Social environment and substance misuse: A study of ethnic variations among inner London adolescents

Objectives. To explore ethnic variations in drug, tobacco and alcohol use and their correlation with other factors which operate through peer, familial and religious influences.

Design. Semi‐structured interviews with 132 12–13‐year‐old young people from four ethnic groups attending secondary schools in two inner London boroughs and a follow‐up interview completed approximately 17 months later.

Results. The data was analysed using chi‐square and McNemar tests. Familial, religious and peer influence closely correlated with ethnicity. Bangladeshi young people showed lower levels of peer and higher levels of religious and familial involvement and lower levels of substance use. White young people reported higher levels of peer, lower levels of religious and familial involvement, and a higher level of substance use. Black African and Black Caribbean young people lay between the two extremes.

Conclusion. The findings suggest that young people with lower levels of familial and religious influence, or higher levels of peer influence, have higher levels of substance consumption than other young people. Health education initiatives need to promote personal decision‐making skills within the context of the young people's individual culture. Cultural diversity should be recognised within local health education needs assessment.     

An investigation of school-related variables as risk and protective factors associated with problematic substance use among vulnerable urban adolescents

Research has shown that early initiation of substance abuse has negative impacts on school performance and is predictive of substance abuse in adulthood. The aim of the present study was to evaluate the association between school-related variables and problematic substance use among adolescents in an urban setting. Adolescent participants (M age = 16.26, SD = 2.10; 65.3% male; 70.2% African-American) completed face-to-face interviews consisting of the Personal Experience Inventory (PEI) and a school-related questionnaire. Participants reported using alcohol to get drunk (44.9%), using marijuana (63.9 %) and other drugs to get high (19.8%). School-related risk and protective factors included: failed a class (61.8%), held back a grade (42.7%), sent to the principal (46.0%), family called for a conference (44.7%), suspended (39.0%), expelled (18.7%), and feeling good about school (61.3%) and teachers (66.1%). Having failed a class (AOR = 2.83), having been held back a grade (AOR = 4.68), and having been sent to the principal (AOR = 2.98) predicted problematic substance use. Feeling good about school (AOR = 0.39) and teachers (AOR = 0.27) was protective against problematic substance use. Findings demonstrate the importance of developing school-based targeted interventions for vulnerable youth.     

Psychosocial correlates of substance use among adolescents in Mersin, Turkey

The objective of this study was to determine the effects of psychosocial factors such as peer group, family and academic self-perception on smoking, alcohol and substance use by adolescents living in Mersin, Turkey. The study included a total of 3282 students from the sixth and tenth grades and college. The number of participating students required from each school was obtained through stratification, and by weighing the enrolled student population in each subgroup. The final sample was derived using a simple random sampling technique. A 45-item self-administered questionnaire was used. The questionnaire included questions about socio-demographic characteristics and lifetime and current (i.e. within the past month) use of cigarettes, alcohol, cannabis, inhalants and other illicit drugs (heroin, cocaine, sedative-hypnotic drugs, etc.). This study found that: (1) higher socio-economic status of the family increased the likelihood of smoking and alcohol use in adolescents; (2) the prevalence of alcohol use was higher in adolescents whose mothers had a higher educational level and whose mothers and fathers drank alcohol; (3) there was a significant association between substance use and having a peer who used a substance; and (4) the prevalence of smoking was significantly higher in students who perceived their academic performance to be poor. Understanding the role and importance of psychosocial factors associated with smoking, alcohol and substance use will be crucial to develop preventive measures for adolescents.     

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.     

Resiliency and survival skills among newly homeless adolescents: Implications for future interventions

Recent studies on homeless adolescents suggest that the profiles of homeless adolescents are heterogeneous, and that certain clusters of homeless adolescents demonstrated resiliency and positive coping strategies. This study examined the relationship between human immunodeficiency virus (HIV)-related risk factors and resiliency (survival skills) of homeless adolescents over a two-year period. Those who did not engage in unprotected sex reported significantly higher survival skills scores. Similarly, those who were monogamous during the study period reported significantly higher survival skills scores. However, there was a significant decline in survival skills scores after 6 months, regardless of the HIV-related risk factors. Findings from this study point to the urgent need to identify and target resilient adolescents early on to provide interventions to facilitate the transition to stable living situations before their resiliency deteriorates.     

The impact parenting behaviors have on recent alcohol use and binge drinking among adolescents based on age

Adolescent alcohol use is a persistent problem in the United States. Despite numerous prevention efforts, alcohol still remains the most commonly used substance among youth. The primary aim of this study was to determine the impact parenting behaviors have on adolescent recent alcohol use and binge drinking among youth aged 12–13 years, 14–15 years, and 16–17 years. For the study purpose, recent alcohol use was defined as drinking alcohol in the past 30 days and binge drinking was defined as consuming five or more alcoholic beverages in a row on the same occasion in the past 30 days of taking the survey. A secondary data analysis of the 2012 National Survey on Drug Use and Health was conducted and included a national sample of 17,399 adolescents. To determine the impact parenting behaviors have on adolescent alcohol use at the varying age ranges, logistic regression analyses were performed. All statistically significant results were retained and subsequent logistic regression analyses were completed to examine the effect parenting behaviors have on past month alcohol use and past month binge drinking for each age group. Results revealed that 13.3% of youth drank alcohol in the past month, and 7.5% of youth binge drank alcohol in the past month. Results indicated a lack of positive parenting behaviors increased the odds of youth reporting recent alcohol use and binge drinking across all ages. Of all age groups, the youngest youth (12–13 years old) had the highest risk of alcohol use and binge drinking after assessing the lack of positive parenting behaviors followed by 14–15-year olds and 16–17-year olds. Three specific parenting practices were found to influence youths’ alcohol use, especially among younger youth. Recommendations for future studies are included.     

女同性恋者童年期不良经历与成年期物质使用行为的相关性分析

目的:了解女同性恋者童年期不良经历（ACE）与成年期物质使用行为的状况,探究二者间的关系,为识别高风险人群、制定针对性干预措施提供依据。方法:2018年7-12月在北京市女同性恋社会组织的协助下,采用方便抽样方法,从参加例行的艾滋病自愿咨询检测服务、外展活动以及同伴推荐的女同性恋者中招募研究对象。应用问卷星（www.w...     

Risky sexual behaviors among Malay adolescents: a comparison with Chinese adolescents in Singapore

Objective: Malays, with majority of the individuals being Muslim, form the largest ethnic group in Southeast Asia. This region is experiencing a rising incidence of HIV infections. Due to circumcision and prohibition of sex outside marriage, being Muslim was argued to be a protective factor against sexually transmitted infections (STI) and Human Immunodeficiency Virus (HIV). However, Malay adolescents were found to be more likely to contract chlamydia and gonorrhea than non-Malay adolescents in Singapore.

Design: Using a cross-sectional survey, we examined and compared safer sex knowledge, attitudes and self-efficacy, and sexual behaviors of 248 sexually active Malay adolescents with 384 Chinese adolescents aged 16–19 years in Singapore. Poisson regression, adjusted for socio-demographic characteristics, was used for modeling each dependent variable. Adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) were obtained.

Results: On multivariate analysis, Malay adolescents were more likely to report marginally unfavorable attitude towards condom use (aPR 1.21 CI 1.00–1.48) and significantly lower confidence in using condoms correctly (aPR 1.24 CI 1.05–1.47) than Chinese adolescents. They were also more likely to report significantly younger first sex age (aPR 0.98 CI 0.96–1.00), never use of condoms for vaginal sex (aPR 1.32 CI 1.16–1.49) and anal sex (aPR 1.75 CI 1.11–2.76) and non-use of contraceptives at last sex (aPR 1.30 CI 1.17–1.45) than Chinese respondents. Malay males were less likely to buy sex (aPR 0.56 CI 0.37–0.85), but they reported higher likelihood of inconsistent condom use with female sex workers (aPR 2.24 CI 1.30–3.87).

Conclusion: Malay ethnicity was associated with unfavorable condom use attitude and lower self-efficacy in using condoms, which was consistent with risky sexual behaviors such as non-use of condoms. Future research should use mixed methods to explore and identify cultural influences to these behaviors.     

The influence of misperceptions about social norms on substance use among school‐aged adolescents

Individuals often have biased perceptions about their peers' behavior. We use an economic equilibrium analysis to study the role social norms play in substance use decisions. Using a nationally representative dataset, we estimate the effect of misperception about friends' alcohol, smoking, and marijuana use on consumption of these substances by youths in grades 7–12. Overestimation of friend's substance use significantly increases adolescent's own use approximately 1 year later, and the estimated effect is robust across specifications including individual‐level fixed effects regression. The effect size is bigger for boys than for girls. The estimates for those who initially underestimated the norm suggest the possibility of a rebound/boomerang effect.     

Health care service use among vulnerable adolescents

Abstract

This article describes the patterns of health care service use among a cohort of vulnerable adolescents with a history of homelessness and uses the Expanded Behavioral Model for Vulnerable Populations to examine factors associated with use of ambulatory and emergent care. We incorporated a health care interview into an existing longitudinal study of newly homeless adolescents, at their 24-month assessment (n?=?183) and assessed their sociodemographic characteristics, including living situation, health insurance rates, having a regular source of care, substance use and health care service use in the past 3 months. By the 24-month assessment, 63% of youth had returned home and 37% were currently homeless. In comparing youth who were currently homeless and those who had returned home, we found similar rates for ambulatory care use (48%) and for emergent care use (15%). The most common reason for seeking ambulatory care related to sexually transmitted disease (STD) testing/HIV testing/reproductive health for both groups. However, currently homeless youth were more likely to seek emergent care for trauma (15% vs. 4%, p?<?0.01) and for common conditions such as skin problems/respiratory infections/gastrointestinal problems/other problems (16% vs. 7%, p?<?0.05). Using multivariate logistic regression, we found older age [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.0–6.5] and health insurance (OR 2.3, 95% CI 1.1–4.5) to be associated with use of ambulatory care; however, only older age (OR 2.7, 95% CI 1.0–7.0) was found to be associated with use of emergent care. Housing status, emotional distress and substance use were not found to be associated with ambulatory or emergent care use. Our findings suggest that facilitating health insurance coverage for vulnerable adolescents with a history of homelessness may lead to increased use of ambulatory care services and may consequently prevent use of emergent care services for conditions that may be treated in the ambulatory care setting.     

Sexual orientation and substance use among adolescents and young adults

Objectives. We examined interrelationships among the 3 dimensions of sexual orientation—self-identity, sexual attraction, and sexual experience—and their associations with substance use among adolescents and young adults.Methods. To estimate total and net associations of sexual identity, attraction, and experience with use of tobacco, drugs, and alcohol, we applied logistic regression to cross-sectional data from the National Survey of Family Growth Cycle 6.Results. We found a lack of concordance among the different dimensions of sexual orientation. More youths reported same-gender sexual attraction and same-gender sexual experiences than identified as lesbian, gay, or bisexual. Estimates of substance use prevalence differed significantly by gender and across dimensions of sexual orientation. Sexual experience was the most consistent predictor of substance use. Women and men with no sexual experience had the lowest odds of all forms of substance use; those reporting sexual experience with partners of both genders had the highest odds.Conclusions. Our findings indicate that sexual identity was less strongly associated with substance use than sexual experience and attraction were, pointing to the need for more nuanced indicators of sexual orientation in public health studies.Increasing evidence points to an association between sexual orientation (SO) and substance use among adolescents and young adults. Population-based research has confirmed earlier studies reporting elevated rates of illicit drug use and problem drinking among youths who reported same-gender attractions or same-gender sexual experiences, or who self-identified as lesbian, gay, or bisexual (LGB).^1–5 Although most quantitative studies lack the measures necessary to elucidate the mechanisms underlying this association, the higher prevalence of substance use among sexual-minority youths typically is understood within the rubric of social stress theory as a manifestation of what has been referred to in research on LGB health as minority stress.^6,7Social stress theory conceptualizes the stigma and prejudice associated with a minority status as psychosocial stressors that are activated by experiences of discriminatory treatment, including both major events and everyday discrimination, continual anticipation of negative treatment, and internalization of negative societal attitudes.^8–11 Substantial evidence links discrimination-based stress to compromised psychological health, including substance use disorders, particularly among African Americans.^12–15 SO has received less attention in this context, but relevant findings so far are largely consistent with the findings for racial/ethnic minorities. Compared with heterosexual persons, lesbians and gay men report greater experience of discrimination^16–18 and have a higher incidence of psychosocial disorders.^19–22In light of the dearth of formal support systems (e.g., school-based gay–straight alliances, LGB community centers) for youths questioning their sexuality and the difficulty some LGB youths face in revealing themselves to family and friends, this evidence makes minority stress a compelling explanation for the association between SO and substance use. However, extant research provides only limited insight into which youths are at elevated risk for substance use because of gay-related stress.²³ This shortcoming reflects the paucity of nationally representative data sets containing information on both substance use and SO, as well as a lack of consensus about how to measure SO.^24,25 In the substance use literature, SO has been operationalized variously as sexual self-identity, sexual (or romantic) attraction, and sexual (or romantic) relationships. Although findings are similar across studies regardless of the measures used and the specific population represented, evidence increasingly suggests that these measures—which correspond approximately to the cognitive, affective, and behavioral dimensions of SO—are not interchangeable.²⁶An evaluation of school-based health surveys that included multiple measures of SO found that within each survey, groups defined on the basis of 1 measure of SO overlapped substantially—but were not entirely congruent—with groups defined by other measures.²⁷ An earlier study of a probability survey of US adults reported similar divergence across subgroups defined by sexual self-identity, attraction, and behavior.²⁸ In short, self-identity, attraction, and behavior are not wholly concordant. Not all individuals who have sexual experience with same-gender partners identify as LGB; nor do individuals who acknowledge same-gender attractions or sexual fantasies necessarily act on them.^29–32The divergence of the cognitive, affective, and behavioral dimensions of SO raises the possibility that identifying as LGB, recognizing same-gender attractions, or engaging in same-gender sexual behavior need not engender similar levels of distress or be similarly associated with substance use. In this study, we used data for teens and young adults from the National Survey of Family Growth Cycle 6 (NSFG-6) to examine the net associations of identity, attraction, and experience with various forms of substance use. We did not assume that all substance use by young people is motivated by psychological distress. Rather, we assumed that any distress associated with a sexual-minority status is sufficient to increase the risk of substance use above what is typical at that stage of the life course. Our analyses addressed 3 issues: (1) the alignment of sexual self-identity, attraction, and experience among youths aged 15 to 24 years; (2) the prevalence of substance use across groups defined by sexual self-identity, attraction, and experience; and (3) the net associations of identity, attraction, and experience with substance use.     

Immigrant status and acculturation influence substance use among New Zealand youth

Objective: To investigate the associations between generational status, acculturation and substance use among immigrant and non‐immigrant secondary school students in New Zealand. Methods: A nationally representative sample of secondary school students in New Zealand was selected using a two‐stage cluster sample design. Of the 8,999 students in the sample, 23.81% were first‐generation immigrants and 20.90% were second‐generation immigrants; the remaining 55.29% students are collectively referred to as ‘non‐immigrant’ peers. Logistic regression models adjusted the associations of interest for age, gender, ethnicity, socioeconomic status and experience of ethnic discrimination. Results: First and second‐generation immigrants showed significantly lower risks of smoking cigarettes compared with their non‐immigrant peers. Similar trends were apparent for consuming alcohol and marijuana weekly. The inclusion of some characteristics suggestive of acculturation in multivariable models did not influence the relationship between generational status and smoking cigarettes, but attenuated the apparent protective effect of being a first‐generation immigrant with regard to alcohol and marijuana use. Conclusions and implications: The study shows the lower likelihood of substance use among newer immigrants in a nationally representative sample of New Zealand youth. Policies and health programs that build on this positive profile and reduce the risk of adverse changes over time require attention.     

Young adolescents' perceived activity space risk,peer networks,and substance use

Adolescent substance use is a developmentally contingent social practice that is constituted within the routine social-environment of adolescents' lives. Few studies have examined peer networks, perceived activity space risk (risk of substance use at routine locations), and substance use. We examined the moderating influence of peer network characteristics on the relationship between perceived activity space risk and substance use among a sample of 250 urban adolescents. Significant interactions were found between peer networks and perceived activity space risk on tobacco and marijuana use, such that protective peer networks reduced the effect of activity place risk on substance use. A significant 3-way interaction was found on marijuana use indicating that gender moderated peer network's effect on activity space risk. Conditional effect analysis found that boys' peer networks moderated the effect of perceived activity space risk on marijuana use, whereas for girls, the effect of perceived activity space risk on marijuana use was not moderated by their peer networks. These findings could advance theoretical models to inform social–environmental research among adolescents.     

Population-level evaluation of school-based interventions to prevent problem substance use among gay,lesbian and bisexual adolescents in Canada

Objective

This study examined whether students' odds of recent substance use were lower in the presence of gay-straight alliances or explicit anti-homophobia policy that had been established at their school recently, or at least 3 years prior.

Methods

We analyzed a population-based sample of students in grades 8 through 12 from the British Columbia Adolescent Health Survey of 2008 (weighted N = 21,708). We used multi-nomial logistic regressions to test the hypothesized effects of gay-straight alliances and policies on substance use outcomes for lesbian, gay and bisexual students, and heterosexual students separately.

Results

Results indicated that gay-straight alliances and anti-homophobic bullying policies were linked to significantly lower odds of some but not all types of recent risky alcohol use, and past-year harms from alcohol or drug use, but almost exclusively in schools where the policies or gay-straight alliances had been established for at least 3 years; and among lesbian, gay and bisexual adolescents, only for girls.

Conclusions

Our findings suggest that these school-based strategies (gay-straight alliances and anti-homophobia policies) to reduce homophobia and foster school inclusion may be beneficial in reducing problem alcohol use among all students, not just sexual minority students.