Preventing alcohol, marijuana, and cigarette use among adolescents: peer pressure resistance training versus establishing conservative norms

BACKGROUND. Two strategies for preventing the onset of alcohol abuse, and marijuana and cigarette use were tested in junior high schools in Los Angeles and Orange Counties, California. The first strategy taught skills to refuse substance use offers. The second strategy corrected erroneous normative perceptions about prevalence and acceptability of use among peers and established conservative groups norms regarding use. METHODS. Four experimental conditions were created by randomly assigning schools to receive (a) neither of the experimental curricula (placebo comparison), (b) resistance skill training alone, (c) normative education alone, or (d) both resistance skill training and normative education. Students were pretested prior to the program and post-tested 1 year following delivery of the program. RESULTS. There were main effects of normative education for summary measures of alcohol (P = 0.0011), marijuana (P = 0.0096), and cigarette smoking (P = 0.0311). All individual dichotomous measures of alcohol, marijuana, and tobacco use indicated significant reductions in onset attributable to normative education. There were no significant main effects of resistance skill training. CONCLUSION. These results suggest that establishing conservative norms is an effective strategy for preventing substance use.     

Effects of School-Level Norms on Student Substance Use

This study examines the relationship between school norms of substance use disapproval (disapproval by the student body) and students' use of cigarettes, alcohol, and marijuana. Data came from nationally representative samples of 8th (N = 16,051), 10th (N = 13,251), and 12th (N = 8,797) grade students, attending 150, 140, and 142 schools, respectively. These students participated in the Monitoring the Future Project in 1999. Measures of school norms of disapproval of substance use were obtained by aggregating students' personal disapproval of daily cigarette use, heavy drinking, and marijuana use within each school. Analysis using logistic nonlinear hierarchical models indicated that in general, school-level disapproval lowered the probability of students' use of these substances, controlling for their own disapproval and for student and school demographic characteristics. The beneficial effect of school-level disapproval of cigarette and marijuana use on 8th-grade students' probability of daily cigarette use and marijuana use was significantly higher than it was for the 12th-grade students. The effect of school-level disapproval of heavy drinking on the probability of students' drinking was not significantly different across the three grades. Further, a school environment of disapproval was also found to create a protective environment for those students in the 8th and 10th grades who were themselves not disapproving of daily cigarette use. These results argue for prevention programs that include creation of an overarching environment of disapproval of substance use in schools.     

Variation in youthful risks of progression from alcohol and tobacco to marijuana and to hard drugs across generations

OBJECTIVES: Much research has documented that youthful substance use typically follows a sequence starting with use of alcohol or tobacco or both and potentially proceeding to marijuana and then hard drug use. This study explicitly examined the probabilities of progression through each stage and their covariates. METHODS: A secondary analysis of data from the National Household Survey on Drug Abuse (1979-1997) was conducted with particular sensitivity to the nature of substance use progression, sampling procedures, and reliability of self-report data. RESULTS: Progression to marijuana and hard drug use was uncommon among persons born before World War II. The stages phenomenon essentially emerged with the baby boom and rose to a peak among persons born around 1960. Subsequently, progression risks at each stage declined. Progression risks were also higher among younger initiators of alcohol, tobacco, or marijuana use. CONCLUSIONS: The recent increase in youthful marijuana use has been offset by lower rates of progression to hard drug use among youths born in the 1970s. Dire predictions of future hard drug abuse by youths who came of age in the 1990s may be greatly overstated.     

The relationship of cigars, marijuana, and blunts to adolescent bidi use

OBJECTIVE: Previous research suggests that bidi, cigar, and marijuana use may be interrelated, but to date, this hypothesis has not been empirically tested. METHODS: We explored the relationships among use of these products using data from 17,429 youths who completed the 2001 National Household Survey on Drug Abuse. Variables of interest included demographics, tobacco use (i.e., cigarettes, cigars), marijuana use, and blunting (i.e., cigars filled with marijuana). Adjusted odds ratios (AOR) for past-month bidi use were generated for each variable; regression models were also generated separately by race/ethnicity. RESULTS: Overall, 1.1% of the youths surveyed reported past month bidi use; higher prevalence was noted for those who were past-month users of cigarettes (4.6%), cigars (7.0%), marijuana (5.8%), and blunts (7.3%). Logistic regression yielded significant odds ratios for all tobacco products, marijuana, and blunts, with the greatest odds associated with past-month cigarette use. Interestingly, the pattern varied notably by race. Among white youth, the greatest odds for past-month bidi use were associated with cigarette use (AOR=3.9), while among black youth the greatest odds were associated with blunting (AOR=9.5). CONCLUSION: The findings demonstrate that the use of cigars and blunts is highly associated with bidi use among youths and these patterns differ by race/ ethnicity. Tobacco control efforts that target youths must address other tobacco products and marijuana and should be tailored appropriately and effectively, with consideration of racial, ethnic, and cultural variations.     

Prospective Influence of Music-Related Media Exposure on Adolescent Substance-Use Initiation: A Peer Group Mediation Model

The present study tests prospective effects of music-related media content (from television, Internet, and magazines) on youth alcohol, cigarette, and marijuana use initiation. Indirect effects through association with substance-using peers were tested in a 4-wave longitudinal data set (2,729 middle school students for the alcohol model, 2,716 students for the cigarette model, and 2,710 students for the marijuana model) from schools across the United States. In so doing, the authors examine theoretical claims regarding socialization mechanisms for effects of popular music listenership on substance use initiation. Results supported direct effects on alcohol and cigarette uptake, and indirect effects through association with substance-using peers on all 3 substances. This research, in combination with prior studies by several research teams, suggests elevated popular music involvement is a risk factor with respect to younger adolescents' substance use behavior. This influence is in part explained by the role of music-related media content in socialization to substance-using peer groups.     

Age of first use of cigarettes among rural and small town elementary school children in Illinois

This study determined age of first use of cigarettes among rural and small town elementary school students. Data were collected from 1,950 elementary school students, grades kindergarten through sixth, attending seven different schools in southern Illinois. Bivariate odds ratios and multivariate logistic regression procedures identified risk factors of cigarette use among this elementary school population. A Duncan multiple-range test revealed no significant difference in cigarette use between grades kindergarten through fifth (average percentage of use for those grades was 4.7%), but use increased significantly to 17.4% in the sixth grade. Predictor variables with the greatest odds ratios were having tried alcohol (OR = 8), having tried chewing tobacco or snuff (OR = 4.4), and being in the sixth grade (OR = 2.2). Healthy People 2010 draft objectives emphasize prevention and reduction of tobacco use among youth. To be effective, tobacco prevention programs must begin in the elementary school years.     

New inroads in preventing adolescent drug use: results from a large-scale trial of project ALERT in middle schools

OBJECTIVES: We evaluated the revised Project ALERT drug prevention program across a wide variety of Midwestern schools and communities. METHODS: Fifty-five South Dakota middle schools were randomly assigned to program or control conditions. Treatment group students received 11 lessons in 7th grade and 3 more in 8th grade. Program effects for 4276 8th-graders were assessed 18 months after baseline. RESULTS: The revised Project ALERT curriculum curbed cigarette and marijuana use initiation, current and regular cigarette use, and alcohol misuse. Reductions ranged from 19% to 39%. Program effects were not significant for initial and current drinking or for current and regular marijuana use. CONCLUSIONS: School-based drug prevention programs can prevent occasional and more serious drug use, help low- to high-risk adolescents, and be effective in diverse school environments.     

The relationship between youth's moral and legal perceptions of alcohol, tobacco and marijuana and use of these substances

Youth's perceptions of the morality of alcohol and other drug use and the perceived legitimacy of laws regulating such use have received scant attention in the international public health literature. To date, the focus has mainly been on emphasizing the health and social disbenefits of substance use in an attempt to counter the perceived psychological benefits (positive expectancies) of use and peer reinforcement. Following exploratory qualitative research, a structured questionnaire was administered to a sample of 611 youths aged 14-17 years. Analysis of the data found that use of alcohol, tobacco and marijuana was directly related to moral perceptions: those considering use as 'wrong under any circumstance' were less likely to be users than those who considered it 'ok under some or any circumstance'. Substance use was also related to legitimacy perceptions: those who thought laws relating to alcohol, tobacco and marijuana use were justified were less likely to be users than those who thought these laws were not justified. The implications of these findings for future research and for the design of more effective intervention strategies are discussed. It is suggested that interventions including student discussion of the moral and legal issues surrounding substance use may prove effective in postponing or even preventing substance use, particularly tobacco and marijuana consumption, or reducing the excess use of these substances.     

Family Meals and Substance Use: Is There a Long-Term Protective Association?

PURPOSE: To examine 5-year longitudinal associations between family meal patterns and subsequent substance use in adolescents. METHODS: A total of 806 Minnesota adolescents were surveyed in public schools in 1998-1999 (mean age, 12.8 years) and again by mail in 2003-2004 (mean age, 17.2 years) as part of a longitudinal population-based study. Logistic regression was used to estimate the odds of tobacco, alcohol, and marijuana use at follow-up for adolescents reporting regular family meals at baseline compared with those without regular family meals, adjusting for family connectedness and prior substance use. RESULTS: Family meal frequency at baseline was associated with significantly lower odds of cigarette smoking, alcohol use, and marijuana use at follow-up among female adolescents, even after adjusting for baseline substance use and additional covariates. Family meals were not associated with use of any substance at follow-up for male adolescents after adjusting for baseline use. CONCLUSIONS: Results from this study suggest that regular family meals in adolescence may have a long-term protective association with the development of substance use over 5 years among females. Parents should be encouraged to establish a pattern of regular family meals, as this activity may have long lasting benefits.     

Pattern of substance abuse among secondary school students in Trinidad and Tobago.

A questionnaire survey of 1,603 secondary school students, aged 14-18 years, was conducted in Trinidad and Tobago in 1988. Prevalence of alcohol use was 84%, tobacco 35%, marijuana 8% and cocaine 2%. Alcohol was the substance most consistently used and students' first exposure to drinking alcohol was with family members. Transitions from primary to secondary schools and from junior to senior schools were associated with increased reporting of alcohol use. Significantly more Indo-Trinidadian than Afro-Trinidadian students reported using alcohol frequently. Conversely more Afro-Trinidadian students than Indo-Trinidadians reported using marijuana. The use of alcohol by students was positively correlated to its use by fathers and negatively with religious activities. The use of drugs among students appears to be a growing problem. There is a need for the implementation of culturally relevant educational prevention programmes in schools.     

Acculturation and Substance Use Among Hispanic Early Adolescents: Investigating the Mediating Roles of Acculturative Stress and Self-Esteem

We examined the extent to which Hispanic orientation and American orientation are associated with substance use (cigarette, alcohol, and marijuana) both directly and indirectly through acculturative stress and self-esteem. Participants were 347 Hispanic early adolescents (50.7% male; mean age = 12.57, SD = 0.92, range 11–15) from two middle schools in western Michigan. Findings showed that self-esteem emerged as the most consistent predictor of likelihood and extent of substance use. Ethnic identity was positively related to risk for substance use, and acculturative stress and self-esteem mediated the relationships of Hispanic cultural orientation to alcohol use. Self-esteem was the most important protective factor against substance use, and as such, we conclude that prevention programs designed to address precocious substance use that incorporate a self-esteem building component could prove useful among Hispanic early adolescents residing in monocultural contexts within the United States.     

The influence of electronic cigarette age purchasing restrictions on adolescent tobacco and marijuana use

ObjectiveIn the United States, many states have established minimum legal purchase ages for electronic nicotine delivery systems (ENDS) to ban adolescent purchases, but these policies may also affect other related substance use. We explore whether ENDS are substitutes or complements for cigarettes, cigars, smokeless tobacco, and marijuana among adolescents by using variation in state-level implementation of ENDS age purchasing restrictions.MethodsWe linked data on ENDS age purchasing restrictions to state- and year-specific rates of adolescent tobacco and marijuana use in 2007–2013 from the Youth Risk Behavior Surveillance System. This data provides a nationally representative sample of adolescents who attend public and private schools. We performed a fixed effect regression analysis exploring the influence of ENDS age purchasing restrictions on outcomes of tobacco use and marijuana use, controlling for state and year fixed characteristics, age-race cohorts, cigarette excise taxes, and cigarette indoor use restrictions.ResultsFor cigarette use, we separate our results into cigarette use frequency. We found causal evidence that ENDS age purchasing restrictions increased adolescent regular cigarette use by 0.8 percentage points. ENDS age purchasing restrictions were not associated with cigar use, smokeless tobacco use, or marijuana use.ConclusionsWe document a concerning trend of cigarette smoking among adolescents increasing when ENDS become more difficult to purchase.     

Early tobacco and alcohol consumption as modifying risk factors on marijuana use

OBJECTIVE: To assess the relationship between early tobacco and alcohol use and the risk of marijuana consumption among schoolchildren. METHODS: A cross-sectional study comprising data from the Fourth National Study on Drug Use in the Chilean School Population (2001). There were studied 54,001 schoolchildren aged between eight and 20 years. Predictors were self-reported tobacco and alcohol use (ever users), age at initiation of tobacco and/or alcohol use, and intensity of tobacco use. The study outcome was self-reported marijuana use (ever users versus never users) and age at initiation of marijuana use. Poisson regression and Weibull regression were used for data analysis. RESULTS: Lifetime prevalence of tobacco use was high: 77%, alcohol 79%, and marijuana 23%. Tobacco consumption increased the likelihood of marijuana use (PR=10.4; 95% CI: 8.9;12.2). Later initiation of tobacco (HR=0.85; 95% CI: 0.84;0.86) and alcohol (HR=0.90; 95% CI: 0.89;0.91) decreased the risk of marijuana use. Marijuana use was higher in heavy smokers compared to light smokers (PR=3.11; 95% CI: 2.96;3.26 versus PR=1.70; 95% CI: 1.58;1.83). CONCLUSIONS: Tobacco use is strongly associated with marijuana use, which is significantly associated with the age at initiation of tobacco use, intensity of tobacco use and concurrent use of alcohol. Prevention strategies should target prevention of adolescent early tobacco use.     

Substance use by indigenous and non-indigenous primary school students

OBJECTIVE: Recent Australian research with adolescents aged 13 to 17 years has found that Indigenous youth are more likely than non-Indigenous adolescents to smoke tobacco and cannabis, although they may be less likely to use alcohol. The objective of this study was to examine whether this pattern exists among younger children. METHOD: A school-based, self-report survey was conducted in primary schools that had high proportions of Aboriginal and Torres Strait Islander children. Four schools were located in metropolitan Brisbane and three in Far North Queensland (sample n = 507 students: 270 girls, 237 boys, aged 9-13 years). RESULTS: Significant numbers of these children had started to experiment with recreational drugs. Twenty-two per cent had attempted to smoke at least one cigarette, 14% smoked in the preceding year, while 3% had smoked more than 10 cigarettes in their lives. Thirty-eight per cent had had at least one drink of alcohol, while 6% had smoked marijuana at least once. There was no significant association between Indigenous/non-Indigenous background and risk of smoking tobacco or marijuana, while Indigenous children were less likely than non-Indigenous children to report experience with alcohol. CONCLUSIONS: Contrary to data from secondary school students, Indigenous youth in primary schools were not more likely than non-Indigenous children to have experimented with tobacco or marijuana, or to be frequent tobacco smokers. It appears therefore that the excessive uptake of drug use among Indigenous youth occurs in the early stages of secondary school. This finding underlines the importance of preventive education in primary schools, especially for Indigenous children who have a high risk of making the transition to drug use in adolescence.     

Effects of state education requirements for substance use prevention

We provide the first evidence on the effects of state laws requiring students to receive education about alcohol, tobacco, and other drugs using data on over a million youths from the 1976–2010 Monitoring the Future study. In difference‐in‐differences and event‐study models, we find robust evidence that these laws significantly reduced recent alcohol and marijuana use among high school seniors by 1.6–2.8 percentage points, or about 8–10% of the overall decline over this period. Our results suggest that information interventions can reduce youth substance use.     

Recency of immigration, substance use, and sexual behavior among Massachusetts adolescents

OBJECTIVES: This study examined the relationships between recency of immigration, substance use, and sexual behavior. METHODS: Surveys were conducted with 2635 Massachusetts 8th and 10th graders that allowed comparisons of health behaviors and risk and protective factors among students living in the United States "always," more than 6 years, or 6 years or less. RESULTS: Compared with lifetime residents, immigrant youths (particularly those living in the United States 6 years or less) reported lower lifetime and recent alcohol and marijuana use (P < .001); sexual intercourse rates were similar across groups. However, recent immigrants were most likely to report peer pressures to engage in, and less parental support to avoid, risk behaviors (P < .001). CONCLUSIONS: A window of opportunity exists to provide primary prevention programs in schools to immigrant youths that may reduce adolescent health risk behaviors.     

Perceived risks and benefits of alcohol,cigarette, and drug use among urban low-income African-American early adolescents.

Perceptions about drugs and the social environment may be important influences on cigarette, alcohol and drug use, yet little is known regarding the perspective of early adolescent boys and girls, especially among minority urban youths. Among 351 African-American low-income urban youth, 9 through 15 years of age, completing a community-based computerized questionnaire, 25% acknowledged alcohol, cigarette, and/or illicit drug use in the past 6 months; 19% expected to use one of those substances in the next 6 months. Family exposure to drugs increased the likelihood that youths expected to use drugs by factors of 4.5 (boys) and 2.5 (girls). Other factors (feelings about drugs, community drug use, long-term expectations) distinguished users from nonusers or had different associations with use in boys and girls. Gender-specific perceptions about drugs may have the potential to be modified in drug and substance use prevention programs.     

Alcohol, Marijuana, and Tobacco Use Among Canadian Youth: Do We Need More Multi-Substance Prevention Programming?

Data from the Canadian Youth Smoking Survey (n = 27,030 in 2006; n = 16,705 in 2004; n = 11,757 in 2002) were used to examine changes in the prevalence and comorbid use of alcohol, tobacco, and marijuana over time and examine if demographic factors and binge drinking are associated with comorbid substance use among youth. Alcohol was the most prevalent substance used, and it was rare to find youth who had used tobacco or marijuana without also having tried alcohol. Youth who reported binge drinking were substantially more likely to also have tried tobacco and/or marijuana. These data suggest that multi-substance prevention programs are required for youth populations.     

Self-reported abuse history and adolescent problem behaviors. II. Alcohol and drug use.

PURPOSE: We examined the associations of self-reported abuse and sexual molestation with self-reported alcohol and drug use in a general population of adolescents. METHODS: We used a stratified cluster sampling procedure with replacement to sample 4790 students in Washington State public schools in Grades 8, 10, and 12. Students were asked whether they had ever been abused by an adult and whether they had ever been sexually molested. They were also asked about their levels of alcohol and drug use and about early initiation of substance use. We conducted polytomous logistic regressions, controlling for gender and grade, using Software for the Statistical Analysis of Correlated Data (SUDAAN). RESULTS: We identified associations between reported abuse history and alcohol and drug use in adolescence and early initiation of substance use. The associations between reported abuse history and alcohol use were stronger at younger ages. The strongest association was between combined abuse and molestation, and relatively severe (heavy) drinking by eighth graders (odds ratio, 7.9; 95% confidence interval, 2.6-17.4). For drug use, the associations with reported abuse history were slightly stronger at higher levels of severity and for combined abuse and molestation compared to nonsexual abuse. For early initiation, the associations with abuse history were stronger for combined abuse and molestation than for nonsexual abuse or molestation alone, and stronger for marijuana use/regular drinking than for alcohol/cigarette experimentation. For example, adjusted odds ratios and 95% confidence intervals (in parentheses) for combined abuse and molestation were 3.5 (2.8-4.5) for alcohol/cigarette experimentation and 12.2 (6.3-23.6) for marijuana use/regular drinking by age 10. For abuse alone, these figures were 2.5 (2.0-3.1) and 4.7 (3.0-7.3), respectively. CONCLUSION: Efforts to reduce substance use and abuse in adolescence, particularly heavy use and use early in adolescence, should consider the possible role of a history of maltreatment.     

Smoking,alcohol consumption,and illicit substances use among adolescents in Poland

Background

The use of alcohol, tobacco, and illicit substances typically first occurs in adolescence. The purpose of this study was to examine alcohol, cigarette, and illicit substance use among adolescents in Poland, including the age of initiation, frequency of use, methods of access, location of use, and parental knowledge and attitude.

Methods

An author-derived questionnaire was used to cross-sectionally survey 541 participants aged 13–17?years old. Due to the fact that some answers were lacking, the number of questionnaires analysed was 538 in case of smoking and illicit substances use, and 535 in case of alcohol drinking.

Results

The use of alcohol, cigarette, and illicit substance among the investigated group was 36.1, 37.6, and 10.8% respectively. The average age of initiation was 13–14?years old. Parents were aware of alcohol, cigarette, and illicit substance use 49.5, 35.8 and 22.4% of the time, respectively, and the rate of acceptance was 5.7 and 6.7% for alcohol and cigarettes. More than 28% of participants smoked in school, and 32.7% accessed illicit substances in the school’s neighborhood.

Conclusions

The rate of alcohol, cigarette, and illicit substance use in Poland is high and increasing, despite globally designed preventative actions. Parents’ awareness of children’s alcohol, cigarette, or illicit substance use is low, and schools hardly fulfil their educational and protective role. Preventative actions are necessary, and local challenges should be considered.