The Dynamic Nature of Risk Factors for Substance Use Among Adolescents

ABSTRACT

Substance use is one of the major social problems facing youth today. The research on risk factors associated with onset and continuation of use is extensive. Typically, reviews of the literature categorize risk factors by environmental domain (i.e., family, peer relations, neighborhoods). This review extends this framework by examining studies that focus on the changing nature of risk factors for substance use among teenagers. The underlying assumption is that, especially during adolescence, these relations are dynamic and shift across time. Five time-related mechanisms are identified and used to describe the research. The article concludes with a discussion about the implications for future research.     

Substance Use Among Adolescents of Parents Living With HIV in New York City

We examined the relationship of community, interpersonal, and personal risk and protective factors to substance use among adolescents of parents with HIV (PWH). Families with HIV (n = 269 PWH and 409 adolescents) from New York City were recruited, and multivariate models were used to examine the associations. Adjusting for age, gender, and ethnicity, substance use was positively associated in univariate analyses with parental substance use, family conflict, adolescent emotional distress, and adverse life events; having academically oriented friends and religiosity were protective. In the multivariate model, multiple problem behaviors (e.g., delinquency) and substance-using peers were significantly associated with substance use. The patterns of associations between the risk factors and substance use are similar to those of adolescents in families not impacted by HIV. Interventions aimed at improving parental care, reducing maladaptive peer networks, and decreasing problem behaviors are important strategies to explore in future prevention studies.     

Alcohol and Cigarette Use and Misuse Among Hurricane Katrina Survivors: Psychosocial Risk and Protective Factors

The present study examined survivors' use and misuse of cigarettes and alcohol following Hurricane Katrina. We also examined several psychosocial factors that we expected would be associated with higher or lower rates of substance use following the hurricane. Participants were 209 adult survivors of Hurricane Katrina interviewed in Columbia, SC or New Orleans, LA between October 31, 2005 and May 13, 2006. Results revealed that survivors were smoking cigarettes, consuming alcohol, and experiencing alcohol consumption-related problems at a substantially higher rate than expected based on pre-hurricane prevalence data. Results also suggested that certain psychosocial factors were associated with participants' substance use and misuse following the hurricane.     

Factors Associated With Sex Under the Influence of Alcohol Among Adolescents With Divorced Parents

This study addresses the association of diverse individual variables, traditionally associated with sexual risk practices in the general population, with sex under the influence of alcohol in adolescents with divorced parents. A sample of 132 adolescents provided information about their knowledge and attitudes toward HIV/AIDS and sexual risk behaviors, self-concept, social anxiety, and sexual sensation seeking. Binary logistic regression revealed that not having sex under the influence is associated with a more positive predisposition to practice safe sex when finding an obstacle, and with less sexual sensation seeking. These and other findings are discussed.     

Cannabis and Amphetamine Use and Associated Factors Among School-Going Adolescents in Nine African Countries

The aim of this study was to assess the prevalence of cannabis and amphetamine use and associated factors among adolescents in nine African countries. We analyzed cross-sectional data from 25,372 adolescents (mean age 14.3 years, SD = 1.6) from nine African countries that participated in the Global School-Based Student Health Survey (GSHS) in 2009–2013. Information was collected with a self-administered structured questionnaire. Overall, past-month cannabis use was 4.1% and lifetime amphetamine use was 5.1% among students. In multivariable unconditional regression analysis older age, personal attributes (suicidal ideation, current smoking, school truancy, and having had two or more sexual partners), smoking status of the father and/or mother, and environmental stressors (having experienced hunger, been bullied, having been in a physical fight and having been attacked) were associated with both past-month cannabis and lifetime amphetamine use. Measures to prevent and control cannabis and amphetamine use should include personal attributes (suicidal ideation, school truancy, and HIV sexual risk behavior) and environmental stressors (food insecurity and violence).     

The Moderating Role of Parental Monitoring on the Influence of Peer Pro-Drug Norms on Alcohol and Cigarette Use Among Adolescents in Mexico

This study utilized data drawn from a study of 980 adolescents living in Tijuana, Mexico, in February 2009 to examine whether parental monitoring had a moderating impact on the influence of peer pro-drug norms on lifetime and past-30-day alcohol and cigarette use among a group of adolescents living along the United States–Mexico border. The results of primary analyses indicated that parental monitoring did moderate the influence of peer pro-drug norms for past-30-day cigarette use for males but not for females. Research and practice implications for U.S. and Mexican culturally grounded prevention programs are discussed.     

Assertiveness Among Young Rural Adolescents: Relationship to Alcohol Use

ABSTRACT

There is evidence of higher prevalence rates for alcohol use among rural adolescents relative to urban adolescents. Strategies aimed at preventing adolescent alcohol use typically include the development of social skills to resist peer pressure; among the social skills frequently targeted is assertiveness. Self-report data were collected from a sample of rural adolescents (N = 470) participating in a longitudinal preventive intervention study. Five hypothesized dimensions of assertiveness were validated with Confirmatory Factor Analysis: Specific Substance Refusal, Individual Rights, Transaction, Justice, and Social Approach. Using gender as a between-subjects factor, plus time and assertiveness as within-subjects factors to predict an alcohol use composite index, repeated measures analyses revealed a number of significant findings. Several assertiveness dimensions were found to have significant effects on the alcohol use index, and significant two-way and three-way interaction effects (gender × time × assertiveness dimension) also were found. Findings support the idea of including multidimensional assertiveness skill development as a component of preventive interventions, particularly for rural adolescents.     

Predictors of Alcohol Use Among Status-Offending Adolescents: Youth and Parent Perspectives

Research exploring parent–child relationships suggests parents often have divergent perspectives from their adolescent children. Understanding youths' and parents' reports in predicting alcohol use is particularly important among detained youths who are at elevated risk for substance-related problems. This exploratory study queried youth entrants to a juvenile detention center (N = 150) and their parents (N = 89) on a host of individual and familial factors to determine risks associated with youths' drinking from youth and parent perspectives. Findings suggest that, in addition to assessing youths' self-reports at juvenile detention admission, parents' divergent views of their teens' alcohol use offer a valuable perspective.     

Alcohol Use Severity and Sexual Risk Behavior Among Female Substance Users

Background: Substance use has been identified as one of the leading factors related to HIV transmission in the United States. The association of problematic drinking with sexual risk behavior puts individuals at greater risk for HIV transmission. This may be of particular concern for women given that approximately 66% of new HIV infections occurring through heterosexual transmission are female. Objectives: To investigate alcohol use severity and sexual risk behavior among females who use heavy, illicit drugs. Methods: Female substances users (N = 251; M_age = 31.90, SD = 7.67; 63.7% Black) self-reported past month alcohol use and lifetime sexual risk behaviors with both casual and steady sex partners. Results: Problematic alcohol users were more likely to use noninjection drugs and less likely to use injection drugs than abstainers and more likely than moderate alcohol users to use alcohol before/during sex with a steady partner. White problematic alcohol users were less likely to use injection drugs before/during sex with a steady partner than abstainers. Black problematic alcohol users were more likely to use non-injection and alcohol than moderate alcohol users before/during sex with steady partners. Conclusions: The current study extends the existing literature by taking a closer look at the role of alcohol use severity in sexual risk taking behavior of Black and White female substance users, a particularly vulnerable group for HIV transmission.     

The Comorbidity of Psychiatric and Substance Use Disorders Among Hispanic Adolescents

Objective: The comorbidity of psychiatric disorders and substance abuse disorders among adolescents and adults is well-documented in the literature. The current study investigates the relationship between psychiatric and substance use disorders in a sample of treatment-seeking Hispanic adolescents. Methods: The study uses baseline data (N = 190) from a randomized control trial testing the effectiveness of a family-based treatment for Hispanic adolescents with substance abuse disorder to examine the relationship between psychiatric disorders and substance use patterns at baseline, including types of substances used (both lifetime use and past-month use) and age at onset of substance use, controlling for age and gender. Results: Linear regression models were used to examine predictors of age at onset, while logistic regression models examined predictors of lifetime substance use. Significant findings predicting age at onset for marijuana and alcohol are discussed. In addition, psychiatric profiles were differentially associated with lifetime use of sedatives, stimulants, and hallucinogens, but not alcohol or marijuana. Conclusions: Findings from this study can be used to help inform the treatment of adolescents seeking mental health and substance use services.     

Risk and Protective Factors for Alcohol and Marijuana Use among African-American Rural and Urban Adolescents

The purpose of this study was to examine individual, family, peer, and community risk and protective factors associated with past-30-days alcohol and marijuana use among African-American adolescents living in rural and urban communities. This study used data collected from 907 tenth- and twelfth-grade African-American students who completed the 2005 Community Youth Survey. Peer and individual risk/protective factors were more influential for urban youths while family and community risk/protective factors were more influential for rural youths. This pattern held for alcohol and marijuana use. Implications for substance use prevention programming are discussed.     

Alcohol Use and Sexual Risk Behaviors Among Adolescents With Psychiatric Disorders: A Systematic Review and Meta-Analysis

Adolescents with psychiatric disorders appear to be at increased risk for acquiring HIV and other sexually transmitted infections; however, little is known about the prevalence of behavioral risk factors in this population. This meta-analysis aimed to assess the prevalence of alcohol use and sexual risk behaviors among adolescents with psychiatric disorders. Electronic database searches identified studies sampling adolescents diagnosed with psychiatric disorders and assessing both alcohol and sexual risk behaviors. Fourteen studies sampling 3,029 adolescents with psychiatric disorders were included. The majority of adolescents with psychiatric disorders report alcohol use and sexual risk behaviors. Risk reduction interventions targeting these two behaviors are needed.     

The Relationships Between Alcohol/Drug Use and Quality of Life Among Adolescents: An International,Cross-Sectional Study

Although a major public health and social concern globally, limited data exist on substance use and their effects among adolescents living in low- and middle-income countries. This study evaluated the relationships between alcohol/drug use and quality of life (QOL) among adolescents in general populations from India, Indonesia, Nigeria, Serbia, Turkey, Bulgaria, and Croatia. The sample included 2,393 adolescents. The Pediatric Quality of Life Inventory (PedsQL) was used for QOL assessments, the Strengths and Difficulties Questionnaire (SDQ) was used for mental health problems, and the CRAFFT self-report questionnaire was administered for eliciting alcohol/drug use. Alcohol/drug use was significantly associated with lower levels of QOL. In particular, substance use among older male adolescents, adolescents with overt psychopathology, or adolescents in lower socioeconomic status was associated with greater reductions in levels of QOL.     

Social Normative Perceptions of Alcohol Use and Episodic Heavy Drinking Among Central and Eastern European Adolescents

This study examined alcohol use and related social normative perceptions among a sample of 1,886 Central-Eastern European high school students. The youth represented in the study averaged 16.5 years of age and were from several localities in the countries of Hungary, Slovakia, Czech Republic, and Romania. Data for the study were collected through a school-based alcohol use survey that was completed in June 2005. Our results support the hypothesis that drinking was related to perception of the prevalence of alcohol use by schoolmates and by the number of friends who drink and/or engage in episodic heavy drinking. Specific implications of findings in terms of substance use prevention are discussed. In addition, the need for future research and the limitations of the current research are discussed. This study was largely financially supported through an international grant from the College of Health and Human Performance, Brigham Young University.     

The Effects of Interventions to Prevent Substance Use Among Adolescents: A Systematic Review

The aim of this systematic review is to describe and evaluate the effects of interventions used for preventing or reducing substance use among adolescents under 18 years of age. Studies (N = 27) available in CINAHL and PubMed from 2007 to 2010 were included. Results showed that family-based interventions and combined interventions have significant outcomes for substance use among adolescents. Similarly, school-based interventions were effective in providing knowledge about substance use, which eventually reduced the substance use. Further research should be conducted in different cultures as well as on computer-based interventions targeting both genders.     

Substance Use and Depressive Symptoms Among Adolescents Treated in a Pediatric Emergency Department

ABSTRACT

The current study examined associations between substance use and depressed mood by gender and type of substance used (no use, alcohol, marijuana, or both alcohol and marijuana) in a sample of 713 adolescents (M_age = 15.3) recruited from a Pediatric Emergency Department (PED). Adolescents who reported any marijuana use had higher overall depressed mood scores compared to all other adolescents. When examined by gender, females with both alcohol and marijuana use reported the highest overall depressed mood symptoms. These results suggest the usefulness of screening and identification of depressive symptoms among adolescents presenting to a PED for substance use-related problems.     

Cultural Values Associated With Substance Use Among Hispanic Adolescents in Southern California

Cultural values can shape people's attitudes toward substance use and influence their risk of experimentation with drugs. This article examines the relationships between cultural values (familism, respeto, and machismo), fatalism (a culturally encouraged personality disposition), and substance use among Hispanic adolescents. In 2005, cross-sectional data were collected from 1,616 Hispanic ninth grade students in Los Angeles. Each cultural value was associated with lifetime substance use; however, these relationships depended on the type of substance and gender. Our findings suggest that it might be useful to incorporate the cultural values and address the personality trait of fatalism in prevention programs for Hispanic adolescents. The study's limitations are noted.     

The Importance of Peers in Alcohol Use Among Latino Adolescents: The Role of Alcohol Expectancies and Acculturation

Abstract

The present study examined the potentially mediating effect of alcohol expectancies and moderating effect of acculturation on the relationship between peer alcohol use and Latino adolescent alcohol use. Participants were 115 adolescents recruited through alternative schools, community events, a community psychologist, and Latino groups at a midwestern university. Questionnaires in this study assessed adolescents' perceptions about both their own and their peers' alcohol use in addition to their expectancies about the effects of alcohol, and their level of acculturation. Demographic characteristics of the sample were also assessed in order to control for their possible effects (e.g., age, gender). Results from the present study indicated that a higher level of peer alcohol use was associated with a higher level of adolescent alcohol use. Additionally, adolescents' expectancies about the effect of alcohol on their social behavior mediated the relationship between peer alcohol use and adolescent alcohol use. Results support previous research suggesting the importance of peers as role models for Latino adolescent alcohol use. Acculturation did not moderate the relationship between peer and adolescent alcohol use. The present study adds understanding as to how Latino adolescents' beliefs regarding alcohol use may influence the relationship between peer alcohol use and adolescent alcohol use.     

Factors Associated With Parental Rules for Adolescent Alcohol Use

This study used the Resilient Families baseline survey to examine associations between the connectedness of parents within the school and parents' rules regarding their children's use of alcohol, prior participation in parenting education, and parents' demographic characteristics. The study involved parents of Year 7 students (mean age 12 years) at secondary schools in Melbourne, Australia (N = 1,238; 2004). Most parents (54%) had no connections with parents of other children in their child's school year. Allowing children to have sips of alcohol or drinks on special occasions was reported by 23% and 6% of parents, respectively, but neither was significantly associated with parental connectedness.     

Multivariate Model of Antisocial Behavior and Substance Use in Spanish Adolescents

This study was designed to examine the causal paths that predict antisocial behavior and the consumption of legal and illegal substances (drugs) in adolescents. The sample comprised 1,629 adolescents, 786 males and 843 females, between 14 and 18 years old. All participants provided reports of family, school, personality, and peer-group factors related to substance consumption and antisocial behavior in adolescence. A biopsychosocial multivariate model was used to predict both legal and illegal substance use, and an adequate match was obtained for both. However, much more variance was accounted for in legal compared to illegal substance use. The major predictors of alcohol and marijuana use were personality factors (aggression and impulsivity) and scholarly factors (adaptation to school and good grades) whereas the major predictor of illegal drug use was negative peer relations (violence and non-conformity). Identification of associated risk factors serves as a basis for appropriate prevention programs to reduce antisocial behaviors and substance use in adolescents.