Adolescent use of social media and associations with sleep patterns across 18 European and North American countries

OBJECTIVE

Over the past decade, concurrent with increasing social media use (SMU), there has been a shift toward poorer sleep among adolescents in many countries. The purpose of this study was to examine the cross-national associations between adolescent SMU and sleep patterns, by comparing 4 different categories of SMU (nonactive, active, intense, and problematic use).

DESIGN, SETTING, AND PARTICIPANTS

Data were from 86,542 adolescents in 18 European and North American countries that participated in the 2017/18 Health Behaviour in School-aged study.

MEASUREMENTS

Mixed-effects linear regression models were used to examine cross-national associations between 4 SMU categories and adolescent sleep duration, bedtime and social jetlag derived from self-reported data.

RESULTS

For all countries combined, nonactive SMU was associated with longer sleep, earlier bedtimes, and less social jetlag, compared to active SMU, although the differences were minor. By comparison, intense and problematic SMU were associated with less sleep and later bedtimes on both school and nonschool days, and greater social jetlag, compared to active SMU. While findings were relatively consistent between countries, some differences were observed, suggesting that the national and cultural context may be important in interpreting results.

CONCLUSIONS

These findings suggest that both intense and problematic SMU are associated with poorer sleep patterns in adolescents across most countries. Further research is needed to identify effective policies, programs, and messaging to promote the healthy use of social media and prevent potential negative impacts on adolescent sleep.

A cross-sectional study on gaming intensity and social vulnerability in adolescents that have a chronic condition

Background

Adolescents growing up with a chronic condition might experience more social vulnerabilities compared to their healthy peers as an indirect result of their conditions. This can lead to a relatedness need frustration for these adolescents. Consequently, they might spend more time playing video games compared to their peers. Research shows that both social vulnerability and gaming intensity are predictors for problematic gaming. Therefore, we investigated if social vulnerability and gaming intensity are more pronounced in adolescents that have a chronic condition compared to the general population; and if these levels reflect the levels of a clinical group being treated for Internet Gaming Disorder (IGD).

Methods

Data on peer problems and gaming intensity were compared from three separate samples: a national representative sample of adolescents, a clinical sample of adolescents that are undergoing treatment for IGD, and a sample of adolescents diagnosed with a chronic condition.

Results

No differences were found on either peer problems or gaming intensity between the group of adolescents that have chronic conditions and the national representative group. The group with chronic conditions scored significantly lower on gaming intensity than the clinical group. No significant differences were found between these groups on peer problems. We repeated the analyses for boys only. Similar results were found for the group with chronic conditions compared to the national representative group. The group with chronic conditions now scored significantly lower on both peer problems and gaming intensity than the clinical group.

Conclusion

Adolescents growing up with a chronic condition appear similar in their gaming intensity and peer problems compared to their healthy peers.

Rules, role models or overall climate at home? Relative associations of different family aspects with adolescents' problematic social media use

AIM

This study aimed to enhance knowledge on which aspects of the family context are most relevant in identifying at-risk/problematic social media users among adolescents. Therefore, we examined the relative contribution to adolescents' at-risk/problematic social media use (SMU) of general and Internet-specific family factors related to three different family (sub)systems: parent-child (Internet-specific rule-setting, reactive restrictions towards Internet use, co-use, adolescents' involvement in rule-setting and positive parenting), parent (parental screen time, phubbing, stress, anxiety and depression) and family (family functioning, family intactness and SES) (sub)system.

METHODS

Questionnaire data came from 403 adolescents (M = 13.51, SD = 2.15) and 396 parents (M = 46.59, SD = 5.29) who participated in wave 1 of the Dutch 'Digital Family project'.

RESULTS

Logistic regression analyses showed that only factors related to the parent-child subsystem remained significant in predicting being an at-risk/problematic social media user when examining predictors related to the parent-child, parent and family (sub)system simultaneously. Specifically, general and Internet-specific parenting practices contributed to the prediction above and beyond each other. Positive parenting and Internet-specific rule-setting seem protective, while parental reactive restrictions towards Internet use could be a risk factor. Positive parenting showed the largest effect size.

CONCLUSION

The results suggest that parental behaviors directed towards the child should be a focus of attention in prevention of adolescents' problematic SMU. In addition, our findings highlight the importance of untangling restrictive mediation (impulsive, in the moment, attempts to limit SMU versus communicating clear rules in advance) when examining its effects.

Pornography Use Profiles and the Emergence of Sexual Behaviors in Adolescence

This research longitudinally explored adolescent pornography (porn) consumption and its association with sexual development in early and middle adolescence. A four-wave design with half-year intervals investigated pornography consumption and different (sexual) activities, such as masturbation, French kissing, petting, giving/receiving manual and oral sex, and intercourse, among 630 respondents (47.9% female, mean age 13.7 years; SD = 0.48) years at T1). A latent growth mixture analysis of pornography consumption revealed two groups with relatively low pornography (LP; 51.8% of the boys, 91.4% of the girls) versus high pornography (HP; 48.2% of the boys; 8.6% of the girls) consumption across time. At T1, HP boys on average watched pornography less than once a month, but more than once a year at T1. At T4, their average pornography use had increased to almost one to two times a week. LP boys never watched pornography at T1. At T4, their average pornography use was still less than once a year. At T1, HP girls never watched pornography, but consumption increased to almost one to three times a month at T4. Across waves of the study, LP girls (almost) never watched pornography. A discrete-time survival mixture analysis of sexual developmental patterning indicated that, compared to their LP peers, both girls and boys in the HP groups showed accelerated development of masturbation, petting, and receiving manual sex. Girls in the HP group were also more inclined to receive oral sex, whereas boys in the HP group also showed earlier and more frequent manual sex and intercourse. Thus, whereas the HP group of boys was substantially larger compared to that of girls, pornography consumption was related to accelerated development of sexual activities for both genders across early and middle adolescence. The discussion deliberates on pornography as a driving force in adolescent sexual development versus pornography as a medium of choice for sexually advanced adolescents.

The course of problematic social media use in young adolescents: A latent class growth analysis

Using four waves of longitudinal data collected in 2015–2019 from 1419 Dutch adolescents (M_age = 12.5, 45.9% female, 21.9% immigrant), this study identified trajectories of problematic social media use (SMU) in parallel with trajectories of SMU frequency. Latent class growth analysis identified two subgroups with relatively high levels of problematic SMU over time: One showed high (24.7%) and one showed average SMU frequency (15.8%). Also, two subgroups with persistently low levels of problematic SMU were identified: One reported low (22.4%) and one reported high SMU frequency (37.1%). Although both subgroups with high levels of problematic SMU reported low subjective well‐being, the group with high SMU frequency showed low self‐control, whereas the group with average SMU frequency reported poor social competencies.

Validation of the Social Media Disorder Scale in Adolescents: Findings From a Large-Scale Nationally Representative Sample

Large-scale validation research on instruments measuring problematic social media use (SMU) is scarce. Using a nationally representative sample of 6,626 Dutch adolescents aged 12 to 16 years, the present study examined the psychometric properties of the nine-item Social Media Disorder scale. The structural validity was solid, because one underlying factor was identified, with adequate factor loadings. The internal consistency was good, but the test information was most reliable at moderate to high scores on the scale's continuum. The factor structure was measurement invariant across different subpopulations. Three subgroups were identified, distinguished by low, medium, and high probabilities of endorsing the criteria. Higher levels of problematic SMU were associated with higher probabilities of mental, school, and sleep problems, confirming adequate criterion validity. Girls, lower educated adolescents, 15-year-olds, and non-Western adolescents were most likely to report problematic SMU. Given its good psychometric properties, the scale is suitable for research on problematic SMU among adolescents.

Adolescents' Intense and Problematic Social Media Use and Their Well-Being in 29 Countries

PURPOSE

This study examined (1) whether intense and problematic social media use (SMU) were independently associated with adolescent well-being; (2) whether these associations varied by the country-level prevalence of intense and problematic SMU; and (3) whether differences in the country-level prevalence of intense and problematic SMU were related to differences in mobile Internet access.

METHODS

Individual-level data came from 154,981 adolescents (meanage = 13.5) from 29 countries that participated in the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey. Intense SMU was measured by the time spent on social media, whereas problematic SMU was defined by symptoms of addiction to social media. Mental (life satisfaction and psychological complaints), school (school satisfaction and perceived school pressure), and social (family support and friend support) well-being were assessed. Country-level data came from aggregated individual-level data and data from the Organisation for Economic Co-operation and Development (OECD) on Internet access.

RESULTS

Two-level regression analyses indicated that in countries with a lower prevalence of intense SMU, intense users reported lower levels of life satisfaction and family support and more psychological complaints than nonintense users. In contrast, in countries with a higher prevalence of intense SMU, intense users reported higher levels of family support and life satisfaction than nonintense users, and similar levels of psychological complaints. In all countries, intense users reported more friend support than nonintense users. The findings regarding problematic SMU were more consistent: In all countries, problematic users reported lower well-being on all domains than nonproblematic users. Observed differences in country-level prevalence rates of intense and problematic SMU could not be explained by mobile Internet access.

CONCLUSIONS

Adolescents reporting problematic SMU are particularly at risk of lower well-being. In many countries, intense SMU may be a normative adolescent behavior that contributes positively to specific domains of their well-being.

Bidirectional effects of Internet-specific parenting practices and compulsive social media and Internet game use

INTRODUCTION

This two-wave prospective study investigated the bidirectional relation between Internet-specific parenting (reactive restrictions, Internet-specific rules, and frequency and quality of communication about Internet) and adolescents' symptoms of social media disorder (SMD) and Internet gaming disorder (IGD). In addition, we investigated whether this relation was different for boys and girls.

METHODS

A sample of 352 adolescents (48.9% boys, M_age = 13.9, SD_age = 0.74, range: 11-15) completed questionnaires at two waves. Zero-inflated cross-lagged analyses in Mplus were performed to predict the level of IGD and SMD symptoms by Internet-specific parenting practices and vice versa, while controlling for age, level of education, and outcome at T₁.

RESULTS

More frequent parent-adolescent communication about Internet predicted more IGD (β = 0.26, p = .03) and SMD symptoms among boys, and more restrictive rules predicted fewer SMD symptoms among girls (β = -0.23, p = .08). More IGD symptoms predicted more reactive rules (β = 0.20, p = .08) among boys and girls and a higher frequency (β = 0.16, p = .02) and lower quality of communication (β = -0.24, p < .001) among boys and girls, respectively.

CONCLUSIONS

This study demonstrates bidirectional relations between Internet-specific parenting and IGD symptoms, but not SMD symptoms. Displaying IGD symptoms seems to elicit ineffective parental responses, which may further exacerbate problematic involvement in gaming. With respect to problematic social use media among girls, this study suggests that parents should set strict rules regarding Internet use, prior to problematic use of social media. Longitudinal studies on the role of parenting in development of Internet-related disorders would be promising in enhancing our understanding of how parents can effectively prevent problematic involvement in online behaviors among their children.

Dutch Adolescents' Motives, Perceptions, and Reflections Toward Sex-Related Internet Use: Results of a Web-Based Focus-Group Study

The Internet offers adolescents unique opportunities to actively shape their own sexual media environment. The aim of this study was to gain in-depth insight into Dutch adolescents' motives, perceptions, and reflections toward Internet use for (a) finding information or advice related to romance and sexuality; (b) searching for and viewing pornographic or erotic material; and (c) romantic and sexual communication (i.e., cybersex/sexting). Data were collected through 12 Web-based focus groups (36 adolescents aged 16 to 19 years, 72.2% girls) and analyzed through three stages of open, axial, and selective coding. The themes that emerged from the focus-group discussions suggest that sex-related Internet use is a complex and ambivalent experience for adolescents. Sex-related Internet use seems an increasingly normalized and common phenomenon. Participants perceived the Internet as a useful source of sexual information, stimulation, inspiration, and communication. Yet they discussed a range of negative consequences and risks related to sex-related online behaviors, particularly concerning pornography's potential to create unrealistic expectations about sex and sexual attractiveness. Participants generally believed they had the necessary skills to navigate through the online sexual landscape in a responsible way, although they believed other young people could be influenced inadvertently and adversely by sex-related online content.

A Scale for the Assessment of Sexual Standards Among Youth: Psychometric Properties

The (hetero)sexual double standard (SDS), prescribing sexual modesty for girls and sexual prowess for boys, negatively affects sexual and mental health. Nevertheless, endorsement and enactment of the SDS is still common. In this study, we respond to recent calls for modernization in the field of sexual double standard research. We describe the development of the "Scale for the Assessment of Sexual Standards among Youth" (SASSY), as well as its psychometric properties. This instrument was designed to measure contemporary sexual double standard endorsement, defined as "the degree to which an individual's attitude reflects a divergent set of expectations for boys and girls, in that boys are expected to be relatively more sexually active, assertive, and knowledgeable and girls are expected to be relatively more sexually reserved, passive, and inexperienced" among adolescents and emerging adults. In Study 1, a pool of 35 items was administered in a Dutch sample (N = 465, 54.8% female, age 16-20). A 20-item set formed a one-dimensional and internally consistent scale and was subsequently administered in a second Dutch sample. Study 2 (N = 818, 58.4% female, age 16-25) again assessed the 20-item set. After dropping one item, the 19-item SASSY proved to be one-dimensional and internally consistent, exhibiting good test-retest reliability, construct validity, and convergent validity. Finally, the instrument showed configural and metric measurement invariance across gender, age, education level, and sexual experience level, and configural, metric, and scalar measurement invariance across time. These studies confirmed the 19-item SASSY to be a reliable and valid new tool for the assessment of contemporary sexual double standard endorsement among adolescents and emerging adults.

Psychosexual Correlates of Sexual Double Standard Endorsement in Adolescent Sexuality

Endorsement and enactment of the (hetero)sexual double standard (SDS), prescribing sexual modesty for girls and sexual prowess for boys, has been shown to be negatively related to sexual and mental health. To be able to challenge the SDS, more insight is needed into the conditions that shape gendered sexual attitudes. A survey was conducted among 465 heterosexual adolescents (aged 16-20 years), examining the relationship between a number of relevant demographic and psychosexual variables and SDS endorsement. SDS endorsement was assessed using a newly developed instrument, the Scale for the Assessment of Sexual Standards Among Youth (SASSY). Gender (being male) and religiousness were significantly associated with increased SDS endorsement. For both boys and girls, increased feelings of entitlement to self-induced sexual pleasure (e.g., masturbation) were significantly associated with reduced SDS endorsement, whereas higher gender investment was significantly associated with increased SDS endorsement. Furthermore, increased feelings of entitlement to partner-induced sexual pleasure and more frequent talking about sexuality with peers were associated with increased SDS endorsement among boys but not among girls. We conclude that future research should explore peer influence processes through peer communication about sex, gender investment, and feelings of entitlement to both self and partner-induced sexual pleasure.

Lower Psychological Well-Being and Excessive Sexual Interest Predict Symptoms of Compulsive Use of Sexually Explicit Internet Material Among Adolescent Boys

Although a growing body of literature addresses the effects of young people's use of sexually explicit Internet material, research on the compulsive use of this type of online content among adolescents and its associated factors is largely lacking. This study investigated whether factors from three distinct psychosocial domains (i.e., psychological well-being, sexual interests/behaviors, and impulsive-psychopathic personality) predicted symptoms of compulsive use of sexually explicit Internet material among adolescent boys. Links between psychosocial factors and boys' compulsive use symptoms were analyzed both cross-sectionally and longitudinally with compulsive use symptoms measured 6 months later (T2). Data were used from 331 Dutch boys (M age = 15.16 years, range 11-17) who indicated that they used sexually explicit Internet material. The results from negative binomial regression analyses indicated that lower levels of global self-esteem and higher levels of excessive sexual interest concurrently predicted boys' symptoms of compulsive use of sexually explicit Internet material. Longitudinally, higher levels of depressive feelings and, again, excessive sexual interest predicted relative increases in compulsive use symptoms 6 months later. Impulsive and psychopathic personality traits were not uniquely related to boys' symptoms of compulsive use of sexually explicit Internet material. Our findings, while preliminary, suggest that both psychological well-being factors and sexual interests/behaviors are involved in the development of compulsive use of sexually explicit Internet material among adolescent boys. Such knowledge is important for prevention and intervention efforts that target the needs of specific problematic users of sexually explicit Internet material.

Sex-Related Online Behaviors, Perceived Peer Norms and Adolescents' Experience with Sexual Behavior: Testing an Integrative Model

Research on the role of sex-related Internet use in adolescents' sexual development has often isolated the Internet and online behaviors from other, offline influencing factors in adolescents' lives, such as processes in the peer domain. The aim of this study was to test an integrative model explaining how receptive (i.e., use of sexually explicit Internet material [SEIM]) and interactive (i.e., use of social networking sites [SNS]) sex-related online behaviors interrelate with perceived peer norms in predicting adolescents' experience with sexual behavior. Structural equation modeling on longitudinal data from 1,132 Dutch adolescents (M(age) T1 = 13.95; range 11-17; 52.7% boys) demonstrated concurrent, direct, and indirect effects between sex-related online behaviors, perceived peer norms, and experience with sexual behavior. SEIM use (among boys) and SNS use (among boys and girls) predicted increases in adolescents' perceptions of peer approval of sexual behavior and/or in their estimates of the numbers of sexually active peers. These perceptions, in turn, predicted increases in adolescents' level of experience with sexual behavior at the end of the study. Boys' SNS use also directly predicted increased levels of experience with sexual behavior. These findings highlight the need for multisystemic research and intervention development to promote adolescents' sexual health.

Sex-related online behaviors and adolescents' body and sexual self-perceptions

BACKGROUND AND OBJECTIVE

This study investigated: (1) the prevalence and development of 2 receptive (sexually explicit Internet material [SEIM] use and sexual information seeking) and 2 interactive (cybersex and general social networking site [SNS] use) online behaviors in adolescence; (2) whether development of these behaviors predict adolescents' body and sexual self-perceptions; and (3) whether parental strategies regarding adolescents' Internet use reduce engagement in sex-related online behaviors.

METHODS

Four-wave longitudinal data among 1132 seventh- to 10th-grade Dutch adolescents (mean age at wave 1: 13.95 years; 52.7% boys) were collected. Developmental trajectories of sex-related online behaviors were estimated by using latent growth curve modeling. Self-perception outcomes at wave 4 and parental strategies predicting online behaviors were investigated by adding regression paths to growth models.

RESULTS

Boys occasionally and increasingly used SEIM. Patterns for girls' SEIM use and boys' and girls' sexual information seeking and cybersex were consistently low. SNS use, however, was a common, daily activity for both. Higher initial levels and/or faster increases in sex-related online behaviors generally predicted less physical self-esteem (girls' SNS use only), more body surveillance, and less satisfaction with sexual experience. Private Internet access and less parental rule setting regarding Internet use predicted greater engagement in sex-related online behaviors.

CONCLUSIONS

Although most sex-related online behaviors are not widespread among youth, adolescents who engage in such behaviors are at increased risk for developing negative body and sexual self-perceptions. Particular attention should be paid to adolescents' SNS use because this behavior is most popular and may, through its interactive characteristics, elicit more critical self-evaluations. Prevention efforts should focus on parents' role in reducing risky sex-related online behaviors.

Adolescents' movement towards cessation of smoking: role and relative value of the processes of change and nicotine dependence

The present study addresses the applicability of the Transtheoretical Model's processes of change in explaining adolescents' readiness to quit smoking. Furthermore, the association between nicotine dependence and readiness to quit was assessed both directly, as well as indirectly through the processes of change. A cross-sectional survey was conducted, identifying 1547 weekly smokers aged 14-18 years. Structural equation modelling showed that the processes of change were only marginally associated with readiness to quit. Adding nicotine dependence to the model showed a direct association between nicotine dependence and readiness to quit. Only one process of change, self-liberation (i.e. choice/commitment to change and belief in the ability to change), was found to mediate this association. Nicotine dependence appeared to be highly important in adolescents' readiness to quit.

Young adolescents' sexual and romantic reference displays on Facebook

PURPOSE

Social networking sites (SNSs) form increasingly popular venues for adolescents to express their developing identity, including their sexual self. This study investigated how and to what extent early and middle adolescents display sexuality and romance on SNSs and the demographic and psychosexual factors associated with their displays.

METHODS

Dutch adolescents aged 11-18 years were recruited and Facebook friended. Participants' Facebook profiles were evaluated for sexual and romantic references and Facebook engagement. Participants completed a digital questionnaire measuring constructs related to romantic and sexual development. Analyses included chi-square and Student's t-tests.

RESULTS

A total of 104 adolescents (M(age) = 15.01, 68.3% female) were Facebook friended. Of 104 profiles, 25 (24.0%) contained 67 sexual references, and 27 (26.0%) contained 204 romantic references. Sexual references were mostly posted by others and referring to others or to no one in particular, whereas romantic references were predominantly posted by and referring to the profile owner. Displayers of sexual and romantic references were, compared with nondisplayers, older, more engaged in Facebook, more sexually experienced, and perceived more of their peers as approving of sex and as sexually active. In addition, sexual displayers were more likely boys and more sexually interested. There were no differences with respect to sexual intention and sexual attitudes.

CONCLUSIONS

A minority of young adolescents display sexual and romantic references on SNSs. References may reflect adolescents' offline sexual and romantic experiences. Yet, they may be powerful in creating behavioral norms; therefore, guidance on interpreting and displaying such messages should be promoted.

Long-term efficacy of nicotine replacement therapy for smoking cessation in adolescents: a randomized controlled trial

BACKGROUND

A double-blind RCT on the short-term efficacy of nicotine patches compared to placebo patches among Dutch adolescents was conducted. The findings demonstrated that nicotine patches are efficacious for smoking cessation at end-of-treatment; however, only in highly compliant participants. We tested whether the effects of NRT also held in 6- (T7) and 12-month (T8) follow-up assessments.

METHODS

Adolescents aged 12-18 years, who smoked at least seven cigarettes a day and who were motivated to quit smoking were recruited at school yards and randomly assigned to either a nicotine patch (n=182) or a placebo patch (n=180) condition according to a computer generated list. Participants (N=257, age: 16.7 ± 1.13 years) attended an information meeting followed by a 6- or 9-week treatment. Smoking cessation, compliance, and potential covariates were measured by means of online questionnaires. Smoking cessation at T8 was biochemically validated by saliva cotinine.

RESULTS

At T7, 8.1% and 5.7% of participants were abstinent in the nicotine and placebo patch groups, respectively. At T8, abstinence was 4.4% and 6.6%, respectively. Intention-to-treat analyses showed no significant effects of NRT on abstinence rates at T7 (OR=1.54, 95% CI=0.57, 4.16) and validated abstinence rates at T8 (OR=0.64, 95% CI=0.21, 1.93) neither after considering compliance nor after adjusting for covariates.

CONCLUSIONS

NRT fails in helping adolescents quit smoking at 6- and 12-month follow-ups. This finding suggests that a more intensive approach is needed to assist youngsters in their quit attempts.

Differential developmental profiles of adolescents using sexually explicit internet material

This study used a person-centered approach to examine whether different developmental trajectories of boys' and girls' use of sexually explicit Internet material (SEIM) exist, which factors predict these trajectories, and whether sexual behavior develops differently for adolescents in these trajectories. A combination of latent class growth analysis on SEIM use and latent growth curve analysis on sexual behavior was used on four-wave longitudinal data of 787 eighth through tenth grade Dutch adolescents. Among boys, four SEIM use trajectories were identified, which were labeled Nonuse/Infrequent Use, Strongly Increasing Use, Occasional Use, and Decreasing Use. Among girls, a large Stable Nonuse/Infrequent Use and smaller Strongly Increasing Use and Stable Occasional Use trajectories were distinguished. Higher initial levels and/or stronger increases in SEIM use were predicted by demographic, social contextual, personal, and media use characteristics, including a stronger sexual interest, a higher degree of perceived realism regarding sexualized Internet content, and more permissive sexual attitudes. Moreover, initial levels of and, to some extent, developmental changes in sexual behavior varied for boys and girls in the different SEIM use trajectories. Whereas some adolescents showed concurrent low levels, or parallel strong increases in SEIM use and sexual behavior, a subgroup of boys decreased their SEIM use while increasing their sexual behavior.

Risk moderation of a parent and student preventive alcohol intervention by adolescent and family factors: a cluster randomized trial

OBJECTIVE

To examine risk moderation of an alcohol intervention targeting parents and adolescents.

DESIGN

A cluster randomized trial including 2937 Dutch early adolescents (m=12.68years, SD=0.51) and their parents randomized over four conditions: parent intervention, student intervention, combined parent-student intervention, and control group.

SETTING

152 classes of 19 high schools in The Netherlands (2006).

METHOD

Moderators at baseline (adolescent: gender, educational level and externalizing behavior; parent: educational level and heavy alcohol use) were used to examine the differential effects of the interventions on onset of (heavy) weekly drinking at 22-month follow-up.

RESULTS

The combined intervention effectively delayed the onset of weekly drinking in the general population of adolescents, and was particularly effective in delaying the onset of heavy weekly drinking in a higher-risk subsample of adolescents (i.e. those attending lower levels of education and reporting higher levels of externalizing behavior).

CONCLUSION

Present and previous results have established the combined intervention to be universally effective in postponing weekly alcohol use among Dutch adolescents, with an added effect on postponing heavy weekly drinking in high risk subgroups. Therefore, implementation of this intervention in the general population of schools in The Netherlands is advised.

TRIAL REGISTRATION

NTR649.

Alcohol-specific parenting, adolescents' self-control, and alcohol use: a moderated mediation model

OBJECTIVE

There is convincing evidence that parental rules about alcohol are important in curbing adolescents' alcohol use. However, little is known about the mechanisms through which the direct link between alcohol-specific parenting and alcohol use is obtained. In this study, we investigated the mediating effect of adolescent self-control on the relationship between alcohol-specific rules and adolescents' drinking behavior and whether this mediation effect depends on the level of quality of communication.

METHOD

A total of 883 adolescents participated in this longitudinal study at ages 13, 14, and 15 years.

RESULTS

Strict rules predicted lower rates of drinking, but no direct effect of the quality of communication on adolescents' alcohol use was found. A higher level of self-control was related to lower rates of drinking in adolescents. The indirect effect of rules about alcohol through adolescents' self-control was statistically significant, yet only in adolescents with high qualitative parent-child communication about alcohol. In adolescents with low quality of parent-child communication, self-control was not related to drinking.

CONCLUSIONS

These findings imply that strict rule setting in combination with qualitative parent-child communication is an important target for prevention. In addition, findings point at the importance of high qualitative parent-child communication for adolescents' motivation to engage in self-control to avoid drinking.

Age at menarche and adolescent alcohol use

Research has shown that early maturation is related to problematic alcohol use, yet the differential effect of early pubertal timing (i.e., younger age at menarche) on the onset of alcohol use and subsequent level of alcohol use has rarely been examined. This distinction is relevant, as younger age at menarche can have differential effects on these outcomes, which in turn can have long-lasting effects. Therefore, the present study examined the relationship between age at menarche and adolescent alcohol use among girls, hereby distinguishing between onset and level of alcohol use. In addition, the moderating effects of alcohol-specific rules, child disclosure and class gender composition were examined. Participants were 430 girls from a Dutch four-wave survey, with a mean age of 12.17 years (SD = 0.50) at the beginning of the study. Results showed that the probability of onset of alcohol use was increased by younger age at menarche, but only when girls were younger than 15. Moderation analyses showed that younger age at menarche increased the risk of alcohol onset only in low risk girls (with high levels of alcohol-specific rules and in classes with a high percentage of girls). Once adolescent girls started drinking alcohol, younger age at menarche was associated positively with alcohol consumption only for girls in classes with a moderate to high percentage of girls. These findings confirm that younger age at menarche is a risk factor for the onset of alcohol use, but strongly suggest that this effect is strongest for girls having restrictive alcohol-specific rules and in classes with a high percentage of girls. Possibly, in the absence of social factors that "push" to alcohol use, biological factors (like age at menarche) become more important. Another possibility is that adolescent girls start drinking alcohol to oppose their parents if they set too strict alcohol-specific rules.

Short-term efficacy of nicotine replacement therapy for smoking cessation in adolescents: a randomized controlled trial

The aim of this randomized, double-blind placebo-controlled clinical trial is to test the efficacy and safety of nicotine replacement therapy (NRT) in promoting end-of-treatment abstinence among adolescents and whether this relation is moderated by medication compliance. Participants (N=257, age: 16.7±1.13 years) attended an information meeting followed by a 6- or 9-week treatment. Self-reported smoking cessation, compliance, and side effects were measured by means of online questionnaires. Intent-to-treat analyses showed that independent of compliance, NRT is effective in promoting abstinence rates after 2 weeks (OR=2.02, 95% CI=1.11-3.69), but not end-of-treatment abstinence. However, end-of-treatment abstinence rates significantly increased in high-compliant (OR=1.09, 95% CI=1.01-1.17) and not in low-compliant participants. No serious adverse events were found. Future research is warranted to disentangle the process involving the decrease in abstinence rates and compliance rates from the third week after the quit date onwards.

A cluster randomized trial on the effects of a parent and student intervention on alcohol use in adolescents four years after baseline; no evidence of catching-up behavior

OBJECTIVE

It is questioned whether the alcohol prevention program "Prevention of Alcohol use in Students" (PAS) is effective in reducing the prevalence of heavy weekend drinking and the amount of drinking among adolescents at the age at which they are allowed to buy alcohol in The Netherlands (16 years). In addition, it is questioned whether the intervention effects are attributed to a delay in onset earlier in adolescence or to the development of skills due to the PAS intervention (mediation analyses).

DESIGN

A cluster randomized trial including 3490 Dutch early adolescents (M age=12.66, SD=0.49) and their parents randomized over four conditions; 1) parent intervention, 2) student intervention, 3) combined intervention and 4) control group.

OUTCOME MEASURES

Outcome measures were prevalence of heavy drinking and amount of weekend drinking measured at age 16, 50 months after baseline.

RESULTS

Only when parents and students were targeted simultaneously could the prevalence of heavy weekend drinking (b=-.44, p=.02) and the amount of alcohol use (b=-.24, p=.02) be reduced. No significant effects of the separate parent and student interventions were found. The effect of the combined PAS intervention on heavy weekend drinking and amount of drinking can be attributed to respectively the increase in self-control and strict parenting, and a delayed alcohol initiation earlier in adolescence.

CONCLUSIONS

The current study confirms the effectiveness of the combined PAS intervention up to the legal drinking age of 16. The results underline that postponing the onset of drinking among early adolescents is not only crucial for health development in the short term, but also impacts the development of a healthier drinking pattern later on.

Effects of nicotine dependence and depressive symptoms on smoking cessation: a longitudinal study among adolescents

INTRODUCTION

Nicotine dependence has been shown to hamper successful smoking cessation in adolescents. Nicotine dependence and depression are highly comorbid, but the relation between depression and smoking cessation is not yet fully understood. Therefore, the present study examines both the longitudinal reciprocal relation between nicotine dependence and depressive symptoms, and the longitudinal effect of these factors on successful smoking cessation and number of quit attempts.

METHODS

A 2-wave longitudinal study was conducted among 535 adolescents aged 13-18. Written self-report questionnaires were administered in a classroom setting. Two models were tested, examining the mutual relation between nicotine dependence and depressive symptoms, as well as the predictive value of these factors on smoking cessation (n = 535), and number of quit attempts (n = 473) 1 year later.

RESULTS

Adolescents with more depressive symptoms have significantly higher levels of nicotine dependence 1 year later. Higher levels of nicotine dependence negatively predicted subsequent successful smoking cessation, whereas depressive symptoms did not. In contrast, depressive symptoms predicted a higher number of unsuccessful quit attempts in the following year, whereas nicotine dependence did not.

CONCLUSIONS

The findings suggest that adolescents tend to smoke cigarettes in order to diminish their depressive feelings, which might provide some support for the self-medication theory. Smoking cessation programs aiming at adolescents should not only focus on symptoms of nicotine dependence but should also pay attention to depressive feelings, since these feelings are related to a higher number of unsuccessful quit attempts.

Developmental alcohol-specific parenting profiles in adolescence and their relationships with adolescents' alcohol use

Previous studies on general parenting have demonstrated the relevance of strict parenting within a supportive social context for a variety of adolescent behaviors, such as alcohol use. Yet, alcohol-specific parenting practices are generally examined as separate predictors of adolescents’ drinking behavior. The present study examined different developmental profiles of alcohol-specific parenting (rule-setting, quality and frequency of communication about alcohol use) and how these patterns relate to the initiation and growth of adolescents’ drinking. A longitudinal sample of 883 adolescents (47 % female) including four measurements (between ages 12 and 16) was used. Latent class growth analysis revealed that five classes of parenting could be distinguished. Communication about alcohol appeared to be fairly stable over time in all parenting classes, whereas the level of rule-setting declined in all subgroups of parents as adolescents grow older. Strict rule-setting in combination with a high quality and frequency of communication was associated with the lowest amount of drinking; parents scoring low on all these behaviors show to be related to the highest amount of drinking. This study showed that alcohol-specific rule-setting is most effective when it coincides with a good quality and frequency of communication about alcohol use. This indicates that alcohol-specific parenting behaviors should be taken into account as an alcohol-specific parenting context, rather than single parenting practices. Therefore, parent-based alcohol interventions should not only encourage strict rule setting, the way parents communicate with their child about alcohol is also of major importance.

Why target early adolescents and parents in alcohol prevention? The mediating effects of self-control, rules and attitudes about alcohol use

AIMS

To examine the effects of a parent and student intervention offered separately and simultaneously (PAS) on onset of weekly drinking via its putative mediators.

DESIGN

A randomized trial with four conditions; (1) parent intervention, (2) student intervention, (3) combined parent-student intervention and (4) control group.

SETTING

High schools selected randomly, located in different areas.

PARTICIPANTS

A total of 2937 early adolescents (mean age = 12.6, standard deviation = 0.49) and their parents.

MEASUREMENTS

Mediation effects were analysed using pretest data and two follow-up measurements (10 and 22 months after baseline). A path model was estimated (Mplus) to examine the effect of the interventions on adolescent-reported mediators (self-control, perceived parental rules and attitudes about alcohol) and parent-reported mediators (parental rules and attitudes about alcohol). Outcome was onset of weekly drinking.

FINDINGS

The parent intervention modified rules and attitudes about alcohol as reported by parents. An indirect effect of the parent intervention via parental rules was found. The combined intervention affected both adolescent-reported and parent-reported rules and attitudes about alcohol and adolescents' perceived self-control, yet only perceived rules and self-efficacy, as reported by adolescents, and parental attitudes mediated the association between the combined intervention and onset of weekly drinking. No significant effects were found of the separate student intervention on the mediating factors.

CONCLUSIONS

The PAS programme proved to be effective as predicted by the theoretical assumptions underlying the interventions. Interventions with parents and adolescents to prevent adolescent alcohol consumption may usefully target parental rules about alcohol and adolescents' self-confidence.

Compulsive internet use among adolescents: bidirectional parent-child relationships

Although parents experience growing concerns about their children's excessive internet use, little is known about the role parents can play to prevent their children from developing Compulsive Internet Use (CIU). The present study addresses associations between internet-specific parenting practices and CIU among adolescents, as well as the bidirectionality of these associations. Two studies were conducted: a cross-sectional study using a representative sample of 4,483 Dutch students and a longitudinal study using a self-selected sample of 510 Dutch adolescents. Results suggest that qualitatively good communication regarding internet use is a promising tool for parents to prevent their teenage children from developing CIU. Besides, parental reactions to excessive internet use and parental rules regarding the content of internet use may help prevent CIU. Strict rules about time of internet use, however, may promote compulsive tendencies. Finally, one opposite link was found whereby CIU predicted a decrease in frequency of parental communication regarding internet use.

General parenting, anti-smoking socialization and smoking onset

A theoretical model was tested in which general parenting and parental smoking predicted anti-smoking socialization, which in turn predicted adolescent smoking onset. Participants were 4351 Dutch adolescents between 13 and 15 years of age. In the model, strictness and psychological autonomy granting were related to lower likelihood of smoking onset, and parental smoking was positively related to smoking onset. Involvement and strictness were positively related to anti-smoking socialization, whereas parents who smoke where less likely to be engaged in anti-smoking socialization. In turn, anti-smoking socialization was negatively related to adolescent smoking. To test mediation, an asymptotic resampling method was used (bootstrapping); anti-smoking socialization appeared to mediate the links between involvement and smoking onset, strictness and smoking onset and parental smoking and smoking onset. In addition, parental smoking appeared to moderate the link between anti-smoking socialization and smoking onset. Implications for prevention were addressed.

An integration of parents' and best friends' smoking, smoking-specific cognitions, and nicotine dependence in relation to readiness to quit smoking: a comparison between adolescents with and without asthma

OBJECTIVE

To study the impact of parents' and best friends' smoking, nicotine dependence, and craving on smoking-specific cognitions, and readiness to quit in adolescents with and without asthma.

METHODS

Structural equation analyses were applied to data from a sample of 1,120 daily smoking adolescents, 83 of whom had asthma.

RESULTS

Adolescents with asthma felt more ready to quit, and cognitions were more strongly related to readiness to quit among adolescents with asthma than among adolescents without asthma. Moreover, best friends' smoking seemed more relevant to the cognitions of adolescents with asthma. Nicotine dependence and craving were strongly related to cognitions, and to readiness to quit in both groups. The relation between craving and readiness to quit, however, was stronger among participants with asthma.

CONCLUSIONS

Reduction of nicotine dependence and craving is essential for both groups. Youth with asthma may benefit even more from cognitive-based cessation services than healthy youth. The finding that adolescents with asthma are relatively more ready to quit, and that their cognitions are more easily affected can be turned into advantages in asthma-specific cessation services.

Associations between the transtheoretical processes of change, nicotine dependence and adolescent smokers' transition through the stages of change

AIMS

To examine the significance of the transtheoretical processes of change in predicting transition through the stages of change in adolescent smokers, as well as the relative role of nicotine dependence in predicting stage transitions.

DESIGN

In grades 9 and 10, adolescents' stage of change, the use of processes of change and nicotine dependence were assessed (T1). Stage transitions were assessed 1 year later (T2). Response rate was 73.2%.

SETTING

Twenty-five secondary schools throughout the Netherlands participated in the present study.

PARTICIPANTS

Respondents were 721 adolescents who were classified as smokers at T1 and consequently completed the paper-and-pencil questionnaire at T2.

MEASUREMENTS

Stages of change and processes of change were assessed according to the original transtheoretical measures. Nicotine dependence was measured using a newly developed multi-dimensional scale consisting of 11 items.

FINDINGS

Few associations were found between the processes of change and stage transitions. Nicotine dependence contributed significantly to the explanation of adolescents' transition from preparation to action, after adjustment for processes of change. No evidence for a moderating effect of nicotine dependence in the relation between the processes of change and stage transitions was found.

CONCLUSIONS

Processes of change do not seem significant in explaining adolescents' stage transitions. As an alternative for promoting the use of the processes of change for intervention purposes in adolescents, it might be more useful to focus on treating nicotine dependence.

Socioeconomic differences in alcohol-specific parenting practices and adolescents' drinking patterns

The aim of this study was to investigate to what extent alcohol-specific parenting practices relate to adolescents' alcohol use, binge drinking, and alcohol-related problems, and whether these associations are moderated by socioeconomic status (SES), i.e. parents' education level and family income. The present data were collected within the framework of a representative study on alcohol use among Dutch students. The present findings are based on data from respondents who had been drinking in the past year (81.5%), and of whom one of the parents had filled out a short questionnaire including SES characteristics (52%). The sample consisted of 1,344 adolescents. Adolescents were approached in a school setting; parents received a short questionnaire at the home address. The results show that applying strict rules about alcohol use and having qualitative good conversations about drinking alcohol seem to prevent adolescents from heavy drinking patterns, whereas parental alcohol use seems to promote adolescents' drinking. A positive association was found between frequency of alcohol communication and availability of alcohol at home on the one hand and adolescents' drinking on the other. Some moderating effects of SES were found.

Smoking behavior in asthmatic and non-asthmatic adolescents: the role of smoking models and personality

Despite the particular health risks for asthmatics, recent international studies have reported that tobacco use among asthmatics is similar to, or even higher than, non-asthmatics. This study examined the role of personality and environment in smoking among asthmatic and non-asthmatic adolescents. In 2003 a random sample of 33 schools (first and second class of secondary education) was obtained in The Netherlands (N = 4,951). The mean age of the participants was 12.83 (SD = .75), and 52.8% were females. Information about asthma, smoking, personality, and environmental smoking was assessed via self-reports on standard epidemiology survey items (asthma, smoking) and the Quick Big Five (personality). Both personality and environmental smoking were associated with smoking. Asthmatics were similarly or even more exposed to environmental smoke than non-asthmatic adolescents and asthmatic adolescents were less emotionally stable and extravert. Associations between personality and own smoking behavior, as well as between smoking models and own smoking behavior were similar for asthmatic and non-asthmatics. Limitations of the study are taken notice of, and implications of the results are briefly discussed.

The relative contributions of parenting practices in smoking behavior of adolescents with and without asthma

This study tested associations between general parenting dimensions, antismoking socialization practices, and parental smoking status on the one hand and adolescent smoking on the other. These associations were examined within asthmatic adolescents, a group particularly vulnerable to the effects of smoking. Participants were 9,008 young adolescents (aged 11-16 years) from the Netherlands. Associations between factors were tested separately as well as in a combined model using multiple logistic regression analyses. Adolescents with current asthma were more at risk of being current regular smokers. Higher scores on parental involvement and strictness, antismoking socialization, and parental smoking abstinence were associated with lower odds of adolescent smoking. Parents of asthmatic adolescents were more likely to use involvement and strictness. Despite the increased health risks of smoking for people with asthma, parents of asthmatic children were generally not more engaged in antismoking socialization; they just talked more about not smoking. Furthermore, parents of adolescents with asthma were more likely to smoke than were parents of adolescents without asthma. In general, multiple logistic regression analyses showed similar effects for nonasthmatic and asthmatic adolescents. Diagnosis of asthma should be followed by suggestions for parents on how to use antismoking socialization (e.g., setting rules). In addition, the importance of having nonsmoking parents in smoking prevention should be emphasized.

The role of smoking-cessation-specific parenting in adolescent smoking-specific cognitions and readiness to quit

BACKGROUND

An instrument assessing smoking-cessation-specific parenting was developed and tested in relation to a) the pros of smoking and quitting and self-efficacy to resist smoking, and b) adolescent readiness to quit.

METHODS

Cross-sectional survey data from 998 Dutch adolescents who smoked regularly were used to perform structural equation analyses.

RESULTS

Adolescents who perceived relatively few advantages of smoking and many benefits of quitting reported a high readiness to quit. Self-efficacy was not related to readiness to quit. Smoking-cessation-specific parenting was both directly related to a high readiness to quit, and indirectly through the perceived pros of quitting. Also, if one or both parents were smokers, adolescents reported experiencing less smoking-cessation-specific parenting and a lower readiness to quit. However, in general, differences in paths were not found between adolescents with two parents who did not smoke and adolescents with one or two parents who smoked.

CONCLUSIONS

Given that anti-smoking socialisation has not yet been operationalised in terms of smoking-cessation-specific parenting, the present results will warrant further research into smoking-cessation-specific parenting in relation to adolescent smoking cessation. Further, parental smoking should not discourage parents from engaging in smoking-cessation-specific parenting as its relations with smoking cognitions and readiness to quit were highly similar in both the group with two parents who did not smoke and the group with one or two parents who smoked.

Excuses to continue smoking: the role of disengagement beliefs in smoking cessation

BACKGROUND

The aim of the present study was to investigate the role of disengagement beliefs in smoking cessation. The association of disengagement beliefs with forward transition through the transtheoretical stages of change and self-reported quitting were examined, with and without adjusting for processes of change.

METHODS

A longitudinal survey was conducted among Dutch smokers, resulting in 367 respondents who completed two questionnaires, one at baseline and one at 8 months follow-up. Disengagement beliefs, intention to quit, actual quitting, and the processes of change were assessed.

RESULTS

The findings showed that disengagement beliefs were negatively associated with forward stage transition and actual quitting. Processes of change only partly mediated these associations.

CONCLUSIONS

Adhering to disengagement beliefs seems to be an inhibitor of progression towards smoking cessation and actual quitting, also after adjustment for processes of change.

Atopic diseases and related risk factors among Dutch adolescents

BACKGROUND

The aim of the present study was to gain insight into the prevalence of asthma, allergic rhinitis, and eczema among Dutch early adolescents, and to study the impact of several social demographic and individual risk factors.

METHODS

Cross-sectional survey study using the self-report questionnaires of the International Study of Asthma and Allergies in Childhood (ISAAC). In January 2003, 10 087 12- to 14-year-old students from 33 secondary schools in four regions of the Netherlands participated in this study.

RESULTS

Of all participants, 52.6% reported that they had an allergic disease at least once in their lifetime. The 12 months prevalence of wheezing, rhinitis, and itchy rash was 12.3%, 28.3%, and 13.5%, respectively. Several social demographic and individual factors (gender, age, education levels, ethnicity, body mass index, and residential area) were significantly associated with the atopic symptoms and diseases.

CONCLUSION

This study showed that allergic conditions are common in the Netherlands. Several social demographic and individual risk factors were related to the atopic diseases and symptoms.

Measuring alcohol use: "quantity frequency variability" and "weekly recall" compared among Turks and Moroccans in the Netherlands

The aim of the present study was to test the quality of the "Quantity Frequency Variability" (QFV) measure and the "Weekly Recall" (WR) measure among second-generation Turks and Moroccans in The Netherlands. Data were gathered in an experimental study conducted in 2002, in Rotterdam, the second largest city in the Netherlands. A sample of 744 second-generation Turks and 753 second-generation Moroccans, aged 16 years and older, was approached to participate in the study. The response rate was 40.3% among Turks and 37.5% among Moroccans, which resulted in 300 Turks (mean age 21.8, of which 51.7% were male) and 282 Moroccans (mean age 20.1, of which 44.9% were male) participating in the experimental study. Differences in item non-response rates and alcohol reports between both measures were analyzed among the drinking sample; i.e., 95 Turks (31.7%) and 26 Moroccans (9.2%). Data showed higher alcohol reports with the QFV measure compared to the WR measure. Furthermore, item non-response rates were significantly lower for the QFV measure compared to the WR measure. The results suggest that, compared to the WR measure, the QFV measure is a more appropriate instrument to study the prevalence of alcohol use among second-generation Turks and Moroccans. Limitations of the study are discussed.

Relative contribution of smoker prototypes in predicting smoking among adolescents: a comparison with factors from the theory of planned behavior

BACKGROUND

It has frequently been suggested that adolescents are more likely to start smoking when they hold favorable social images or prototypes of smoking peers. Although empirical evidence supports the role of smoker prototypes in predicting smoking, little is known about the relative contribution of smoker prototypes, in comparison to more well-established social cognitive factors. Therefore, the present study investigated the relative impact of smoker prototypes, in comparison to factors of the theory of planned behavior, in predicting smoking among adolescents.

METHODS

A three-wave prospective study was conducted among 612 Dutch 8th grade students (aged 12-13 years). Questionnaires were administered and adolescents were followed during one year.

RESULTS

The results indicate that smoker prototypes are predictive of adolescent smoking behavior. Adolescents who believe that smoking peers are sociable more frequently engage in smoking behavior. Moreover, adolescents who hold the image that smoking peers are rebellious are less inclined to engage in smoking. These prototype factors predict a significant proportion of variance in smoking status, over and above the components of the theory of planned behavior.

CONCLUSION

The findings of the present study are interesting because they suggest that intervening on the level of smoker prototypes may contribute to the effectiveness of current programs aiming at the prevention of adolescents' smoking behavior.

Parental smoking and smoking behavior in asthmatic and nonasthmatic adolescents

BACKGROUND

Smoking may have serious consequences for asthmatics. Nevertheless, studies have shown that smoking behavior among asthmatics is similar to or even higher than that of nonasthmatics. Since the relationship between parental smoking and child smoking is well established, this study examined whether the association between parental and child smoking behavior is similar for asthmatic and nonasthmatic adolescents. The impact of parental smoking history was also explored.

METHODOLOGY

A cross-sectional sample of 10,087 Dutch adolescents was used to assess the prevalence of asthma and smoking behavior. Moreover, respondents had to report whether one of their parents currently smoked, had stopped, or had never smoked. In case a parent was a former smoker, the respondent had to report his or her own age at the moment that the parent stopped smoking.

RESULTS

Logistic regression analyses showed that, compared with nonasthmatic adolescents, asthmatic adolescents were more likely to have smoking parents. Furthermore, similar associations were found between parental smoking and adolescent smoking among asthmatic and nonasthmatic adolescents. The time at which maternal smoking ceased was associated with a decreased likelihood for ever smoking for both asthmatic and nonasthmatic adolescents.

CONCLUSIONS

Asthmatic adolescents need to become more aware of the health risks of smoking. Therefore, tailor-made antismoking campaigns are needed at schools to reduce misconceptions among asthmatic adolescents about the risks of smoking. In addition, a personal intervention approach aimed particularly at smoking parents of an asthmatic child, may make them aware of the consequences for their offspring and help them to stop smoking.

Self-comparison processes, prototypes, and smoking onset among early adolescents

BACKGROUND

Research has shown that social images or prototypes of smoking peers play a role in adolescents' decisions to start smoking. To devise effective prevention measures, specific information is needed about how adolescents evaluate characteristics associated with smoker prototypes. Such evaluation is assumed to occur through self-comparison processes, that is, 'self-consistency' and 'self-enhancement' motivations. This is one of the first studies to examine longitudinal relations between both these motivational processes and smoking behavior.

METHODS

Self-reported data on motivational processes and smoking were gathered at two waves (with a 1-year interval) among Dutch adolescents (12-16 years). Relations between self-comparison processes and willingness to smoke or future smoking behavior were tested among a sample of 1938 respondents.

RESULTS

Smoker prototypes predicted adolescents' smoking onset, particularly those images that referred to daily smoking peers as being "cool" or "rebellious." Furthermore, self-consistency and self-enhancement motivations predicted smoking onset for certain characteristics associated with smoker prototypes.

CONCLUSION

Evidence for the role of self-consistency and self-enhancement motivations in adolescents' smoking onset suggests that smoking prevention projects should target both similar and aspiring features associated with the image of smoking peers.

THE EFFECT OF DATA COLLECTION MODE AND ETHNICITY OF INTERVIEWER ON RESPONSE RATES AND SELF-REPORTED ALCOHOL USE AMONG TURKS AND MOROCCANS IN THE NETHERLANDS: AN EXPERIMENTAL STUDY

AIMS

To test the effects of data collection mode and ethnicity of interviewers on response rates and self-reported alcohol use among second-generation Turks and Moroccans in Rotterdam, The Netherlands.

METHODS

Two hundred and sixty-nine Turks and 271 Moroccans were interviewed face-to-face, and 475 Turks and 482 Moroccans received a mailed questionnaire. Half of the Turks and Moroccans randomly allocated to the interview mode were ethnically matched to the interviewer; the remainder were allocated to a Dutch interviewer.

RESULTS

Turks and Moroccans more often responded to a face-to-face interview than to a mailed questionnaire. No effect of ethnicity of interviewer on response rates was demonstrated. With respect to the effects on alcohol reports, Turks and Moroccans tended to report a higher alcohol use in the mailed survey than in the face-to-face interview. They reported significantly more often excessive drinking in the mail survey than in the face-to-face interviews. Ethnicity of the interviewer resulted in Turks and Moroccans reporting a higher prevalence of alcohol use during the previous 6 months when interviewed by a Dutch interviewer compared with an ethnically matched interviewer.

CONCLUSIONS

Among second-generation Turks and Moroccans, mail surveys seem most suitable to measure mean and excessive alcohol use. However, interviews held by Dutch interviewers seem to be the most appropriate method to study the prevalence of alcohol use during the previous 6 months.

Explaining adolescents' smoking and drinking behavior: the concept of smoker and drinker prototypes in relation to variables of the theory of planned behavior

Research has demonstrated that social image factors play an important role in the course of adolescent's substance use, that is, smoking and drinking. The concept of social images or prototypes is embedded into a theoretical model called the prototype/willingness model. The present study addresses the relative value of the prototype/willingness model in relation to the theory of planned behavior. To study relations between prototypes and adolescents' willingness and intention to engage in smoking and drinking behavior, cross-sectional data among 2814 adolescents (12-16 years) were gathered. Results show that adolescents describe daily-smoking and weekly-drinking peers generally as slightly well adjusted, slightly rebellious, not really cool, and not really attractive. Positive relations were observed between smoker and drinker prototypes and adolescents' intention and willingness to smoke and drink in the future. Furthermore, regression analyses showed that prototypes of daily-smoking and weekly-drinking peers explained a significant part of the variance in intention and willingness to smoke and drink, and added significantly to the variance explained by the variables of the theory of planned behavior.

Methodological problems related to alcohol research among Turks and Moroccans living in the Netherlands: findings from semi-structured interviews

OBJECTIVES

To identify factors related to alcohol use among Turks and Moroccans living in the Netherlands. Furthermore, to reveal methodological problems related to research among Turks and Moroccans in general and to alcohol research among these groups in particular.

DESIGN

Individual face-to-face interviews were carried out with Dutch researchers (n = 9), Turkish and Moroccan (health) practitioners working in the field with Turks (n = 4) or Moroccans (n = 2), and members of the target population with a Turkish (n = 3) or a Moroccan background (n = 2). Furthermore, focus-group interviews were held with Turkish women (n = 4), Turkish men (n = 3), Moroccan women (n = 4) and Moroccan men (n = 3) working as health professionals.

RESULTS

Alcohol use seems prevalent particularly among second-generation Turks and Moroccans and is related to: upbringing, influence of peer groups, integration and the degree in which Islamic rules are practised. Written questionnaires seem more appropriate for second-generation Turks and Moroccans, because they have fewer language problems and are more familiar with Western bureaucratic society. However, both generations may prefer face-to-face interviews since both groups fear that 'written' answers about the sensitive subject 'alcohol use' may somehow become known among community members. Similarly, an interviewer with a Dutch background may elicit more reliable answers about alcohol use than an interviewer with a Turkish or Moroccan background.

CONCLUSION

In alcohol research special attention should be paid to second-generation Turks and Moroccans. Although it is probably easier to conduct alcohol studies in this group than in first-generation Turks and Moroccans, quantitative research is needed to test the hypothesis that written questionnaires elicit more reliable answers about alcohol use than face-to-face interviews. Furthermore, the influence of ethnic matching on response and data quality should be tested further.