using OLS regression, a secondary data analysis examined the relationship between peer, parent and grandparent substance use norms, and intentions to use substances (N = 148). Findings indicated that grandparent and peer norms were the strongest predictors of intentions to use substances. Implications of these results include the need for concerted, culturally focused efforts that address AI youth substance use by targeting AI peer and family networks.

Antecedent predictors of children's initiation of sipping/tasting alcohol

BACKGROUND

Sipping or tasting alcohol is one of the earliest alcohol-use behaviors in which young children engage, yet there is relatively little research on this behavior. Previous cross-sectional analyses determined that child sipping or tasting is associated with the child's attitude toward sipping and with a family environment supportive of alcohol use, but not with variables reflecting psychosocial proneness for problem behavior as formulated in Problem Behavior Theory (Jessor and Jessor, Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth, 1977, Academic Press, New York). This study extended these analyses longitudinally to identify antecedent predictors of the childhood initiation of sipping or tasting alcohol in a multiwave study.

METHODS

A sample of 452 children (238 girls) aged 8 or 10 and their families was drawn from Allegheny County, PA, using targeted-age directory sampling and random digit dialing procedures. Children were interviewed using computer-assisted interviews. Antecedent variables collected at baseline (Wave 1) were examined as predictors of the initiation of sipping/tasting alcohol in childhood (before age 12) among Wave 1 abstainers (n = 286).

RESULTS

Ninety-four children initiated sipping/tasting alcohol in a nonreligious context between baseline and turning age 12. Initiation of sipping/tasting did not generally relate to baseline variables reflecting psychosocial proneness for problem behavior. Instead, as found in the previous cross-sectional analyses, the variables most predictive of initiating sipping/tasting were perceived parents' approval for child sipping, parents' reported approval for child sipping, parents' current drinking status, and children's attitudes toward sipping/tasting alcohol.

CONCLUSIONS

These longitudinal analyses replicate the earlier cross-sectional results. Young children's sipping/tasting of alcohol reflects parental modeling of drinking and parental approval of child sipping and does not represent a precocious manifestation of a psychosocial proneness to engage in problem behavior.

Evaluating a model linking assessed parent factors to four domains of youth risky driving

Motor vehicle collisions are the leading cause of death in youth aged 15-19. Research has consistently shown that driver education programs do not result in safer youth driving. Indeed, the biggest predictor of collisions involving youth is parental history of collisions. The current study examined how parental modeling of and teaching about risky driving behaviors related to youth practices within four domains of risky driving (aggressive, substance use, distracted, moving violations), and evaluated whether the Prototype-Willingness Model explains links from parent to teen driving practices. Participants (N=432) were undergraduate students (mean age 18 years, age range 17-22 years) who had obtained their G2 driver's license within the past year; the G2 driver's license allows youth to drive alone on all municipal roads, with some restrictions on their blood alcohol level and the number of passengers they can carry. Results revealed that parental modeling was more predictive than parental teaching for all domains of risky driving examined. Youth whose parents modeled risky driving behaviors were found to be more likely to have engaged in those risky driving behaviors in the past, as well as to be more willing to engage in the behaviors in the future. The Prototype-Willingness Model was not a good fit to explain these relations. Findings from this study highlight the role parents play in the development of youth risky driving practices.

Parental socialization and children's susceptibility to alcohol use initiation

OBJECTIVE

This study examined relations between children's susceptibility to alcohol use initiation and parents' alcohol-specific beliefs, attitudes, and practices and whether these relations vary by parental alcohol use.

METHOD

The sample comprised 1,050 pairs of mothers or mother surrogates and their third-grade children (51.8% female) recruited for a 4-year intervention trial. Families were recruited from school districts located primarily in North Carolina; the school districts provided permission for study recruitment materials to be distributed to families but were not otherwise involved in the research. Data are from the baseline cross-sectional telephone interviews conducted with the mothers and children. Children's susceptibility to alcohol use initiation is based on child reports, and parental alcohol-specific beliefs, attitudes, and practices are based on maternal reports.

RESULTS

All parental alcohol socialization attributes were statistically significantly associated as hypothesized with child susceptibility to alcohol use initiation. In the final full model, the mother's disapproving attitude about child sipping and the interaction between mother-child communication and parental alcohol use frequency were uniquely significantly associated with child susceptibility. Talking with the child about harmful consequences of alcohol use was associated with reduced child susceptibility in families where parents drank alcohol more frequently but had no relationship with child susceptibility in families where parents drank infrequently.

CONCLUSIONS

The normative interactions that parents have with their elementary school children may inhibit or facilitate children's susceptibility to alcohol use. To the extent that child susceptibility leads to early onset of use, prevention programs directed at parents to reduce child susceptibility are indicated.

Intergenerational transfer of smoking across three generations and forty-five years

OBJECTIVES

Although many have examined the linkages between smoking behaviors across 2 generations, few have examined these linkages among 3 generations.

METHODS

U.S. population representative data for 3 generations are drawn from the Panel Study of Income Dynamics (PSID) in order to examine whether smoking behaviors are passed down from generation to generation and the magnitude of the influence of smoking behaviors across generations (N = 830).

RESULTS

Results indicate direct linkages between both grandparent (G1) and parent (G2) smoking (OR = 4.53; 95% CI = 2.57-7.97) and parent (G2) and young adult offspring (G3) smoking (OR = 2.91; 95% CI = 1.60-5.31). Although the direct link between grandparent (G1) and grandchildren (G3) was not significant (OR = 2.25; 95% CI = 0.96-5.23, p < .10), mediation analyses reveal that the link between G3 and G1 smoking is significantly mediated by G2 smoking.

CONCLUSIONS

Regardless of generation, parent smoking behavior has a direct influence on offspring smoking behavior. The link between grandparent (G1) and grandchild (G3) smoking is mediated by parent (G2) smoking, suggesting that smoking behavior is passed from one generation to the next generation and in turn to the next generation.

The mediating role of alcohol-related memory associations on the relation between perceived parental drinking and the onset of adolescents' alcohol use

AIMS

The aim of the current study was to examine the mediating role of alcohol-related memory associations in the relation between perceived parental drinking and the onset of adolescents' alcohol use. Gender and grade were also included in the analyses.

DESIGN

We tested a mediation model within a structural path modelling framework using longitudinal data (two waves).

SETTING AND PARTICIPANTS

The sample consisted of 608 Canadian adolescents (42.9% boys), who did not have any alcohol experiences at the first measurement. The adolescents were recruited from all grades 7-9 classes in a large school district in western Canada.

MEASUREMENTS

Alcohol-related memory associations were tested with the Word Association Test. We used adolescent self-reports of alcohol use and parental drinking.

FINDINGS

Results clearly showed a mediation effect of alcohol-related memory associations [estimate = 0.023, 95% confidence interval (CI): 0.002-0.044). That is, parental drinking as perceived by the adolescent was related positively to alcohol-related memory associations, which in turn predicted adolescents' alcohol use a year later. Gender and grade were related to alcohol-related memory associations. That is, boys and adolescents of higher grades had more memory associations.

CONCLUSIONS

Children appear to form memory associations related to alcohol before they ever drink alcohol themselves, and these associations appear to mediate the link between their perceptions of their parents' drinking and their own initial alcohol use.

Letting children sip: understanding why parents allow alcohol use by elementary school-aged children

OBJECTIVES

To investigate prosipping beliefs about alcohol among parents and the relations among these beliefs, parents' alcohol-specific attitudes and practices, and children's reports of initiation of alcohol use.

DESIGN

Telephone interview study of parent-child dyads. Data for the present study are from the baseline interviews of a 4-year intervention trial.

SETTING

Southeastern United States.

PARTICIPANTS

One thousand fifty pairs of mothers or mother surrogates and their third-grade children who were recruited for the 4-year intervention trial.

MAIN OUTCOME MEASURES

Key measures from parents included prosipping beliefs (ie, beliefs that sipping alcohol has protective consequences for children), attitudes about children's sipping, and parenting practices that affect children's opportunity to try alcohol. The key measure from children was experience sipping beer, wine, or other types of alcohol.

RESULTS

The belief among mothers that allowing children to sip alcohol can have protective consequences for children, including making children less likely to drink as adolescents and making them better at resisting peer influence to drink, ranged from approximately 15% to almost 40%. Alcohol use was reported by 32.8% of children. A strong, significant association was found between parental prosipping beliefs and children's reported alcohol use.

CONCLUSIONS

The notion that early exposure to alcohol can be beneficial has a strong foothold among some parents of elementary school-aged children. More research is needed to understand how parents acquire prosipping beliefs and to test messages that effectively modify such beliefs and associated prosipping attitudes and practices among parents.

Starting to smoke: a qualitative study of the experiences of Australian indigenous youth

Background

Adult smoking has its roots in adolescence. If individuals do not initiate smoking during this period it is unlikely they ever will. In high income countries, smoking rates among Indigenous youth are disproportionately high. However, despite a wealth of literature in other populations, there is less evidence on the determinants of smoking initiation among Indigenous youth. The aim of this study was to explore the determinants of smoking among Australian Indigenous young people with a particular emphasis on the social and cultural processes that underlie tobacco use patterns among this group.

Methods

This project was undertaken in northern Australia. We undertook group interviews with 65 participants and individual in-depth interviews with 11 youth aged 13–20 years led by trained youth ‘peer researchers.’ We also used visual methods (photo-elicitation) with individual interviewees to investigate the social context in which young people do or do not smoke. Included in the sample were a smaller number of non-Indigenous youth to explore any significant differences between ethnic groups in determinants of early smoking experiences. The theory of triadic influence, an ecological model of health behaviour, was used as an organising theory for analysis.

Results

Family and peer influences play a central role in smoking uptake among Indigenous youth. Social influences to smoke are similar between Indigenous and non-Indigenous youth but are more pervasive (especially in the family domain) among Indigenous youth. While Indigenous youth report high levels of exposure to smoking role models and smoking socialisation practices among their family and social networks, this study provides some indication of a progressive denormalisation of smoking among some Indigenous youth.

Conclusions

Future initiatives aimed at preventing smoking uptake in this population need to focus on changing social normative beliefs around smoking, both at a population level and within young peoples’ immediate social environment. Such interventions could be effectively delivered in both the school and family environments. Specifically, health practitioners in contact with Indigenous families should be promoting smoke free homes and other anti-smoking socialisation behaviours.

Childhood attention-deficit/hyperactivity disorder (ADHD) and growth in adolescent alcohol use: the roles of functional impairments, ADHD symptom persistence, and parental knowledge

Research on the relation between childhood attention-deficit/hyperactivity disorder (ADHD) and adolescent alcohol use has found mixed results. Studies are needed that operationalize alcohol use in developmentally appropriate ways and that test theoretically plausible moderators and mediators in a longitudinal framework. The current study tested childhood ADHD as a predictor of alcohol use frequency at age 17 and age-related increases in alcohol use frequency, through adolescence for 163 adolescents with ADHD diagnosed in childhood and 120 adolescents without ADHD histories. Childhood ADHD did not predict either alcohol outcome. However, parental knowledge of the teen's friendships, activities, and whereabouts moderated the association such that childhood ADHD predicted alcohol use frequency at age 17 when parental knowledge was below median levels for the sample. Mediational pathways that explained this risk included social impairment, persistence of ADHD symptoms, grade point average, and delinquency. Social impairment was positively associated with alcohol use frequency through delinquency; it was negatively associated with alcohol use frequency as a direct effect independent of delinquency. These nuanced moderated-mediation findings help to explain previously inconsistent results for the ADHD-adolescent alcohol use association. The findings also imply that future research and intervention efforts should focus on ADHD-related social and academic impairments as well as symptom persistence and parenting efforts. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Influence of motion picture rating on adolescent response to movie smoking

OBJECTIVE

To examine the association between movie smoking exposure (MSE) and adolescent smoking according to rating category.

METHODS

A total of 6522 US adolescents were enrolled in a longitudinal survey conducted at 8-month intervals; 5503 subjects were followed up at 8 months, 5019 subjects at 16 months, and 4575 subjects at 24 months. MSE was estimated from 532 recent box-office hits, blocked into 3 Motion Picture Association of America rating categories: G/PG, PG-13, and R. A survival model evaluated time to smoking onset.

RESULTS

Median MSE in PG-13-rated movies was ∼3 times higher than median MSE from R-rated movies, but their relation with smoking was essentially the same, with adjusted hazard ratios of 1.49 (95% confidence interval [CI]: 1.23-1.81) and 1.33 (95% CI: 1.23-1.81) for each additional 500 occurrences of MSE respectively. MSE from G/PG-rated movies was small and had no significant relationship with adolescent smoking. Attributable risk estimates showed that adolescent smoking would be reduced by 18% (95% CI: 14-21) if smoking in PG-13-rated movies was reduced to the fifth percentile. In comparison, making all parents maximally authoritative in their parenting would reduce adolescent smoking by 16% (95% CI: 12-19).

CONCLUSIONS

The equivalent effect of PG-13-rated and R-rated MSE suggests it is the movie smoking that prompts adolescents to smoke, not other characteristics of R-rated movies or adolescents drawn to them. An R rating for movie smoking could substantially reduce adolescent smoking by eliminating smoking from PG-13 movies.

Developmental momentum toward substance dependence: natural histories and pliability of risk factors in youth experiencing chronic stress

BACKGROUND

Mitigation of substance use (SU) disorder (SUD) risk factors is a common goal of prevention. Research has clarified much about risk factors including their prediction of SU/SUD, associations with other etiological variables and mediation of SU outcomes. Greater understanding of the emergence of risk factors themselves may improve prevention. For example, in lieu of experimental data, the level of resistance to change of a risk factor (its pliability) could inform "dosage" of intervention needed to reduce the risk.

METHODS

Two attributes of 22 previously-documented predictors of SU/SUD were quantified: natural history (average age-related trend) and pliability (quantified using correlations between intercepts and growth parameters of hierarchical linear modeling trajectories). The longitudinal sample of 1147 8- through 16-year-olds were recruited from a northeastern summer camp for youth experiencing chronic stress due to one or more stressors (X¯=2.2stressors, SD=1.41) which typically last at least one year. Half were male, 69.3% were European-American, 8.5% were African-American, and the remaining were small proportions each of other or mixed races/ethnicities.

RESULTS

Average trajectories of 21 predictors correspond to increasing SUD risk with age. Predictor pliability varied greatly, ranging from extremely high for School Commitment to extremely low for Peer Pressure Susceptibility.

CONCLUSIONS

Results suggest different intervention strategies may be needed to manage risk factors over the long-term. To illustrate, maintaining a high school commitment appears to require boosters whereas reducing peer pressure susceptibility appears to require high initial "dosage" with less need for boosters.

Association between substance use and psychosocial characteristics among adolescents of the Seychelles

BACKGROUND

We examined the associations between substance use (cigarette smoking, alcohol drinking, and cannabis use) and psychosocial characteristics at the individual and family levels among adolescents of the Seychelles, a rapidly developing small island state in the African region.

METHODS

A school survey was conducted in a representative sample of 1432 students aged 11-17 years from all secondary schools. Data came from a self-administered anonymous questionnaire conducted along a standard methodology (Global School-based Health Survey, GSHS). Risk behaviors and psychosocial characteristics were dichotomized. Association analyses were adjusted for a possible classroom effect.

RESULTS

The prevalence of cigarette smoking, alcohol drinking and cannabis use was higher in boys than in girls and increased with age. Age-adjusted and multivariate analyses showed that several individual level characteristics (e.g. suicidal ideation and truancy) and family level characteristics (e.g. poor parental monitoring) were associated with substance use among students.

CONCLUSIONS

Our results suggest that health promotion programs should simultaneously address multiple risk behaviors and take into account a wide range of psychosocial characteristics of the students at the individual and family levels.

Preferred drug resistance strategies of urban American Indian youth of the southwest

This study explored the drug resistance strategies that urban American Indian adolescents consider the best and worst ways to respond to offers of alcohol, cigarettes, and marijuana. Focus group data were collected from 11 female and 9 male American Indian adolescents attending urban middle schools in the southwest. The youth were presented with hypothetical substance offer scenarios and alternative ways of responding, based on real-life narratives of similar youth. They were asked to choose a preferred strategy, one that would work every time, and a rejected strategy, one they would never use. Using eco-developmental theory, patterns in the preferred and rejected strategies were analyzed to identify culturally specific and socially competent ways of resisting substance offers. The youth preferred strategies that included passive, non-verbal strategies like pretending to use the substance, as well as assertive strategies like destroying the substance. The strategies they rejected were mostly socially non-competent ones like accepting the substance or responding angrily. Patterns of preferred and rejected strategies varied depending on whether the offer came from a family member or non-relative. These patterns have suggestive implications for designing more effective prevention programs for the growing yet underserved urban American Indian youth population.

"Immortal but frightened"-smoking adolescents' perceptions on smoking uptake and prevention

BACKGROUND

To curb the tobacco epidemic a combination of comprehensive interventions are needed at different levels. Smoking uptake is a multi-factorial process that includes societal factors as well as social and individual characteristics. An understanding of the process is essential in order to model interventions. The aim of this study was to explore the role of smoking for young smokers by focusing on the mechanisms that facilitate young people starting to smoke as well as what could have prevented them from starting.

METHODS

A qualitative research design using focus group discussions was chosen as the basis for a content analysis approach. Eight focus groups were conducted with five to six participants in each (four groups with boys, four with girls). The informants were purposively selected to represent smokers in the age range of 15-16 years within the county. The total number of group participants was 44; 21 were girls and 23 boys. The study was performed at 7-9th grade schools in Västerbotten County in northern Sweden.

RESULTS

Three themes related to different aspects of youth smoking behaviour emerged from the analysis. Theme 1) "gaining control" reflects what makes young people become smokers; theme 2) "becoming a part of the self" focuses on what facilitates youths to start smoking; theme 3) "concerned adults make a difference" indicates what may prevent them from starting.

CONCLUSION

Young smokers described starting to smoke as a means of gaining control of feelings and situations during early adolescence. Smoking adolescents expect adults to intervene against smoking. Close relations with concerned adults could be a reason for less frequent smoking or trying to quit smoking. Interventions aimed at normative changes, with consistent messages from both schools and parents about the negative aspects of tobacco seem to be a feasible approach for preventing youth from using tobacco.

Parental and offspring assessment of driving capability under the influence of drugs or alcohol: gender and inter-generational differences

The current study set to examine whether there are inter-generational and gender-based differences between family members self-assessing their ability to drive under normal conditions and while under the influence of either alcohol or drugs. Participants were 135 young-adults and both their parents, consisting 45 family triads, who received self-assessment questionnaires relating to their driving skills in various road scenarios. Each family triad was randomly assigned to one of three groups: either requested to base the assessments on normal driving conditions, or under the influence of either drugs or alcohol, thus forming a control group, and two experimental groups (alcohol and drugs), respectively. The findings indicate the assessments of both the alcohol and drugs groups were more severe than those of the control group. The alcohol group assessments were less strict than the drug group assessment (non-significantly). Inter-generational differences indicated that the parents' driving-skills assessments were lower than those of their offspring, corresponding with previous findings (Elkind, 1967; Finn and Bragg, 1986). A significant within-subject interaction has been found between the respondent's gender and familial relations regarding the self-assessment of driving skills: male respondents assessed better driving skills compared to the self estimates of both parents (which did not significantly differ). In contrast, female respondents' estimates did not differ from their fathers' and both fathers' and daughters' estimates were significantly higher than that of the mothers in each family.

Factors associated with adolescents' smoking experience and staying tobacco free

Introduction It is not expected that those who did not smoke during their adolescent years will start to smoke later in life. This study was planned to learn the thoughts of Turkish adolescents about staying tobacco free.Methods A descriptive study was conducted in 2007 with 866 adolescents aged 11 to 14 years. On a self-administered questionnaire, non-smoker students answered both multiple choice and open-ended questions about why they would not smoke in the future. The Chi-square test and logistic regression analysis was used for statistical assessment. For the answers to the open-ended questions, thematic analysis was applied.Results The mean age of the participants was 12.84 ± 1.14 years. The incidence of a smoking experience at least once in the participant's lifetime was 12% and the rate of current smoking was 3.6%. The most listed reasons for staying tobacco free were health problems directly related to smoking (64%), such as 'it can cause diseases' or 'it kills', negative effects of smoking other than health (51%), such as 'it smells bad' or 'it is toxic', and some subjective judgements related only with their self perceptions, such as 'I am happy and healthy' or 'it affects growth negatively' (20%).The most well-known problem related to tobacco use was lung cancer and the least well-known problems were bladder cancer and chronic bronchitis. Most of the smoking students (68%) were not aware that second-hand smoking was harmful (p=0.003). There were significant correlations between smoking experience and male gender, having a smoker in the household and low educational level of the mother or the father (p=0.000, p=0.018, p=0.022, p=0.044 respectively).Conclusion We suggest that the beliefs and perceptions of adolescents about smoking should be given as much consideration as the negative effects of cigarettes in planning smoking free messages.

The illustration-based Assessment of Liability and EXposure to Substance use and Antisocial behavior for children

BACKGROUND/OBJECTIVES

Ontogenetic prevention of substance abuse requires that an individual's "profile" of substance abuse predictors is assessed to guide intervention decision-making ( [1] ). For child intervention, self-report data provide information that cannot be obtained from other sources such as parents or teachers. However, efficient child report instruments of substance abuse risk factors are lacking. The Assessment of Liability and EXposure to Substance use and Antisocial behavior((c)) (ALEXSA((c))) is an illustration-based, computerized child report assessment for early manifestations and predictors of substance abuse and antisocial behavior.

METHODS

Construct validity and test-retest reliabilities of ALEXSA subscales were estimated in 272 nine to twelve-year old students from regular and remedial education classrooms.

RESULTS

Anecdotal and quantitative data demonstrated that children enjoy the ALEXSA format. All factors and 34 of 39 subscales had good or better reliabilities. Nine factors were extracted: Disinhibition (example subscales are Irritability, Impulsivity), Sensation Seeking (e.g., Gambling, Social Disinhibition), Self Management (e.g., Planning and Concentration, Problem Solving), Family Discord (e.g., Family Behavior Problems, Family Conflict), Parent Fortification (e.g., Parental Monitoring, Parent Attachment), Social Contagion (e.g., Friends' Conduct Disorder Criteria, Peer Pressure Susceptibility), Social Support (e.g., Social Support: Adults, Number of Friends), Neighborhood Risks (e.g., Gang Exposure, Neighborhood Atmosphere), and School Protection (e.g., Academic Competency, School Commitment).

SCIENTIFIC SIGNIFICANCE

The ALEXSA could provide efficient child reports for research, needs assessment, and outcomes to support etiology and prevention of substance abuse and antisocial behavior.

Prevalence and correlates of tobacco use among middle and high school students in western Alaska

OBJECTIVES

Tobacco use is the leading cause of preventable death in the United States and contributes to increased incidence, morbidity and mortality from cancer, heart disease, stroke, complications of pregnancy and respiratory illness. Tobacco use rates are highest among American Indians and Alaska Natives. This study examined the prevalence and correlates of tobacco use among youth residing in rural western Alaska.

STUDY DESIGN

Data were analysed from the 2003 Youth Risk Behavior Survey (YRBS) administered to a regional sample of adolescents attending school in western Alaska.

METHODS

Data were analysed from 260 middle school (52% female, 87% Alaska Native) and 258 high school (48% female, 93% Alaska Native) students.

RESULTS

Among middle school students, 39% reported current use of ST, 24% reported cigarette smoking and 50% reported current use of any tobacco product. On multivariate analysis, independent correlates of current use of any tobacco were Alaska Native ethnicity (p=0.002) and ever use of marijuana (p<0.001). Among high school students, 38% reported current ST use, 43% reported cigarette smoking and 60% reported current use of any tobacco product. Independent correlates of current use of any tobacco were increasing age (p=0.007), ever use of marijuana (p<0.001), current use of marijuana (p=0.005) and reporting a suicide attempt within the past 12 months (p=0.003). No significant gender differences on tobacco use emerged for middle or high school students.

CONCLUSIONS

This study documents the high tobacco use rates among youth residing in western Alaska, with over half of the adolescents reporting tobacco use. Developing interventions to promote tobacco use prevention and cessation is an essential step towards reducing tobacco-related health disparities in this rural population. Expanded efforts are needed to address tobacco use among youth residing in this region of Alaska.

Developing parenting programs to prevent child health risk behaviors: a practice model

Research indicates that developing public health programs to modify parenting behaviors could lead to multiple beneficial health outcomes for children. Developing feasible effective parenting programs requires an approach that applies a theory-based model of parenting to a specific domain of child health and engages participant representatives in intervention development. This article describes this approach to intervention development in detail. Our presentation emphasizes three points that provide key insights into the goals and procedures of parenting program development. These are a generalized theoretical model of parenting derived from the child development literature, an established eight-step parenting intervention development process and an approach to integrating experiential learning methods into interventions for parents and children. By disseminating this framework for a systematic theory-based approach to developing parenting programs, we aim to support the program development efforts of public health researchers and practitioners who recognize the potential of parenting programs to achieve primary prevention of health risk behaviors in children.

A comparison of tobacco-related risk factors between preadolescents with and without cancer

INTRODUCTION

To compare preadolescents with and without cancer on current smoking status, future intentions to smoke, and tobacco-related risk factors, as well as to explore the relationship between cancer status and tobacco-related variables with intentions.

PROCEDURE

Ninety-four preadolescents undergoing treatment for cancer and a matched comparison sample of 190 participants without cancer, ages 8 to 11 years, completed questionnaires about their smoking habits, intentions to smoke and tobacco-related psychosocial risk factors.

RESULTS

No preadolescents with cancer and only two preadolescents without cancer reported current smoking. Compared to healthy nonsmoking preadolescents, nonsmokers with cancer were approximately one-half as likely to report future intentions to smoke. Intention to smoke was better predicted by variables most proximal to smoking including older age, being male, not having cancer, having close friends who smoke, parental smoking, and lower perceived vulnerability for tobacco-related illnesses. In the model examining distal variables, preadolescents who were more rebellious, older, and without cancer were more likely to report future smoking intentions.

DISCUSSION/CONCLUSIONS

Although future intentions to smoke differed according to cancer status, the relationship between tobacco-related risk factors and future smoking intentions appeared to be similar among preadolescents with and without cancer.

IMPLICATIONS FOR CANCER SURVIVORS

Smoking prevention and tobacco-related health risk education should begin during the elementary years, a time prior to smoking initiation and the development of solidified smoking attitudes. The diagnosis and treatment of pediatric cancer may provide an excellent opportunity for health care providers to begin communicating anti-smoking messages and health risk counseling to their young patients and families.

Alcohol-specific socialization practices and alcohol use in Dutch early adolescents

The present study examined the associations of alcohol-specific socialization practices and heavy parental drinking with alcohol use in early adolescents. Cross-sectional nationwide survey data from 2599 parent-adolescent (mean age=12.16) dyads were used to conduct logistic regression analyses. Onset of alcohol use as well as infrequent and regular drinking were associated with tolerant rules and attitude as reported by adolescents, and by a tolerant attitude as reported by parents. In contrast to former studies including middle and late adolescents, parental alcohol use was not found to be associated with early adolescent alcohol use, nor did parental alcohol use influence the impact of parental rules. Restrictive alcohol-specific socialization was, independent of parental alcohol use, related to absence of (regular) early adolescent drinking. Thus, this study demonstrated that in early adolescence alcohol-specific parenting is more important for adolescent drinking than parental alcohol use.

Resilience and patterns of health risk behaviors in California adolescents

OBJECTIVES

Assess whether adolescent health risk behaviors cluster, and whether resiliency factors are associated with observed clusters.

METHODS

The cross-sectional population-weighted 2003 California Health Interview Survey was used (N=4010). Four gender-specific clusters were based on smoking, alcohol use, low fruit/vegetables consumption, and physical inactivity. Resiliency factors included parental supervision, parental support, role model presence and adolescent mental health. Conditional regression was used to measure the association of individual health risk behaviors and clusters with resiliency factors.

RESULTS

Health risk behaviors clustered as follows: "Salutary Adherents" (no reported health risk behaviors), "Active Snackers" (physically active, low fruit/vegetable consumers), "Sedentary Snackers" (physically inactive, low fruit/vegetable consumers), and "Risk Takers" (smokers, alcohol users, many also physically inactive and low fruit/vegetable consumers). Greater parental supervision was associated with lower odds of being in unhealthful clusters. Among males, having greater parental support reduced odds of being an "Active Snacker" or "Sedentary Snacker." Among females, role model presence reduced odds of being in unhealthful clusters, while depressiveness increased the odds.

CONCLUSIONS

Health promoting interventions should address multiple health risk behaviors in an integrated fashion. Gender-specific, ethnically-targeted, family-centered strategies that address parenting, particularly parental supervision would be useful. Addressing depressiveness may be especially important for female adolescents.

Variability in initial nicotine sensitivity due to sex, history of other drug use, and parental smoking

Initial sensitivity to nicotine's effects during early exposure to tobacco may relate to dependence vulnerability. We examined the association of initial nicotine sensitivity with individual difference factors of sex, other drug use history (i.e. cross-tolerance or cross-sensitization), and parental smoking status in young adult nonsmokers (N=131). Participants engaged in 4 sessions, the first 3 to assess the dose-response effects of nasal spray nicotine (0, 5, 10 microg/kg) on rewarding, mood, physiological, sensory processing, and performance effects, and the fourth to assess nicotine reinforcement using a choice procedure. Men had greater initial sensitivity than women to some self-reported effects of nicotine related to reward and incentive salience and to impairment in sensory processing, but men and women did not differ on most other effects. Prior marijuana use was associated with greater nicotine reward, nicotine reinforcement was greater in men versus women among those with prior marijuana use, and having parents who smoked was related to increased incentive salience. However, history of other drug use and parental smoking were not otherwise associated with initial nicotine sensitivity. These findings warrant replication with other methods of nicotine administration, especially cigarette smoking, and in more diverse samples of subjects naïve to nicotine. Yet, they suggest that sex differences in initial sensitivity to nicotine reward occur before the onset of dependence. They also suggest that parental smoking may not increase risk of nicotine dependence in offspring by altering initial nicotine sensitivity, and that cross-tolerance between other drugs and nicotine may not be robust in humans.

Treatment of substance abuse during pregnancy

Treatment programs for women who use drugs during pregnancy have developed out of a backdrop of punitive policies and the psychosocial complexities of this population, which include psychological comorbidities and consideration of the needs of their children. In this literature review, we examine evidence-based approaches to treatment for these women and some promising newer initiatives. We also discuss limitations of this research and issues that need to be addressed. The increasing understanding and acceptance of substance abuse as a treatable mental health disorder brings renewed optimism to this field.