Adolescent Alcohol Use: Protective and Predictive Parent,Peer, and Self-Related Factors

Adolescent alcohol use has been linked with a multitude of problems and a trajectory predictive of problematic use in adulthood. Thus, targeting factors that enhance early prevention efforts is vital. The current study highlights variables that mitigate or predict alcohol use and heavy episodic drinking. Using Monitoring the Future (MTF) data, multiple path analytic models revealed links between parental involvement and alcohol abstinence and initiation. Parental involvement predicted enhanced self-esteem and less self-derogation and was negatively associated with peer alcohol norms for each MTF grade sampled, with stronger associations for 8th and 10th graders than 12th graders. For younger groups, self-esteem predicted increased perceptions of alcohol risk and reduced drinking. Self-derogation was associated with peers’ pro-alcohol norms, which was linked to lower risk perceptions, lower personal disapproval of use, and increased drinking. Peer influence had a stronger association with consumption for 8th and 10th graders, whereas 12th graders’ drinking was related to personal factors of alcohol risk perception and disapproval. In all grades, general alcohol use had a strong connection to heavy episodic drinking within the past 2 weeks. Across-grade variations in association of parent, peer, and personal factors suggest the desirability of tailored interventions focused on specific factors for each grade level, with the overall goal of attenuating adolescent alcohol use.     

A Prospective Study of Intraindividual and Peer Influences on Adolescents' Heterosexual Romantic and Sexual Behavior

Theories and empirical studies of adolescent sexual behavior have identified the contributions of personal attributes and social experiences; however, it is rare that models have clarified developmental pathways to adolescent sexual behavior that include (1) factors assessed prior to and early in adolescence and (2) dyadic experiences in adolescence that provide the opportunity for sexual behavior (i.e., dating). Using data from a prospective study, structural equation modeling was used to test a model predicting adolescent sexual behavior at age 19, denoted by the number of lifetime sexual partners. Predictors examined were sociability and impulsivity assessed at 30 months of age, physical characteristics and experiences with peers measured at age 12-13, the age of first romantic relationship, and frequency of alcohol use at age 16. The pathway to greater sexual involvement was marked by some desired personal attributes (e.g., sociability) and peer experiences (e.g., higher quality friendships). These associations were mediated, however, by earlier initiation of romantic relationships and more frequent use of alcohol in middle adolescence. Earlier initiation of romantic relationships and more frequent alcohol use were predicted by greater sociability and less impulsivity in childhood, higher quality friendships and greater peer acceptance in early adolescence, and a more mature appearance and physical attractiveness (among females) at age 13. The findings imply a complex pathway that leads to a greater accumulation of sexual partners by age 19. This pathway begins in childhood and includes individual qualities, peer acceptance, romantic relationships, and alcohol use.     

Family processes for children in early elementary school as predictors of smoking initiation.

OBJECTIVES: To assess the relationship between family processes measured when children are in early elementary school and initiation of cigarette smoking in early adolescence. METHODS: The analysis sample of 810 children was drawn from a longitudinal study of students from a suburban school district in the Pacific Northwest. Predictor variables were assessed when children were in second or third grade, and smoking initiation was measured when the children were in sixth or seventh grade. Measures of family processes were entered separately into logistic regression models that included controls for household structure and income, parent smoking, and peer and child characteristics. RESULTS: Measures of child attachment to parent and parent involvement with the child's school were significantly and negatively associated with smoking initiation. Among control variables, parent smoking, child grade level, and child antisocial behavior and depression were the strongest predictors of smoking initiation. CONCLUSIONS: The results point to the importance of family bonding and parent supportiveness as protective factors and parent smoking and early childhood antisocial behavior and depression as risk factors for smoking initiation in pre- or early adolescence.     

Do Risky Friends Change the Efficacy of a Primary Care Brief Intervention for Adolescent Alcohol Use?

PurposeTo determine if peer risk (having friends who drink or approve of drinking) modifies the effects of a computer-facilitated screening and provider brief advice (cSBA) intervention on adolescent alcohol use.MethodsWe assessed the intervention effect using logistic regression modeling with generalized estimating equations on a sample of 2,092 adolescents. Effect modification by peer risk was analyzed separately for alcohol initiation (drinking at follow-up in baseline nondrinkers) and cessation (no drinking at follow-up in baseline drinkers) by testing an interaction term (treatment condition by peer risk). Interpretation of the interaction effect was further clarified by subsequent stratification by peer risk.ResultsThe intervention effect on alcohol cessation was significantly greater among those with peer risk (adjusted relative risk ratios; risk 1.44, 1.18–1.76 vs. no risk .98, .41–2.36) at 3 months' follow-up. There was no such finding for alcohol initiation.ConclusionsAlcohol screening and brief provider counseling may differentially benefit adolescent drinkers with drinking friends.     

Tobacco smoking and depressed mood in late childhood and early adolescence

OBJECTIVES: This study builds on previous observations about a suspected causal association linking tobacco smoking with depression. With prospective data, the study sheds new light on the temporal sequencing of tobacco smoking and depressed mood in late childhood and early adolescence. METHODS: The epidemiologic sample that was studied consisted of 1731 youths (aged 8-9 to 13-14 years) attending public schools in a mid-Atlantic metropolitan area, who were assessed at least twice from 1989 to 1994. A survival analysis was used to examine the temporal relationship from antecedent tobacco smoking to subsequent onset of depressed mood, as well as from antecedent depressed mood to subsequent initiation of tobacco use. RESULTS: Tobacco smoking signaled a modestly increased risk for the subsequent onset of depressed mood, but antecedent depressed mood was not associated with a later risk of starting to smoke tobacco cigarettes. CONCLUSIONS: This evidence is consistent with a possible causal link from tobacco smoking to later depressed mood in late childhood and early adolescence, but not vice versa.     

Private peer group settings as an environmental determinant of alcohol use in Dutch adolescents: results from a representative survey in the region of Twente

This study supports the hypothesis that the drinking setting can be an environmental risk factor for hazardous alcohol use. In a survey of Dutch adolescents (n = 1516), alcohol consumption and participation in private peer group settings (PPSs), environments where adolescents meet and drink alcohol without direct adult supervision, were measured. After controlling for demographic variables, adolescents visiting PPSs as compared to non-visitors, appeared to have a significantly higher lifetime prevalence of alcohol use, average weekly consumption, and frequency of heavy episodic drinking. Moreover, accounting for school clustering, the frequency of PPS visits was associated with increased alcohol consumption.     

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.     

Risk and protective factors related to native Hawaiian adolescent alcohol use

The present study examined protective and risk factors in the prediction of alcohol use for Hawaiian and non-Hawaiian (i.e. Caucasian, Japanese, Filipino, 'other') adolescents. Comparable rates of approximately 25% were found for both the Hawaiian and non-Hawaiian samples regarding sometimes drinking too much alcohol. However, Hawaiians reported a statistically significantly higher rate (3.7%) of taking 'a drink in the morning to steady my nerves or to get rid of a hangover' than non-Hawaiians (1.3%). The reason for this is unknown but might indicate a higher rate of dependent alcohol use. The overall results supported the traditional model of protective and risk factors predicting alcohol use (R(2) > 15.0%), with relatively few differences found between the two ethnic groups. Further research is needed in assessing possibly unique cultural variables such as Hawaiian acculturation.     

Correlates of Sexual Risk Behaviors Among High School Students in Colorado: Analysis and Implications for School-based HIV/AIDS Programs

Objectives of this study are to examine correlates of antecedent sexual risk exposures associated with HIV/AIDS infection among adolescents participating in the 2005 Colorado Youth Behavioral Risk Survey (CYBRS), and to determine gender differences associated with these exposures since previous studies have produced mixed findings. Variables assessing these relationships were drawn from CYBRS, 2005. We used χ² to assess bivariate relationships and multinomial logistic regression to evaluate associations among dependent variables (sexual risk behaviors, age at first sex, and number of sexual partners in the past 3 months) and independent variables (in-school HIV/AIDS education, use of illegal substances, physically forced sex, and alcohol use). We found no significant effect of having received in-school HIV/AIDS education on all outcome measures. Compared with females, males were more likely to initiate sex at a relatively younger age, report unprotected sex with multiple partners, and drink alcohol before sexual intercourse. Among females, using 2 illegal substances increased the odds of early sexual debut by 12 times, while using ≥3 substances increased the same odds to 44-fold. Likewise, binge drinking was also associated with higher odds of having multiple partners. Hispanic ethnicity and physically forced sex variables were consistently associated with high risk sexual behaviors, early sexual initiation, and increased number of sexual partners. Efforts to control the HIV/AIDS epidemic among adolescents may need to focus on targeted interventions aimed at addressing gender- and racial/ethnic-specific risk exposures among this population group, including risk behaviors linked with lifetime physically forced sex. The need to re-examine the role of in-school HIV prevention programs to build adequate competencies among students, parents and community leaders to reduce risk exposures associated with HIV/AIDS infection among youth is emphasized.     

Understanding the Link Between Early Sexual Initiation and Later Sexually Transmitted Infection: Test and Replication in Two Longitudinal Studies

PurposeAge at sexual initiation is strongly associated with sexually transmitted infections (STI); yet, prevention programs aiming to delay sexual initiation have shown mixed results in reducing STI. This study tested three explanatory mechanisms for the relationship between early sexual debut and STI: number of sexual partners, individual characteristics, and environmental antecedents.MethodsA test-and-replicate strategy was employed using two longitudinal studies: the Seattle Social Development Project (SSDP) and Raising Healthy Children (RHC). Childhood measures included pubertal age, behavioral disinhibition, and family, school, and peer influences. Alcohol use and age of sexual debut were measured during adolescence. Lifetime number of sexual partners and having sex under the influence were measured during young adulthood. Sexually transmitted infection diagnosis was self-reported at age 24. Early sex was defined as debut at <15 years. Path models were developed in SSDP evaluating relationships between measures, and were then tested in RHC.ResultsThe relationship between early sex and STI was fully mediated by lifetime sex partners in SSDP, but only partially in RHC, after accounting for co-occurring factors. Behavioral disinhibition predicted early sex, early alcohol use, number of sexual partners, and sex under the influence, but had no direct effect on STI. Family management protected against early sex and early alcohol use, whereas antisocial peers exacerbated the risk.ConclusionsEarly sexual initiation, a key mediator of STI, is driven by antecedents that influence multiple risk behaviors. Targeting co-occurring individual and environmental factors may be more effective than discouraging early sexual debut and may concomitantly improve other risk behaviors.     

Smoking initiation and nicotine dependence symptoms in Ukraine: findings from the Ukraine World Mental Health survey

OBJECTIVES: Cigarette smoking is a major cause of morbidity and mortality in former Soviet countries. This study examined the personal, familial and psychiatric risk factors for smoking initiation and development of nicotine dependence symptoms in Ukraine. STUDY DESIGN: Cross-sectional survey. METHODS: Smoking history and dependence symptoms were ascertained from N=1711 adults in Ukraine as part of a national mental health survey conducted in 2002. Separate analyses were conducted for men and women. RESULTS: The prevalence of lifetime regular smoking was 80.5% in men and 18.7% in women, with median ages at initiation among smokers of 17 and 18, respectively. Furthermore, 61.2% of men and 11.9% of women were current smokers; among the subgroup of lifetime smokers, 75.9% of men and 63.1% of women currently smoked. The youngest female cohort (born 1965-1984) was 26 times more likely to start smoking than the oldest. Smoking initiation was also linked to childhood externalizing behaviors and antecedent use of alcohol in both genders, as well as marital status and personal alcohol abuse in men, and childhood urbanicity and birth cohort in women. Dependence symptoms developed in 61.7% of male and 47.1% of female smokers. The rate increased sharply in the first four years after smoking initiation. Dependence symptoms were related to birth cohort and alcohol abuse in both genders, as well as growing up in a suburb or town and childhood externalizing behaviors in men, and parental antisocial behavior in women. CONCLUSIONS: Increased smoking in young women heralds a rising epidemic in Ukraine and underscores the need for primary prevention programs, especially in urban areas. Our findings support the importance of childhood and alcohol-related risk factors, especially in women, while pre-existing depression and anxiety disorders were only weakly associated with starting to smoke or developing dependence symptoms.     

Correlates of marijuana use in Colombian adolescents: a focus on the impact of the ecological/cultural domain.

To examine the influence of ecological/cultural factors and family, personality, and peer factors present during early adolescence that influence marijuana use in late adolescence. A community sample of 2,226 Colombian adolescents living in mixed urban-rural communities and their mothers were interviewed in their homes by trained Colombian interviewers, first in 1995-1996 and then again 2 years later. The scales used were based on item intercorrelations and grouped into the following categories: (a) adolescent personality, (b) family traits, (c) peer factors, (d) ecological/cultural variables, and (e) marijuana use. Data were examined using hierarchical regression modeling to determine the relationship between each of the domains and late adolescent marijuana use. The findings supported the family interactional theory of adolescent drug use behavior and found that factors in all of the domains had a direct effect on late adolescent marijuana use as well as indirect effects mediated through the more proximal domains in the model. Of particular interest was the strength of the influence of the ecological/cultural factors, which far exceeded that observed in similar studies done in the United States. Owing to the similarity with findings from studies conducted in the United States, interventions designed domestically could effectively be directly applied to adolescents in Colombia. The findings also suggest that prevention programs designed specifically to target ecological or cultural factors may have the most profound influence for reducing marijuana use in late adolescence.     

Energy Drink Use Among Ohio Appalachian Smokers

Caffeine-containing energy drinks have emerged as a public health concern due to their association with caffeine toxicity and alcohol use. Despite the fact that previous research has linked caffeine use in the form of coffee drinking to smoking, there is little research examining the association between energy drinks and smoking. The present study examines demographic and behavioral factors associated with energy drink use among a sample of rural Ohio Appalachian smokers. It was hypothesized that male gender, young age (21–30 years.) and alcohol use would be associated with energy drink use. A sample of adult smokers (n = 298) from Ohio Appalachian counties were interviewed regarding demographic and behavioral factors. Logistic regression analysis was used to assess the association between these factors and energy drink use. Seventy percent of Ohio Appalachian smokers studied had ever used an energy drink and 40 % had used an energy drink in the past month. Young age, male gender, and single marital status were associated with higher odds of ever having used an energy drink. Young age, and binge drinking were associated with higher odds of past 30-day use while abstinence from drinking was associated with lower odds of past 30-day use. Ohio Appalachian adult smokers had higher rates of energy drink use compared to previous estimates of ever or past month use found in other studies. The combined use of caffeine, nicotine, and alcohol warrants attention due to potential for health risk.     

Underage drinking: Prevalence and risk factors associated with drinking experiences among Argentinean children

The aim of this study was to describe the prevalence and predictors of alcohol drinking behavior in children. Data were obtained from 367 children, aged 8–12 years (M = 10.44 years, SD = 1.21 years; 61.9% female) from the city of Córdoba, Argentina. Several scales were used to assess risk factors, including personality traits, alcohol expectancy (i.e., beliefs about the consequences of using alcohol), and perceived peer alcohol use, for alcohol drinking and alcohol drinking experiences. Hierarchical regression analysis was used to determine the contribution of multiple risk factors to the quantity of alcohol consumed. The results showed that 58% of the children had tasted alcohol, and approximately one-third drank alcohol again after the first drinking experience. Twelve-year-old children had a significantly higher prevalence of tasting and drinking alcohol and a significantly greater frequency and quantity of alcohol consumed than younger children. Eighty percent of the children who liked alcohol during their first drinking experience reported that they drank alcohol again. Among the children who did not like alcohol during their first drinking experience, only 31% drank alcohol again. Underage drinking usually occurred under adult supervision in family settings when parents or other relatives allowed them to drink or were aware of their children's drinking. The hierarchical regression analysis showed that being older and male, having more peers that drink alcohol, having higher levels of extroversion, and having alcohol expectancy for social facilitation increased the risk for greater alcohol use. The final model explained 33% of the total variance.     

Outrunning the risks: a behavioral risk profile of runners

There is a need to assess better the relationship between physical activity and other health behaviors through population-based studies. Using the state-based Behavioral Risk Factor Surveillance System, we examined the behavioral risk factors of smoking, alcohol use, hypertension detection, obesity, seat-belt use, and physical activity in 2,412 runners and 26,538 nonrunners. Our analyses demonstrated marked differences in behavioral risk profiles between runners and nonrunners. Runners, regardless of the amount of running, were more likely to be nonsmokers, be of normal weight, be normotensive, and regularly use seat belts than were nonrunners of similar age and sex. Patterns of alcohol use were not different when comparing male runners with male nonrunners. However, female runners were more likely to drink and drive and to use alcohol on a chronic basis compared to their nonrunning counterparts. The "runner's lifestyle" may convey a certain level of protection from chronic disorders that are associated with these risk factors. However, further prospective studies are needed to examine in more detail the relationship of running to the risks and/or benefits for improved health.     

Dutch adolescent private drinking places: Prevalence,alcohol consumption,and other risk behaviors

The aim of this research was to explore the increasingly popular Dutch health phenomenon of ‘gathering in private peer group settings (barracks)’, with a focus on the prevalence and characteristics of barracks, alcohol consumption, and other (risk) behaviors of their visitors. Three studies were conducted. The first consisted of field research in which 51 barracks were visited and group-interviews were held. The second was an Internet study in which 442 barracks' websites were analyzed using content analysis. The third consisted of a questionnaire completed by 1457 adolescents, aged 15–17, in order to explore differences in behavior between barracks visitors and non-visitors. There was wide variation in barracks' characteristics and culture. Barracks' members and visitors also organize diverse activities that are publicly shown on the websites. Barracks are associated with various legal issues, such as alcohol sales to minors, lack of parental supervision, and illicit drug use. Barracks' visitors drink alcohol more frequently, drink more alcohol per occasion (up to fifteen bottles of beer a night), and have been drunk more frequently than non-visitors. Policymakers must be aware of the barracks phenomenon and use their powers in adjacent political and legal areas (such as in binge drinking, illicit drug use, and public safety) to intervene and create solid, responsible, and tailor-made policies.     

Problems of alcohol and other drug use and abuse in adolescents

In summary, although there has been much progress, alcohol and other drug use and abuse in adolescents remains a major medical and public health problem. Epidemiological studies of adolescents and young adults provide important information about the frequency, quantity, and types of drugs used among these populations. A number of theories on causation and initiation of use of alcohol and other drugs have been postulated, and each adds important new information to the field. Impressive gains have been made in the identification of risk profiles which lead to alcohol and other drug use. Although this work has been comprehensive in its approach, studying the influences of family and peer factors, psychological and biological variables, and environmental and demographic characteristics, many questions remain unanswered with regard to the distinguishing features of those at risk who progress to problem use.

Additionally, although treatment programs have been developed specifically to meet the special needs of adolescents, treatment outcome studies and better assessment procedures to determine which adolescents need which specific types of treatment are still needed. Finally, effective physician education strategies are needed to ensure appropriate practice behaviors among health care providers, who should be an important link in the coordination of efforts as the health care community responds to the problem of alcohol and other drug abuse.     

Childhood maltreatment and the risk of substance problems in later life

This paper examines the risk of developing problems in adolescence and adulthood, particularly those associated with substance use, as a consequence of experiencing physical or sexual abuse during childhood. We review both retrospective and prospective research, conducted with both adolescent and adult respondents. Although there are some marked discrepancies in the findings from retrospective and prospective studies, these are probably due to differences in methodology, particularly between using official records and self-report to identify cases of abuse. Despite the wide range of methodologies and samples used in these studies, most indicate that the experience of childhood abuse is a risk factor for a number of common mental disorders in adolescence and adulthood, including alcohol and drug-related problems. In many cases, the experience of abuse appears to lead in later life to increased feelings of depression and anxiety which, while not sufficient to result in the diagnosis of a mental health disorder, place the victims at greater risk of developing substance problems. Multivariate studies indicate that this positive association remains even when controlling for important variables such as the presence of parental alcohol problems. The paper concludes with a number of recommendations for future research, so that it can be established whether the risk arises specifically from child abuse or neglect, or from the more general impact on child development of adverse family relationships.     

Patterns of initiation of sex and drug-related activities among urban low-income African-American adolescents.

PURPOSE: To examine the pattern of adolescent's involvement in drug-related behaviors and sexual initiation, and its relationship with: (a) age and gender, (b) sensation- seeking, (c) perceptions of peer and family risk involvement, and (d) involvement in high-risk sexual behavior. SUBJECTS: Two hundred and sixty-one urban African-American youth, aged 9 to 15 years at baseline, who were sexually experienced by the end of the 4-year study interval. The longitudinal assessment (4 years) was focused on: (a) alcohol use, illicit drug use, and drug trafficking; (b) high-risk sex; (c) propensity to sensation seeking; and (d) perceived peer and family risk involvement. RESULTS: Involvement increased over the 4-year study interval such that over half of the adolescents reported use of alcohol and/or use of marijuana in the final assessment period. For each of the three drug-related activities examined, the largest proportion of youth who engaged in sexual intercourse never engaged in drug-related activity, and the next largest proportion initiated sexual involvement before drug use. Sensation-seeking scores, which were relatively stable across time, were lower among girls, and also were lower among youth who remained uninvolved in drug-related behaviors. For all three drug-related behaviors, rates of high-risk sex were higher among youth who initiated both sex and drugs, and were lower among youth who reported engaging only in sex. Although youth who did eventually initiate drug use had higher perceived levels of family and peer drug use compared to those who remained uninvolved, these perceptions did not contribute directly to high-risk sexual behavior. CONCLUSIONS: Youth who will become both sexually active and involved with drugs during adolescence are especially vulnerable to involvement in high-risk sexual behavior.     

Effects of a Take-Home Drug Prevention Program on Drug-Related Communication and Beliefs of Parents and Children

Five hundred and eleven fourth, fifth, and sixth grade students and their parents from six schools in northwest Arkansas participated in this study. Students were blocked on school and grade level, then assigned randomly by class to either the intervention Keep A Clear Mind (KACM) program or a waiting list control. KACM students received four weekly correspondence lessons designed to be completed at home with a parent. KACM students reported significantly less perceived peer use of alcohol, tobacco, and marijuana, as well as significantly less peer pressure susceptibility to experiment with cigarettes. Mothers in the KACM program reported significantly more recent and frequent communication with their children about refusing drugs, and significantly greater discussions with their children regarding how to resist peer pressure to use alcohol, tobacco, and marijuana. Intervention program fathers reported significantly more communication with their children concerning how to resist peer pressure to drink alcohol and use tobacco, and significantly greater motivation to help their children avoid drug use. No significant differences were found between groups on student intentions to use drugs. These data suggest a print medium that emphasizes parent-child activities holds promise for accessing families and enhancing drug prevention communication.