The Association Between Substance Use and Risky Sexual Behaviors Among Incarcerated Adolescents

Objectives: The purpose of this study is to examine the relationships between substance use and risky sexual behaviors and having acquired a sexually transmitted disease. Methods: The sample consisted of 210 incarcerated adolescents ages 12–17. Data were collected through 40-min interviews administered by trained research assistants. Multivariate analysis was used to examine the relationship between risky sexual behaviors and substance use when adjusting for other covariates. Results: Almost three-quarters (70.6%) of these incarcerated adolescents regularly use one or more substances. Inconsistent condom use and sex with multiple partners (>2) was reported by approximately 70% of those surveyed. The regular use of substances elevated the odds of having sex with multiple partners (OR = 11.88), exchanging sex for money or drugs (OR = 4.64), and inconsistent condom use (OR = 3.06). Conclusion: Given strong associations between risky sexual behavior and substance use, interventions should be more multiproblem-focused. Health interventions should attempt to address common causes of both behaviors. Effective interventions will be those that can successfully demonstrate effects on outcomes that measure both the intervention effects on substance use and risky sexual behaviors.     

新疆3城市青少年吸烟和饮酒行为调查

目的了解青少年吸烟和饮酒状况,为开展健康教育提供参考依据。方法采用多阶段随机抽样,从新疆3个城市选取不同学校类型的初中、高中和大学学生8869名进行问卷调查。结果35.2%的学生有吸烟行为,其中5.0%在7岁以前开始吸烟;58.3%的学生有饮酒行为,其中7.5%在7岁以前开始饮酒。结论随着年龄的增长,学生开始吸烟和饮酒的比例增高。应对学生加强健康教育,控制吸烟和限制饮酒。     

Relationship Between Current Substance Use and Unhealthy Weight Loss Practices Among Adolescents

Objectives To determine the relationship between current substance use and unhealthy weight loss practices (UWLP) among 12-to-18 year olds. Methods Participants were 12-to-18 year olds who completed the 2013 Youth Risk Behavior Survey in Florida (N = 5620). Current alcohol, tobacco, and marijuana use was self-reported based on last 30-day use. UWLP was defined based on self-report of at least one of three methods to lose weight in last 30-days: (1) ≥24 h of fasting, (2) diet pill use, and (3) laxative use/purging. The reference group included those with no reported UWLP. Logistic regression models adjusted for age, gender, race/ethnicity, academic performance, age-sex-specific body mass index percentiles, and perceived weight status were fitted to assess relationships between UWLP and current substance use. Results About 15 and 41 % of adolescents reported ≥1 UWLP and use of ≥1 substance in the last 30-days, respectively. Over half (60.1 %) of adolescents who reported substance use engaged in UWLP (p < 0.0001). The prevalence of current alcohol use (50.6 %) was the highest among those who reported UWLP, followed by marijuana (31.9 %), tobacco (19.7 %), and cocaine (10.5 %) use. Adolescents who reported current tobacco [adjusted odds ratio (AOR) 2.7, 95 % confidence interval (CI) 2.1–3.6], alcohol (AOR 2.2, 95 % CI 1.9–2.6), or marijuana (AOR 2.1, 95 % CI 1.7–2.5) use had significantly higher odds of UWLP compared to their non-user counterparts. Conclusions This cross-sectional study shows that substance use and UWLP behaviors are likely to co-exist in adolescents. Further studies are necessary to determine the temporal relationship between substance use and UWLP. It is recommended that intervention programs for youth consider targeting these multiple health risk behaviors.     

大学生心理压力与吸烟行为的相关性分析

目的研究心理压力对大学生吸烟行为的影响,为制定干预措施提供依据。方法采用整群抽样方法,抽取某综合性大学一～三年级在校大学生9 766名,以自填式结构问卷调查学生的心理压力、自身和同伴吸烟情况及社会经济学指标。以"从未吸烟者"作为对照组,分别以"尝试吸烟者"和"现吸烟者"作为病例组,分析心理压力对大学生吸烟行为的影响。结果进入大学后仍有学生尝试或形成吸烟行为。调整社会经济学指标和同伴吸烟行为的影响后,对未来工作和学业的担心(OR=1.021,95%CI=1.002～1.040)是男生尝试吸烟的危险因素;学习压力(OR=1.064,95%CI=1.011～1.116)是女生尝试吸烟的危险因素,人际与环境压力(OR=1.152,95%CI=1.013～1.314)是女生现吸烟的危险因素。结论心理压力与大学生吸烟行为存在一定程度的相关性,并且对不同性别和不同吸烟行为的影响不同。     

Association Between Anxiety and Smoking in a Sample of Urban Black Men

Background Anxiety and smoking associations have been examined previously, but not in high risk populations of smokers, such as black males, who bear an excess burden of smoking-related illnesses. Methods This study assessed the relation between self-reported smoking status and anxiety using data collected by structured telephone interviews with a sample of 430 black, middle-aged males participating in an ongoing cancer prevention trial. Results There was a significant association between anxiety caseness and smoking (p = .006), with more probable cases among current smokers. A priori t-tests showed that current smokers had greater anxiety than former and nonsmokers (p’s = 0.02). Among current smokers, greater anxiety was associated with heavier smoking (p = .008), an association not present among former smokers. Discussion This study could guide future experimental studies examining smoking-anxiety associations and inform intervention strategies addressing anxiety in underserved nicotine dependent populations with high tobacco-related risks.     

Body Weight Perception, Unhealthy Weight Control Behaviors, and Suicidal Ideation Among Korean Adolescents

BACKGROUND: This study examined the mediating function of body weight perception (BWP) in the relation between body mass index (BMI) and unhealthy weight control behaviors (UWCBs; eg, fasting, using diet pills, or laxatives), and between BMI and suicidal ideation. It also explored the correlation between exposure to multiple UWCBs and suicidal ideation among Korean adolescents.
METHODS: Data on BMI, BWP, UWCBs, and suicidal ideation were obtained from the 2006 Korean Youth Risk Behavior Web-based Survey, a school-based survey conducted on a nationally representative sample of students in grades 7–12 (36,463 boys and 33,433 girls). Data were analyzed using bivariate and multivariate logistic regression.
RESULTS: BMI was significantly associated with both UWCB and suicidal ideation among boys and girls, even after controlling for covariates. However, the significance and magnitude of the association between BMI and UWCB were considerably attenuated when BWP was added to the model. When BWP was included, the association between overweight BMI status and suicidal ideation became nonsignificant in both sexes, whereas the association between underweight BMI status and suicidal ideation remained significant among boys. Adolescent boys and girls engaging in multiple UWCBs were at greater risk for experiencing suicidal thoughts.
CONCLUSIONS: This study suggests that BWP represents a potential mediator between BMI and UWCB, and between BMI and suicidal ideation among both boys and girls. Thus, school programs addressing issues related to BWP should be developed and targeted at adolescents to reduce the potential risks for both UWCB and suicidal behavior.     

Gender Comparisons of Unhealthy Weight-control Behaviors Among Sixth-Graders

ObjectiveTo examine gender differences in unhealthy weight-control behaviors (UWCB) and identify key psychosocial and demographic correlates of UWCB among sixth-graders.MethodsA cross-sectional survey was completed by 146 boys and 153 girls at a middle school. Secondary data analyses included bivariate tests and multivariable logistic regression.ResultsForty-seven percent of participants reported 1 or more UWCB, with no differences by gender (P = .75). Factors common to boys and girls included: lower global self-esteem; lower body-esteem; and greater negative parental modeling among participants who engaged in UWCB compared to those who did not. However, multivariable models revealed gender differences. Among boys, body mass index, negative parental modeling, and global self-esteem retained statistically significant associations with UWCB after controlling for other variables in the model, whereas race and weight-related body-esteem remained significant for girls.Conclusions and ImplicationsThis research highlights the need for gender-specific UWCB prevention programs implemented in late childhood and early adolescence.     

珠海市青少年吸烟行为现况及影响因素分析

目的 了解珠海市青少年吸烟行为及其影响因素，为制定有效的控烟措施提供科学依据。方法 采取多阶段分层整群抽样法、应用世界卫生组织（WHO）／中国卫生部提供的《全球青少年烟草调查中国问卷》，对珠海市25所中学初二至高一年级的学生2480名进行问卷调查。结果 尝试过吸烟（包括只吸1口）的学生占29．4％，其中男生为42．0％，女生为14．6％，差异有显著性；第一次吸烟时年龄小于12岁的学生占49．7％；吸烟的学生中62．9％的香烟来自于商店或烟摊，84．9％的学生能从商店或烟摊买到香烟；父母都吸烟或其中一人吸烟的高达65．5％，父母吸烟的子女吸烟的比例明显高于父母不吸烟的子女，差异有显著性（X^2=21．576，P〈0．01）；44．5％的学生认为学校没有组织过控烟活动；96．2％的学生对吸烟有害健康有正确的认识，但呈现出知识、信念、行为的分离。结论 珠海市青少年尝试吸烟现象较为普遍，父母吸烟对子女吸烟行为产生严重影响。应在家庭、学校、社区形成良好的控烟支持环境。     

Association Between Neighborhood-Level Smoking and Individual Smoking Risk: Maternal Smoking Among Latina Women in Pennsylvania

Objective

We examined whether or not high maternal smoking rates at the neighborhood level increase the likelihood of individual smoking by Latina women in the three months prior to and during pregnancy, independent of other individual and neighborhood factors.

Methods

This study was observational in nature, using linked vital statistics records for 24,443 Latina women in Pennsylvania (2009–2010) and U.S. Census data for 2,398 census tracts. We used multilevel logistic regression models to determine the individual odds of self-reported maternal smoking given different census tract-level rates of maternal smoking in the previous three years (2006–2008), adjusting for maternal and census-tract characteristics, including ethnic density, population density, and poverty.

Results

Higher levels of maternal smoking at the census-tract level were associated with increased individual odds of smoking among Latina mothers. In the fully adjusted model, a 10% increase in the neighborhood smoking rate was associated with a 1.28 (95% confidence interval 1.22, 1.34) increase in the individual odds of smoking.

Conclusion

Latina women living in census tracts where more women have smoked during or immediately prior to pregnancy are themselves at higher risk of smoking during this period.Tobacco control is a U.S. public health priority and maternal smoking is of particular importance.¹ Maternal smoking is associated with premature birth and low birthweight, birth defects, sudden infant death syndrome, and the exacerbation of childhood asthma and other respiratory disorders.² Furthermore, parental smoking increases the risk that children themselves will smoke as adults.³ In the United States, one in every seven women is estimated to smoke during pregnancy.⁴ Although women of Latina heritage are less likely to smoke than women from other ethnic/racial groups, Latina women account for approximately 23% of U.S. births each year.^5,6 A 1% absolute decrease in maternal smoking among Latina women would impact the health and well-being of more than 9,000 infants and mothers of Latina origin annually.Individual risk factors for prenatal and maternal smoking among Latina women in the United States include poverty, lower education levels, younger age, English language preference, and U.S. nativity.^7–9 Smoking behaviors also have been found to be contingent upon neighborhood characteristics, meaning the physical, demographic, or social characteristics of the relatively small geographic area surrounding one''s residential address. This research has predominantly focused on smoking among the general adult and adolescent populations.^10–14 For example, Xue et al. found that high co-ethnic density (i.e., a neighborhood characteristic defined at the level of census block groups) decreased the risk of tobacco use by African American adolescents independent of individual characteristics such as age, socioeconomic status (SES), and exposure to parental substance use.¹⁰ Similarly, Kandula et al. found that Asian American women living in “Asian enclaves” (i.e., census tracts with ≥50% Asian residents) in California were less likely to smoke than women not living in Asian enclaves, even after taking into account individual characteristics such as age, marital status, education, income, emotional well-being, duration of U.S. residency, and language spoken at home. Notably, neighborhood SES (a composite measure comprising concentrated affluence, concentrated poverty, percentage of college-educated residents, and percentage of home ownership) was not associated with increased or decreased odds of smoking in this minority population.¹⁵A limited but evolving literature has focused on neighborhood-level factors associated with smoking during pregnancy. Studies examining neighborhood-level associates of maternal smoking in Sweden, South Carolina, and California have found that neighborhood poverty is independently associated with risk of tobacco use during pregnancy.^16,17 In a nationwide analysis of U.S. natality files, Shoff and Yang found that after adjusting for individual-level characteristics such as age, education, and race/ethnicity, a one-unit increase in county-level SES (a composite measure comprising various county-level statistics for educational attainment, income, occupation, and household composition) was associated with a 21% decrease in the individual likelihood of smoking during pregnancy. They also found that women in rural counties were less likely than women in non-rural areas to smoke during pregnancy.¹⁸ Shaw et al. also found that as county-level co-ethnic density increases, Latina women are substantially less likely to smoke during pregnancy. For example, Latina women in U.S. counties with <1% Latino residents compared with Latina women in counties with 15% to <50% Latino residents had an adjusted odds ratio for smoking during pregnancy of 0.35 (95% confidence interval [CI] 0.28, 0.42). Among Latina women living in counties with ≥50% Latino residents, the adjusted odds ratio was 0.11 (95% CI 0.07, 0.17).¹⁹The relationships between neighborhood measures and individual behavior may be mediated by structural, spatially correlated factors, such as the availability of tobacco products and exposure to tobacco advertising. They may also be mediated by social factors, such as decreased chronic stress in neighborhoods in which high co-ethnic density results in greater social connectedness, support, or cohesion for members of the dominant ethnic group. It is also possible that this association is due to differences in social norms (i.e., shared beliefs about how people should behave).^20–22 In general, Latina women who live in neighborhoods with a high proportion of Latino residents are also living in neighborhoods where maternal smoking is infrequent. This environment may reinforce a perceived social norm—that women do not smoke during preconception or pregnancy (or smoke at all)—that may be a more important determinant of individual maternal smoking behavior than the neighborhood''s ethnic composition. This potential social norm that exists in Latino neighborhoods is suggested by an analysis completed by Shaw and Pickett, who demonstrated that non-Latina women living in U.S. counties with ≥50% Latino residents are also much less likely to smoke during pregnancy than women who live in less Latino-dense areas, independent of individual characteristics such as age, marital status, and education.²³ Shoff and Yang also found that the individual odds of smoking during pregnancy were lower for women living in counties with a higher proportion of Latino residents compared with women living in neighborhoods with lower proportions of Latino residents, adjusting for maternal race/ethnicity.¹⁸We sought to advance this literature by examining the relationship between peer smoking rates at the census-tract level and the individual-level probability of smoking in the three months prior to or during any trimester of pregnancy. We hypothesize that Latina women living in census tracts where more women smoke immediately prior to or during pregnancy will themselves be more likely to smoke prior to or during pregnancy, independent of other individual and census tract-level risk factors. Because residential Latino ethnic density has a strong relationship with maternal smoking, and because maternal smoking behaviors differ significantly among racial/ethnic groups, we focused our analysis on Latina women.^5,24     

儿童青少年体成分与肺通气功能的相关性研究

目的探讨体脂、瘦体重等体成分指标以及脂肪分布模式与肺通气功能的相关性,为儿童青少年生长发育研究提供依据。方法对525名6~18岁儿童青少年测定身高、体重、腰围、臀围,运用生物电阻抗(BIA)测定体脂百分含量、瘦体重含量等体成分指标,同时测试肺通气功能指标。采用协方差分析男女儿童不同的体脂、BMI和腰臀比水平时通气功能指标的变化情况,逐步回归分析年龄、身高、体成分及其分布指标等对肺通气功能的影响。结果控制年龄后,男女儿童青少年随体脂百分含量、BMI和腰臀比的上升,肺活量指数和单位面积最大通气量(MVV)均呈下降趋势。男生肺活量指数与BMI、腰围和体脂百分含量呈负相关,用力肺活量(FVC)、第1秒用力呼出量(FEV1)和最大通气量(MVV)与身高和瘦体重呈正相关,MVV与腹部皮脂厚度负相关,单位面积MVV与体脂百分含量和腹部皮脂厚度负相关;女生肺活量指数与BMI、上臂皮脂厚度负相关;FVC,FEV1,MVV和单位面积MVV、年龄及身高正相关,单位面积MVV还与上臂皮脂厚度呈负相关。结论体脂含量增加会对通气功能产生负性作用,中心性体脂分布对通气功能会产生一定影响,尤其是男生。     

Prevalence and Impact of Unhealthy Weight in a National Sample of US Adolescents with Autism and Other Learning and Behavioral Disabilities

We estimated the prevalence of obesity, overweight, and underweight among US adolescents with and without autism and other learning and behavioral developmental disabilities (DDs) and assessed the health consequences of obesity among adolescents with DDs. From the 2008 to 2010 National Health Interview Survey, we selected 9,619 adolescents ages 12–17 years. Parent respondents reported weight, height, presence of DDs and health conditions. We calculated body mass index (BMI) and defined obesity, overweight, and underweight as ≥95th, ≥85th to <95th, and <5th percentiles, respectively, using established criteria. We created mutually-exclusive DD subgroups using the following order of precedence: autism; intellectual disability; attention-deficit-hyperactivity-disorder; learning disorder/other developmental delay. We compared BMI outcomes among adolescents in each DD group versus adolescents without DDs using multivariable logistic regression. Socio-demographic factors and birthweight were included as confounders. Estimates were weighted to reflect the US population. Both obesity and underweight prevalences were higher among adolescents with than without DDs [adjusted prevalence ratios (aPR) 1.5 (1.25–1.75) and 1.5 (1.01–2.20), respectively]. Obesity was elevated among adolescents with all DD types, and was highest among the autism subgroup [aPR 2.1 (1.44–3.16)]. Adolescents with either a DD or obesity had higher prevalences of common respiratory, gastrointestinal, dermatological and neurological conditions/symptoms than nonobese adolescents without DDs. Adolescents with both DDs and obesity had the highest estimates for most conditions. Obesity is high among adolescents with autism and other DDs and poses added chronic health risks. Obesity prevention and management approaches for this vulnerable population subgroup need further consideration.     

The Association Between Nonbarrier Contraceptive Use and Condom Use Among Sexually Active Latina Adolescents

PurposeThis study aimed to determine the association between use of highly effective methods of nonbarrier contraception and condom use in a sample of Latina adolescents and whether the change to a more effective method of nonbarrier contraception is associated with a change in condom use.MethodsAs part of a larger study, 442 sexually active Latina adolescents aged 14–18 years were surveyed immediately before an appointment with a medical care provider at a school-based health center and 3 months later. Ordinal logistic and linear regression were used in the analysis of cross-sectional and longitudinal data to assess the relationship between patterns of nonbarrier contraception and condom use.ResultsThe use of all types of nonbarrier methods of contraception was significantly associated with decreased condom use. Change over time from a less effective to a more effective nonbarrier method of contraception was also associated with a decrease in condom use. Greater number of sexual encounters was associated with lower the frequency of condom use.ConclusionsThe use of highly effective methods of nonbarrier contraception was associated with reduced frequency of condom use. This highlights the need to promote condom use concurrently with nonbarrier methods of contraception to improve protection against both pregnancy and STIs.     

Misuse of Over-the-Counter Cough or Cold Medications Among Adolescents: Prevalence and Correlates in a National Sample

The current research examines the misuse of over-the-counter cough/cold medications among adolescents with data from the 2006 National Survey on Drug Use and Health. Findings indicate that age, gender, family income, physical and mental health, and the use of alcohol and other drugs are correlates of the misuse of over-the-counter cough/cold medications.     

Relationship Between Self-Esteem and Smoking Behavior Among Japanese Early Adolescents: Initial Results from a Three-Year Study

Researchers examined the relationship between self-esteem and smoking behavior among Japanese elementary and junior high school students. Students (2,090) in fourth to ninth grade from three elementary schools and two junior high schools in the Hyogo and Niigata prefectures completed an anonymous questionnaire. Self-esteem was measured using the Harter Perceived Competence Scale, the Pope Self-Esteem Scale, and the Rosenberg Self-Esteem Scale. Results indicated that never smokers had higher cognitive, family, and global self-esteem, but lower physical self-esteem than ever smokers. Grade and gender were significantly associated with self-esteem, showing a decrease of self-esteem with increases in grade and a higher level of self-esteem among boys than girls. The results suggest that effective smoking prevention programs for Japanese early adolescents should be integrated into more comprehensive health education or health promotion programs including self-esteem enhancement training.     

Menthol Brand Switching Among Adolescents and Young Adults in the National Youth Smoking Cessation Survey

This study examines patterns of menthol and nonmenthol cigarette use from 2003 to 2005 in a cohort of smokers, aged 16 to 24 years in the National Youth Smoking Cessation Survey. At follow-up, 15.0% of baseline menthol smokers had switched to nonmentholated cigarettes; by contrast, 6.9% of baseline nonmenthol smokers had switched to mentholated cigarettes. Differences in switching patterns were evident by gender, race/ethnicity, parental education, and smoking frequency. These data support previous evidence that young smokers start with mentholated cigarettes and progress to nonmentholated cigarettes.Following enactment of the Family Smoking Prevention and Tobacco Control Act in June 2009,1 fruit, candy, and clove characterizing flavorings in cigarettes were banned to reduce youth smoking initiation. Menthol is the only characterizing flavor that was not banned outright by the act. Nationally representative surveys have shown an age gradient in menthol use, with the youngest smokers (aged 12–17 years) most likely to smoke mentholated cigarettes.2^,3 Studies of adolescents report that middle school smokers and recent initiates are more likely to use mentholated cigarettes than high school smokers and those smoking longer than 1 year, respectively.4 With other studies,5–7 these results argue that menthol facilitates smoking initiation and that mentholated cigarettes serve as starter tobacco products for youths.4Although these nationally representative studies document an age gradient in menthol use, they do not address smoking patterns in the same individuals over time and whether there is a disproportionate shift from early use of mentholated cigarettes to nonmentholated cigarette use later on. The current study assesses patterns in menthol and nonmenthol cigarette use over time in young smokers, aged 16 to 24 years.     

南宁市青少年吸烟行为流行现状

目的了解南宁市青少年的吸烟状况以及吸烟行为影响因素,为制定有效干预措施提供依据。方法采用分层整群抽样方法,对南宁市6所初中、6所高中、3所职业高中和2所大学共3 573名学生进行匿名自填问卷调查。结果南宁市青少年尝试吸烟报告率为37.8%,第一次吸完整支烟时≤13岁的报告率为14.3%;现在吸烟报告率为14.7%,被动尝试吸烟的报告率为50.9%。结论南宁市青少年对吸烟的成瘾性及危害认识不足。家庭环境和同伴压力是主要影响因素。加强对吸烟行为的早期预防教育和干预刻不容缓。     

The Relationship Between Violence Syndemics and Sexual Risk Behaviors Among African American Adolescents: Implications for Future Research

PurposeWe present a conceptual framework based on a review of the literature to highlight the interconnecting and reinforcing elements of a violence syndemic and how this syndemic influences sexual risk behaviors among African American heterosexual adolescents.MethodsWe review existing peer-reviewed published research from 2000 to 2020 that links a violence syndemic (i.e., racism and race-related stress, neighborhood and police violence, peer violence, and family violence and disruptions) to adolescent sexual risk behaviors. Empirical findings and theoretical underpinnings are used to document this relationship and illuminate the factors that mediate this relationship.ResultsEmpirical studies support the links between specific types of violence and sexual risk behaviors among African American adolescents. Further, existing studies point to the important relationships among the specific types of violence, supporting a violence syndemic approach.ConclusionsWhile more researchers are examining socio-ecological contextual factors as important predictors for sexual risk behaviors, there remains inadequate understanding about how violence types reinforce one another to heighten sexual risk behaviors among African American heterosexual adolescents. This article presents new directions for adolescent research, especially how a violence syndemic approach can be used to explain sexual risk, but also to refocus intervention design on the complex burdens experienced by this population.