Classification of probable online social networking addiction: A latent profile analysis from a large-scale survey among Chinese adolescents

BACKGROUND AND AIMS

Problematic online social networking use is prevalent among adolescents, but consensus about the instruments and their optimal cut-off points is lacking. This study derived an optimal cut-off point for the validated Online Social Networking Addiction (OSNA) scale to identify probable OSNA cases among Chinese adolescents.

METHODS

A survey recruited 4,951 adolescent online social networking users. Latent profile analysis (LPA) and receiver operating characteristic curve (ROC) analyses were applied to the validated 8-item OSNA scale to determine its optimal cut-off point.

RESULTS

The 3-class model was selected by multiple criteria, and validated in a randomly split-half subsample. Accordingly, participants were categorized into the low risk (36.4%), average risk (50.4%), and high risk (13.2%) groups. The highest risk group was regarded as "cases" and the rest as "non-cases", serving as the reference standard in ROC analysis, which identified an optimal cut-off point of 23 (sensitivity: 97.2%, specificity: 95.2%). The cut-off point was used to classify participants into positive (probable case: 17:0%) and negative groups according to their OSNA scores. The positive group (probable cases) reported significantly longer duration and higher intensity of online social networking use, and higher prevalence of Internet addiction than the negative group.

CONCLUSIONS

The classification strategy and results are potentially useful for future research that measure problematic online social networking use and its impact on health among adolescents. The approach can facilitate research that requires cut-off points of screening tools but gold standards are unavailable.

Normative, passionate, or problematic? Identification of adolescent gamer subtypes over time

BACKGROUND AND AIMS

For most youngsters, gaming is a fun and innocent leisure activity. However, some adolescents are prone to develop problematic gaming behavior. It is therefore important to have a comprehensive understanding of psychosocial and game-related characteristics that differentiate highly engaged gamers from problematic gamers. To that end, this study evaluated the stability and consistency of Internet gaming criteria (as suggested by the DSM-5) and psychosocial characteristics in a two-wave longitudinal study including 1928 young adolescents (mean age = 13.3 years, SD = 0.91, 57% boys).

METHODS

A confirmatory factor analysis revealed good stability of the Internet gaming disorder (IGD) construct over time. Latent class analyses revealed three classes for boys (recreational, engaged, and problematic) and two classes for girls (recreational and engaged).

RESULTS

Significant differences between classes emerged for problem criteria (conflict and problems in social life), gaming duration, impulsivity, social competence, and attention/hyperactivity. The absence of a problematic gaming class for girls suggests that girls are less likely to develop problematic gaming behavior.

DISCUSSION

The IGD criteria as proposed by the DSM-5 are a helpful tool to identify problematic gamers, although the results of this study suggest that using a strict cut-off point might result in false positives, particularly for boys. Problem criteria appeared to be the most sensitive and specific in identifying the problematic gamer, whereas escapism criteria were the least specific and sensitive. Careful consideration of the current proposed criteria to identify problematic gaming behavior could benefit the research and clinical field.

A Latent Class Analysis of the Co-occurrence of Risk Behaviors among Adolescents

Objectives: In this study, we examined the co-occurrence of multiple health-risk behaviors to determine whether there are any differences in the pattern of co-occurrence by sex. Methods: We conducted latent class analysis using the national 2013 Youth Risk Behavior Survey data for the overall sample, and separately by sex (N = 13,583). Results: Over half of the sample (53%) belonged to the low risk subgroup (Class 1). Class 2 accounted for 15% of adolescents, and over 40% in this subgroup reported riding with a drunk driver, and 63% reported texting while driving a vehicle. Over 14% belonged to Class 3, which had a higher probability of being depressed and suicidal (81% and 64%, respectively). Class 4 accounted for over 9% of adolescents who reported high probabilities for current cigarette (97%), tobacco (99%), and alcohol use (73%); and over half reported current marijuana use (52%). Class 5 accounted for 8.5% of adolescents identified as high-risk polysubstance users. Analyses showed differences by sex in the pattern of co-occurrences. Conclusion: Several adolescent risk behaviors are interrelated regardless of sex. However, sex differences in the higher probability of depressive symptoms and suicidality among girls highlight the need for interventions that consider the demographic composition of adolescents.

Development of Aggression Subtypes from Childhood to Adolescence: a Group-Based Multi-Trajectory Modelling Perspective

The persistence of elevated subtypes of aggression beginning in childhood have been associated with long-term maladaptive outcomes. Yet it remains unclear to what extent there are clusters of individuals following similar developmental trajectories across forms (i.e., physical and indirect) and functions (i.e., proactive and reactive) of aggression. We aimed to identify groups of children with distinct profiles of the joint development of forms and functions of aggression and to identify risk factors for group membership. A sample of 787 children was followed from birth to adolescence. Parent and teacher reports, and standardised assessments were used to measure two forms and two functions of aggressive behaviour, between six and 13 years of age along with preceding child, maternal, and family-level risk-factors. Analyses were conducted using a group-based multi-trajectory modelling approach. Five trajectory groups emerged: non-aggressors, low-stable, moderate-engagers, high-desisting, and high-chronic. Coercive parenting increased membership risk in the moderate-engagers and high-chronic groups. Lower maternal IQ increased membership risk in both high-desisting and high-chronic groups, whereas maternal depression increased membership risk in the high-desisting group only. Never being breastfed increased membership risk in the moderate-engagers group. Boys were at greater risk for belonging to groups displaying elevated aggression. Individuals with chronic aggression problems use all subtypes of aggression. Risk factors suggest that prevention programs should start early in life and target mothers with lower IQ. Strategies to deal with maternal depression and enhance positive parenting while replacing coercive parenting tactics should be highlighted in programming efforts.

Unpacking Adultification: Institutional Experiences and Misconduct of Adult Court and Juvenile Court Youth Living Under the Same Roof

The present study explores the ability of juvenile waiver policy and the resulting adult court status to impact the experiences and behavior of male youth originating from differing jurisdictions but incarcerated together within state-level juvenile correctional facilities. Using official agency data and youth survey data, this research examines how "adult" status influences behavior for waived youth compared with their juvenile court counterparts. Structural equation modeling and multiple group analysis is used to determine the extent to which adult status moderates the measurement structure of models related to individual characteristics, institutional experiences, and institutional misconduct. Results reveal an improvement in model fit to occur when estimated across the two groups of juvenile court and adult court youth, beyond that which occurs when parameters are constrained to be equal for these two groups. This work reveals adult status to be powerful enough to moderate the effects of who a youth is and what that youth experiences, on how that youth behaves during a term of juvenile incarceration.

Item Generation and Content Validity of the Child-Adolescent Bullying Scale

BACKGROUND

Healthcare providers do not uniformly screen young patients for exposure to bullying, and no screening instruments have been developed for widespread use in clinical settings.

OBJECTIVES

The objectives of this study were to (a) generate scale items by identifying and eliciting concepts relevant to youths with potential exposure to bullying as well as to professionals who work with bullied youths and (b) assess the content validity of the new Child-Adolescent Bullying Scale (CABS) instrument.

METHODS

A mixed-methods design was used to develop an initial pool of 52 items. The study was conducted in four phases: (I) comprehensive review of the existing literature; (II) concept elicitation through the conduct of focus groups with school-age youths and professionals who work with bullied youths; (III) concept selection and item construction; and (IV) content validation assessment of relevance, clarity, and dimension of each item by a panel of 30 international bullying and measurement experts through completion of an online survey.

RESULTS

An initial pool of 52 potential items was developed during Phases I-III of the study. During Phase IV, item- and scale-level content validity indices were calculated and were used to refine the item pool. These strategies resulted in a new, 22-item tool, with scale-level content validity indices of .954 for clarity and .920 for representativeness.

DISCUSSION

Evaluation of the CABS tool with a sample of youths drawn from healthcare settings will be necessary to assess the performance of the CABS items, further evaluate its psychometric properties, and further refine the tool.

Classification of problematic Internet usage types by motives and contexts with elementary and secondary school-aged counseling clients

BACKGROUND AND AIMS

Past research on the classification of problematic Internet use (PIU) has focused on symptom-based severity and usage motive in order to understand its mechanism. Recently, usage context, such as family or social relationships, has been identified as a key influencing factor of PIU. Therefore, we extended the classification of PIU to include usage context in addition to symptom-based severity and usage motive.

METHODS

To classify PIU types, we conducted two studies. First, we performed a clustering analysis, where 265 counseling cases were clustered into usage types in terms of motive and context. After characterizing each usage type, we examined their hierarchical relationships by considering symptoms. Second, we performed a focus group interview with six counselors to increase the transferability of usage types. This transferability was established by matching counselors' quotations to the usage types. When usage types showed consistency between quotations and the clustering analysis, we identified the progression patterns between hierarchical relationships.

RESULTS

The clustering analysis of motive and context yielded six usage types with three hierarchical relationships. The focus group interview results verified the transferability of these six types and identified two progression patterns between the hierarchical relationships.

DISCUSSION AND CONCLUSION

Although usage motive and context were given equal weight before the clustering analysis, the resulting types revealed that usage context played a greater role in the classification process.

Prospective Association between Dieting and Smoking Initiation among Adolescents

Purpose.

To examine the relation between dieting and smoking initiation among adolescents.

Design.

Prospective data from a nationally representative study were used.

Setting.

Two waves (1994 to 1996) of the National Longitudinal Study of Adolescent Health.

Subjects.

The sample included 7795 non-Latino Caucasian and non-Latino African-American adolescents.

Measures.

Dieting status was the independent variable and trying smoking and initiation of regular smoking were the dependent variables. Covariates included age, ethnicity, overweight status, false self-perception about being overweight, and availability of cigarettes at home.

Analysis.

Logistic regression and latent transition analyses were used.

Results.

Females had a higher prevalence of dieting (55%) when compared with males (25%). Dieting initiation was a significant predictor for initiation of regular smoking among females (OR = 1.94, p = .010), but not among males. Inactive dieting was a significant predictor among males (OR = 1.74, p = .031), but not among females. Compared to nondieters, initiating and consistent female dieters reported a higher probability of trans itioning to having tried regular smoking, although results from logistic regression suggested that the association between consistent dieting and initiation of regular smoking was not significant.

Conclusions.

There is a positive relation between initiating dieting and initiating regular smoking among females, but among males it is the inactive dieters who show a positive relationship. Results illustrate the importance of examining the association between dieting and the initiation of regular smoking.

Profiles of cognitive appraisals and triangulation into interparental conflict: Implications for adolescent adjustment

Youth appraisals and triangulation into conflicts are key mechanisms by which interparental conflict places youth at risk for psychological maladjustment. Although evidence suggests that there are multiple mechanisms at work (e.g., Fosco & Feinberg, 2015; Grych, Harold, & Miles, 2003), this body of work has relied on variable-centered analyses that are limited to the unique contributions of each process to the variance in outcomes. In reality, it is possible that different combinations of these risk mechanisms may account for multifinality in risk outcomes. Using latent profile analysis (LPA) we examined profiles of threat appraisals, self-blaming attributions, and triangulation in relation to internalizing and externalizing problems in a sample of 285, ethnically diverse high school students. The current analyses revealed 5 distinct profiles of appraisals and triangulation, including an overall low-risk group and a global high-risk group, in which all 3 processes were below average or above average, respectively. Additional profiles included combinations of threat and blame, threat and triangulation, and blame and triangulation. Links between these profiles and emotional distress, problem behavior, and academic outcomes are discussed. (PsycINFO Database Record

Trajectories of childhood neighbourhood cohesion and adolescent mental health: evidence from a national Canadian cohort

BACKGROUND

The objective of this study was to examine associations between trajectories of childhood neighbourhood social cohesion and adolescent mental health and behaviour.

METHOD

This study used data from the National Longitudinal Survey of Children and Youth, a nationally representative sample of Canadian children. The sample included 5577 children aged 0-3 years in 1994-1995, prospectively followed until age 12-15 years. Parental perceived neighbourhood cohesion was assessed every 2 years. Latent growth class modelling was used to identify trajectories of neighbourhood cohesion. Mental health and behavioural outcomes were self-reported at age 12-15 years. Logistic regression was used to examine associations between neighbourhood cohesion trajectories and outcomes, adjusting for potential confounders.

RESULTS

Five distinct trajectories were identified: 'stable low' (4.2%); 'moderate increasing' (9.1%); 'stable moderate' (68.5%); 'high falling' (8.9%); and 'stable high' (9.3%). Relative to those living in stable moderately cohesive neighbourhoods, those in stable low cohesive neighbourhoods were more likely to experience symptoms of anxiety/depression [odds ratio (OR) = 1.73, 95% confidence interval (CI) 1.04-2.90] and engage in indirect aggression (OR = 1.62, 95% CI 1.07-2.45). Those with improvements in neighbourhood cohesion had significantly lower odds of hyperactivity (OR = 0.67, 95% CI 0.46-0.98) and indirect aggression (OR = 0.69, 95% CI 0.49-0.96). In contrast, those with a decline in neighbourhood cohesion had increased odds of hyperactivity (OR = 1.67, 95% CI 1.21-2.29). Those in highly cohesive neighbourhoods in early childhood were more likely to engage in prosocial behaviour ('high falling': OR = 1.93, 95% CI 1.38-2.69; 'stable high': OR = 1.89, 95% CI 1.35-2.63).

CONCLUSIONS

These results suggest that neighbourhood cohesion in childhood may have time-sensitive effects on several domains of adolescent mental health and behaviour.

Early starting, aggressive, and/or callous-unemotional? Examining the overlap and predictive utility of antisocial behavior subtypes

Antisocial behavior (AB) in adolescence predicts problematic outcomes in adulthood. However, researchers have noted marked heterogeneity within the broad group of youth engaging in these destructive behaviors and have attempted to identify those with distinct etiologies and different trajectories of symptoms. In the present study, we evaluate 3 prominent AB subtyping approaches: age of onset, presence of callous-unemotional (CU) traits, and aggressive versus rule-breaking symptoms. We examined the overlap of these subtypes and their predictive validity in a diverse sample of 268 low-income young men followed prospectively from adolescence into emerging adulthood. We found that those with early starting AB were uniquely high on aggressive symptoms but not on CU traits. Early starting AB and both aggression and rule breaking measured during adolescence predicted most subsequent psychiatric and AB outcomes in early adulthood in univariate models, whereas CU traits were only predictive of adolescent arrests, later substance dependence diagnosis, and later CU traits. Finally, after accounting for shared variance among predictor variables, we found that aggressive symptoms explained the most unique variance in predicting several later outcomes (e.g., antisocial personality disorder) over and above other subtyping approaches. Results are discussed in relation to of the use of existing subtyping approaches to AB, noting that aggression and age of onset but not CU traits appear to be the best at predicting later negative outcome.

Psychometric support of the school climate measure in a large, diverse sample of adolescents: a replication and extension

BACKGROUND

The School Climate Measure (SCM) was developed and validated in 2010 in response to a dearth of psychometrically sound school climate instruments. This study sought to further validate the SCM on a large, diverse sample of Arizona public school adolescents (N = 20,953).

METHODS

Four SCM domains (positive student-teacher relationships, academic support, order and discipline, and physical environment) were available for the analysis. Confirmatory factor analysis and structural equation modeling were established to construct validity, and criterion-related validity was assessed via selected Youth Risk Behavior Survey (YRBS) school safety items and self-reported grade (GPA) point average.

RESULTS

Analyses confirmed the 4 SCM school climate domains explained approximately 63% of the variance (factor loading range .45-.92). Structural equation models fit the data well χ(2) = 14,325 (df = 293, p < .001), comparative fit index (CFI) = .951, Tuker-Lewis index (TLI) = .952, root mean square error of approximation (RMSEA) = .05). The goodness-of-fit index was .940. Coefficient alphas ranged from .82 to .93. Analyses of variance with post hoc comparisons suggested the SCM domains related in hypothesized directions with the school safety items and GPA.

CONCLUSIONS

Additional evidence supports the validity and reliability of the SCM. Measures, such as the SCM, can facilitate data-driven decisions and may be incorporated into evidenced-based processes designed to improve student outcomes.

Dating violence and suicidal behavior in adolescents

The aim of this paper is to assess the possible consequences of adolescent physical, emotional and sexual dating violence through a review of the literature on the topic. An electronic search of major biomedical bibliographic databases (Pubmed, ISI, PsycINFO) was used to retrieve articles providing information on the prevalence rates, risk factors, associated consequences and possible preventive measures for adolescent dating violence across different populations. Currently, there have been few longitudinal studies conducted to identify potential risk factors for entering a violent dating relationship in adolescence. Risky behaviors such as early sexual intercourse may predispose someone for victimization. Dating violence itself is also a predictor of future dating violence. Adolescent dating violence was associated with an increase in other violence-related behaviors, substance use, depression, poorer educational outcomes, posttraumatic stress, unhealthy weight control and risky sexual behavior. The association between adolescent dating violence and an increase in suicidal behavior is a major public health concern. Future research should focus on longitudinal studies so that a causal relationship between dating violence and suicidality may be better understood.

What does it take to be a smoker? Adolescents' characterization of different smoker types

INTRODUCTION

Studies have demonstrated that clinical- and research-based definitions of who a smoker is and what constitutes smoking often differ from adolescent-derived definitions, which can be problematic for effective intervention and prevention efforts. We investigated how adolescents define different smoker types (nonsmoker, smoker, regular smoker, addicted smoker, heavy smoker, experimental smoker, casual smoker, and social smoker) using multiple indicators of smoking behaviors, including frequency, amount, place, and length of time cigarette smoking, and whether differences exist by smoking experience.

METHODS

Quantitative and qualitative methods were used to analyze data from a cohort of adolescents (N = 372) in northern California.

RESULTS

We found differences in how adolescents characterized smoker types based on their own smoking experience. Ever-smokers tended to have a greater flexibility in determining what constituted nonsmoking and heavy smoking, while never-smokers had much narrower definitions. Results also indicated that adolescents may mistakenly associate nicotine addiction with a high frequency and amount of cigarette use as 74.3% characterized an addicted smoker as having smoked for a few years or more. In addition, there was a considerable amount of overlap in definitions between different smoker types, particularly among the smoker-regular smoker, addicted smoker-heavy smoker, and casual smoker-social smoker pairs.

CONCLUSION

Health communication strategies for youth smoking prevention need to address the wide variability and overlap in how adolescents define different smoker types. Greater attention should be directed to understanding the nuances of how adolescents define smoking in order to maximize the effectiveness of youth-centered smoking prevention and cessation messages.

[The relationship between tobacco smoking and risk behaviour syndrome among 15-year-old adolescents in Poland and other European countries]

In most of studies on the multiple risk behaviour syndrome, tobacco smoking is consider as one of the main components. In this paper smoking was excluded from this syndrome. On the contrary, a set of behaviours that includes: alcohol abuse, cannabis use and aggressive behaviours (bullying, fighting) was described and its association with smoking related behaviours was evaluated. Data were collected from 15-year-old students (N = 50618) from 28 countries participating in Health Behaviour in School-aged Children (HBSC) survey in 2005/06. Representative samples of pupils completed a standardised questionnaire during school hours in each country. Risk Behaviour Syndrome (RBS) was measured on the scale ranged 0-12 points, categorized into 3 levels. We tried to answer the following questions: 1) is early tobacco onset related with the higher risk of being involved in multiple problem behaviours; 2) what is the prevalence of regular tobacco smoking among adolescents reporting multiple problem behaviours; 3) in what extent gender modifies above relationships; 4) are similar patterns observed in Poland and combined international sample. The results have shown, that in Poland 22.6% of boys and 5.0% of girls reported high level of RBS (6 points or more). The prevalence of every day smoking was equal to 14.9% and 10,1%, in boys and girls, respectively. This percentage increased to 38.8% and 61.0% in the group of boys and girls reporting high score on RBS scale. More boys than girls started to smoke at age 13 yrs or earlier (38.6% vs. 27.1%). Adolescents who begun smoking earlier, were more likely to be regular smokers at age 15, and more likely to report multiple risk behaviors. In all countries the influence of early tobacco onset on the RBS is more evident among girls.

[Theory of resilience. Key conceptual constructs and chosen issues]

The aim of this article is to familiarize readers with key conceptual constructs related to resilience theory. This theory explains the phenomenon of children's and adolescents' positive adaptation despite various adverse life conditions and traumatic events. The resilience theory emphasizes the importance (relevance) of positive factors and mechanisms for child and adolescent development. Thus, it could be very useful for developing primary prevention and mental health promotion programmes among children and youth. This article is based on a review of publications written by significant resiliency researchers: M Rutter, N. Garmezy, E. Werner, S. Luthar, A. Sameroff, K. Kumpfer, A. Masten, M. Zimmerman, D. Cicchetti. More than 20 articles and book chapters published during the past 25 years were taken into consideration. They were chosen from the electronic database available at the University of Michigan and SAMSHA, and publications available in Poland. Several resilience definitions are mentioned, indicating the interactive and dynamic process of positive adaptation. These definitions encompass the impact of both risk and positive factors (and their interaction) on the individual's behavior, competence and health. The key conceptual constructs such as risk, risk factors, positive factors, resilience models and mechanisms are described in this article. The differences between the risk and protective mechanism are also presented. The difficulties related to operationalization of the key resilience constructs in empirical research are discussed. Common difficulties are related for example to clear criteria for risk and positive adaptation, and for risk group selection.

The psychometric properties of the Swedish version of the Adolescent Drug Abuse Diagnosis (ADAD)

The psychometric properties of the Swedish version of the Adolescent Drug Abuse Diagnosis (ADAD) instrument were evaluated in two adolescent groups. The participants in the Normal group comprised 121 adolescents aged 15-17 years and the participants in the group of adolescents with antisocial problems comprised 1168 youths aged 10-21 years detained under the Swedish Care of Young Persons Act in special youth homes. The ADAD instrument produced good interrater reliability; the subscales showed moderate internal consistency and concept validity was satisfactory and comparable with American and Swiss versions. Finally, the ADAD subscales produced meaningful correlations. The interviewer rating, the adolescent's rating and the composite scores are compared and discussed. The Swedish version of ADAD appears to be a psychometrically good instrument for assessing the severity of adolescent problems and their need for treatment. However, the composite scores need to be reconstructed to be useful in future research.

Classes of disruptive behavior problems in referred adolescents

BACKGROUND

Previous studies have found considerable overlap between attention/hyperactivity problems, aggressive/oppositional problems and delinquent/conduct problems in adolescents.

SAMPLING AND METHODS

Mothers of 1,965 11- to 18-year-olds (1,116 boys, 849 girls), referred to mental health agencies, completed the Child Behavior Checklist (CBCL). Latent class analysis was conducted on the Attention Problems scale (representing problems with attention, impulsivity and hyperactivity), Aggressive Behavior and Rule-Breaking Behavior scales of the CBCL.

RESULTS

Six latent classes were found. One of these classes contained individuals who suffered predominantly from attention problems and to a far lesser degree from aggressive or rule-breaking behaviors. The other 5 classes represented individuals with varying degrees of attention problems, aggressive behaviors and rule-breaking behaviors.

CONCLUSIONS

Contrary to previous studies, the present study indicated that, in a large referred sample, problems with attention, impulsivity and hyperactivity can be considered as a diagnostic construct that should be distinguished from aggressive or rule-breaking behaviors. However, the present study did not support the existence of diagnostic classes constituted by individuals who primarily suffer from aggressive behaviors or rule-breaking behaviors, and not from attention problems or hyperactivity. Implications of these findings for future research and clinical practice are discussed. The value of the study was limited by the use of parent reports only.

Self-weighing in adolescents: helpful or harmful? Longitudinal associations with body weight changes and disordered eating

PURPOSE

This study addresses the question: Is frequent self-weighing related to changes in body weight and disordered eating behaviors over a 5-year period among adolescent females and males?

METHODS

Project EAT is a 5-year population-based longitudinal study. Participants completed surveys exploring factors associated with eating and weight concerns. Participants included 2516 adolescents who were transitioning from early to middle adolescence (younger cohort) and from middle to late adolescence (older cohort).

RESULTS

In the older cohort of females and in both cohorts of males, frequent self-weighing at Time 1 was not associated with weight changes at Time 2 (5 years later), after adjusting for Time 1 weight status and sociodemographic characteristics. In the younger cohort of females, Time 1 frequent self-weighing predicted weight increases at Time 2. In both cohorts of females, but not in males, Time 1 frequent self-weighing predicted higher prevalences of Time 2 disordered eating behaviors, including unhealthy weight control behaviors and binge eating, after adjusting for Time 1 behavioral outcomes, weight status, and sociodemographic characteristics.

CONCLUSIONS

Frequent self-weighing was not associated with weight change, with the exception of predicting weight increases in younger females. In females, but not males, self-weighing predicted a higher frequency of binge eating and unhealthy weight control behaviors. Although further research is needed to explore the potential merits and problems associated with regular self-weighing, the findings suggest that population-based obesity prevention strategies targeting adolescents should avoid messages likely to lead to frequent self-weighing.

Screenieboppers and extreme screenies: the place of screen time in the time budgets of 10-13 year-old Australian children

OBJECTIVES

Excessive 'screen time' has been associated with a range of psychosocial disturbances and increasing pediatric obesity. This study describes the magnitude, distribution, composition and time-distribution of children's screen use; examines correlates of screen use; and characterises 'extreme' screen users (top quartile).

METHODS

1,039 South Australian children aged 10-13 years old completed a multimedia 24-hour activity recall diary on 2-4 occasions in 2002, including at least one school day and one non-school day.

RESULTS

The median screen time was 229 minutes.d(-1). This was higher in boys (264 vs. 196 minutes; p<0.001) and on non-school days (260 vs. 190 minutes; p<0.001), increased with age (p=0.003), and decreased with socio-economic status (SES; p=0.003). Television consumed 73% of all screen time, video games 19%, non-game computer use 6%, and cinema 2%. The top quartile of screen users were more likely to be boys (OR=3.8), have low physical activity (OR=4.3), spend >25% of screen time playing video games (OR=1.8), sleep less, and be of lower SES.

CONCLUSIONS AND IMPLICATIONS

Interventions to reduce screen time should target inactive, low-SES boys, encourage earlier bedtimes, and limit video game use.

Construct validity of physical activity and sedentary behaviors staging measures for adolescents

PURPOSE

To evaluate the construct validity of physical activity (PA) and sedentary behaviors (SB) staging measures for adolescents that incorporate the current national recommendations.

METHOD

The Progressive Aerobic Cardiovascular Endurance Run, Actigraph accelerometer, and self-reported hours of TV viewing served as criterion measures. Participants were 878 adolescents (M age = 12.74, 53.6% girls, 39.9% non-White).

RESULTS

The PA staging measure had mixed evidence of convergent validity and strong evidence of divergent validity. The SB staging measure had strong and generalized evidence of convergent validity but weak evidence of divergent validity, which could be related to inaccurate assumptions about the relation of SB to PA and fitness. Results were generally in the expected direction and provide preliminary evidence for the construct validity and generalizability of both staging measures. However, more research is warranted to validate the staging measures with Actigraph-measured PA and sedentary time. Effect sizes (eta(2) values) ranged from small to large (.02-.63).

CONCLUSION

PA and SB stage-of-change measures that are congruent with current national recommendations and appropriate for use among adolescents were partially supported for their construct validity.

Evaluation of the effects of the Aban Aya Youth Project in reducing violence among African American adolescent males using latent class growth mixture modeling techniques

This study employs growth mixture modeling techniques to evaluate the preventive effects of the Aban Aya Youth Project in reducing the rate of growth of violence among African American adolescent males (N = 552). Results suggest three distinct classes of participants: high risk (34%), medium risk (54%), and low risk (12%) based on both the participants' initial violence scores and their growth of violence over time. Results further show significant effects (almost 3 times as large as the effect found in the regular one-class analysis) for the high-risk class but not for the medium- or low-risk classes.

On the measurement of nicotine dependence in adolescence: comparisons of the mFTQ and a DSM-IV-based scale

OBJECTIVE

To compare nicotine-dependent smokers identified by the modified Fagerström Tolerance Questionnaire (mFTQ) and a scale based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), in a multiethnic adolescent sample.

METHODS

A school survey was conducted on 6th- to 10th-grade students (N=15,007) in a large urban public school system.

RESULTS

The two scales formed two distinct factors. The concordance between the two classifications of nicotine dependence was low. The DSM identified a much larger number of nicotine-dependent smokers than the mFTQ, mostly because smokers met dependence criteria at much lower levels of cigarettes consumed, especially when they were depressed. Rates of dependence were higher among whites than minority-group members, especially African Americans. Control for level of cigarette consumption attenuated or eliminated ethnic differences.

CONCLUSIONS

This investigation provides some understanding of youths defined as dependent by each scale but cannot by itself indicate which scale better measures dependence. Differences in dependence rates among ethnic groups are accounted for mostly by quantity of cigarettes smoked.

The SOGS-RA vs. the MAGS-7: prevalence estimates and classification congruence

The purpose of this study was to compare the prevalence rate estimates and congruence in classification status derived from two popular measures of adolescent gambling (SOGS-RA and MAGS-7). Adolescents from three states (Alabama, Mississippi, and Oregon) completed an anonymous questionnaire ( n =1846 high school students total). Results indicate that the prevalence of probable adolescent pathological gambling varied both as a function of instrument and cut-off point utilized for classification (range 1.7%-8.2%). Classification groups (non-problem, at-risk, and problem gamblers) generated by both instruments were found to be associated with reports of gambling frequency, amount of money lost in one gambling occasion, and parental gambling problems. However, concern was raised because the MAGS-7 and the SOGS-RA had little congruence in their three-group classification decisions for specific individuals (e.g., only 20.5% agreement for problem gamblers). To improve clinical utility, an empirical case was made for using the SOGS-RA to generate a fourth group of adolescent gamblers, which we labeled "probable pathological gamblers" (SOGS-RA > or = 6). This group was differentiated from the remaining gambling groups on all the validity indices. The implications and limitations of these findings, as well as future directions, are discussed.

Defining and understanding healthy lifestyles choices for adolescents

PURPOSE

To: (a) establish criteria for defining positive health behaviors and lifestyle; and (b) identify characteristics of adolescents who practice a healthy lifestyle.

METHODS

Responses from a 1998 survey via questionnaire, of 1487 students, from a public high school, Cambridge, Massachusetts, were used to assess correlates of healthy lifestyle choices. Strict and broad assessments of healthy behaviors were defined for students: use of alcohol, tobacco, and illegal drugs; sexual behavior; attempted suicide. Whereas the "strict" criteria included only those adolescents who did not practice any of the behaviors in question, the broad criteria reflected experimentation and moderate risk-taking. The prevalence of positive behaviors was assessed by demographic and student characteristics. In addition, logistic regression models were created to predict determinants of teenagers' healthy lifestyles using both strict and broad definitions.

RESULTS

Using strict criteria of healthy lifestyle, significant predictors were being female, born outside the United States, higher academic performance, and fewer stressful life events. Using a broad definition of a healthy lifestyle, significant predictors were being non-Caucasian, in the lower grade levels at the school, higher academic performance, and fewer stressful life events. In both models, peers' approval of risky behaviors negatively influenced teens' lifestyles, whereas parents' disapproval of risky behaviors was a positive influence.

CONCLUSIONS

These results reinforce the importance of school, peer, and parent support of positive behaviors. It is important for public health workers and families to understand and define healthy lifestyles choices for adolescents.

Developing a school functioning index for middle schools

Despite widespread recognition of schools' role in the healthy development of youth, surprisingly little research has examined the relationships between schools' overall functioning and the health-related behavior of students. School functioning could become an important predictor of students' health-related behavior and may be amenable to intervention. This paper describes the development and testing of the School Functioning Index (SFI) as a first step in investigating this question. The index was developed for use with middle schools and conceived as a predictor of students' violent behavior, with the potential for extending research applications to additional health and social behaviors. Using social cognitive theory, social ecological theory, and social disorganization theory as guides, three domains were identified to operationalize school functioning and identify candidate SFI items: 1) resources available to the school and students; 2) stability of the school population; and 3) the schools' performance as a socializing agent for students. Data for candidate SFI items were collected from public archives and directly from 16 middle schools participating in a school-based dietary intervention study. Data collection from schools, particularly concerning student aggressive behavior and disciplinary actions, presented challenges. The final SFI comprised nine items and demonstrated good internal consistency and variability. The SFI was modestly correlated in expected directions with violence and other health behaviors. This work supports the feasibility of combining multiple school-level indicators to create a measure of overall school functioning. Further investigation of validity and more acceptable data collection methods are warranted.

When and where do youths have sex? The potential role of adult supervision

OBJECTIVE

Interventions to reduce high-risk behaviors such as sex and substance use among youths have focused mainly on promoting abstinence, refusal skills, and negotiation skills, yet the frequency of high-risk behaviors among youths may also be influenced by opportunity, particularly the amount of time during which they are not supervised by adults. In this study, we examined when and where youths have sex and whether there is a relationship between unsupervised time and sex, sexually transmitted diseases (STDs), and substance use.

METHODS

A cross-sectional survey was conducted in 6 public high schools in an urban school district. Participants were 1065 boys and 969 girls from a school-based STD screening program. Ninety-eight percent of students were black, and 79% were in the free or reduced lunch program. Most students reported living with 1 parent only, primarily the mother (52%); only 27% lived in 2-parent families. Sexual activity, substance use, and the prevalence of gonorrhea or chlamydia as determined by a ligase-chain reaction test on a urine sample were measured.

RESULTS

Fifty-six percent reported being home without an adult present 4 or more hours per day after school. There was no difference in the number of unsupervised after-school hours between children in 1- and 2-parent families. Fifty-five percent of boys and 41% of girls were participating in or planned to participate in after-school activities during the school year. Boys were more likely than girls to report having had sex for the first time before age 14 (42% vs 9%) and had a greater number of lifetime sex partners (mean: 4.2 vs 2.4 partners). Among the respondents who had had intercourse, 91% said that the last time had been in a home setting, including their own home (37%), their partner's home (43%), and a friend's home (12%), usually after school. Boys were more likely than girls to report having had sex in their own homes (43% vs 28%) and less likely than girls to report having had sex in their partner's homes (30% vs 59%). Fifty-six percent of youths who had had intercourse reported that the last time was on a weekday: 18% before 3:00, 17% between 3:00 and 6:00, and 21% after 6:00. There were no gender differences in the day of the week or time of day during which students reported having had intercourse. Youths who were unsupervised for 30 or more hours per week were more likely to be sexually active compared with those who were unsupervised for 5 hours a week or less (80% vs 68%). In addition, for boys, the greater the amount of unsupervised time, the higher the number of lifetime sex partners. Among girls but not among boys, sexual activity was associated with nonparticipation in after-school programs; 71% of those who were not participating in an after-school activity were sexually active compared with 59% of those who were participating. Tobacco and alcohol use were associated with unsupervised time among boys but not among girls. Boys who were unsupervised >5 hours per week after school were twice as likely to have gonorrhea or chlamydial infection as boys who were unsupervised for 5 hours or less.

CONCLUSIONS

We found that substantial numbers of youths currently spend long periods of time without adult supervision and have limited opportunities to participate in after-school activities. More than half of sexually active youths reported that they had sex at home after school, and, particularly for boys, sexual-and drug-related risks increased as the amount of unsupervised time increased. As youths come of age, parents probably believe that it is appropriate to leave them increasingly on their own, and, accordingly, prevention approaches have concentrated on providing information and motivation for abstinence or safer sex. However, given the independent association between the amount of unsupervised time and sexual behaviors (with STD rates suggestive of particularly risky sexual behaviors) and substance use behaviors, it is worth considering increasing youth supervision, if not by parents, then by programs organized at schools organized at school or other community settings. Parents and community members should consider increasing opportunities for supervised activities to determine whether this will reduce risk-taking among youths.

Measuring risk and protective factors for substance use, delinquency, and other adolescent problem behaviors. The Communities That Care Youth Survey

Risk and protective factors predictive of adolescent problem behaviors such as substance abuse and delinquency are promising targets for preventive intervention. Community planners should assess and target risk and protective factors when designing prevention programs. This study describes the development, reliability, and validity of a self-report survey instrument for adolescents ages 11 to 18 that measures an array of risk and protective factors across multiple ecological domains as well as adolescent problem behaviors. The instrument can be used to assess the epidemiology of risk and protection in youth populations and to prioritize specific risk and protective factors in specific populations as targets for preventive intervention.

Measuring risk and protective factors for substance use, delinquency, and other adolescent problem behaviors. The Communities That Care Youth Survey

Risk and protective factors predictive of adolescent problem behaviors such as substance abuse and delinquency are promising targets for preventive intervention. Community planners should assess and target risk and protective factors when designing prevention programs. This study describes the development, reliability, and validity of a self-report survey instrument for adolescents ages 11 to 18 that measures an array of risk and protective factors across multiple ecological domains as well as adolescent problem behaviors. The instrument can be used to assess the epidemiology of risk and protection in youth populations and to prioritize specific risk and protective factors in specific populations as targets for preventive intervention.

Gradients in risk for youth injury associated with multiple-risk behaviours: a study of 11,329 Canadian adolescents

This study used the Canadian version of the World Health Organization-Health Behaviour in School-Aged Children (WHO-HBSC) Survey to examine the role of multiple risk behaviours and other social factors in the etiology of medically attended youth injury. 11,329 Canadians aged 11-15 years completed the 1997-1998 WHO-HBSC, of which 4152 (36.7%) reported at least one medically attended injury. Multiple logistic regression analyses failed to identify an expected association between lower socio-economic status and risk for injury. Strong gradients in risk for injury were observed according to the numbers of multiple risk behaviours reported. Youth reporting the largest number (7) of risk behaviours experienced injury rates that were 4.11 times (95% CI: 3.04-5.55) higher than those reporting no high risk behaviours (adjusted odds ratios for 0-7 reported behaviours: 1.00, 1.13, 1.49, 1.79, 2.28, 2.54, 2.62, 4.11; p(trend) < 0.001). Similar gradients in risk were observed within subgroups of young people defined by grade, sex, and socio-economic level, and within restricted analyses of various injury types (recreational, sports, home, school injuries). The gradients were especially pronounced for severe injury types and among those reporting multiple injuries. The analyses suggest that multiple risk behaviours may play an important role in the social etiology of youth injury, but these same analyses provide little evidence for a socio-economic risk gradient. The findings in turn have implications for preventive interventions.

Cigarette acquisition and proof of age among US high school students who smoke

OBJECTIVE

To determine how US high school students who are under 18 years of age and who smoke obtain their cigarettes and whether they are asked for proof of age.

DESIGN AND SETTING

Data from the Centers for Disease Control and Prevention's 1995, 1997, and 1999 national Youth Risk Behavior Surveys which employed national probability samples of students in grades 9-12 (ages 14-18 years).

MAIN OUTCOME MEASURES

Associations of usual source of cigarettes and request for proof of age with variables such as sex, race/ethnicity, grade, and frequency of smoking.

RESULTS

In 1999, among current smokers under age 18 years, 23.5% (95% confidence interval (CI), -4.5% to +4.5%) usually purchased their cigarettes in a store; among these students, 69.6% (95% CI -5.7% to +5.7%) were not asked to show proof of age. As days of past month smoking increased, reliance on buying cigarettes in a store (p < 0.001) and giving someone else money to buy cigarettes (p < 0.001) increased, and usually borrowing cigarettes decreased (p < 0.001). From 1995 to 1999, relying on store purchases significantly decreased (from 38.7% (95% CI -4.6% to + 4.6%) to 23.5% (95% CI -4.5% to +4.5%)); usually giving someone else money to buy cigarettes significantly increased (from 15.8% (95% CI -3.6% to +3.6%) to 29.9% (95% CI -4.5% to + 4.5%)).

CONCLUSIONS

Stricter enforcement of tobacco access laws is needed to support other community and school efforts to reduce tobacco use among youth. Furthermore, effective interventions to reduce non-commercial sources of tobacco, including social, need to be developed and implemented.

[Evaluation of theoretical accuracy, reliability, discriminative power and difficulty for physical, mental and social well-being scales in adolescents]

The purpose of this study was to develop and validate the questionnaire used to measure adolescents' wellbeing and its physical, mental and social dimensions. The questionnaire was composed of two parts: the first part contained wellbeing indicators and the second part contained criterion indicators (health disorders and harmful behaviours). Physical wellbeing scale contained the most common complaints due to psychosocial and life style factors, and was measured by three indicators: headache, abdominal pain and backache. Mental wellbeing scale contained emotional and moral dimensions that were recognised as closely connected with the physical disorders from one hands and the process of socialisation from the other hands. There were eight indicators: fatigue, stress, fear, depression, loneliness, helplessness, feeling of guilt, and low self-complacency. Five indicators: perceived social support, relationship with mother, father, friends and teacher measured social wellbeing scale. Each indicator of wellbeing is scored in three scales: dichotomise scale, five-point Likert scale and visual analogue scale. The cluster sample of 445 schoolchildren aged 14-15 years, randomly selected from the last grade of elementary schools of Warsaw was surveyed in October-November 1999. The physical, mental, social and total wellbeing scales were found to be reliable, but differing in internal consistency. The total and mental scales of wellbeing demonstrated high reliability, while the physical and social scales demonstrated moderate reliability. Analysis of correlation between criterion and tested variables showed acceptable discriminative power of the physical, mental, social and total wellbeing scales. Respondents assessed the five-point Likert scale as easier in comparison to dichotomise and visual analogue scales.

High-risk behaviors associated with early smoking: results from a 5-year follow-up

PURPOSE

To compare grade 7 nonsmokers, experimenters, and smokers on the basis of prevalence of other problem behaviors at both grade 7 and grade 12.

METHODS

Based on longitudinal self-report data from 4327 California and Oregon students, we used logistic regression to develop weighted estimates of the prevalence of academic difficulties, substance use, and delinquent behavior within the three smoking status groups at grades 7 and 12. Huber variance estimates, which adjust for weighting and clustering of observations, were used to assess the statistical significance of differences across groups.

RESULTS

Compared with nonsmokers, early smokers were at least 3 times more likely by grade 12 to regularly use tobacco and marijuana, use hard drugs, sell drugs, have multiple drug problems, drop out of school, and experience early pregnancy and parenthood. These adolescents were also at higher risk for low academic achievement and behavioral problems at school, stealing and other delinquent behaviors, and use of predatory and relational violence. Early experimenters were at significantly greater risk for these problems as well, although to a lesser extent than smokers. Importantly, the higher risk among experimenters and smokers of experiencing many of these problems was evident as early as grade 7.

CONCLUSIONS

Early experimenters and smokers are more likely than nonsmokers to experience various problem behaviors by grade 12, with many of these problems evident as early as grade 7. Results suggest that substance use programs that target multiple problems in addition to smoking may be most effective for these high-risk adolescents.

Perspectives in adolescent risk-taking through instrument development

Understanding the high-risk adolescent's perception of risk taking is essential for health professionals to determine appropriate interventions. The purpose of this study was to examine the psychometric properties of the revised Adolescent Risk-Taking Instrument (ARTI) designed to measure the high-risk adolescent's perception of risk taking. This study also examined the variables that are most predictive of social adaptation and risk taking. An ex post facto design was used to standardize data collection and to assess the psychometric properties of the revised ARTI. The nonprobability sample consisted of 167 adolescents attending school in an urban, health-underserved area. Exploratory factor analysis supported construct validity, and Chronbach's Coefficient Alpha supported internal consistency reliability. The reliability coefficient for the risk taking and social adaptation constructs were .80 and .77, respectively. Current perspectives on adolescent risk taking and implications for the use of the ARTI in clinical practice are addressed.

A study of the patterns and correlates of substance use among adolescents applying for drug treatment

OBJECTIVE

To inform planners by providing a psychosocial and drug-use profile of adolescents who have applied for a drug-treatment program.

METHOD

The setting was a residential drug-treatment program in Sydney for adolescents from NSW and the ACT. The design was a descriptive study of consecutive program applicants over 18 months. Study participants were 14-18 years, 53% were male. Most assessments were telephone interviews. The instrument incorporated the Opiate Treatment Index, Adolescent Drug Abuse Diagnosis, Severity of Dependence Scale and Symptom Checklist 90-Revised (SCL-90-R).

RESULTS

Study participants tended to be poly-substance users, mostly using cannabis, heroin and/or alcohol. Heavy use in terms of frequency and amounts of use were reported, e.g. 50% of the sample used heroin daily and the mean number of standard drinks consumed on the last day of drinking was 18. High levels of problems in the areas of social functioning, criminal activity, psychological distress, physical health, HIV risk and substance dependence were reported. For example, most participants were unemployed and 88% had committed a crime in the previous month. Higher rates of some problems were identified among females, heroin users and benzodiazepine users.

CONCLUSIONS

The sample reported a high level of involvement in substance use and associated problems. The profile suggested that improvements might be difficult to achieve and to maintain.

IMPLICATIONS

A comprehensive, intensive, longer-term drug-treatment program to address the number and extent of substance-related problems for such adolescents is recommended.

Structural, relative, and absolute agreement between parents' and adolescent inpatients' reports of adolescent functional impairment

This study assessed agreement between parents' and adolescent inpatients' scores on caretaker and self-report versions of the Functional Impairment Scale for Children and Adolescents (FISCA and FISCA-SR). Self-report data describing impairment in eight domains were collected from 375 inpatients (M age = 15.0 years, 55% females), with parent data available for 233 (62%). Confirmatory factor analysis demonstrated structural congruence between a hypothesized, three-factor model, based on a prior study of the parent FISCA, and an observed model, based on responses to the FISCA-SR (GFI = .95). Correlations (measuring relative agreement) and paired comparisons of means (assessing absolute agreement) generally identified stronger agreement in "public" than "private" domains of impairment, and greater relative than absolute agreement in covert, antisocial domains.

A comparison of sexually abused and non-sexually abused adolescents in a clinical treatment facility using the MMPI-A

OBJECTIVE

In the current study, the adolescent version of the Minnesota Multiphasic Personality Inventory, the MMPI-A, was used to address concerns voiced about the mixing of different developmental ages, use of inadequate comparison groups, and the lack of reliance on reliable and valid measures of psychological, behavioral, and psychosocial problems used in previous studies of sexually abused children and adolescents.

METHOD

A total of 107 adolescents in residential treatment (73 boys and 34 girls) were included in the study. Seventy-two of these adolescents had reportedly been sexually abused (42 boys and 30 girls); 35 had not been abused (31 boys and 4 girls). Predictions based on previous research with adolescents were made and tested regarding which MMPI-A validity, clinical, and content scales would differ between the sexually abused and non sexually abused groups of adolescents.

RESULTS

Overall, and consistent with many predictions, sexually abused adolescents had both statistically and clinically higher elevations on several MMPI-A scales than did their non-abused counterparts. No scales were more elevated for non-abused adolescents than for abused adolescents.

CONCLUSIONS

Sexually abused adolescents in residential treatment, as a group, present with concerns that their non-abused counterparts did not have, or did not share to the same extent. Treatment recommendations based on the MMPI-A scale elevations are provided, limitations of the current study discussed, and directions for further research are suggested.

Young novice driver subtypes: relationship to high-risk behavior, traffic accident record, and simulator driving performance

Two studies were undertaken to obtain empirical support for the existence of driver subtypes in the young novice driver population. In Study 1, 198 participants (55% male) aged 16 to 19 completed an extensive self-report questionnaire. Five novice driver subtypes were identified through a cluster analysis of personality and driving-related measures. Two relatively high-risk or deviant subtypes (Clusters 1 and 5) were identified, characterized by high levels of driving-related aggression, competitive speed, driving to reduce tension, sensation seeking, assaultiveness, and hostility. The individuals in Cluster 5 also reported low levels of emotional adjustment and high levels of depression, resentfulness, and irritability. In Study 2, a subset of participants from each of the subtypes drove several scenarios in a driving simulator. The subtypes differed in their responses to an emergency situation and several potential traffic hazards. They also differed in the proficiency with which they could control their attention among concurrent tasks in high-workload situations. Most of the significant differences were related to lower levels of driving skill among the two most deviant subtypes (Clusters 1 and 5). The potential applications of this research include the design of training programs and other countermeasures to address the young novice driver crash problem.

Contraceptive knowledge and behavior of conventionalists, careerists, idealists, bouncers, desperadoes, and outsiders

The aim of the survey was to determine the contraceptive behavior and knowledge on contraceptive methods of adolescents. We defined six clusters according to personality, leisure activities, and sociodemographic characteristics: conventionalists, careerists, idealists, bouncers, desperadoes, and outsiders. 1010 Austrian adolescents aged 14-24 years participated in the survey. 96%-100% indicated that they were familiar with the condom and the contraceptive pill. The two most popular contraceptive methods cited were the condom (39%) and OC (34%). Whereas 40% of conventionalists reported that OC were their preferred method of contraception, 53% of idealists indicated that they preferred the condom. 66% of the desperadoes indicated that they considered the pill expensive. 85% of conventionalists and careerists believe that OC offer the best protection against pregnancy. Clusters with higher self-esteem and those with a higher educational level were more likely to believe that this method is unreliable. The results obtained indicate that outsiders, desperatoes, and bouncers show deficits in sex education; only careerists and idealists appeared to be better informed. Research on adolescent contraceptive behavior should drop the traditional stratifying criteria and appreciate the diversity of adolescent populations in order to be better able to classify adolescents according to their contraceptive attitudes.

Obsessive compulsive symptoms at initial presentation of adolescent eating disorders

An association between obsessive compulsive disorder and eating disorders has often been reported in the literature. It has been suggested that the association may be accounted for by depression, starvation or family factors but the literature remains inconclusive. In this study self-report scales were used to measure eating attitudes, obsessional symptoms, depressive symptoms and family functioning in an eating disordered group, a psychiatric control group and in the parents of both groups. The eating disordered group scored significantly higher than controls on the Maudsley Obsessive Compulsive Inventory and the Leyton Obsessional Inventory but not on the Childhood Depression Inventory. The differences were not correlated with Quetelet's Body Mass Index. Both groups of parents scored within the normal range for all scales. The high obsessional scores in the anorexic group seem to be due to high scoring on items relating to perfectionism. The role of perfectionism as a risk factor for the development of eating disorders and OCD is discussed.

Patterns of sexual partnerships among adolescent females

OBJECTIVE

To develop a multidimensional classification of sexual partnerships.

METHODS

Eighty-two female subjects (ages 15-20 years; 77% African American) used coital logs to record dates of 1265 coital events, partner initials, and condom use. Logs were collected at 1-, 3-, 9-, 15-, and 21-month return visits. Three adolescent health professionals independently classified partnership patterns of each subject; classification schemes were revised until complete consensus for each subject was obtained.

RESULTS

Complete agreement in partnership classification was reached after 3 rounds. The consensus partnership classification had three dimensions: number (1, > or = 2 partners), pattern (1 partner, serially exclusive, concurrent), and duration (any partnership < or = 21 days, all partnerships >21 days). A total of 34 of 82 (34%) of subjects had > or = 2 partners; 11 of 34 (32%) had concurrent partnerships. Twenty of 82 (24%) had only partnerships lasting >21 days. Condom use was less common for subjects in only longer-term (>21 days) partnerships, but did not significantly vary by number or pattern.

CONCLUSION

Multiple dimensions of adolescent sexual partnerships may be identified. Detailed research and clinical assessments along these dimensions may improve understanding of protective behaviors such as condom use.

Integrative research review of risk behaviors among adolescents in rural, suburban, and urban areas

PURPOSE

The purpose of this integrative review was to describe the state of the science regarding adolescent risk behaviors, with particular emphasis on comparisons among rural, urban, and suburban populations.

METHOD

The review was done at two levels, moving from the major national survey studies which included data collected in the late 1980s up to 1993, to more focused topical areas including studies with data collection and publication between 1990 and 1996 within each identified category of adolescent health issues. A total of 137 published works across several disciplines were reviewed. Suggestions for clinical practice were drawn from the significant research findings. In addition, risk behaviors were compared to national baseline data and objectives.

RESULTS

The level of research in this topic area was primarily descriptive. Currently, only a small portion of the national objectives for decreasing adolescent risk behaviors have been met. Successful intervention programs, although few in number, usually included not only topical education but also adolescent interaction with peers and support systems to raise awareness and change behaviors.

CONCLUSIONS

The risk behaviors for the adolescent population as a whole have been well described. Education alone is not sufficient to change behaviors. Objective outcomes must be identified and health care providers need to use research findings in their practice with adolescents. It is time to intervene with developmentally and culturally appropriate strategies. There was a large gap in the literature regarding risk behaviors and protective factors for rural adolescents. The few studies that included subjects from rural settings indicated that the view that rural adolescents are engaged in fewer or less severe risk behaviors is misleading.

Longitudinal patterns of tobacco smoking from childhood to middle age

This study described the development of tobacco smoking of subjects between ages 12 and 36 using prospectively collected self-reports of 212 Swedish men and women born in the 1950s. Smoking habits were studied in terms of stability, longitudinal patterns of smoking, and the relation between age of initiation and later smoking. Findings showed that light smoking (up to 6 cigarettes/day) did not remain stable after adolescence. Typical development patterns from age 15 to age 36 included staying a nonsmoker; smoking intensely (>10 cigarettes/day) and continuing into adulthood; smoking less intensely for some periods; or smoking intensely and quitting before age 36. Differences in age at smoking initiation were related to later habitual smoking only when participants reported initiation had occurred after age 12.

Correlates of occasional cigarette and marijuana use: are teens harm reducing?

This paper examines characteristics that distinguish heavy and occasional cigarette and marijuana use among U.S. high school seniors. High school seniors who completed the 1994 Monitoring the Future survey (N = 15,929) were classified as nonusers, occasional users, and heavy users of cigarettes and marijuana. Level of use was examined with regard to degree of perceived risk of regular use, perceived risk of occasional use as well as several psychosocial factors previously shown to be associated with use (e.g., peer use, close friends' approval of use, and self-esteem). Involvement with other drugs and high-risk behaviors across levels of use was also examined. Heavy users of cigarettes or marijuana reported significantly lower perceived risk of regular use of each substance compared to occasional users. Heavy and occasional users did not generally differ with regard to perceived risk of occasional use. Compared to heavy users, occasional cigarette or marijuana users reported significantly lower rates of illicit drug use, heavy alcohol use, and high-risk driving behaviors as well as fewer problem behaviors and higher grades. Some adolescents may moderate their cigarette and marijuana use to minimize harmful effects they associate with heavier use (i.e., they may be practicing harm reduction). Additional research is needed to better understand controlled substance use, and incorporate this information into prevention and cessation programs.

The Reasons for Living Inventory for Adolescents (RFL-A): development and psychometric properties

The role of adaptive beliefs and attitudes against suicide has not been given adequate attention in the clinical or assessment literature. This article reports on the development and initial psychometric properties of a 32-item self-report inventory, the Reasons for Living Inventory for Adolescents (RFL-A). In Phase 1, we used exploratory and confirmatory factor analyses to identify five correlated factors: Future Optimism, Suicide-Related Concerns, Family Alliance, Peer Acceptance and Support, and Self-Acceptance. In Phase 2, we cross-validated the 5-factor oblique model in a different group of adolescents recruited from two high schools. In addition, we examined evidence for convergent, discriminant, and construct validities. The coefficient alpha indices for the RFL-A total and scales were satisfactory. In Phase 3, we evaluated additional evidence of reliability and validity using samples of high school and psychiatric inpatient adolescents. The results suggest that the RFL-A is a short, reliable, and valid measure that is potentially useful in the assessment of adolescent suicidal behavior.