Rural adolescent alcohol, tobacco, and illicit drug use: a comparison of students in Victoria, Australia, and Washington State, United States

Purpose: There are inconsistent research findings regarding the impact of rurality on adolescent alcohol, tobacco, and illicit substance use. Therefore, the current study reports on the effect of rurality on alcohol, tobacco, and illicit drug use among adolescents in 2 state representative samples in 2 countries, Washington State (WA) in the United States and Victoria (VIC) in Australia. Participants: The International Youth Development Study (IYDS) recruited representative samples of students from Grade 7 (aged 12 to 13 years) and Grade 9 (aged 14 to 15) in both states. A total of 3,729 students responded to questions about alcohol, tobacco, cannabis, and other illicit substance use (n_VIC= 1,852; n_WA= 1,877). In each state, males and females were equally represented and ages ranged from 12 to 15 years. Methods: Data were analyzed to compare lifetime and current (past 30 days) substance use for students located in census areas classified as urban, large or small town, and rural. Findings were adjusted for school clustering and weighted to compare prevalence at median age 14 years. Findings: Rates of lifetime and current alcohol, tobacco, and cannabis use were significantly higher in rural compared to urban students in both states (odds ratio for current substance use = 1.31). Conclusions: In both Washington State and Victoria, early adolescent rural students use substances more frequently than their urban counterparts. Future studies should examine factors that place rural adolescents at risk for alcohol, tobacco, and illicit drug use.     

Health-as-a-Value, Spirituality, and Cigarette and Alcohol Use Among Russian High School Students

National estimates suggest that the prevalence of tobacco and alcohol use is higher among adolescents in Russia than among adolescents in the United States and other European countries. However, research on the psychosocial correlates of, as well as protective factors for, tobacco and alcohol use among Russian adolescents has been relatively limited. Research conducted primarily in the United States has shown that spirituality and health-as-a-value are plausible predictors of adolescent substance use. However, these constructs have not been extensively studied in regions outside the United States. In this study, we tested whether spirituality and heath-as-a-value had protective effects on past-month cigarette and alcohol use behaviors and next-year cigarette and alcohol use intentions among Russian high school students (N?=?354, mean age?=?15.7?years), after controlling for known predictors of adolescent substance use such as age, gender, socioeconomic status, peer substance use, and sensation seeking. We found a significant inverse relationship between health-as-a-value and recent cigarette and alcohol use as well as future cigarette use intentions. However, we did not find a significant relationship between spirituality and any substance use variables. Implications of these findings for school-based substance use prevention are discussed.     

The Influence of Household Substance Use on Children's Later Cigarette, Alcohol and Drug Use: A Three Factor Model

During the development of a psychometric instrument designed to identify adolescents at risk from developing an addictive state later in life, a strong association was found between family and adolescent substance use.

Adolescent cigarette, alcohol and drug use was found to be higher in families where these substances were used than in families that were abstemious. Not only did an association exist between adult and adolescent use of the same substance, it was also found that a cross-over effect existed whereby, for instance, adult alcohol use was associated with increased adolescent cigarette smoking. This effect was particularly strong where adult cigarette smoking appeared to be a significant factor in adolescent drug use.

A three factor model comprising of Modelling, Attitude and Availability is suggested to explain the difference in adolescent substance use in using and non-using households.     

Prevalence and related risk factors of licit and illicit substances use by adolescent students in Southern Taiwan

Deleterious health sequelae caused by licit and illicit substance use is a serious problem in our society. Adolescent students and particularly those who are prone to substance use are of special concern in the prevention of drug abuse. The purpose of this study was to investigate the prevalence of alcohol consumption, tobacco smoking and illicit drug use and to identify the risk factors related to these habits among adolescent students. A total of 1358 adolescent students aged 16–18 y old were recruited into this study via stratified random sampling from a vocational school in Kaohsiung city. Students were asked to complete a structured questionnaire anonymously and a 96.7% response rate was achieved. Prevalence of substances use was estimated as follows: alcohol drinking, 70.7% (boys 75.1%, girls 51.4%); tobacco smoking, 56% (boys 61.8%, girls 30.2%); illicit drug use 6.4% (boys 6.6%, girls 5.6%). Significant risk factors that emerged as common correlates with substances use were behaviour problems, non-negative attitude toward parent's substance use, and peer influence. A dose–response relationship was found between the prevalence of drinking, smoking, illicit drug use and the number of risk factors adolescents were exposed to. Prevention of adolescent substance abuse should be attempted and risk factors should be reduced. An educational approach is essential not only to gain/impart knowledge of substance abuse, but also to develop an effective program for health and social development.     

Testing Putative Causal Associations of Risk Factors for Early Intercourse in the Study of Twin Adults: Genes and Environment (STAGE)

Adverse childhood experiences and substance use have been identified as potential causal risk factors for early-onset sexual intercourse. While it is possible that exposure to these risk factors directly increases the likelihood of engaging in early intercourse, an alternative explanation is that observed associations between these variables are due to shared familial confounds. These unmeasured confounds may increase the likelihood of being exposed to these risk factors and of engaging in early intercourse. Participants drawn from a population-based study of Swedish adult twins (ages 19–47 years; N = 12,126) reported on their history of exposure to early physical and sexual trauma, cigarette use, and cannabis use. We investigated the nature of the association between these risk factors and young age at first intercourse, using a comparison of twins differentially exposed to each risk factor. When compared to non-exposed, unrelated individuals, participants who reported adverse childhood experiences or who engaged in early cigarette use or cannabis use were more likely to engage in early intercourse. However, co-twin comparisons indicated that observed associations between these risk factors and early intercourse may be due to familial factors shared within twin pairs, and risk factor exposure may not lead directly to early intercourse. Our results suggest that preventing trauma exposure or preventing or delaying adolescents’ cigarette smoking or cannabis use may not effectively delay intercourse onset; instead, other aspects of the adolescent’s environment should be addressed.     

Risk for initiation of substance use as a function of age of onset of cigarette, alcohol and cannabis use: findings in a Midwestern female twin cohort

OBJECTIVE: We investigated whether use and early-onset use of cigarettes, alcohol and cannabis contributed an increase in risk for initiation of subsequent psychoactive substances in women (N = 3729, mean age = 21.7). METHODS: Drugs were ordered in ascending order of initiation: cigarettes, alcohol, cannabis and other illicit drugs, with early-onset use of each drug used as a time-varying covariate to predict initiation of subsequent drugs. Interactions of use and early-onset use, with age of initiation of subsequent drugs, were evaluated using discrete-time Cox survival analyses. RESULTS: The association between each substance and the early-onset of subsequent drug use was strong (ORs 1.54-19.9). Women who initiated cigarette, alcohol or cannabis use at an early age were at elevated risk for early experimentation with each subsequent drug class. Furthermore, early-onset of more than one substance contributed greater risk for initiation of subsequent drugs. CONCLUSION: Prevention efforts should target risk factors that contribute to early initiation of cigarette and alcohol use and may subsequently correlate with hard drug involvement.     

Correlates of cannabis initiation in a longitudinal sample of young women: the importance of peer influences

OBJECTIVE: Cannabis is the most commonly used illicit drug in developed nations. In adolescent girls especially, rates of cannabis use have increased over the last decade, urging the need to characterize the potential correlates of onset of cannabis use during emerging adulthood. METHOD: Using data from 1065 females (collected 1994-2005) who participated in both the baseline and follow-up wave of interviews of the Missouri Adolescent Female Twin Study, we examined the associations between correlates from the peer, parental and individual domains and new onsets of cannabis use, using logistic regression. RESULTS: Univariate models revealed that initiation of cannabis use was associated with alcohol and cigarette use at baseline, peer attitude towards alcohol/cigarette/cannabis use, peer substance use and other aspects of impulse-disinhibited behavior. However, multivariate stepwise modeling retained only the significant influences of alcohol use at baseline and peer attitudes towards cannabis as correlates of cannabis initiation. CONCLUSION: Having peers with favorable attitudes towards alcohol, cigarette and cannabis use is an important correlate of initiation of cannabis use in women. Prevention and intervention efforts need to take this into account when developing drug resistance training programs for adolescents.     

The neighborhood effects of disrupted family processes on adolescent substance use

In the current paper, we argue that the neighborhood-level of disrupted family processes (weak social ties to parents and coercive family interaction) should have a contextual effect on adolescent substance use (cigarette smoking, heavy drinking, and lifetime cannabis use), because adolescents living in neighborhoods in which disrupted family processes are prevalent should be more likely to associate with deviant (substance using) peers. We use nested data on 5491 Icelandic adolescents aged 15 and 16 years in 83 neighborhoods to examine the neighborhood-contextual effects of disrupted family processes on adolescent substance use (cigarette smoking, heavy drinking, and lifetime cannabis use), that is, whether neighborhoods in which disrupted family processes are common have more adolescent substance use, even after partialling out the individual-level effects of disrupted family processes on substance use. As predicted, we find that the neighborhood-levels of disrupted family processes have significant, contextual effects on all the indicators of substance use, and that association with substance using peers mediates a part of these contextual effects. The findings illustrate the limitation of an individual-level approach to adolescent substance use.     

Substance use,generation and time in the United States: The modifying role of gender for immigrant urban adolescents

Although immigrant youth have lower rates of substance use than US born youth, whether substance use varies by generation and time in the US is unclear. This study examines adolescent alcohol, tobacco and marijuana use by generation/time in US (i.e., first generation, in US ≤4 years; first generation, in US >4 years; second generation; and third generation or higher). Data come from a 2008 survey of Boston, Massachusetts public high school students (n = 1485). Multivariable logistic regression models were used to examine the association between generation/time in the US and risk of past 30-day substance use, adjusting for age and race/ethnicity. To determine whether the associations differed by gender, we fit gender stratified regression models. The prevalence of substance use was lowest among immigrants who had been in the US ≤4 years. Among girls, generation/time in US was not related to alcohol use or to tobacco use. For boys, being an immigrant regardless of number of years in the US, as well as second generation was associated with a significantly lower risk of tobacco use, compared to third generation youth. Additionally, immigrant boys who had been in the US ≤4 years had a significantly lower risk of alcohol use. Among both boys and girls, all first and second generation youth were significantly less likely to report marijuana use compared to third generation youth. Immigrant youth have a lower risk of alcohol, tobacco and marijuana use relative to US born youth; however the protective effect of foreign nativity on alcohol was eroded much more quickly than for tobacco or marijuana. The effects of generation and time in US on substance use differ by gender and the particular substance.     

Family structure, parent-child relationships, and alcohol and other drug use among teenagers in France and the United Kingdom

This paper compares samples of 15-16-year-olds from the UK and France on their usage of alcohol, tobacco and illicit drugs and also seeks to describe the associations between alcohol and other drug use with "family variables" within the two countries. Compared to UK adolescents, French adolescents showed a slightly higher rate of cigarette smoking, were almost identical on cannabis use, rather lower on the use of other illicit drugs and very considerably lower on alcohol use. Family variables were related to substance use. In the two countries, children from non-intact families, those who were not satisfied with their relationships with their father or mother and those who were less closely monitored, were more likely to be heavy substance users than other students. Logistic regressions showed that parental knowledge of the whereabouts of their offspring on Saturday evenings was the strongest factor, in both countries, that family structure is frequently still significant in the UK, and that paternal relationships are highly significant among French students. Differences in national drinking culture, urbanization and parental practices are discussed in an attempt to interpret some of these findings.     

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.     

Comparisons of polydrug use at national and inner city levels in England: associations with demographic and socioeconomic factors

PurposeThis study compares polydrug use in national and inner city samples to (1) examine patterns of use underlying different prevalence rates and (2) identify how inner city polydrug use needs targeting in ways not suggested by national research.MethodsLatent class analyses on indicators of illicit drug use in the last year, hazardous alcohol use, and cigarette smoking were compared between the inner city 2008-2010 South East London Community Health study (n = 1698) and the nationally representative 2007 Adult Psychiatric Morbidity Survey in England (n = 7403). Multinomial logistic regressions then examined latent class solutions with demographic and socioeconomic factors.ResultsBoth samples revealed three notably similar classes of polydrug users: a "high-drug" group using multiple substances; a "moderate-drug" group using cannabis, alcohol, and cigarettes; and a "low-drug" group reporting minimal alcohol and cigarette use. However, South East London Community Health reported lower risks of polydrug use for ethnic minorities but not for more educated participants.ConclusionsDespite higher polydrug use prevalence in the inner city, latent classes of polydrug users were similar between samples. Some demographic and socioeconomic factors differed between the samples, suggesting the need for inner city services to use both local and national data for policy planning.     

Concurrent alcohol and tobacco use during early adolescence characterizes a group at risk

AIMS: To investigate whether concurrent alcohol and tobacco use during early adolescence characterizes a subgroup that differs from users of one substance only regarding several risk factors for later substance use problems. METHODS: Participants were from a prospective longitudinal cohort study of 384 children at risk for later psychopathology, with the majority being born with obstetric complications and psychosocial adversities. Assessments of adolescent drug consumption and related intrapersonal characteristics were obtained at age 15. RESULTS: Compared to consumers of alcohol only, 15-year-olds drinking and smoking during the same time period (past 4 weeks) had significantly higher levels of consumption and more excessive use of alcohol, started drinking at an earlier age, had higher scores on the Fagerstr?m Test for Nicotine Dependence, and more cannabis use. This group could be distinguished from users of alcohol only by higher novelty seeking and more positive alcohol effect expectancies. Compared to consumers of tobacco only, concurrent users reported higher nicotine dependence and more cannabis use. No significant differences were observed regarding frequency and age at initiation of tobacco use, tobacco-related sensitivity, self-efficacy and instrumentality as well as novelty seeking. CONCLUSIONS: Concurrent alcohol and tobacco use during early adolescence is associated with characteristics that are well known as risk factors for later alcohol use problems and dependence and that should be targeted by prevention programs.     

Cannabis,risk and normalisation: evidence from a Canadian study of socially integrated,adult cannabis users

Howard Parker’s ‘normalisation thesis’ has made a significant contribution to youth drug studies in many countries. Parker’s thesis has been less investigated, however, for its application across the life course, and few scholars have considered its utility for assessments of the meaning and experience of drug-related health risks. This article adds to discussions of drugs, normalisation and risk by analysing qualitative data collected from 165 long-term cannabis users aged 20–49 years in four Canadian provinces between 2008 and 2010. We focus on participants’ assessments of the risks and harms associated with persistent cannabis use and the strategies they employed to mitigate these risks. Our findings indicate important distinctions between culturally mediated conceptions of cannabis-related risks and the more narrowly grounded perception of cannabis harms based on personal or peer experience. These distinctions correspond with participants’ reports of a significant shift in cannabis’ risk profile in Canada. Participants attributed this shift to three factors: the growing prevalence of cannabis use; the rise of ‘medical marijuana’ and renewed attention to the drug’s therapeutic benefits and what they perceived to be the low incidence of cannabis-related harms in Canada. We conclude that understanding how health risks are assessed and managed by cannabis users should help to clarify how and why more tolerant attitudes about cannabis have emerged in Canada and how this change may impact on non-users’ expectations about any future initiation of use. We close by reflecting on the implications of our findings for cannabis-related public health, education and harm reduction initiatives.     

A cross-national comparison of risk and protective factors for adolescent substance use: the United States and Australia.

PURPOSE: To compare risk and protective factors that influence youth substance use in Australia and the United States. The two countries have different policy orientations toward substance use: Australia has adopted harm-reduction policies, and the United States has adopted abstinence-focused policies. METHODS: Cross-sectional survey data were collected from independent samples of adolescents in the states of Maine (N = 16,861; 53% female, 7% Non-white) and Oregon (N = 15,542; 51% female, 24% Non-white) in the United States and Victoria in Australia (N = 8442; 54% Female, 11% Non-white) in 1998 (Maine and Oregon) and 1999 (Victoria). Chi-square tests, t-tests, effect size comparisons, and logistic regression analyses that accounted for age and gender were used to investigate cross-national similarities and differences in: (a) rates of cigarette, alcohol, and marijuana use; (b) levels of risk and protective factors; and (c) magnitudes of associations between risk and protective factors and substance use. RESULTS: More adolescents in Victoria reported using cigarettes and alcohol, whereas more of the U.S. adolescents reported using marijuana. Exposure to risk and protective factors was generally similar in the cross-national samples. However, adolescents in Maine and Oregon perceived handguns to be more readily available, reported more participation in religious activities, and were higher in sensation-seeking and social skills; and adolescents in Victoria had more favorable attitudes toward drug use and reported community norms and parental attitudes more favorable to drug use. Most of the risk and protective factors were strongly associated with substance use to a similar degree in Victoria, Maine, and Oregon. However, among adolescents in Maine and Oregon peer/individual risk and protective factors associated with social detachment were more strongly related to substance use, and among adolescents in Victoria, family protective factors were less strongly related to alcohol use. CONCLUSIONS: Inter-country influences on youth substance use are generally similar despite different policy directions. Existing differences suggest that the abstinence policy context is associated with higher levels of illicit drug use and stronger relations between individual indicators of social detachment and substance use, whereas the harm reduction policy context is related to more cigarette and alcohol use, possibly from exposure to normative influences that are more tolerant of youth drug use.     

Social and Emotional Adjustment Following Early Pregnancy in Young Australian Women: A Comparison of Those Who Terminate,Miscarry, or Complete Pregnancy

PurposeTo compare social and emotional adjustment including educational attainment and substance use in women who had a child, pregnancy termination, or miscarriage by young adulthood.MethodsData were from a population-based longitudinal study of the health and well-being of 1,943 young Australians (Victorian Adolescent Health Cohort Study) followed from 15 to 24 years of age. The sample was restricted to female participants and based on pregnancies reported by age 24 years. Analyses were adjusted for early teenage depressive symptoms, cigarette smoking, alcohol use, cannabis use, and parent socioeconomic context.ResultsA total of 208 pregnancies (in 170 women) were reported from a sample of 824 young women by 24 years of age. Compared with those who had never been pregnant, those who had a child had lower tertiary education completion and a higher risk of nicotine dependence; those who terminated a pregnancy were more commonly single and had a higher risk of smoking and alcohol use as well as nicotine and alcohol dependence; and those who had a miscarriage had a higher risk of depressive symptomatology and binge drinking as well as nicotine and cannabis dependence.ConclusionsYoung women who have been pregnant by their mid-twenties report a range of difficulties in social and emotional adjustment that vary across the different pregnancy outcomes. Broad-based psychosocial health care is essential not only for young women whose pregnancies proceed to live birth, but also for those whose pregnancies end with miscarriage or induced abortion.