Brief report: Pregnant by age 15 years and substance use initiation among US adolescent girls

We examined substance use onset and associations with pregnancy by age 15 years. Participants were girls ages 15 years or younger (weighted n?=?8319) from the 1999-2003 Youth Risk Behavior Surveillance System (YRBS). Multivariable logistic regression examined pregnancy as a function of substance use onset (i.e., age 10 years or younger,?11-12, 13-14, and age 15 years) for alcohol, cigarettes and marijuana, controlling for race/ethnicity and metropolitan location. Of girls pregnant by age 15 years (3% of the sample, weighted n?=?243), 16% had smoked marijuana by age 10 years and over 20% had smoked cigarettes and initiated alcohol use by age 10 years. In the multivariable analysis, marijuana use by age 14 years and/or cigarette smoking by age 12 years clearly distinguished girls who became pregnant by age 15 years and is perhaps due to a common underlying risk factor.     

Posttraumatic stress disorder and substance use in inner-city adolescent girls

The purpose of this study is to examine rates of nicotine, marijuana, and alcohol use as well as patterns of problematic substance use and posttraumatic stress disorder (PTSD) symptoms in inner-city adolescent girls. One hundred four adolescents who obtained medical care at a hospital-based adolescent clinic were systematically surveyed for trauma exposure, posttraumatic stress symptoms, and substance use. A subset (N = 54, 52%) of girls completed a semistructured psychiatric diagnostic interview (K-SADS-PL) to ascertain timing of PTSD symptoms relative to substance use. Compared with traumatized girls without PTSD, girls with full and partial PTSD were significantly more likely to use nicotine, marijuana, and/or alcohol on a regular basis. Fifteen girls met criteria for both PTSD and a substance-use disorder. For 80% of these girls, the age of onset of PTSD was either before or concurrent with the onset of their substance-use disorder. Inner-city adolescent girls with PTSD exhibit problematic substance use and may be at high risk of developing a comorbid substance-use disorder.     

Traumatic life events and PTSD among women with substance use disorders and schizophrenia

OBJECTIVE: The authors assessed the prevalence of traumatic life events and posttraumatic stress disorder (PTSD) among women with schizophrenia or schizoaffective disorder and co-occurring substance abuse or dependence. The association between PTSD and specific traumatic life events was also examined. METHODS: Fifty-four drug-addicted women with schizophrenia or schizoaffective disorder participated in the study. All women were psychiatric outpatients and completed a large battery of structured clinical assessments. RESULTS: High rates of trauma, particularly physical abuse (81 percent), and revictimization--being abused both as a child and as an adult--were reported. The average number of traumatic life events reported was eight, and almost three-quarters of the sample reported revictimization. Rates of current PTSD were considerably higher than those documented in previous study samples of persons with serious mental illness and of drug-addicted women in the general community. PTSD was significantly associated with childhood sexual abuse and revictimization. CONCLUSIONS: The high levels of trauma and revictimization observed in the study highlight the need for the development of evidence-based interventions to treat trauma and its aftermath among women with schizophrenia or schizoaffective disorder. Given the overlap in symptoms between PTSD and schizophrenia, a better understanding is needed of how PTSD is expressed among people with schizophrenia. Recommendations and standards for the assessment of PTSD among this population need to be articulated. Finally, the comparatively high rates of PTSD suggest that the combination of schizophrenia or schizoaffective disorder and substance use disorder makes these women particularly vulnerable to adverse outcomes.     

Morningness/eveningness, pubertal timing, and substance use in adolescent girls

The purpose of this study was to examine the associations between Morningness/Eveningness (M/E; a measure of sleep-wake preference) and alcohol, cigarette, and marijuana use as well as the interaction of M/E and pubertal timing. The data represent baseline measures from a longitudinal study examining the association of psychological functioning and smoking with reproductive and bone health in 262 adolescent girls (11-17 years). The primary measures used for this study were pubertal timing (measured by age at menarche), the Morningness/Eveningness scale, and substance use (alcohol, cigarettes, and marijuana). Multiple group path modeling showed that there was a significant interaction between pubertal timing and M/E on cigarette use. The direction of the parameter estimates indicated that for the early and on-time groups, Evening preference was associated with more cigarette use. For the late timing group the association was not significant. The results point to the need to consider sleep preference as a characteristic that may increase risk for substance use in adolescents.     

Race-specific transition patterns among alcohol use classes in adolescent girls

We used data from the National Longitudinal Study of Adolescent Health to examine transitions among alcohol use classes in 2225 White and African American adolescent girls, and race differences in predictors of transition into and out of problematic drinking classes. Latent class analysis confirmed four classes for White girls and three for AA girls, defined in a previous study. Latent transition analysis revealed more stable abstainers and decreasing alcohol use among AA girls, and more increasing alcohol use among White girls, though stable abstainers were the largest group in both races. Increasing use was predicted by delinquency, academic misbehavior, substance use, and peer support for White girls, and by older age and delinquency for AA girls. Decreasing use was predicted by older age and depressive symptoms for White girls, and by family relationship quality and substance use for AA girls. Study limitations and implications of findings are discussed.     

Magical thinking and decision-making strategies among late adolescent regular gamblers: A mediation model

In the present study, the relation between the tendency to seek supernatural connections between external events and one's own thoughts, words, and actions and gambling among late adolescents has been studied. Psychologists have called this tendency magical thinking. The principal aim of the present study was to test the fit of an explanatory model of risk that starts from magical thinking and passes through maladaptive decision-making strategies, culminating with pathological gambling. Two hundred twenty-two Italian late adolescents, regularly attending bingo halls, aged between 19 and 21 years, completed measures on magical thinking, decision-making strategies, and gambling. Results highlight that young adults adopting dysfunctional modes of thought (i.e. magical thinking) tend to engage with maladaptive styles of decision-making that predispose them to gamble.     

The influence of genetic factors and life stress on depression among adolescent girls

BACKGROUND: The possible causes of greater depression among adolescent girls were investigated by examining variation in the influence of genetic and environmental risk factors among 182 prepubertal female, 237 prepubertal male, 314 pubertal female, and 171 pubertal male twin pairs from the Virginia Twin Study of Adolescent Behavioral Development. OBJECTIVES: To compare the trajectory of depressive symptoms among boys and girls from childhood to adolescence; to analyze the role of genetic, shared, and unique environmental factors in depression among prepubertal and pubertal male and female twins; and to investigate a possible link between liability to depression and one salient index of the child's environment: past-year life events. METHODS: Child-reported depression was assessed using the Child and Adolescent Psychiatric Interview and ratings of past-year life events and pubertal status obtained by maternal questionnaire and interview, respectively. RESULTS: The impact of life events on depression was particularly evident in the adolescent girls. The results from model fitting indicate increased heritability for depression in this group, and its long-term consistency was mediated primarily by latent genetic factors. Model fitting also showed that at least part of the liability to depression and to life events can be linked to a common set of genes in the adolescent girls, and there is a notable developmental increase in the genetic variance for life events. CONCLUSIONS: The greater heritability for depression in pubertal girls, its genetic mediation over time, and the increase in genetic variance for life events may be one possible explanation for the emergence of increased depression among pubertal girls and its persistence through adolescence.     

Mental health and medical problems and service use among adolescent substance users

OBJECTIVE: Adolescents entering the substance abuse treatment system frequently exhibit mental health and medical problems. Because little is known about whether these youths receive services to address these problems, this study examined the services received by youths admitted to substance abuse treatment. METHOD: Admission and 3-month follow-up reports of mental health, medical problems, and service use were examined within a large cohort (N = 1,088) of 12-19-year-olds admitted to seven inpatient and outpatient substance abuse treatment programs across the United States between 1998 and 2001. RESULTS: High levels of mental health problems were found at both time points, but few received mental health treatment. In contrast, there were lower rates of medical problems, and more than half received services. Logistic regression predicting mental health treatment receipt found females in residential settings with more current and baseline distress to be more likely to receive services. Ethnicity, baseline behavioral problems, and whether or not currently in substance abuse treatment did not predict service use. A logistic regression predicting medical services showed that females in residential treatment were also more likely to receive medical treatment. CONCLUSION: Although these results require replication and validation, they suggest that more could be done to take advantage of the opportunity to link youths entering substance use treatment with mental health services.     

Children in family mediation: A practice model

The authors briefly describe the history of family mediation under the perspective of the role of the children in the process of mediation. They state that originally children were not directly included. But through empirical studies and different higher escalated families asking for help by mediation, the inclusion of children got an important issue in theory and practice. The discussion began with the question in which phases of the mediation process the children should be included - it went to the issue of the age of the children - and the authors propose to take the amount of escalation in the family as the most important point of reference to decide if and how the children should be included. They suggest to diagnose the loss of responsibility and autonomy of the parents on a nine level scale (from F. Glasl) with the parents and to decide and negotiate with them how the children will be included. They describe five different settings of inclusion of the children.     

Parent substance use as a predictor of adolescent use: A six-year lagged analysis

The present study investigated the role of parental use of alcohol, cigarettes, and marijuana on lagged changes in the specific substance use of their adolescent offspring over a six-year period. The analyses also examined the relative influence of mothers and fathers and their interaction as moderated by marital status and age and gender of the adolescent. A generalized estimating equations approach, analogous to quasi-like-lihood, was employed to estimate regression coefficients via an iterative weighted least squares algorithm. Findings indicated that, when employed as time-varying covariates, parental substance use resulted in substance-specific effects on fluctuations in the adolescent’s own use. Age, parent marital status, and each parent’s marijuana use independently were jound to significantly affect adolescent marijuana use. In contrast, the complex relationship between parent and adolescent use of alcohol and cigarettes showed variation by substance, age, and gender of both parents and adolescents. Within a developmental context, the results suggest that parent use of substances must be considered risk factors with particular effects on their younger offspring. Thus, prevention efforts should be directed at middle childhood and include components aimed at parents as well as their children.

     

A test of the structural model of initiation of dieting among adolescent girls

This article reports alternative findings from a pilot study to those presented recently (Strong GF, Huon KG. J. Psychosom. Res., 1998; 44:315-326) in regard to the proposed model of sociopsychological processes involved in the initiation of dieting among young adolescent girls. One hundred thirteen female high school pupils completed a battery of questionnaires that assessed dieting status, dietary restraint, autonomous functioning, skill-related functioning, social influence, and family functioning. The results indicate that family functioning predicts dietary restraint but that this effect is mediated by peer influence to diet. Furthermore, family functioning was associated with autonomous functioning, suggesting that this relationship should be pursued in a future test of the model. This pattern of results is different from an earlier test of the model, which indicated only a parental influence on dieting status. The results confirm that peer influences should be retained as a causal factor in a reformulated structural model.     

Pharmacotherapy of adolescent substance use disorders: a review of the literature

OBJECTIVE: Substance use disorders (SUD) are increasingly conceptualized as developing during adolescence. Moreover, adolescent SUD are viewed as one of the most difficult mental health conditions to treat. The role of pharmacotherapy for adolescents with SUD is not well delineated. We systematically reviewed existing pharmacotherapy studies of adolescent SUD. METHODS: A computerized search of the literature addressing the pharmacotherapy of SUD in adolescents was performed. Data from relevant peer-reviewed scientific presentations were also included. RESULTS: Five case reports (n = 8 subjects), six open studies that primarily addressed SUD with comorbid psychiatric disorders (n = 73 subjects), and five placebo-controlled studies (n = 156 subjects) on the pharmacological treatment of youths with SUD were identified. Pharmacological agents appear to reduce comorbid psychopathology with a milder reduction in SUD symptoms. The most robust evidence exists for the treatment of SUD comorbid with affective disorders. There is a limited database supporting the use of agents to reduce substance craving and the preventative effects of pharmacotherapy on subsequent SUD development in adolescents with specific psychiatric disorders. CONCLUSION: Further controlled studies directed at reducing drug use and craving, and guiding the integration of pharmacotherapy and psychosocial interventions for SUD with the treatment of comorbid psychiatric illness, are necessary.     

Predicting adolescent violence: impact of family history,substance use,psychiatric history,and social adjustment

OBJECTIVE: The aim of this study was to provisionally develop an efficient screening method to detect adolescents at high risk for committing a violent act by young adulthood. In addition, the authors sought to use this screening instrument, in conjunction with child and parent psychopathology and substance abuse data, to determine the accuracy of violent outcome predictions. METHOD: The probands were men with a lifetime history of DSM-III-R substance use disorder (N=38) and men with no adult psychiatric disorder (N=61). Their biological sons were studied at two time points. At age 12-14, the offspring completed a 13-item Violence Proneness Scale, which was derived by using items from the revised Drug Use Screening Inventory. The occurrence of violent acts was then assessed at a follow-up evaluation when the offspring were 19 years of age. RESULTS: Among the offspring, a DSM-III-R axis I psychiatric disorder and a Violence Proneness Scale score of 10 or higher at age 12-14 predicted a violent outcome by age 19. The overall accuracy of prediction was 77%. Sensitivity was 81%, and specificity was 76%. Substance use disorder or psychopathology in the probands or substance use frequency in the children did not contribute to the prediction of violence. CONCLUSIONS: The brief Violence Proneness Scale, which measures school and peer adjustment, in conjunction with a childhood psychiatric history may constitute an efficient screening procedure for identifying youth who are at high risk for committing acts of violence.     

Maternal substance use and HIV status: adolescent risk and resilience

We examined the risk and protective factors and mental health problems of 105 low SES, urban adolescents whose mothers were coping with alcohol abuse and other drug problems. Approximately half of the mothers were also HIV-infected. As hypothesized, there were few differences between adolescents of HIV-infected and HIV-uninfected mothers in background characteristics, mental health issues and current substance use risk behaviors. In addition to maternal substance abuse, youth in both groups experienced similar risk factors including early foster care placement and high levels of maltreatment. Current patterns of emerging risk behaviors were evident among youth in both groups as well as signs of resiliency including high levels of school attendance. These results underscore the importance of interventions for youth of substance abusing mothers, particularly those living in urban poverty.     

Case series: outbreak of conversion disorder among amish adolescent girls

OBJECTIVE: Outbreak investigations are challenging in a cross-cultural context, and outbreaks of psychiatric disease are rare in any community. We investigated a cluster of unexplained debilitating illness among Amish girls. METHOD: We reviewed the medical records of cases, consulted with health care providers, performed active case finding, administered open-ended and structured interviews, and met with Amish community members. A case-patient was defined as a resident of the county who was bedridden for more than 3 weeks with otherwise unexplained systemic weakness and anorexia from January 2000 to February 2002. RESULTS: Five case-patients were identified. All were Amish girls aged 9 to 13 years. All five had debilitating voluntary motor deficits, anorexia, and weight loss. Four experienced neck weakness with inability to hold up their heads. Thorough medical evaluations failed to identify an organic etiology. All five patients met the diagnostic criteria for conversion disorder. Substantial social conflict within the Amish community preceded illness onset. Family behavioral interventions were recommended. Three months after the investigation, four of five patients demonstrated some improvement. CONCLUSIONS: Clinicians should be aware of the potential for outbreaks of psychogenic illness and work to address the challenges of developing effective intervention strategies, particularly in the cross-cultural context.     

Booster sessions and long-term effects of behavioral family therapy on adolescent substance use and school performance.

This study investigated the long-term impact on adolescent substance use and academic failure of 6 months of booster sessions following the termination of behavioral family therapy. Subjects were four 14-16-year-old white and Hispanic males and females whose parents or teachers had referred them for 5-12 months of behavioral family therapy. The first subject received no booster sessions; after the typical decrease in substance use and academic problems at the end of treatment, his problems recurred and subsequently worsened during follow-up. The other three subjects responded similarly to behavioral family therapy, but this was followed by 6 months of booster sessions, leading to a second decrease in substance use and academic problems. Improvement was maintained throughout follow-up. These results suggest that booster sessions can prevent the recurrences of adolescent problem behavior that often follow treatment termination.     

Clarifying co-rumination: associations with internalizing symptoms and romantic involvement among adolescent girls

Co-rumination, or excessive discussion of problems within friendships, has been associated with internalizing symptoms and is especially prevalent among adolescent girls. Eighty-three early adolescent girls participated in a prospective study further examining this construct. Co-rumination was positively correlated with depressive symptoms and positive aspects of friendship, but did not predict longitudinal changes in depressive symptoms. Co-rumination was negatively related to social anxiety when controlling for depressive symptoms. Co-rumination correlated positively with romantic experiences, and the two interacted to predict longitudinal changes in depressive symptoms, implying that co-rumination may only be depressogenic under certain circumstances. Theoretical ramifications for the construct of co-rumination and interpersonal aspects of adolescent internalizing symptoms are discussed.