The influence of alcohol outlet density and advertising on youth drinking in urban Tanzania

Despite the detrimental effects of alcohol on adolescent health, high rates of alcohol use are reported among Tanzanian youth. We conducted systematic community mapping and participatory group activities with 177 adolescents in Dar es Salaam to explore how alcohol outlet density and advertising may contribute to adolescent drinking in urban Tanzania. Findings revealed a high density of alcohol-selling outlets and outdoor advertisements. The abundance of alcohol-related cues, including their close proximity to places where youth congregate, may facilitate and increase adolescent alcohol use in Tanzania. Participants recommended several changes to the alcohol environment to reduce adolescent drinking. Structural interventions that reduce adolescents' access and exposure to alcohol are needed in Tanzania.     

Medical Conditions of Adolescents in Alcohol and Drug Treatment: Comparison with Matched Controls

PurposeAlcohol and drug problems are associated with medical problems among adults. Research on the relationship of adolescent alcohol and drug use disorders to specific medical problems is less developed and focused on acute consequences. This study addresses gaps in the literature regarding medical comorbidities in adolescents with alcohol and drug use disorders.MethodsThis study compares the prevalence of medical conditions among 417 adolescent alcohol and drug treatment patients with 2082 demographically matched controls from the same managed care health plan and examines whether comparisons vary among substance-type subgroups.ResultsApproximately one-fourth of the comorbid conditions examined were more common among adolescent alcohol and drug patients than among matched controls, and several were highly costly conditions (e.g., asthma, injury). We also found that pain-related diagnoses, including headache and abdominal pain, were more prevalent among alcohol and drug patients.ConclusionsOur findings point to the importance of examining comorbid medical and chemical dependency in both adolescent primary care and specialty care. Moreover, optimal treatment of many common medical disorders may require identification, intervention, and treatment of a substance use problem.     

Intermittent access to beer promotes binge-like drinking in adolescent but not adult Wistar rats

Teenagers are more likely than adults to engage in binge drinking and could be more vulnerable to long-term brain changes following alcohol abuse. We investigated the possibility of excessive adolescent drinking in a rodent model in which beer (4.44% ethanol vol/vol) is presented to adult and adolescent male Wistar rats. Experiment 1 tracked ad libitum beer and water consumption in group-housed rats from postnatal day (PND) 28-96. Rats consumed an average of 7.8 g/kg/day of ethanol during adolescence (PND 34-55) and this gradually declined to a lower level of intake in adulthood (PND 56-93) of 3.9 g/kg/day. In Experiment 2, beer was made available to both adolescent (PND 29+) and adult (PND 57+) rats for 2 h each day in a custom-built “lickometer” apparatus over 75 days. Access to beer was provided either 1 day out of every 3 (“intermittent” groups) or every day (“daily” groups). Relative to body weight, adolescent rats consumed more beer than adult rats in these limited access sessions. Adolescents with intermittent access consumed more than adolescents with daily access, a “binge”-like effect that was not observed in adult groups and that disappeared in adulthood. After 3 months of daily or intermittent alcohol consumption, the preference for beer versus sucrose was assessed. Rats previously kept under an intermittent schedule displayed a higher preference for beer relative to 3% sucrose, but only when testing occurred after 2 days of abstinence. In Experiment 3, adolescent (PND 30-37) and adult (PND 58-65) rats were given 20-min access to beer and their blood alcohol concentrations (BACs) were assessed. Adolescent groups consumed more alcohol than adults and showed higher BACS that were typical of human “binge” drinking (>80 mg/dL). Despite this, the correlation between BAC and beer intake was similar in both age groups. Together these results show that the intermittent presentation of alcohol itself appears to have subtle long-lasting effects on the motivation to consume alcohol. The findings support the use of beer solutions in modeling binge-like patterns of human alcohol consumption in adolescent rats.     

Environmental stressors, low well-being, smoking, and alcohol use among South African adolescents

This is the first study to examine the pathways from environmental stressors to substance use among a sample of South African adolescents (N = 2195). The study objective was to assess how environmental stressors might affect cigarette smoking and alcohol use among South African adolescents, and to focus on one mechanism, low well-being, which might mediate this association. Participants consisted of 2195 Black, mixed ancestry ("Colored"), Indian, and White youth, aged 12-17 years old (mean age = 14.6; SD = 1.8), recruited via a multi-stage stratified sampling procedure in Durban, Cape Town, and Johannesburg, South Africa. Data were collected via individual in-person structured interviews, administered by trained interviewers in the participant's preferred language. Structural equation modeling was used to analyze the interrelationships of environmental stressors (violent victimisation, legal and illegal drug availability) and low well-being (depressive symptoms, low self-esteem, health problems) with respect to adolescent cigarette smoking and alcohol use. The results supported our hypotheses: Environmental stressors were related to low well-being which, in turn, was linked to both adolescent smoking and alcohol use. There were also direct pathways from environmental stressors to both adolescent smoking and alcohol use. Smoking and alcohol use were significantly correlated. The findings suggest that environmental stressors may be associated with diminished psychological and physical well-being, as well as smoking and alcohol use, among South African adolescents. Longitudinal research is warranted to further understand the interrelationship of environmental stressors, low well-being, and adolescent substance use, so that these issues may be addressed by South African programmes and policies.     

Habit formation: Implications for alcoholism research

Characteristics of individuals with severe alcohol use disorders include heightened cue sensitivity, compulsive seeking, craving, and continued alcohol use in the face of negative consequences. Animal models are useful for understanding behavioral and neurological mechanisms underlying problematic alcohol use. Seeking of operant reinforcers including alcohol is processed by two mechanisms, commonly referred to as “goal-directed” (action-outcome) and “habitual” (stimulus-response). As substance use disorders are characterized by continued use regardless of unfavorable outcomes, it is plausible that drug use causes an unnatural disruption of these mechanisms. We present a critical analysis of literature pertaining to behavioral neuroscience alcoholism research involving habit formation.     

Adolescents entering chemical dependency treatment in private managed care: ethnic differences in treatment initiation and retention

PurposeThere has been little research on adolescents of different ethnicities in chemical dependency (CD) treatment, despite a focus on ethnic disparities in health care in recent years. In particular, little is known about ethnic differences in utilization of adolescent CD services.MethodsWe examined treatment initiation and treatment retention in a sample of African American, Native American, Latino, Asian American, and Caucasian adolescents entering CD treatment in a private, managed care health plan (n = 419). Our conceptual framework included ethnicity as the main factor as well as measures of external pressure and internal motivation/readiness for treatment, family environment, psychiatric co-morbidities, and severity of alcohol and drug problems. Logistic and Poisson regression were used to examine differences.ResultsThe study found ethnic differences in treatment initiation and treatment retention. Native American adolescents had lower odds of returning after intake to initiate treatment compared with Caucasians (odds ratio [OR] .35, p = .009), and African American youth spent less time in treatment than Caucasians (RR: .49, p < .001).ConclusionsStudy findings indicate differences in treatment initiation for Native Americans and in treatment retention for African Americans. Intake and orientation sessions offer an opportunity to intervene with Native American youth. Given their high psychiatric co-morbidity, they may also benefit from the availability of psychiatric services. Even after adjusting for severity, we found shorter treatment retention for African American adolescents and suggest that organizational factors, such as cultural competency, may play an important role.     

The Influence of Alcohol-Specific Communication on Adolescent Alcohol Use and Alcohol-Related Consequences

Alcohol-specific communication, a direct conversation between an adult and an adolescent regarding alcohol use, contains messages about alcohol relayed from the adult to the child. The current study examined the construct of alcohol-specific communication and the effect of messages on adolescent alcohol use and alcohol-related consequences. Parent-adolescent dyads were assessed biannually for 3 years (grades 9–11 at wave 6) to examine these relations in a large longitudinal study of adolescents initially in grades 6 through 8. An exploratory factor analysis identified two factors among alcohol-specific communication items, permissive messages and negative alcohol messages. Results showed previous level of adolescent alcohol use moderated the relation between permissive messages and alcohol use outcomes. Plotting of these interactions showed greater alcohol use and consequences with increasing permissive messages in adolescents with higher versus lower levels of previous alcohol use. Results suggest that parental messages regarding alcohol use may impact adolescent alcohol use beyond the effect of general parenting style and parental alcohol use.     

The role of the pediatrician in preventing suicide in adolescents with alcohol use disorders

Worldwide, suicide is among the top five causes of mortality in the 15- to 19- year age group. Pediatricians and primary care providers are in a distinctive position to help prevent suicide in adolescents. According to the Guidelines for Adolescent Preventive Services, all adolescents should have at least an annual preventive services visit, which should address both the biomedical and psychosocial aspects of health. Suicide prevention may best be accomplished by detection and management of specific risk factors, rather than by attempting to recognize those youth who are considered most likely to commit suicide. Alcohol use has been regarded as an important risk factor for adolescent suicidal behavior and the diagnosis of an alcohol use disorder indicates an elevated risk for adolescent suicide. Although the causal relationship between alcohol use and suicide remains unknown, a clear and strong relationship exists. Pediatricians and other health care providers should be skilled to recognize risk factors for adolescent suicide, including alcohol and drug misuse, depression, major loss, and recent suicides within a community. The relative frequency of suicidal behavior among adolescents suffering from alcohol use disorders and its distressing effects on individuals, families and society merits further research and development of prevention strategies in general pediatric settings.     

Exploring substance use normalization among adolescents: A multilevel study in 35 countries

The substance use normalization thesis predicts that adolescent substance users are less likely to report substance use risk factors in high than in low prevalence countries. This study tests whether national population-level alcohol, cigarette and cannabis prevalence rates moderate the strength of the relationship between individual level social and behavioral risk factors and individual level alcohol, cigarette and cannabis use. Data from 2009/2010 Health Behaviour in School-Aged Children Study (N = 68,045, age = 15) from 35 countries was analyzed using logistic Hierarchical Linear Modeling. As expected based on low cannabis prevalence rates in all countries studied, no evidence of normalization was found for recent cannabis use. Also in line with the normalization thesis, results show that for substance use that reaches above 40% in at least some of the countries studied (drunkenness, alcohol and cigarette use), adolescents who reported use are less likely to report social and behavioral risk factors in high prevalence countries than in low prevalence countries. However, support for the normalization thesis was only partial in that results show that in models where evidence for normalization was found, there are risk factors that predict substance use to an equal degree regardless of country level prevalence rates. The current research shows that the normalization thesis is a useful framework for understanding the contextual aspects of adolescent alcohol, tobacco, and cannabis use. The study has implications for drug prevention as it suggests that selective prevention efforts may be particularly useful in low prevalence countries where screening based on risk factors may usefully identify adolescents at most risk for developing drug use problems. This approach may be less useful in high prevalence countries where screening based on risk factors is less likely to satisfactorily identify those at risk for developing drug use problems.     

Tobacco and Alcohol Use as an Explanation for the Association Between Externalizing Behavior and Illicit Drug Use Among Delinquent Adolescents

The prevalence and persistence of adolescent substance use and abuse is a national health issue, and substance use among adolescents is frequently comorbid with other psychiatric disorders. Most studies in this area utilize samples of middle or high school students or from inpatient settings. Less is known about substance use and psychiatric comorbidity among delinquent adolescents. The present study examined data from two cohorts of juvenile offenders collected over a 2-year period (n = 245, n = 299). Participants reported frequency of cigarette, alcohol, marijuana, and other substance use. Participants' parents completed a measure of behavior problems. Path analyses suggested that parental reports of externalizing problems were significantly related to self-reported substance use while parental reports of internalizing problems were not. Results also suggested that smoking and alcohol use act as mediators between externalizing problems and marijuana and other drug use. Although there were some mean differences by gender, the pattern of relationships amongst the variables did not differ by gender. Implications of the findings and future directions are discussed.     

Female Conduct Disorder: Health Status in Young Adulthood

PurposeOne of the risk factors for poor adult health may be adolescent antisocial behavior, especially in girls. This study was conducted to determine if negative young adult health outcomes in girls who previously had adolescent antisocial behavior could be explained by demographic factors and pre-existing health problems.MethodsThis 3-year longitudinal study recruited 93 girls, ages 15–17 years (52 with conduct disorder [CD]; 41 with no psychiatric illness [normal controls; NC]) from the community. Baseline interviews of girls and parents collected demographic, psychiatric, and medical history data. Three annual interviews collected data about medical problems, health care service utilization, and reproductive health. In addition, the final follow-up included a standardized self-report questionnaire about young adult health status.ResultsCD and NC groups did not differ in age, racial composition, social class, proportion of smokers, or drug and alcohol experimentation. They were qualitatively different in baseline medical histories. Controlling for age at follow-up and baseline medical problems, the CD group as young adults had worse overall health, more discomfort, higher rates of unhealthy habits, lower rates of healthy behaviors, and more pregnancies at earlier ages. There were no group differences in rates of disorders, injuries, or health care usage.ConclusionsAdolescent girls with CD as young adults have poorer overall health, more discomfort, more health risk behaviors, and earlier onset of adult reproductive behaviors, even when controlling for demographic factors and pre-existing health history. Clinical and research implications are discussed.     

Tobacco Use and Other Risk Behaviors among Adolescents in an STD Clinic

Background. This study examined the potential for tobacco use and other health risk behavior interventions in the context of an urban sexually transmitted diseases (STD) clinic.Methods. A cross-sectional survey of two populations. Adolescents seen at an STD clinic or at the teen clinic of a community health center completed a self-administered computer survey in 1996. Risk behaviors, attitudes, and readiness to stop smoking were analyzed for 225 patients at the STD clinic and 248 patients at the teen clinic.Results. Compared with adolescents in the teen clinic, adolescents in the STD clinic were more likely to have smoked frequently (OR 1.7, 95% CI 1.1, 3.0), used any illegal drug (OR 2.7, 95% CI 1.3, 5.5), recently binged on alcohol (OR 1.7, 95% CI 1.0, 2.8), and had more than 10 lifetime sexual partners (OR 1.9, 95% CI 1.0, 3.4). Weapon carrying, readiness to stop smoking, and attitudes toward smoking did not differ between sites.Conclusions. Cigarette smoking and other health risk behaviors are more prevalent among adolescents in an STD clinic than among adolescents in a community health center. STD clinics are potential sites for cigarette, alcohol, and drug use interventions among “hard to reach” adolescents.     

Alcohol-drinking patterns and metabolic syndrome risk: the 2007 Korean National Health and Nutrition Examination Survey

Alcohol consumption has been known to be related to the prevalence of metabolic syndrome (MS). Although some studies have revealed that mild to moderate alcohol consumption reduces the risk of MS, most of these studies have focused the effect of alcohol consumption amount on MS. We examined the association between alcohol-drinking patterns and MS by using the alcohol use disorders identification test (AUDIT) questionnaire to study 1,768 alcohol drinkers (847 men, 921 women) aged 20-75 years from Korean National Health and Nutrition Examination Survey in 2007. When compared with the subjects in the reference group (AUDIT score ≤7), the odds ratios (ORs, 95% confidence intervals [CIs]) for MS of subjects in the highest group (AUDIT score ≥16) were 3.92 (2.40-6.22) in men and 2.27 (0.87-5.89) in women after adjusting for confounding variables. Among the items of the AUDIT score, several alcohol-drinking patterns, including “drinking frequency,” “usual drinking quantity,” “frequency of high-risk drinking,” “frequency of inability to stop drinking,” “frequency of feeling guilty after drinking,” and “frequency of inability to remember after drinking” were strongly associated with the prevalence of MS in men. In women, there were significant relationships between MS and “usual drinking quantity,” “frequency of feeling guilty after drinking,” and “frequency of inability to stop drinking.” In summary, AUDIT score was strongly associated with MS in Korean adults, particularly in men. Accordingly, in addition to the amount of daily alcohol consumption, alcohol-drinking patterns should be addressed in the prevention and treatment of MS.     

Parental Messages about Substance Use in Early Adolescence: Extending a Model of Drug-Talk Styles

This study extends a typology of parent–offspring drug talk styles to early adolescents and investigates associations with adolescent substance use. Data come from a self-report survey associated with a school-based, 7th grade drug prevention curriculum. Mixed methods were used to collect data across four measurement occasions spanning 30 months. Findings highlight the frequencies of various drug-talk styles over time (i.e., situated direct, ongoing direct, situated indirect, ongoing indirect, never talked), messages adolescents hear from parents, and comparisons of alcohol, cigarette, and marijuana use by drug-talk style. This study advances an understanding of parent–adolescent communication about substances and holds practical implications for drug prevention efforts.     

A state-based model of prevention: Indiana's example

Public health officials in the United States have battled alcohol, tobacco, and other drug (ATOD) use among adolescents for the past few decades, but only in 2002 did they begin to see a decline in rates of use. ATOD use and abuse are associated with numerous problems, including criminal behavior and increased adolescent morbidity and mortality rates. Researchers have sought to identify best-practice procedures for ATOD prevention; the state of Indiana has a strong ATOD prevention system in place that has the potential to serve as a model for other U.S. localities because of its best-practice approach to public health services. This article outlines the activities of the Indiana Prevention Resource Center to provide an example to strengthen public health professionals' ability to prevent ATOD use and abuse and to provide for a healthy adolescent population.     

Alcohol Consumption and Psychological Distress in Adolescents: A Multi-Country Study

PurposeTo examine the association between alcohol use and psychological distress among adolescents in a range of developing countries.MethodsSecondary data analysis of the Global School-Based Student Health Survey was conducted using nationally representative data from 12 developing countries: Botswana, Grenada, Indonesia, Kenya, Myanmar, the Philippines, Saint Lucia, Saint Vincent and the Grenadines, the Seychelles, Thailand, Trinidad and Tobago, and Uganda. The surveys were conducted between 2003 and 2008 and involved 32,001 adolescents primarily aged 13–15 years. We used multivariate logistic regression analysis to determine the association between alcohol use and psychological distress.ResultsThe prevalence of past 30-day alcohol use and lifetime drunkenness varied widely across countries, as did the occurrence of psychological distress (anxiety-induced sleeplessness and/or depression). The risk of psychological distress was significantly higher among adolescents when using alcohol in all countries except Myanmar. In nine of the 12 countries, past 30-day alcohol use was associated with psychological distress, while students who had been drunk at least once in their lifetime had an increased risk of experiencing psychological distress in 11 of the study countries.ConclusionsThe high prevalence of alcohol use among adolescents and the strength of the association with psychological distress present a major public health challenge in developing countries. The urgent need to reduce adolescent alcohol use necessitates the implementation of context- and culture-specific strategies that reduce the physical availability of alcohol.     

Alcohol and adolescent suicide

Adolescent suicide is a major public health problem. In this review, the authors discuss different aspects of the relation between alcohol abuse and suicidal behavior in adolescents, including epidemiology, role of family history, comorbidity, gender differences, neurobiology, treatment, and prevention. In the general population, about 2,000 adolescents in the United States die by suicide each year. Suicide continually ranks as the second or third leading cause of death of persons between the ages of 15 and 34 years old. The suicide rate in young people has more than doubled during the period from 1956 to 1993. This increasing suicide rate has been blamed on the increase of adolescent alcohol abuse. Availability of alcohol and guns at home may contribute to suicide risk in adolescents. Comorbid psychopathology, which is common among adolescent alcohol abusers, substantially increases risk for suicide completions and attempts. Depressed adolescents may use alcohol to self-medicate depressive symptoms. Alcohol abuse and suicidal behavior in adolescents and in adults has been found to have biochemical, genetic, and psychological correlates. Ideally, treatment of adolescents who receive a diagnosis of an alcohol use disorder and co-occurring suicidality should follow an integrated protocol that addresses both conditions. Future studies of psychological and neurobiological mechanisms of suicidality in adolescents with alcohol and/or substance abuse are merited.     

The density of alcohol outlets and adolescent alcohol consumption: An Australian longitudinal analysis

Higher density of alcohol outlets has been linked to increased levels of adolescent alcohol-related behaviour. Research to date has been cross-sectional. A longitudinal design using two waves of annual survey data from the Australian arm of the International Youth Development Study was used. The sample comprised 2835 individuals with average age at wave 2 of 14 years (SD=1.67; range=11–17 years). GSEM was used to examine how absolute levels of alcohol outlet density was associated with student-reported alcohol use one year later, while controlling for prior alcohol use, risk factors at wave one and changes in density over the 2 years. Adolescents' perception of alcohol availability and friends' alcohol use were tested as potential mediators of the association between alcohol outlet density and adolescent alcohol use. Elasticity modelling identified a 10% increase in overall density at wave one was associated with an approximately 17% increase in odds of adolescent alcohol consumption at wave two. Living in areas with a higher density of outlets was associated with a statistically significant increase in the likelihood of adolescents developing early age alcohol consumption.     

Preventing suicide in adolescents with alcohol use disorders

Adolescent suicide is an escalating crisis that needs to be addressed by clinicians and researchers. Alcohol use has consistently been implicated in adolescent suicide and it is generally assumed that alcohol use leads to an increased risk in suicidality, suicide attempts and completed suicides. It can lead to adolescent suicidality through alcohol myopia, disinhibition, and impaired judgment. Multiple genetically related intermediate phenotypes might contribute to the risk of alcohol misuse and suicidal behavior in adolescents. Genetic variations that enhance the risk for mood and anxiety symptoms or susceptibility to stress might increase risk through different mechanisms. Comorbid disorders such as depression are frequently exhibited in adolescents who misuse alcohol, therefore any adolescent who appears to be at risk for alcoholism or depression should always be screened for all other psychiatric disorders and for suicidality; some signs suicidal adolescents may exhibit include withdrawal, personality change, and a loss of interest in pleasurable activities. While assessment is important, prevention is crucial in any attempt to decrease the incidence of adolescent suicide. The US Center for Disease Control and Prevention (CDC) has established a set of seven guidelines that can be implemented from kindergarten through high school in order to establish alcohol prevention efforts in schools. Through beginning prevention efforts at a young age, it is hopeful that both alcohol misuse and adolescent suicide can be reduced.     

Associations of family environment and individual factors with tobacco, alcohol and illicit drug use in adolescents

Despite abundant literature the respective roles of psychosomatic status, personality, health perception, family environment, and sport activity in tobacco, alcohol and illicit drug use have not been well known. To assess their roles, an epidemiological cross-sectional study was conducted in 3294 middle and high school adolescents, 2396 (73%) of whom agreed to participate. The standardized questionnaire was filled out by the teenagers under the supervision of the teachers. Strong associations were found between tobacco, alcohol, and illicit drug use. The prevalence of alcohol use and illicit drug use were respectively 7 and 10 times higher in smokers than in non-smokers. On the whole, the potential risk factors for tobacco, alcohol, and illicit drug use were age, psychosomatic status and psychotropic drug consumption, boring family atmosphere, not living with both father and mother, and health perception. Mother being a housewife was a protective factor. No marked role was noted for the head of family's socio-occupational category. Personality would be indicators of self-control ability. Indeed, some self-reported personalities (serious, attentive, calm, organized) had protection roles whereas some others (easily irritable, aggressive, worried, clumsy, careless, solitary, etc.) were risk factors (risk-taking or deviant behaviors). Some sports activities were found to be negatively related, but some others related positively with drug use, possibly due to repetitive meetings between the adolescents at risk. Preventive measures may be targeted at these risk factors.