Indicators of adolescent alcohol use: a composite risk factor approach

A self-reported alcohol inventory measured prevalence and frequency of lifetime, recent, and current alcohol use by an opportunity sample of 3226 young people aged 11-18 in Welsh secondary schools in 2005 comparing findings to extant U.K. and European levels. A risk factor-based questionnaire enabled comprehensive, sensitive sample profiling by gender and age, combining factor analysis with logistic regression to identify composite risk factors influential upon alcohol use by young people in Wales and salient to policy makers and practitioners, notably the endogenous factors: anti-social behaviour/attitudes, inadequate relationships/activities in school, negative experiences in school, lack of commitment to school, and impulsivity. Overlap with composite risk factors for youth offending was identified, but not with drug use, suggesting that the commonly cited "gateway" relationship between elements of "substance use" requires further examination. The study's limitations and implications are discussed.     

Health and Social Difficulties in High School Students using High Amounts of Alcohol and Drugs: Implications for Screening

The use of frequency-based criteria to detect harmful substance use in adolescents is rare despite its potential to identify young people at risk. We compared high school students who use high amounts of substances to students with lower levels (or nil) of use across health and well-being indicators to explore the feasibility of this kind of categorization. Based on survey questions from Youth'12, a cross-sectional adolescent health survey involving 3% (8,500) of New Zealand high school students, we selected criteria indicative of substance use that would warrant specialist alcohol and other drugs (AOD) treatment. Two sets of “high-use” criteria (e.g., drinking “alcohol most days a week or more”) for both older and younger adolescents were selected. Eleven percent of students met criteria for “high use,” with higher rates in males and older students. Rates of high use were similar across high-, medium- and low-deprivation neighborhoods. Binge alcohol use (9.2%) was the predominant form of “high use.” Students with “high use” reported poorer health outcomes across numerous areas including mental health, physical health, risk behaviors, and access to health care. Only 5% of “high-use” students had accessed an AOD service. The wide range of negative health outcomes associated with a high level of substance use suggests that brief screening focusing on the level of substance use may help in identifying young people at risk. Simple and brief processes may improve the uptake and implementation of screening in primary care and other settings, and further research in this area is recommended.     

Adolescent Drinking and Alcohol-Related Problems in a Nationwide General Population

A sample of 1,325 adolescents drawn from a nationwide multistage probability master sample of 4,290 persons were interviewed at their homes in 1984. The purpose of this study was to investigate the patterns and quantity of alcohol consumption and related problems. Moreover, mental health status of respondents and “risk” factors were explored. Alcohol use increased from the very young to the older ones and decreased between lifetime and past week frequencies. Of adolescents, 18% reported two or more alcohol-related problems including suffering from depressive symptoms. Discriminant analysis revealed 14 predictors with high discriminating power between problematic and nonproblematic drinking.     

“Skittles & Red Bull is my favourite flavour”: E-cigarettes,smoking, vaping and the changing landscape of nicotine consumption amongst British teenagers – implications for the normalisation debate

Aims: From an academic discourse explaining trends in drug-related attitudes and behaviours, “normalisation” now also encompasses public health policy advocating “denormalisation” of smoking. This study explored young people’s attitudes and behaviours to cigarettes and e-cigarettes to ascertain whether a process of “renormalisation” was underway. Methods: A six-month multi-method study was conducted in NW England. Data collection in April-July 2014 included a convenience sample survey of 233 students; secondary analysis of a 3,500 respondent survey; stakeholder interviews; participant observation sessions; focus groups; and participatory research events with over 100 students. Findings: With the public performance of “vaping” valued as an indicator of experienced use, young people used e-cigarettes primarily for flavour combinations and to perform “tricks”. Smoking cessation and nicotine consumption were less important motivations. When comparing e-cigarettes with eight indicators of normalisation – additionally, legal status and risk perception – there were indications of a growing cultural accommodation of “vaping”. Conclusion: The changing landscape of nicotine and non-nicotine products challenges traditional conceptualisations of “smoking” and “non-smoking” and problematises the notion of linear processes of normalisation in respect not just of young people’s tobacco and nicotine use, but more generally, of delivery systems and the drugs dispensed within them, suggesting marketplace-differentiated normalisation.     

Identifying young people who drink too much: the clinical utility of the five-item Alcohol Use Disorders Identification Test (AUDIT)

The current study investigated the patterns and consequences of alcohol use among young people and their perceptions of associate health risk, and explored the clinical utility of the five-itemversion of the Alcohol Use Disorders Identification Test (AUDIT) in screening young people for hazardous drinking. A cross-sectional sample of 393 young people aged 16-19 years were accessed through two tertiary colleges in South London and self-completed an anonymous, confidential questionnaire recording the five-item AUDIT, patterns of alcohol consumption, hazardous consequences and perception of associate health risk. Over 90% of the sample reported drinking alcohol regularly, commonly excessive weekend use and related physical, psychological and social consequences. A significant minority (20.4% of males, 18.0% of females) reported consumption of alcohol in excess of UKrecommended limits, while almost a third (34.2%of males, 30.2%of females) reported scores in the 'hazardous' range of the five-item AUDIT. However, the majority had little perception of associate health risk, perceiving their use to be 'light' and unproblematic. Only one in 10 of those drinking at 'hazardous' levels recognized their alcohol use as problematic, most believing the hazardous consequences of this use were acceptable. Self-reported patterns of alcohol consumption (except age first used) and total number of psychological and social hazardous consequences were found to significantly predict AUDIT scores using linear regression analysis. Therefore the five-item AUDIT appears to have predictive validity, reflecting self-reported alcohol consumption, perception of associate health risk and hazardous consequences among young people. It is concluded that it may consequently have clinical utility as a simple screening tool (suitable for use by a variety of professionals in contact with young people) for the identification of hazardous alcohol consumption among this population. \[Miles H, Winstock A, Strang J. Identifying young people who drink too much: the clinical utility of the five-item Alcohol Use Disorders Identification Test (AUDIT). Drug Alcohol Rev 2001:20:9-18]     

Identifying High School Students “At Risk” for Substance Use and Other Behavioral Problems: Implications for Prevention

Attendance and grade point average (GPA) data are universally maintained in school records and can potentially aid in identifying students with concealed behavioral problems, such as substance use. Researchers evaluated attendance (truancy) and GPA as a means to identify high school students at risk for substance use, suicide behaviors, and delinquency in 10 high schools in San Antonio, Texas, and San Francisco, California, during the spring and fall of 2002. A screening protocol identified students as “high risk” if (1) in the top quartile for absences and below the median GPA or (2) teacher referred. Survey responses of 930 high-risk students were compared with those from a random sample of 393 “typical” students not meeting the protocol. Bivariate and multivariate analyses assessed associations between the screening protocol variables and demographics, risk and protective factors, and problem outcomes. The individual contribution of each of the variables was also assessed. Students identified as high risk were significantly more likely than typical students to use cigarettes, alcohol, and marijuana, evidence suicide risk factors, and engage in delinquent behavior. Norms varied between the two districts; nevertheless, high-risk students showed consistent differences in risk and protective factors, as well as problem behaviors, compared with typical students. Because of site differences in data collection and teacher participation, the comprehensive protocol is recommended, rather than individual indicators alone (e.g., truancy). Strengths of the screening protocol are the ready availability of school record data, the ease of use of the adapted protocol, and the option of including teacher referral. More research is recommended to test the generalizability of the protocol and to ensure that there are no unintended negative effects associated with identification of students as high risk.     

Pre-Teen Drug Users in Scotland

Aim. To compare and contrast those SI pupils in Scotland (typically age 11 to 12) who have initiated illegal drug use with their non-illegal drug using peers. Design. Self-completion school surveys totaling 930 SI pupils. Setting. Dundee, Perth and Kinross, and Lanarkshire, Scotland. Findings. This research has identified that approximately one in ten SI pupils have already initiated illegal drug use in Scotland. Young people who reported using illegal drugs at this early age tended to have started smoking and drinking alcohol at an earlier age than their non-illegal drug using peers and to be both smoking and drinking alcohol at a higher level than those peers. The illegal drug using pupils were much more likely than their peers to have been exposed to illegal drugs, to have been involved in a range of problem behaviours and to have friends who were also involved in a range of problem behaviours. The illegal drug using young people were also much more likely to have someone in their family who was also using illegal drugs. Conclusions. There is a need to target interventions upon those young people who have initiated illegal drug use at this early age, however doing so is unlikely to be straightforward. It is suggested that there may be some merit in using an “at-risk” type register to focus upon those young people at particularly high risk of initiating illegal drug use.     

Substance Use Among High-School Students: Relationships with Temperament,Personality Traits,and Parental Care Perception

Alcohol use, “alcohol abuse,” and illicit drug use were investigated in a representative sample of 1076 urban, northern Italian high school students aged 14 to 19 years in 2001. In addition to questions on substance use, the participants were asked about school achievements and perceived substance use among friends. All the students were submitted to Zuckerman Sensation Seeking Scale (SSS) scale, Eysenck Personality Questionnaire (EPQ), Buss-Durkee Hostility Inventory (BDHI), and Parental Bonding Instrument (PBI). Lifetime alcohol use was found in 80.5%, “alcohol abuse” in 37.7%, cannabis use in 26.2%, ecstasy in 2.8%, heroin in 3.8%, and cocaine in 8.3% of the students: gender differences were significant for alcohol use, “alcohol abuse” and ecstasy use, with male subjects outnumbering females, but not for reported cannabis, heroin, and cocaine use. Early substance use onset among adolescents aged 14–16 years was detected. Higher sensation seeking on SSS, social coping impairment on EPQ, direct aggressiveness on BDHI, poor school achievements, and lower parental care on PBI were found associated with illicit drug use and “alcohol abuse” (multiple drugs users). Increased levels of aggressiveness and sensation seeking were evidenced both in minimal experimenters (ME) and habitual users (HU), without any significant difference, in comparison with abstinent students. Similarly, ME scored higher than abstinent subjects on EPQ for social coping impairment, but lower than HU. Parental care perception was lower in HU, but not in ME with, respect to abstinent subjects. Pearson inverse correlation was demonstrated between PBI scores and EPQ maladaptation and BDHI aggressiveness. Data from this preliminary pilot study suggest that temperamental traits and personality changes may be associated to early substance use “proneness” and reduced perception of parental care.     

Examining Sequences of Adolescent Substance Use Initiation Involving Over-the-Counter (OTC) Drug Abuse

Over-the-counter (OTC) drug abuse among adolescents is an increasingly visible and meaningful trend in the United States, but little research has been done to contextualize OTC drug abuse. This study examined a large sample of 152,678 middle school and high school adolescents in an attempt to understand sequences of OTC drug abuse initiation, and the sociodemographic and risk factor-related precursors thereof. We found that while many adolescents who had ever abused an OTC drug and used one or more “gateway” drugs (alcohol, cigarettes, or marijuana) initiated the use of the gateway drug first, there was also a subset of adolescents whose sequence of initiation began with OTC drug abuse. We also found that different risk factors and sociodemographic characteristics predicted different sequences of use. For example, interaction with antisocial peers predicted initiating gateway drug use prior to OTC drug abuse, but not the reverse sequence. Other predictor variables, including gender, grade, and parental attitudes toward drug abuse also differentiated these sequences; we discuss both the theoretical and practical implications of these findings.     

Risk factors for alcohol use, frequent use, and binge drinking among young men who have sex with men

We examined the prevalence and patterns of alcohol use within a large, ethnically diverse sample of young men who have sex with men (YMSM) and identified psychosocial correlates of these alcohol-use patterns. A sample of 526 YMSM (ages 18-24 years) was recruited in Los Angeles, CA using a venue-based, stratified probability sampling design. Based on criteria used by previous research with young adults, participants were assigned to one of four alcohol-use/non-use groups according to frequency and number of drinks per sitting in the last 30 days. Findings revealed a high prevalence of alcohol use (91%) within the sample, with 21% reporting binge drinking; of binge drinkers, 40% reported frequent binge drinking. Multinomial logistic regression analyses revealed that race/ethnicity, gay bar attendance, depression, sensation seeking, peer risk behaviors, and age of alcohol initiation significantly differentiated between non-/light users from frequent and binge drinkers. Results also indicated unique psychosocial profiles among frequent/binge drinkers. The heterogeneity of predictors associated with different patterns of alcohol use highlights the need to consider unique risk profiles and alcohol-use trajectories according to exposure to different risk and protective factors.     

Smoking Is Associated with Increased Risk of Binge Drinking in a Young Adult Hispanic Population at the US-Mexico Border

Background: This study examines factors related to general health and health behavior, including smoking, that may be associated with binge drinking, drinking “at risk,” and potential for alcohol use disorder among young adults of Mexican ancestry. Methods: A total of 2191 young adult emergency department (ED) patients (18–30 years) of Mexican ancestry in a public hospital proximate to the US-Mexico border completed health surveys while they were waiting to be treated, including questions on general health, drinking, smoking, and drug use. Results: Thirty-seven percent of the study participants reported binge drinking, 38% were “at-risk” alcohol users (above National Institute on Alcohol Abuse and Alcoholism guidelines), and 22% were Rapid Alcohol Problem Screen (RAPS) positive (indicating potential for alcohol use disorder). Smoking was reported by 31%, marijuana use by 16%, and other drug use by 9%. Multiple variable models revealed that smoking was the strongest factor associated with binge drinking. Those who smoked were 3.1 (P < .0001) times more likely to binge drink. Other factors independently associated with binge drinking were age 22–25 years (odds ratio [OR] = 1.5, P = .003), male gender (OR = 1.5, P = .0001), and ED visit for injury (OR = 1.4, P = .007). Conclusions: There is a strong association of smoking and binge drinking. Study findings suggest that brief interventions designed to reduce preventable health risks for young Hispanics should include discussion of both binge drinking and smoking behaviors.     

Drinking Reasons,Alcohol Consumption Levels,and Drinking Locations among Drunken Drivers

In a DUI offender sample, four drinking reason factors are regressed on alcohol consumption variables and frequency of drinking in seven types of locations. Drinking for “pleasure” and “opposite sex/drunkenness” reasons are associated with both quantity consumed per occasion and away-from-home locations such as automobiles, bars, and parties, suggesting high traffic accident risk. “Escapism” reasons are related to quantity consumed per occasion, but are only weakly associated with specific locations; and “sociability” reasons are associated with drinking in friends’ homes, but are not related to high consumption levels. Implications for DUI countermeasures are discussed.     

The Risk Environment of Heroin Use Initiation: Young Women,Intimate Partners,and “Drug Relationships”

This paper examines young women's initiation to heroin use in the context of an intimate relationship based on data from a small-scale ethno-epidemiology of heroin use in Ireland, 2007–2009. The epidemiological sample included 120 young people, and life history interviews were conducted with a sub-sample of 40 youth aged 16–25 years. A detailed analysis of the “risk environment” of young women's heroin initiation highlights a complex interplay between women's agency and intimate partner influence. It is argued that dichotomous representations of women as victims or emancipated consumers do not adequately capture the complexity of women's initiation journeys. The study's limitations are noted and implications for drug use prevention and harm reduction strategies are discussed.     

Sensation Seeking,Attitudes Toward Drug Use,and Actual Use Among Adolescents: Testing a Model for Alcohol and Ecstacy Use

The use of ecstasy (MDMA), one of the most popular substances among young people in the context of many leisure and fun activities, is moving from party and recreation circuits to high schools and college dorms, in many cases in combination with alcohol consumption. Bearing in mind the concurrent use of the two drugs and the “gateway” thesis of a progression from legal drugs to illegal ones, a causal model of linkages among sensation seeking, attitudes toward alcohol and ecstasy consumption, and frequency of use was tested using structural equation modeling (SEM). The data were obtained from a sample of 450 high school students ranging in age from 14 to 18 (47% male, 53% female). An additional moderator analysis was performed in order to examine a possible moderating role of sensation seeking in the relationship between attitudes toward consumption and frequency of use of both alcohol and ecstasy. Results were consistent with the hypothesis that positive attitudes toward consumption mediate the effects of sensation seeking on drug use. In addition, whereas our results were coherent with the existence of direct effects of sensation seeking on drug use, these were only found in the case of alcohol consumption. However, a moderating effect of this same variable was observed in the relationship between positive attitudes toward ecstasy consumption and its frequency of use. General and specific clinical implications and limitations of these findings are discussed and future lines of research suggested.     

Beyond Leisure: The Role of Alcohol in the Lives of Nigerian University Students

Background: Alcohol consumption among young people in Nigeria has traditionally been constrained due to the socio-cultural belief that alcohol is for adults. In contemporary Nigeria, media reports indicate that young people drink alcohol regularly in large quantities, but empirical research on what motivates their alcohol use is lacking. Objectives: To explore the motives for consuming alcohol among male and female students at a Nigerian university. Methods: Drawing on motivational theories of alcohol use, 31 semi-structured interviews were conducted with students (aged 19–23 years). The data were analyzed to generate themes with the aid of NVivo software. Results: Three themes (drinking to cope; overcoming academic performance anxiety; and drinking to socialize) were identified under coping, enhancement and social motives. First, while both male and female participants used alcohol to attenuate sorrow, anger, and stress, females also drank to ameliorate depression and heartbreak due to relationship problems. Second, men and women perceived that alcohol provided them with “academic courage.” Hence, they drank to boost their confidence in delivering class seminars. Relatedly, women used alcohol in a bid to enhance their retentive memory before taking written examinations. Third, men and women engaged in gendered heavy drinking rituals purposefully to get drunk and loosen up. This enables men to discuss what they referred to as “men's affairs” while it enables women to “reveal deep secrets” (to inebriated group members) that they would not ordinarily reveal when they are sober. Women's drink choice was associated with social motives because spirits were used purposefully to quicken their intoxication. Conclusions: Participants who drank due to coping and social motives consumed larger quantities of alcohol than they consumed on “normal” drinking occasions. We discuss the implications of these findings and offer suggestions for public health interventions that policymakers might consider implementing, to reduce alcohol-related harms in the Nigerian Higher Education system.     

Energy drinks and alcohol-related risk among young adults

Background: Energy drink consumption, with or without concurrent alcohol use, is common among young adults. This study sought to clarify risk for negative alcohol outcomes related to the timing of energy drink use. Methods: The authors interviewed a community sample of 481 young adults, aged 18–25, who drank alcohol in the last month. Past-30-day energy drink use was operationalized as no-use, use without concurrent alcohol, and concurrent use of energy drinks with alcohol (“within a couple of hours”). Negative alcohol outcomes included past-30-day binge drinking, past-30-day alcohol use disorder, and drinking-related consequences. Results: Just over half (50.5%) reported no use of energy drinks,18.3% reported using energy drinks without concurrent alcohol use, and 31.2% reported concurrent use of energy drinks and alcohol. Relative to those who reported concurrent use of energy drinks with alcohol, and controlling for background characteristics and frequency of alcohol consumption, those who didn't use energy drinks and those who used without concurrent alcohol use had significantly lower binge drinking, negative consequences, and rates of alcohol use disorder (P < .05 for all outcomes). There were no significant differences between the no-use and energy drink without concurrent alcohol groups on any alcohol-related measure (P > .10 for all outcomes). Conclusions: Concurrent energy drink and alcohol use is associated with increased risk for negative alcohol consequences in young adults. Clinicians providing care to young adults could consider asking patients about concurrent energy drink and alcohol use as a way to begin a conversation about risky alcohol consumption while addressing 2 substances commonly used by this population.     

Alcohol Use and Risk Taking Among Regular Ecstasy Users

We examine alcohol use in conjunction with ecstasy use and risk-taking behaviors among regular ecstasy users in every capital city in Australia. Data on drug use and risks were collected in 2004 from a national sample of 852 regular ecstasy users (persons who had used ecstasy at least monthly in the preceding 6 months). Users were grouped according to their typical alcohol use when using ecstasy: no use, consumption of between one and five standard drinks, and consumption of more than five drinks (“binge” alcohol use). The sample was young, well educated, and mainly working or studying. Approximately two thirds (65%) of the regular ecstasy users reported drinking alcohol when taking ecstasy. Of these, 69% reported usually consuming more than five standard drinks. Those who did not drink alcohol were more disadvantaged, with greater levels of unemployment, less education, higher rates of drug user treatment, and prison history. They were also more likely than those who drank alcohol when using ecstasy to be drug injectors and to be hepatitis C positive. Excluding alcohol, drug use patterns were similar between groups, although the no alcohol group used cannabis and methamphetamine more frequently. Binge drinkers were more likely to report having had three or more sexual partners in the past 6 months and were less likely to report having safe sex with casual partners while under the influence of drugs. Despite some evidence that the no alcohol group were more entrenched drug users, those who typically drank alcohol when taking ecstasy were as likely to report risks and problems associated with their drug use. It appears that regular ecstasy users who binge drink are placing themselves at increased sexual risk when under the influence of drugs. Safe sex messages should address the sexual risk associated with substance use and should be tailored to reducing alcohol consumption, particularly targeting “heavy” alcohol users. The study's limitations are noted.     

“I’m not afraid of those ones just ‘cause they’ve been prescribed”: Perceptions of risk among illicit users of pharmaceutical opioids

BackgroundThere has been a rise in the illicit use of pharmaceutical opioids (“pain pills”) in the United States. Conducted with young adult non-medical users of pharmaceutical opioids, this study uses qualitative methods and cultural consensus analysis to describe risk perceptions associated with pharmaceutical opioids and to determine patterns of cultural sharing and intra-cultural variation of these views.MethodsThe qualitative sub-sample (n = 47) was selected from a larger sample of 396 young adults (18–23 years old), who were participating in a natural history study of illicit pharmaceutical opioid use. Qualitative life history interviews, drug ranking task, and cultural consensus analysis were used to elicit participant views about risks and harms associated with pain pills and other drugs, as well as alcohol and tobacco.ResultsCultural consensus analysis revealed that the participants shared a single cultural model of drug risks, but the level of agreement decreased with the increasing range of drugs ever used. Further, those with more extensive drug use histories differed from less “experienced” users in their views about OxyContin and some other drugs. Overall, pain pills were viewed as addicting and potentially deadly substances, but these properties were linked to the patterns and methods of use, as well as characteristics of an individual user. Further, risks associated with pharmaceutical opioids were further curtailed because they “came from the doctor,” and thus had a legitimate aspect to their use.ConclusionsThis study highlights potential problems with universal approaches to substance use prevention and intervention among young people since such approaches ignore the fact that substance use education messages may be experienced differently depending on an individual's drug use history and his/her perceptions of drug risks. Findings reported here may be useful in the development of prevention and intervention programs aimed at reducing the harm associated with illicit use of pain pills.     

Hook-Up Sexual Experiences and Problem Behaviors Among Adolescents

This study focuses on the sexual phenomenon of “hooking up.” A hook-up is defined as a single sexual encounter that may or may not include sexual intercourse with someone who is a stranger, brief acquaintance, or friend. The aim of this study was to document the prevalence of hook-ups in a sample of 1,011 urban middle and high school students and to examine the relationship between hooking up and a variety of problem behaviors, including, alcohol, cigarette, and/or illicit drug use, truancy, and school suspensions. The results revealed that 28% of the sample had engaged in at least one hook-up experience, and this percentage increased with age. Hook-ups were correlated moderately with all problem behaviors examined.