Attitude and peer influences on adolescent substance use: the moderating effect of age, sex, and substance

Adolescent predictors of substance use in young adulthood among individuals with childhood-onset chronic pain: A follow-up study

BACKGROUND

Adolescent chronic pain is a substantial public health problem, and pain symptoms often persist into adulthood. Young adults with chronic pain are at elevated risk for more frequent tobacco, alcohol and cannabis use, and cross-sectional research highlights the importance of psychosocial vulnerability factors. Limited research has examined how adolescent predictors, including mental health symptoms, pain, sleep and family functioning, impact later, young adult substance use.

METHODS

A prospective cohort of 229 young adults (77.3% female; Mage = 21.0, SD = 1.6) with childhood-onset chronic pain completed measurements in adolescence and a follow-up assessment in young adulthood of past 3-month substance use frequency.

RESULTS

Adolescent sleep quality and male sex were associated with more frequent tobacco use; adolescent depression was associated with more frequent alcohol use, and adolescent pain severity was associated with less frequent, and male sex was associated with more frequent cannabis use.

CONCLUSIONS

Adolescent predictors of young adult substance use among youth with childhood-onset chronic pain represent important factors that may inform assessment, prevention and treatment of substance use in this population. Identifying and testing psychological interventions that target these vulnerability factors may reduce overall substance use risk in young adulthood.

SIGNIFICANCE

This prospective observational study of young adults with childhood-onset chronic pain identified adolescent depression and sleep quality as vulnerability factors associated with substance use. Given the increasing risk for substance use during adolescence and young adulthood, these findings highlight the potential importance of early intervention to reduce substance use among young adults with childhood-onset chronic pain.

Adolescents' Cannabis Knowledge and Risk Perception: A Systematic Review

To systematically review evidence evaluating cannabis-related knowledge and perception of risk in children and adolescents. We systematically searched Medline, PsycINFO, and EMBASE using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. 133 studies from around the world (including ages 10-18 yrs) met inclusion criteria, with 70% meeting grade 2C quality. Increased knowledge and perception of risk of cannabis frequently correlated with lower levels of current use and intent to use. Studies examining correlations over time generally demonstrated increased adolescent cannabis use and decreased perception of risk. Included prevention-based interventions often enhanced knowledge and/or perception of risk in adolescents exposed to the intervention. Studies exploring outcomes relating to legislative changes for recreational marijuana use demonstrated considerable heterogeneity regarding knowledge and perception of risk whereas studies that focused on medicinal marijuana legislative changes overwhelmingly demonstrated a decrease in perception of risk post legalization. Increased knowledge and perception of risk of cannabis in adolescents often correlate with lower levels of current use and intention to use in the future. Further study and implementation of public health and clinically-oriented strategies that seek to increase knowledge among youth about the potential health harms of cannabis use should continue and be prioritized.

Associations between psychological stress, discrimination, and oral health-related quality of life: the buffering effects of social support networks

Stress and discrimination negatively affect quality of life, but social support may buffer their effects. This study aims: (1) to examine the associations between psychological stress, discrimination, and oral health-related quality of life (OHRQoL); and (2) to assess whether social support, stress and discrimination interact to modify their associations with OHRQoL. We used cross-sectional household-based data from a study including 396 individuals aged 14 years and over from families registered for government social benefits in a city in Southern Brazil. OHRQoL was measured with the Oral Impacts on Daily Performance (OIDP) scale; psychological stress was assessed with the Perceived Stress Scale (PSS); social support was assessed based on the number of close relatives or friends of the participant, and discrimination was assessed with a short version of the Everyday Discrimination Scale. Interactions were estimated using the relative excess of risk due to interaction (RERI). Adjusted effects were calculated with logistic regression. The prevalence of oral impacts among people with higher and lower PSS scores was 81.6% and 65.5%, respectively (p < 0.01). Social support was found to have no interactions with stress levels and discrimination. The association between social discrimination and OHRQoL (OIDP score > 0) was OR = 2.03 (95%CI: 1.23; 3.34) among people with a low level of stress, but was OR = 12.6 (95%CI: 1.31; 120.9) among those with higher levels (p = 0.09, for interaction). Individuals who reported experiencing higher levels of psychological stress and discrimination had worse OHRQoL; a synergistic effect with social support was not clear.

Gender differences in the stress-buffering effects of mindfulness facets on substance use among low-income adolescents

Problematic substance use during adolescence predicts numerous adverse outcomes, including increased risk of substance use disorders in adulthood. Adolescents often use substances to cope with stress, particularly adolescents who have experienced environmental stress in childhood (e.g., low-income environments), but research indicates stress-related substance use disorders may develop differently across gender. This highlights a need to identify coping resources for stress-related substance use and understand whether these coping resources are differentially effective across gender. Mindfulness has garnered evidence as a coping resource for stress-related problematic substance use; however, there is limited research on how specific mindfulness facets (e.g., nonjudgment) may buffer against stress-related substance use among adolescents. This study examined whether overall mindfulness and specific facets buffered the association between stress and substance use differentially across gender in a predominantly low-income, racially-diverse (42 % Black, 24 % White, 15 % Hispanic/Latinx, 13 % Asian, 3 % American Indian/Alaskan Native, and 3 % multiracial) sample of adolescents (n = 212) using moderated moderation models. Girls with lower levels of two mindfulness facets (i.e., acceptance/nonjudgement, decentering/nonreactivity), relative to girls with higher levels, demonstrated a greater probability of substance use with increased stress. Conversely, boys with higher levels of acceptance/nonjudgement and decentering/nonreactivity, relative to boys with lower levels, reported a greater probability of substance use with increased stress. Results suggest that acceptance/nonjudgment and decentering/nonreactivity may be protective against stress-related substance use for girls and potentially contraindicated for boys, indicating that adolescent substance use prevention and intervention efforts may need to be tailored by gender.

Longitudinal Effects of Peer, School, and Parenting Contexts on Substance Use Initiation in Middle Adolescence

Purpose: Preventing substance use initiation (SUI) can reduce negative consequences associated with adult substance use disorder. The role of involvement with deviant peers, school connectedness, and parenting quality on SUI was investigated among a community sample (N = 387).Method: PROCESS tested whether three parenting quality factors (Parental Knowledge and Affective Relationships, Parental Control, and Parental Communication and Involvement) served as moderators of two different mediation pathways (involvement with deviant peers and school connectedness) on three SUI outcomes (alcohol, cigarettes, and marijuana).Results: Involvement with deviant peers mediated the relation between school connectedness and substance use. Low school connectedness predicted high deviant peer affiliation, which, in turn, predicted high SUI. School connectedness did not mediate involvement with deviant peers and substance use. Parenting quality factors were not significant moderators.Conclusion: Supporting adolescents who lack strong school connections may help prevent involvement with deviant peers, which, in turn, may prevent SUI.

Helicopter parenting and alcohol use in adolescence: A quadratic relation

Aims: Research has underscored that an excessively intrusive parental style, defined as helicopter parenting, could be a risk factor for maladaptive behaviours in youth, including alcohol use and drug consumption. However, such at-risk behaviours have also been associated with low levels of parental involvement and warmth. Thus, the relationship between parental involvement and at-risk behaviours in adolescents is not clear. The purpose of the current study was to identify the relation between helicopter parenting and alcohol use in a sample of Italian youth. Design: The participants were 402 adolescents (233 female) between the ages of 14 and 19 years (M_age= 17.20, SD = 1.66). Hierarchical multiple regression analyses were conducted to examine linear, quadratic, and exponential models and to verify which model best described the correlation. Results: The results showed a quadratic correlation between mothers’ helicopter parenting and alcohol use, whereby higher and lower levels of mothers’ helicopter parenting were associated with adolescents’ alcohol use. Conclusions: The empirical data are essential for improving our understanding of the implications and potential outcomes of helicopter parenting during adolescence.

Youth Observation of E-Cigarette Use in or Around School, 2019

INTRODUCTION

E-cigarette use increased dramatically among U.S. students during 2017-2019, and school plays an important role in preventing and reducing youth substance use. This study examines the prevalence and correlates of self-reported youth observation of e-cigarette use on school grounds.

METHODS

Data from the 2019 National Youth Tobacco Survey (N=19,018) were analyzed to examine the prevalence and factors associated with youth observation of e-cigarette use in or around the school. Multivariable logistic regressions were performed to assess the associations between youth observation of e-cigarette use and the susceptibility to initiate cigarettes or e-cigarettes. Analyses were conducted in 2020.

RESULTS

In 2019, about 63.9% of students (16.8 million) reported noticing youth use of e-cigarettes in or around the school, with bathroom or locker room as the most common location (33.2%). Female (versus male) students; high-school (versus middle-school) students; non-Hispanic Whites (versus other groups); former and past 30-day e-cigarette users (versus never users); students with exposure to tobacco marketing (versus none); and students living with a household member using e-cigarettes (versus not) had higher odds of reporting the observation of vaping in schools. Among never tobacco users (n=11,518), observation of vaping in schools was associated with higher odds of being susceptible to smoking cigarettes (AOR=1.2, 95% CI=1.0, 1.3) and using e-cigarettes (AOR=1.7, 95% CI=1.6, 1.9), especially among middle-school students.

CONCLUSIONS

E-cigarette use is common on school grounds, and youth observation of vaping in schools may increase the risk of initiating tobacco use in the future. School vaping policy and education programs are needed to curb youth e-cigarette use.

Polysubstance use among adolescents in Malaysia: Findings from the National Health and Morbidity Survey 2017

BACKGROUND

Polysubstance use is defined as the use of more than one non-prescribed licit or illicit substance either concurrently or simultaneously. This study aimed to determine the prevalence of single substance users and polysubstance users and 'their associated factors among adolescents in Malaysia.

METHODS

This study was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2017, a cross-sectional survey conducted among Malaysian school-going adolescents aged 13 to 17. The NHMS utilised a two-stage stratified cluster sampling. Multivariate Multinomial Logistic Regression analysis was applied.

RESULTS

The overall prevalence of single substance use and polysubstance use among adolescents were 17.2% and 5.1% respectively. The multinomial model showed a higher likelihood of being single or polysubstance user among male (single user OR = 3.0, poly user OR = 4.6), others Bumiputeras vs Malay (single user OR = 1.7, poly user OR = 5.3), those who live with a single parent (single user OR = 1.2, poly user OR = 1.4), involved in truancy (single user OR = 1.7, poly user OR = 3.6) and being bullied (single user OR = 1.3, poly user OR = 3.4), those who had lack of peer support (single user OR = 1.3, poly user OR = 1.4), poor parental bonding (single user OR = 1.4, poly user OR = 1.8), depression (single user OR = 1.4, poly user OR = 3.2) and those who had no close friend (single user OR = 1.3, poly user OR = 2.7).

CONCLUSION

Our study highlighted multiple significant associated factors of single and polysubstance use among adolescents in Malaysia. This result can assist in the development of specific intervention and prevention programs targeting high-risk groups.

African American adolescent substance use: The roles of racial discrimination and peer pressure

Peer pressure to use drugs and alcohol is one of the strongest predictors of adolescent substance use. In addition to this normative adolescent stressor, African American adolescents often also face race-related stress in the form of racial discrimination, which has been linked to maladaptive coping responses such as substance use. The interaction of these stressors may help explain substance using behaviors for African American adolescents. The present study explored the relationship between eighth-grade school-based racial discrimination experiences, peer pressure to use drugs and alcohol, and gender to predict 11th-grade marijuana and alcohol use (N = 610; 49% female). Logistic regression analyses indicated teacher- and peer-perpetrated racial discrimination experiences were related to higher alcohol use. Eighth-grade peer pressure to use drugs moderated the relations between teacher- and peer-perpetrated racial discrimination and 11th-grade marijuana use. Overall, results indicate that school-based racial discrimination increases risk for adolescent substance use, and peer pressure moderates this relation for multiple types of racial discrimination. No moderation by gender was found. The importance of considering race-related stress in conjunction with more general adolescent stress to understand African American adolescent substance use is discussed.

Revisiting the Empirical Status of Social Learning Theory on Substance Use: A Systematic Review and Meta-Analysis

Background: Despite ample empirical research testing components of Akers' Social Learning Theory (SLT) on substance use, no research to date has attempted to synthesize the empirical evidence. Objectives: The purpose of this article is to synthesize prior research that has examined the utility of SLT for predicting specific types of substance use, both legal and illegal. Methods: Using a systematic review and meta-analysis, the current study estimated the effect size results from 83 primary studies published between 1974 and 2018 that had empirically tested concepts of Akers' SLT regarding substance use. In addition, moderator analyses examined variations in effect sizes across measurement constructs and among specific types of substance use. Results: Results indicated medium-sized weighted mean effect size estimates for SLT in relation to substance use. Regarding conceptualization of SLT, measures of Differential Association produced the strongest effect size estimates. Moderator analyses also revealed that mean effect size estimates were largest for soft drugs, for studies conducted in the context of the United States, and for adult samples. Conclusions: The authors conclude that SLT constructs may be better suited for explaining soft drug use than hard drug use. Given the relatively sparse primary research that has controlled for temporal ordering, collected data from multiple differential associates, or considered opportunity effects, caution in the interpretation of synthesis results is warranted.

Gender Differences in the Relationships among Young Adults' Religiosity, Risk Perception, and Marijuana Use: A Moderated Mediation Model

BACKGROUND

Studies show that religiosity is a protective factor against marijuana use. Given many religions' teachings to promote risk perception of substance use, risk perception possibly mediates the relationship between religiosity and marijuana use. Moreover, since males and females differ in religiosity, risk perception, and marijuana use, gender may moderate religiosity's indirect effect on marijuana use through risk perception and religiosity's direct effect on marijuana use. Despite substantial research on religiosity and adolescent marijuana use, little research has targeted the young adult population.

OBJECTIVES

This study is the first to investigate the conditional nature of religiosity's influence on marijuana use through risk perception among young adults in the U.S.

METHODS

Using a nationally representative sample from the 2014 National Survey on Drug Use and Health (N = 12,646), conditional process analysis was examined through significant test of the index of moderated mediation. Additionally, mediation analysis was conducted in male (n = 6042) and female (n = 6604) groups separately to further characterize the nature of the relationships.

RESULTS

Religiosity's indirect effect on marijuana use through risk perception was found to be significantly different between males and females, while there were no gender differences in religiosity's direct effect on marijuana use. The indirect effect of religiosity on marijuana use via risk perception was significant among both males and females and was larger for females than males.

CONCLUSION

Prevention interventions for young adults' marijuana use that incorporate religiosity should emphasize factors related to risk perception and have a gender informed perspective. Direction for future research is provided.

Development of an effective virtual environment in eliciting craving in adolescents and young adults with internet gaming disorder

Internet gaming disorder (IGD) is a new disorder that warrants further investigation, as recently noted in the research criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Offering controlled environments that increase cue-induced craving, virtual reality cue-exposure therapy has been shown to be effective for some addiction disorders. To assess the feasibility of virtual reality for patients with IGD, this study aimed to develop virtual environments that represent risk situations for inducing craving, and assess the effect of virtual reality in cue reactivity. A total of 64 male adolescents and young adults (34 with IGD and 30 without) were recruited for participation. We developed a virtual internet café environment and the participants were exposed to four different tasks. As the primary feasibility outcome, cravings were measured with a visual analogue scale measuring current urge to play a game after exposure to each task. The virtual internet café induced significantly greater cravings in patients with IGD compared to controls. Additionally, patients exhibited a significantly higher acceptance rate of an avatar's invitation to play a game together than that of controls. In IGD, craving response to the tasks was positively associated with the symptom severity score as measured by Young's Internet Addiction Test. These findings reveal that virtual reality laden with complex game-related cues could evoke game craving in patients with IGD and could be used in the treatment of IGD as a cue-exposure therapy tool for eliciting craving.

Attitudes and Beliefs About New Psychoactive Substance Use Among Electronic Dance Music Party Attendees

BACKGROUND

Attitudes and beliefs about drug use have been shown to be robust correlates of use of drugs such as alcohol, marijuana, and cocaine; however, little is known regarding attitudes or beliefs about new psychoactive substances (NPS). We sought to examine attitudes and beliefs about NPS and how they relate to self-reported use in a high-risk population-electronic dance music (EDM) party attendees.

METHOD

1,048 individuals (age 18-40) were surveyed entering EDM parties in New York City in 2016. We queried lifetime use and attitudes and beliefs specific to NBOMe, 2C series drugs, "bath salts" (synthetic cathinones), tryptamines, dissociative NPS, and synthetic cannabinoids.

RESULTS

More than half the sample reported being unfamiliar with NPS other than "bath salts" and synthetic cannabinoids. "Bath salts" received the highest ratings of strong disapproval (34.3%), followed by synthetic cannabinoids (23.3%), compared to other NPS (10-14%). "Bath salts" were perceived to be a great risk by 43.1% of the sample, followed by synthetic cannabinoids (27.0%), and other NPS (12-16%). "Bath salts" were reportedly least likely to be used if offered (2.9%). In multivariable models, reporting no disapproval towards use was associated with increased odds of reporting use of 2C drugs, "bath salts", and tryptamines. Having friends who use and reporting intent to use or willingness to use if offered were also associated with use of various NPS classes.

CONCLUSIONS

This study delineated attitudinal and belief-related correlates of use of various NPS classes. Results can inform prevention effects as NPS continue to emerge.

Harsh Parenting, Deviant Peers, Adolescent Risky Behavior: Understanding the Meditational Effect of Attitudes and Intentions

Although research supports the influence of parents and peers on adolescent risky behavior, less is known about mechanisms proposed to explain this relation. This study examined the influence of adolescent attitudes and intentions about such behaviors. Prospective, longitudinal data came from rural youth who participated throughout adolescence (n= 451). Observed harsh parenting and relationship with deviant peers was assessed in early adolescence, attitudes and intentions were measured during middle adolescence, and risky behavior was assessed in late adolescence. Results indicated that parenting and deviant peers was related to engagement in tobacco use, alcohol use, and risky sexual behaviors. Moreover, attitudes and intentions mediated this relationship even after parent use and adolescent early involvement in these behaviors were taken into account.

Changes in Marijuana use over the Transition into Marriage

Reductions in substance use tend to coincide with marriage, as both may occur during emerging adulthood. During the transition to marriage, it is possible that one's spouse may be the influence that causes the reduction in substance use. Data on participants (N = 471 couples) for this report are taken from a longitudinal study of early marriage. The objective of the current analysis is to determine if having a spouse who uses marijuana is associated with a greater likelihood of one's own use. Additionally, we are interested in spousal influence and cessation. The findings support spousal influence. Husbands are more likely to start using marijuana if their wives use marijuana, but the reverse is not true. Husbands also are more likely to stop using if their spouses do not use. During the transition into marriage, the drug use of one spouse does affect the other. However, this influence appears to be unidirectional, with wives influencing their husbands more often.

Encouraging the Disuse of Illicit Drugs Among At-Risk Youth

Youth at risk of illicit drug abuse and other delinquent acts are the target of social work services. Preventing or discouraging the use of illicit drugs among at-risk youth is a long-standing practical and research concern. For this reason, the preventive function of courage is a research gap the present study seeks to fill. The study collected data from 169 at-risk youths and their social workers with two-wave panel surveys. Results show that courage in Wave 1 presented a strong negative effect on illicit drug use in Wave 2 in the youth, controlling for illicit drug use in Wave 1 and background characteristics. Moreover, the negative effect was stronger when Wave 1 drug use was more likely. These results imply the helpfulness of encouraging at-risk youth to gather courage to resist the temptation to use illicit drugs.

Stress and Alcohol, Cigarette, and Marijuana Use Among Latino Adolescents in Families with Undocumented Immigrants

Families in which one or more members are undocumented immigrants experience unique hardships. Yet, little is known about stress and substance use among adolescents growing up in these families. The present study examined associations between two sources of adolescent stress (i.e., low parental involvement due to contextual constraints and family economic insecurity) and lifetime alcohol, cigarette, and marijuana use among adolescents in families with undocumented members. The sample was comprised of 102 adolescents (10-18 years old) and one of his or her parents. Participants responded a survey in English or Spanish. Adolescent lifetime use of alcohol, cigarette, and marijuana was 51%, 32.4%, and 37.3%, respectively. Chi-Square analyses found no significant gender differences in lifetime substance use. Logistic regression models showed that adolescent stress due to hindered parental involvement increased the odds of both lifetime cigarette and marijuana use after controlling for gender, age, linguistic acculturation, familism, parental control, and negative peer affiliation. Being a girl increased the odds of lifetime alcohol use. Family economic stress was not associated with lifetime substance use. Results suggest that hindered parental involvement might be a stressor and a risk factor for cigarette and marijuana use among adolescents growing up in families with undocumented members. Because parents in these families are likely to be undocumented, policies that allow immigrants to apply for legal status could improve parents' working conditions and facilitate parental involvement; in turn, such policies could decrease the risk for adolescent substance use among children of Latino immigrants.

Risk and protective factors for adolescent substance use: a comparative study of secondary school students in rural and urban areas of Osun State, Nigeria

BACKGROUND

Substance use is a leading adolescent health problem globally, but little is known regarding associated factors for adolescent substance use in Nigeria. This study compared the prevalence of substance use among in-school adolescents in urban and rural areas of Osun State, Nigeria, and identified risk and protective factors.

METHODS

This cross-sectional study involved 600 randomly selected adolescents (aged 10-19 years) from rural and urban areas of Osun State, Nigeria. Data were collected using the facilitated self-completed questionnaire method. Binary logistic regression was used to examine the association of individual, peer, and parental factors with adolescent substance use. Adjusted odds ratio (OR) and 95% confidence interval (CI) were obtained.

RESULTS

About two-thirds of respondents had used substances in both rural (65.7%) and urban areas (66.0%) (p=0.93). Logistic analysis showed private school attendance as a risk factor for substance use (OR=2.32, 95% CI=1.20-4.46) and adolescent disapproval of adult substance use as a protective factor (OR=0.47, 95% CI=0.27-0.82) in rural areas. For urban areas, having friends who use substances (OR=4.04, 95% CI=1.39-11.6) and a mother having had tertiary education (OR=3.34, 95% CI=1.06-10.4) were risk factors while parental disapproval of substance use (OR=0.50, 95% CI=0.28-0.90) was a protective factor.

CONCLUSION

Lifetime prevalence of substances is high among in-school adolescents in Osun State. The risk and protective factors for adolescent substance use somewhat differ for rural and urban areas, and these have implications for designing effective intervention strategies.

Changes in the strength of peer influence and cultural factors on substance use initiation between late adolescence and emerging adulthood in a Hispanic sample

We examine whether peer substance use and cultural factors differentially influence the initiation of tobacco, alcohol, and marijuana use in adolescence and emerging adulthood (EA) among a community-based sample of Hispanics. Participants provided data in 11th grade (M = 16.8 years old, SD = 0.54) and emerging adulthood (M = 20.3 years old, SD = 0.6). Peer tobacco use had a stronger association with initiation of tobacco use in emerging adulthood (OR = 1.46, 95% CI = 1.13, 1.89) than in adolescence (OR = 1.20, 95% CI = 1.03, 1.40), but this pattern was not observed with initiation of alcohol or marijuana use. Cultural orientation is associated with initiation of tobacco use during EA but not with initiation of alcohol or marijuana use.

Moral Disengagement, Anticipated Social Outcomes and Adolescents' Alcohol Use: Parallel Latent Growth Curve Analyses

Moral disengagement is a social cognitive process that has been extensively applied to transgressive behaviors, including delinquency, aggression and illicit substance use. However, there has been limited research on moral disengagement as it relates to underage drinking. The current study aimed to examine moral disengagement contextualized to underage drinking and its longitudinal relationship to alcohol use. Moreover, the social context in which adolescent alcohol use typically occurs was also considered, with a specific emphasis on the social sanctions, or social outcomes, that adolescents anticipate receiving from friends for their alcohol use. Adolescents were assessed across three time-points, 8 months apart. The longitudinal sample consisted of 382 (46% female) underage drinkers (12-16 years at T1). Parallel latent growth curve analysis was used to examine the bi-directional influence of initial moral disengagement, anticipated social outcomes, and alcohol use on subsequent growth in moral disengagement, anticipated social outcomes and alcohol use. The interrelation of initial scores and growth curves was also assessed. The findings revealed that, in the binary parallel analyses, initial moral disengagement and anticipated social outcomes both significantly predicted changes in alcohol use across time. Moreover, initial anticipated social outcomes predicted changes in moral disengagement. These findings were not consistently found when all three process analyses were included in a single model. The results emphasize the impact of social context on moral disengagement and suggest that by targeting adolescents' propensity to justify or excuse their drinking, as well as the social outcomes adolescents anticipate for being drunk, it may be possible to reduce their underage drinking.

The youth alternative solutions program: evaluating a hospital-based intervention for adolescent substance use

Issues of alcohol and drug use are more pronounced during adolescence than at any other period of the lifespan and represent a significant public health concern in the United States. As a result, there is currently a need for research on developmentally appropriate interventions for adolescent substance use (SU). Nurses and other mental health professionals working with adolescents need effective evidenced-based programs to refer clients having issues with SU. The current pilot study evaluated the effectiveness of the Youth Alternative Solutions Program, a hospital-based intervention program at a Level I trauma center in Southern California that partners with community stakeholders to accomplish its goals. A sample of 27 adolescents was recruited from August 2010 until October 2011. Twenty-seven total participants completed both pretest and posttest questionnaires; 14 of these participants also completed follow-up data collection. Results indicated a significant increase in negative alcohol outcome expectancies between the three study time points. More comprehensive studies of the Youth Alternative Solutions Program should be conducted in the future to determine the utility of hospital-based SU interventions and to provide evidence of the program's long-term effects.

Risk for inhalant initiation among middle school students: understanding individual, family, and peer risk and protective factors

OBJECTIVE

Because initiation of inhalants at an early age is associated with a range of health and behavioral problems, including an increased likelihood of inhalant dependence (based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), we conducted discrete time survival analyses to determine the role of time-invariant and time-variant (over five waves) risk and protective factors as well as grade in inhalant initiation among middle school students.

METHOD

The current study uses data from 3,215 students who were initially surveyed as sixth graders in 2008-2009 and were resurveyed in seventh and eighth grades. Students were part of a larger substance use prevention trial conducted in greater Los Angeles. The sample is racially/ethnically diverse (54% Hispanic/Latino, 16% Asian, 14% White, 3% African American) and 51% male.

RESULTS

Seventeen percent of youths initiated inhalants during middle school. Higher drug refusal self-efficacy, familism (i.e., values related to family), and parental respect were associated with decreased odds of inhalant initiation. Having a significant adult or older sibling who used substances was associated with increased risk of initiation, but adult influence declined linearly and by the end of seventh grade was no longer a risk factor. Self-rated popularity was associated with inhalant initiation in seventh grade only, and perceived substance use by peers was associated with inhalant initiation in sixth grade only.

CONCLUSIONS

The influence of adults, siblings, and peers on inhalant use may be strongest in sixth and seventh grade. Interventions to prevent inhalant initiation should target sixth and seventh graders, address influence by family and peers, and provide skills training to improve drug refusal self-efficacy.

A qualitative exploration of attitudes towards alcohol, and the role of parents and peers of two alcohol-attitude-based segments of the adolescent population

Background

An earlier study using social marketing and audience segmentation distinguished five segments of Dutch adolescents aged 12–18 years based on their attitudes towards alcohol. The present, qualitative study focuses on two of these five segments (‘ordinaries’ and ‘ordinary sobers’) and explores the attitudes of these two segments towards alcohol, and the role of parents and peers in their alcohol use in more detail.

Methods

This qualitative study was conducted in the province of North-Brabant, the Netherlands. With a 28-item questionnaire, segments of adolescents were identified. From the ordinaries and ordinary sobers who were willing to participate in a focus group, 55 adolescents (30 ordinaries and 25 ordinary sobers) were selected and invited to participate. Finally, six focus groups were conducted with 12–17 year olds, i.e., three interviews with 17 ordinaries and three interviews with 20 ordinary sobers at three different high schools.

Results

The ordinaries thought that drinking alcohol was fun and relaxing. Curiosity was an important factor in starting to drink alcohol. Peer pressure played a role, e.g., it was difficult not to drink when peers were drinking. Most parents advised their child to drink a small amount only. The attitude of ordinary sobers towards alcohol was that drinking alcohol was stupid; moreover, they did not feel the need to drink. Most parents set strict rules and prohibited the use of alcohol before the age of 16.

Conclusions

Qualitative insight into the attitudes towards alcohol and the role played by parents and peers, revealed differences between ordinaries and ordinary sobers. Based on these differences and on health education theories, starting points for the development of interventions, for both parents and adolescents, are formulated. Important starting points for interventions targeting ordinaries are reducing perceived peer pressure and learning to make one’s own choices. For the ordinary sobers, an important starting point includes enabling them to express to others that they do not feel the need to drink alcohol. Starting points for parents include setting strict rules, restricting alcohol availability at home and monitoring their child’s alcohol 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.

The relation of self-esteem and illegal drug usage in high school students

BACKGROUND

Adolescence is the period of stress and strain. Researchers have shown that adolescents without strong social supports would have tendency towards smoking and drug abuse.

OBJECTIVES

This study aimed to evaluate the relationship between low self-esteem and illegal drug abuse.

MATERIALS AND METHODS

Participants were 943 grades nine to 12 high school students, from Sarakhs during 2010 - 2011. Adolescents participated in the study, completed two self-report questionnaires. The first questionnaire included questions about individual and family information, smoking and illegal drug abuse history, and the second was the Rosenberg's self-esteem scale.

RESULTS

53.8% of participants were male (507 individuals). The mean Rosenberg self-esteem score was 19.8 + 5.2, and the most frequent obtained scores were from 22 to 30. The difference of Rosenberg self-esteem score test between students who did not use any substance and those who had a history of smoking or drug abuse like heroin, pills, alcohols, betel nut (Nas) and other drugs (such as Pan and Hookah) was significant (P < 0.001). But this difference was not significant for marijuana (hashish) and opium. The difference of mean self-esteem scores between adolescents who lived with both or one of the parents, and those who did not live with any of parents, was significant (P = 0.04). There was also a significant association between the number of children in the family and self-esteem score.

CONCLUSIONS

The current study showed significant association between the Rosenberg self-esteem test results and smoking, and illegal drug abuse like heroin, pills, alcohol, Nas, and other substances. Therefore, increasing self-esteem is essential for preventing the adolescents' emotional and behavioral disorders. This fact could guide us to the new approaches for smoking and drug-abuse prevention in adolescents.

Identification of trajectories of social network composition change and the relationship to alcohol consumption and norms

BACKGROUND

College drinking is embedded in a social context, drawing attention to the effects of social network composition on consumption. The presence of heavy drinking friends in social networks predicts later alcohol misuse, but little is known about how the composition of one's social network composition changes over time. This study identified changes in social network composition in a sample of at-risk students and examined the relationship among network trajectories, alcohol consumption, and descriptive norms.

METHODS

Participants were 503 students (64% male) mandated to participate in an alcohol prevention intervention for residence hall alcohol policy violations. At baseline, students provided self-report data about alcohol consumption, perceived peer drinking norms, and peer alcohol involvement. Parallel assessments were completed at 6- and 12-months post-baseline.

RESULTS

Growth-mixture models identified four groups of individuals with similar levels of heavy drinkers in their social networks. The majority of students had stable or decreasing numbers of heavy drinkers in their networks across the study, whereas two groups reported relatively stable densities of heavy drinkers from baseline to 6-months and increasing densities from 6- to 12-months. At baseline, the four groups were generally equivalent on consumption and normative perceptions. At 6- and 12-months, however, the groups differed significantly on consumption and norms.

CONCLUSIONS

These results suggest that changes in the number of heavy drinkers in college students' social networks may have significant implications for at-risk drinking.

Familial, social, and individual factors contributing to risk for adolescent substance use

Data from the National Institute on Drug Abuse (NIDA) and the Centers for Disease Control and Prevention (CDC) reveal high numbers of adolescent substance use in the United States. Substance use among adolescents can lead to increased risk of transmission of sexually transmitted infections, vehicular fatalities, juvenile delinquency, and other problems associated with physical and mental health. Adolescents are particularly susceptible to involvement in substance use due to the underdeveloped state of the adolescent brain, which can lead to reduced decision-making ability and increased long-term effects of drugs and alcohol. Understanding the causes of adolescent substance use is vital for successful prevention and intervention programs.

Finding the way out: a non-dichotomous understanding of violence and depression resilience of adolescents who are exposed to family violence

OBJECTIVE

In this cross-sectional study on family violence and resilience in a random sample of 5,149 middle school students with a mean age of 14.5 years from four EU-countries (Austria, Germany, Slovenia, and Spain) we examined the prevalence of exposure to family violence, and we worked from the premise that adolescent can be resilient to family violence. We expanded the definition of resilience to include the absence of both physical aggression and depression symptoms in adolescents who have been exposed to violence in their families and extended our understanding of resilience to include three levels which we describe as: "resilient", "near-resilient" and "non-resilient", thus responding to calls for a more fluid and paths-based understanding of resilience.

METHODS

Data were collected via self-administered surveys consisting of a number of subscales that investigate depression symptoms and physical aggression. The study was analyzed with a three-stage strategy using logistic regression procedures, in which regression analyses were conducted separately for girls and boys using seven steps for modeling the three resilience levels.

RESULTS

More than 30% of our respondents reported experiencing family violence. Contrary to previous research findings, our data showed that structural characteristics like country, gender, socio-economic status and migration status were minimally predictive of violence and depression resilience at any level. Overall, for both sexes, despite some small but significant sex differences, resilience is strongly linked to personal and relational characteristics and the absence of experiences that involved exposure to and direct experiences with violence. Resilience supportive factors confirmed by this study are: higher emotional self-control, talking with parents or friends about violence, seeking help to avoid violence, and not endorsing aggression supportive beliefs. Also key to resilience are irrespective of country, gender, and SES are lower levels of experience with: victimization by boys, engagement in physical altercation with boys, parental abuse, witnessing of physical spousal abuse, exposure to an authoritarian (harsh) parenting style and verbal aggression from teachers.

CONCLUSION

From a content perspective this means that resilience is more than the absence of one or two behavioral factors. This also means that positive changes in resilience levels can be facilitated by supporting constructive personal and social relationships with family members, peers, and teachers. These results are discussed in terms of their practical implications for policy and intervention.

The role of deliberative decision making, parenting, and friends in adolescent risk behaviors

Adolescents may engage in risk behaviors that jeopardize their futures. Although adolescent risk-taking has long been attributed to faulty decision making, surprisingly little research has directly examined this link. This study examined the role of deliberative decision making (the tendency to consider options and consequences before making a decision) and social contextual variables (parenting and friend influences) in alcohol and drug use, risky sex, and delinquency. Participants were 7,748 adolescents (50% female) in grades 7-11 from the Add Health dataset (M age = 14.87, SD = 1.54). Hierarchical regression analyses revealed that deliberative decision making and contextual variables were associated with risk behavior concurrently and 1 year later. Furthermore, deliberative decision making interacted with social contextual variables in some models, indicating that deliberative decision making may be especially important in certain contexts. These findings suggest that both cognitive and social factors need to be considered to explain adolescents' decisions to engage in risk behavior.

Project success' effects on substance use-related attitudes and behaviors: a randomized controlled trial in alternative high schools

Using a randomized controlled effectiveness trial, we examined the effects of Project SUCCESS on a range of secondary outcomes, including the program's mediating variables. Project SUCCESS, which is based both on the Theory of Reasoned Action and on Cognitive Behavior Theory, is a school-based substance use prevention program that targets high-risk students. We recruited two groups of alternative high schools in successive academic years, and randomly assigned schools in each group to either receive the intervention (n = 7) or serve as a control (n = 7). Students completed surveys prior to and following the administration of the program, and again 1 year later. Although participation in Project SUCCESS significantly increased students' perceptions of harm resulting from alcohol and marijuana use, students in the control group reported greater increases in peer support. We also found conflicting evidence in two opposing trends related to students' perceptions of the prevalence and acceptability of substance use. Therefore, the effects of Project SUCCESS on substance use-related beliefs and behaviors must be considered mixed.

Social networks and alcohol use among nonstudent emerging adults: a preliminary study

We examined the social networks and alcohol use of a community-based sample of nonstudent emerging adults (N=59). The research examined (1) personal network characteristics and the drinking habits of its members, (2) the link between network alcohol use and personal alcohol involvement, (3) perceived social norms as they related to network alcohol use, and (4) relationship between perceived social norms and personal alcohol involvement. Men and women (M age=27 years) were equally represented in the social network. Level of educational attainment of members was diverse. On average, respondents were in contact on a daily basis with network members and about 38% of the network was known between 1 and 5 years. The majority (57%) of the network consisted of household or family members. There were some associations between network drinking and personal alcohol involvement. The proportion of "drinking buddies" in one's network was directly associated with perceived drinking norms. Perceived drinking norms also were positively associated with personal alcohol use, alcohol-related problems, and approval of drinking behaviors. Findings from this study have implications for understanding social factors in the drinking behavior of nonstudent emerging adults and could inform the development of effective prevention and treatment interventions for this important, but understudied group of drinkers.

Project ALERT’s Effects on Adolescents’ Prodrug Beliefs: A Replication and Extension Study

This article represents a replication and extension of previous studies of the effects of Project ALERT, a school-based substance use prevention program, on the prodrug beliefs of adolescents. Specifically, the authors’ research examined Project ALERT’s effects on adolescents’ intentions to use substances in the future, beliefs about substance use consequences, normative beliefs, and resistance self-efficacy. In all, 34 schools with Grades 6 to 8 completed this randomized controlled trial and 71 Project ALERT instructors taught 11 core lessons to 6th graders and 3 booster lessons to 7th graders (one grade level earlier than in previous studies). Students were assessed in 6th grade prior to the onset of the intervention, in 7th grade after the completion of the 2-year curriculum, and again 1 year later in 8th grade. The authors found no evidence to suggest that Project ALERT had a positive impact on any alcohol, cigarette, or marijuana prodrug beliefs. Implications for school-based substance use prevention are discussed.

Similarities between eating attitudes among friendship groups in childhood: the moderating role of child anxiety

OBJECTIVE

This study explores the similarities between individual and group eating and weight concerns in 8-11-year-old children. It also evaluates whether child anxiety moderates the relationships between individual and group eating and weight concerns.

METHODS

One hundred and fifty four children aged 8-11 completed questionnaires concerning their friendship groups, their eating and weight concerns, and their levels of anxiety.

RESULTS

Children's own scores on dietary restraint, body dissatisfaction, and external eating were significantly correlated with their friendship groups' scores on dietary restraint. Child anxiety moderated the relationships between group dietary restraint and individual scores on external eating. Group levels of dietary restraint predicted higher levels of external eating in children with moderate or high anxiety.

CONCLUSIONS

In pre-adolescent children, peer group levels of dietary restraint are related to individual eating and weight concerns. More anxious children may be more susceptible to peer influences on their eating behaviors.

Homeless, Street-Involved Emerging Adults: Attitudes Toward Substance Use

Research has indicated that a high proportion of homeless emerging adults use substances. This article aims to understand the attitudes of these young adults concerning their substance use and its effect on their lives. A mixed methods study using semistructured interviews and self-report instruments was conducted with 87 emerging adults who received homeless services from a community drop-in center. Qualitative analyses found that participants reported positive attitudes of substance use; however, many recognized the benefits of a life without drugs or alcohol. Findings suggest attitudes toward substance use and the role of substance use in the lives of homeless emerging adults are viewed as a valuable means of coping with street life, connecting with peers, and managing physical and mental health symptoms.

Correlates of later-onset cannabis use in the National Epidemiological Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND

Much of the research surrounding correlates of cannabis initiation has focused on adolescent and young adult populations. However, there is growing evidence that cannabis onset occurs later in life as well and little is known of the risk and protective influences that are associated with late-onset cannabis initiation.

METHODS

We used data on 34,653 individuals that participated in both the first wave and the 3-year follow-up (3YFU) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Univariate and multivariate logistic regression was used to examine the association between cannabis initiation at 3YFU and socio-demographic, religious/pro-social and psychiatric measures. Analyses were also conducted in age bands to further distinguish across the lifespan.

RESULTS

Of the 27,467 lifetime abstainers at wave 1509 had initiated cannabis use at 3YFU. Consistent associations between divorce, religious attendance, volunteer/community service, alcohol abuse/dependence, nicotine dependence and cannabis initiation were noted in the full sample and across age-bands.

CONCLUSIONS

Religious and pro-social activities are negatively associated with late-onset cannabis onset while divorce and alcohol and nicotine-related problems are positively associated with later onset.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

SCIENTIFIC SIGNIFICANCE

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

Genetic and non-genetic influences on the development of co-occurring alcohol problem use and internalizing symptomatology in adolescence: a review

AIMS

Alcohol problem use during adolescence has been linked to a variety of adverse consequences, including cigarette and illicit drug use, delinquency, adverse effects on pubertal brain development and increased risk of morbidity and mortality. In addition, heavy alcohol-drinking adolescents are at increased risk of comorbid psychopathology, including internalizing symptomatology (especially depression and anxiety). A range of genetic and non-genetic factors have been implicated in both alcohol problem use as well as internalizing symptomatology. However, to what extent shared risk factors contribute to their comorbidity in adolescence is poorly understood.

DESIGN

We conducted a systematic review on Medline, PsycINFO, Embase and Web of Science to identify epidemiological and molecular genetic studies published between November 1997 and November 2007 that examined risk factors that may be shared in common between alcohol problem use and internalizing symptomatology in adolescence.

FINDINGS

Externalizing disorders, family alcohol problems and stress, as well as the serotonin transporter (5-HTT) S-allele, the monoamine oxidase A (MAOA) low-activity alleles and the dopamine D2 receptor (DDR2) Taq A1 allele have been associated most frequently with both traits. An increasing number of papers are focusing upon the role of gene-gene (epistasis) and gene-environment interactions in the development of comorbid alcohol problem use and internalizing symptomatology.

CONCLUSIONS

Further research in adolescents is warranted; the increasing availability of large longitudinal genetically informative studies will provide the evidence base from which effective prevention and intervention strategies for comorbid alcohol problems and internalizing symptomatology can be developed.

The social network and alcohol use

OBJECTIVE

Previous research has found that a drinking-supportive social network has a strong influence on heavy drinking and alcohol-related problems over time. The objective of this work was to understand the individual difference and interpersonal factors that predict changes in the social network relevant to alcohol use.

METHOD

Data are from a large, ongoing prospective sample of 634 newly married couples in the United States. The current study examined the association between individual, relationship, and partner factors as they relate to changes in the number of drinking buddies in the social network during the first 7 years of marriage.

RESULTS

After controlling for the number of drinking buddies before marriage, as well as the frequency of heavy drinking, several individual, relationship, and partner factors were associated with changes in the social network over time. For both husbands and wives, alcohol expectancies and a partner's social network related to changes in the number of drinking buddies over time. Additionally, husbands with higher levels of extroversion and agreeableness had a greater number of drinking buddies over time. Among wives, personality factors were not related to changes in the number of drinking buddies over time.

CONCLUSIONS

This work extends previous research by examining factors that predict changes in the social network that are most influential in alcohol use. Identifying these factors is important for informing prevention and treatment efforts.

Strengthening resistance self-efficacy: influence of teaching approaches and gender on different consumption groups

Our study focused on strengthening the individual self-efficacy of low achieving 8th graders reducing drug-specific peer pressure through theoretical and practical training. The subject of the intervention was based on a substance-specific life skills program offering both teacher-centered and student-centered teaching approaches. A cluster analysis identified four consumption groups in our pre-test setting: (1) A "potentially curious" sample; (2) an "actually curious" sample; (3) an "experimenter" sample; and (4) a "consumer" sample. Self-efficacy was measured three times in a pre-, post-, and retention-test design. Only the "potentially curious" sub-sample showed higher resistance self-efficacy, boys and girls revealed no differences. Altogether, a short- and middle-term consistent increase was detected in both teaching methods. Consequences to increase the efficiency of drug prevention measurements are being discussed.

Impact of the "peers as family" dormitory wing-based intervention on college student alcohol use and its secondhand effects

An intervention to reduce college alcohol use and secondhand effects was tested. Freshmen dormitory wings at a large Mid-Atlantic public university were assigned to single-gender (SG) or mixed-gender (MG) Information-Motivation-Behavior (IMB) workshops implemented during the first weeks of school, or a control condition. Students were surveyed before school began and at 2- and 6-month follow-up. Analyses indicated that, among males, the adjusted mean weekly alcohol use was lower in the SG than the control condition (1.89 vs. 2.72, p = .041). Among females, the adjusted mean weekly alcohol use was lower in the MG than the SG (1.60 vs. 2.44, p = .021) and control condition (1.60 vs. 2.27, p = .056). Further research should identify underlying mechanisms for effective alcohol behavior change among male and female wing-mates.

Risk factors for alcohol use, frequent use, and binge drinking among young men who have sex with men

We examined the prevalence and patterns of alcohol use within a large, ethnically diverse sample of young men who have sex with men (YMSM) and identified psychosocial correlates of these alcohol-use patterns. A sample of 526 YMSM (ages 18-24 years) was recruited in Los Angeles, CA using a venue-based, stratified probability sampling design. Based on criteria used by previous research with young adults, participants were assigned to one of four alcohol-use/non-use groups according to frequency and number of drinks per sitting in the last 30 days. Findings revealed a high prevalence of alcohol use (91%) within the sample, with 21% reporting binge drinking; of binge drinkers, 40% reported frequent binge drinking. Multinomial logistic regression analyses revealed that race/ethnicity, gay bar attendance, depression, sensation seeking, peer risk behaviors, and age of alcohol initiation significantly differentiated between non-/light users from frequent and binge drinkers. Results also indicated unique psychosocial profiles among frequent/binge drinkers. The heterogeneity of predictors associated with different patterns of alcohol use highlights the need to consider unique risk profiles and alcohol-use trajectories according to exposure to different risk and protective factors.