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.     

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.     

Psychoactive substance use among Arab adolescent school dropouts in Israel: a phenomenon and its implications

This comprehensive study is the first to examine rates of legal and illegal psychoactive substance use and their predictors specifically among Arab adolescent school dropouts. It investigates the links between sociodemographic, interpersonal, cognitive and personality characteristics and use rates.
Four hundred and seventy-six Arab adolescents aged 12–18 from throughout Israel, who had dropped out of school, participated in the study in late 2004. Sampling was done using a cluster method in order to choose specific localities. Participants completed self-report questionnaires assessing substance use and other variables.
Legal substances – alcohol and tobacco – were used by 36% and 30% of the respondents, respectively, in the previous year. Being male, non-religious and having higher behavioural intentions and positive attitudes regarding use increased the odds of substance use. The best predictors of alcohol use were gender and religiosity, each raising the odds of use by 3.5. The best predictor of tobacco use was gender, raising the odds by 12.7. The best predictors of illegal use, behavioural intentions and risk perception, each doubled the odds of use.
These and other results facilitate a better understanding of substance use among Arab adolescent dropouts and can foster the development of appropriate prevention and intervention programmes for this underserved population.     

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.     

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.     

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.     

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.     

Alcohol and tobacco use among rural Mexican adolescents: individual, familial, and community level factors

PURPOSE: We investigated the contributions of individual, family, and community-level factors for explaining alcohol use and smoking among rural Mexican adolescents. METHODS: As part of a national survey, 3922 adolescents and their mothers from 333 poor, rural communities in seven Mexican states provided cross-sectional data on family-level, socioeconomic, and psychosocial factors, and individual-level data on substance use and psychological symptoms. Community standard of living was also assessed. RESULTS: Generalized linear models adjusted for sampling design indicated that adolescents' use of alcohol was associated with being male, older, employment, and having a mother who used alcohol. Being from an indigenous family living in a majority-indigenous community was associated with less alcohol use. Family income, family size, and community standard of living were not directly associated with adolescents' alcohol use. Current smoking was associated with being male, older, and more anxious, having a mother who smoked, and having a mother with higher educational attainment. Further analyses indicated patterns in which adolescents' alcohol use was moderated by gender and ethnicity. CONCLUSIONS: Beyond the contribution of male gender and age as risk factors, maternal substance use uniquely explained variability in alcohol and cigarette use among Mexican adolescents from rural communities. Indigenous ethnicity and living in majority-indigenous community settings appeared to confer protective benefits with respect to alcohol. These findings extend prior research in Mexico and in other countries that identify the combined importance of developmental contexts and individual-level factors for adolescent health.     

The protective influence of spirituality and "Health-as-a-Value" against monthly substance use among adolescents varying in risk.

PURPOSE: To investigate the influence of two potentially protective factors, Health-as-a-Value and spirituality, on monthly alcohol, cigarette, and marijuana use in two multiethnic groups of adolescents varying in risk. METHODS: Three-hundred-eighty-two students from continuation/alternative high school, a population considered at risk for drug use, participated in the study. The other sample of 260 students was drawn from a medical magnet high school, and is considered to be at lower risk. Similar surveys containing measures of spirituality, "Health-as-a-Value," and monthly substance use, were distributed. Logistic regression analyses were performed. RESULTS: The analyses revealed that spirituality was protective against monthly alcohol use and marijuana use in the lower risk sample. In the higher risk sample, spirituality was protective against all monthly use. "Health-as-a-Value" (HAV) was protective against monthly alcohol use in the low risk sample, and protective against all monthly use in the higher risk sample. Importantly, when both constructs were entered into the same model, spirituality and HAV were independently protective of all monthly use for the higher risk sample and of monthly alcohol use in the lower risk sample. CONCLUSIONS: These findings extend earlier work on protective factors. "Health-as-a-Value" and spirituality may be protective against substance use in environments with different levels of use. Future studies should explore these findings in longitudinal analyses.     

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

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

Socio-Demographic Variability in Adolescent Substance Use: Mediation by Parents and Peers

The current study examined socio-demographic variability in adolescent substance use and the mediating roles of maternal knowledge, paternal knowledge and peer substance use. The data were obtained from the United States records (N = 8,795) of the Health Behavior in School-Aged Children 2005/2006 Survey, in grades 6 through 10. The analyses employed multiple indicator multiple cause and structural equation models. Adolescent substance use was measured by frequencies of alcohol use, being drunk, and cigarette and marijuana use in the past month. Peer influence had a direct influence on adolescent substance use. Maternal knowledge had both direct and indirect influences on adolescent substance use through its negative association with substance-using peers, whereas paternal knowledge only had an indirect influence. Parental knowledge and peer substance use totally mediated differences in adolescent substance use by grade; differences between Caucasian and African-American or Hispanic adolescents; and differences between adolescents from two-parent families and those from single-mother, single-father or mother-stepfather families. Parental knowledge and peer substance were important mediators which largely accounted for variability in the prevalence of adolescent substance use by grade, race/ethnicity, and family structure.     

The Mediating Role of Parent–Child Bonding to Prevent Adolescent Alcohol Abuse Among Asian American Families

The purpose of this paper is to describe unique culturally-based factors that may increase the vulnerability of Asian American adolescents to engage in alcohol use and abuse and the role of parent-child bonding as a protective factor. In particular, this paper addresses the interactions among acculturation, alcohol use, and parent-child bonding and the challenges Asian American families face in strengthening parent-child bonds. We begin by examining likely causes for alienation that occur as a result of immigration to the United States. We then present the cultural context of Asian American families that can also serve to create distance between parent and child, including the contrasting cultural orientations of individualism and collectivism, Asian traditional values, differences in Eastern and Western parenting styles, and intergenerational cultural dissonance. Next, we present a review of the research that has examined acculturation as a risk factor for alcohol use and abuse among Asian American adolescents, with special attention to the mediating role of parent-child bonding. Finally, we conclude with recommendations for future research on the risk and protective factors for adolescent substance abuse, as well as other risky health behaviors among the growing population of Asian Americans in the United States.     

The Role of Risk and Protective Factors in Substance Use Across Adolescence

PURPOSE: To compare the relative influence of risk and protective factors across several domains on adolescent substance use in a large sample of youth. METHODS: Cross-sectional survey data were collected from students in grades 6, 8, 10, and 12 in Pennsylvania (N = 91,778). Generalized linear mixed models were estimated for each grade level to examine associations among indices of three risk factors (individual, peer, and family) and three protective factors (family, school, and community) and both recent and lifetime substance use. RESULTS: The risk factors were stronger predictors of substance use outcomes compared with the protective factors, regardless of grade level or substance use type. In particular, the individual and peer risk factors were strongly related to lifetime and recent use of cigarettes, alcohol, and marijuana. Among the protective factors, the strongest associations with substance use were found in the community domain. Several age-related differences in the associations were also found, suggesting that family and community factors were more salient among younger adolescents whereas peer and school factors were stronger among older adolescents. CONCLUSIONS: These findings provide support for the social development model (SDM), which proposes that adolescent substance use is associated with factors across multiple spheres of influence. Age-related differences in these associations suggest that effective interventions to reduce adolescent substance use may need to emphasize different domains of risk and protective factors at different stages of adolescent development.     

Saturation of tobacco smoking models and risk of alcohol and tobacco use among adolescents.

PURPOSE: To examine how saturation of an adolescent's environment with models of cigarette smoking (e.g., parents, siblings, friends) affects the probability of tobacco and alcohol use among junior high and high school students. METHODS: The Health and Smoking Questionnaire was administered to 806 adolescents (182 smokers and 624 nonsmokers; 57.2% female) average age of 15.1 years (SD = 1.6) in a mid-size Midwestern town. The questionnaire contains standardized items in five domains: demographics, smoking status and history, perceptions of risk and risk reduction, risk factors for tobacco use, and parenting style. RESULTS: Risk for smoking or using alcohol increased dramatically as the number of models who smoke increased in an adolescent's environment. For instance, adolescents with one significant other who smoked were nearly four times (OR = 3.76, p <.001) more likely to smoke than someone with no significant others who smoked. However, if an adolescent had four significant others who smoked, they were over 160 times more likely to smoke (OR = 161.25, p <.001). Similar results were found for alcohol use; adolescents who had one significant other who smoked were more than 2.5 (OR = 2.66, p <.001) times more likely to drink than those without smoking models. Adolescents who had four significant other smoking models were 13 times (OR = 13.08, p <.001) more likely to drink. CONCLUSIONS: As the number of cigarette smokers in an adolescent's environment increases, risk of tobacco and alcohol use increases substantially. These data suggest that multiple models of tobacco use will substantially increase risk for substance use in adolescents.     

Peer Attitudes Effects on Adolescent Substance Use: The Moderating Role of Race and Gender

We examined the relationship between adolescents’ perceptions of their close friends’ attitudes about substance use, and their own use of cigarettes, alcohol, and marijuana. Using data from the 2010 National Survey on Drug Use and Health, a multistage area probability sample sponsored by the Substance Abuse and Mental Health Services Administration (n?=?17,865), we tested the direct and moderating effects of subgroups of race and gender on perceptions of adolescents’ close friends on past month substance use. Significant effects were found on peer attitudes influencing substance use for all race and gender subgroups. Close friends’ attitudes of indifference were associated with increased substance use and disapproval associated with reduced use, controlling for age, income, family structure, and adolescents’ own attitudes of risk of substance use. Significant moderating effects of peer attitudes on cigarette and marijuana use were found for both gender and race moderators. Conditional effects of the moderation by race were also examined for gender subgroups. The moderating effect of race on close friends’ attitudes impacting cigarette and marijuana use was stronger in magnitude and significance for females compared to males. Female marijuana and cigarette use was more influenced by close friends’ attitudes than males, and whites were more influenced by their close friends than Hispanics and blacks. White females are more susceptible to close friends’ attitudes on cigarette use as compared to white males and youth of other races. Implications for socially oriented preventive interventions are discussed.     

Receptivity to protobacco media and its impact on cigarette smoking among ethnic minority youth in California

Adolescents from different ethnic groups show different cigarette smoking prevalence rates, suggesting potential differences in receptivity to and influences from protobacco media. Understanding these differences will be helpful in tailoring smoking prevention and cessation programs for diverse adolescent populations in the United States. Data from cross-sectional surveys of 20,332 randomly sampled California boys and girls, 12-17 years of age, were analyzed. Results indicate that receptivity to protobacco media was lower among African Americans, Asian Americans, and Hispanics than among White youth. There was a consistent dose-response relationship between receptivity to protobacco media and 30-day cigarette smoking across ethnic groups. Having a cigarette brand preference was associated with the highest risk for cigarette smoking, having a favorite tobacco ad showed the lowest risk, while having received or being willing to use tobacco promotional items was associated with a moderate risk. After controlling for 13 covariates, the odds ratio for receptivity to protobacco media and 30-day cigarette smoking was significant for Whites (RR = 1.38, p < 0.01) and Hispanics (RR = 1.46, p < 0.01), but not for African American (RR = 1.05, p > 0.05) and Asian American (RR = 1.17, p > 0.05) youth. African American, Asian American, and Hispanic adolescents have a lower level of receptivity to protobacco media than do Whites. The association between media receptivity and 30-day cigarette smoking exists for all four ethnic groups without controlling for other smoking predictor variables, but only for Hispanics and Whites when other variables are controlled. Protecting adolescents from protobacco advertising influences is an important element in tobacco control among ethnic minority youth.     

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.

     

Tabak- und Alkoholkonsum bei 11- bis 17-jährigen Jugendlichen

In this paper, tobacco and alcohol consumption among adolescents in Germany was analyzed. In addition to the current situation, we report temporal developments and trends. Data were obtained from the first follow-up of the KiGGS study (KiGGS Wave 1) conducted from 2009 to 2012. All girls and boys aged 11–17 years (n?=?5,258) were included. The results show that currently 12.0?% of 11- to 17-year-old adolescents in Germany smoke, 5.4?% of them on a daily basis. At-risk drinking (AUDIT-C total score) was prevalent among 15.8?% of adolescents, heavy episodic drinking (six or more alcoholic standard drinks on a single occasion at least once a month) among 11.5?%. No significant gender differences were found for most indicators. However, among adolescents aged 14–17 years, boys revealed a greater inclination toward heavy episodic drinking than girls did (23.1 vs. 16.5?%, p?<?0.01). Regarding smoking, distinct socioeconomic differences were observed. For example, adolescents from families with a low socioeconomic status (SES) smoke significantly more often on a regular or daily basis compared with their peers from high-SES families (OR?=?1.95, 95?% CI?=?1.16–3.27 and OR?=?3.71, 95?% CI?=?2.05–6.69, respectively). The relationship between SES and alcohol consumption is rather weak. Significant differences emerged only regarding lifetime prevalence of alcohol consumption, and indicate lower consumption rates among low-SES compared with high-SES adolescents (OR?=?0.47, 95?% CI?=?0.33–0.68). Consideration of the KiGGS baseline study data (2003–2006) shows that smoking prevalence has dropped almost by half from 20.4 to 12.0?%. The percentage of adolescents who have ever drunk alcohol has decreased from 62.8 to 54.4?%. These results are consistent with the findings of other studies on adolescent tobacco and alcohol consumption and should be considered in the context of preventive efforts that have been strengthened in recent years, especially regarding tobacco use.