Relations Among Internalizing and Externalizing Symptoms and Drinking Frequency During Adolescence

Background: In adolescence, internalizing (e.g., anxious, depressive, and withdrawn) and externalizing (e.g., aggressive, oppositional, delinquent, and hyperactive) symptoms are related with alcohol use. However, the directionality among internalizing symptoms, externalizing symptoms, and alcohol use during adolescence is equivocal. Moreover, gender differences and similarities among these behaviors are not definitive in existing literature. Objectives: This study examined longitudinal relationships between internalizing and externalizing symptoms and past-month alcohol use among adolescent boys and girls. Methods: Using longitudinal survey data from a study of community-dwelling adolescents (n = 724), we estimated cross-lagged structural equation models to test relations between internalizing and externalizing symptoms (as measured by the Youth Self Report, YSR [Achenbach, 1991]) and self-report alcohol use in the past month among adolescents. Gender differences were tested in a multiple group structural equation model. Results: Alcohol use at age 12 was a predictor of internalizing and externalizing symptoms at age 15 for both boys and girls. With regard to gender differences, girls demonstrated an association between internalizing symptoms and drinking at age 12, whereas boys showed a stronger association between externalizing symptoms and drinking at age 18. Conclusions/Importance: Early alcohol use is problematic for youth, and results of this study lend support to prevention programs for youth. Preventing or curbing early drinking may offset later externalizing and internalizing symptoms, as well as ongoing alcohol use, regardless of gender.     

Impulsivity and expectancy in risk for alcohol use: comparing male and female college students in Taiwan

This was a longitudinal study designed to examine whether gender differences would exist in acquired preparedness model (APM) for explaining the risk of alcohol use in Chinese college students. Impulsivity was assessed for 3,584 students in 2002. In 2003, 1,377 students were traced and assessed in alcohol outcome expectancy, drinking behavior, and alcohol related problems, with 1,122 valid data (male=438). Separated by gender, the data was analyzed with the Structural Equation Model. Results showed that positive, not negative, outcome expectancy for alcohol mediated impulsivity's effect on alcohol use, and alcohol use had a direct effect on alcohol related problems in both males and females. In males, both negative and positive outcome expectancies failed to mediate impulsivity and alcohol related problems. In females, only positive outcome expectancy mediated the relation between impulsivity and alcohol related problems. This longitudinal data supported the acquired preparedness model for the risk in alcohol use among Chinese college students, providing a reference for designing prevention and intervention strategies guided towards both genders.     

Hazardous drinking and weight-conscious drinking behaviors in a sample of college students and college student athletes

ABSTRACT

Background: “Weight-conscious drinking” refers to behaviors to restrict calories in conjunction with consuming alcohol and is associated with numerous negative consequences. This behavior has been observed in the college student population but has not been examined among college student athletes. Methods: This cross-sectional study assessed drinking, hazardous drinking levels (Alcohol Use Disorders Identification Test—Consumption [AUDIT-C] sum score), and weight-conscious drinking behaviors (for weight loss purposes and for intoxication purposes) using a paper-and-pencil survey that was completed by students at a large, private university in the Southwest United States. The sample for this study included college student nonathletes (n = 482; 212 males and 270 females) who completed the survey in 1 of 34 classes and college student athletes (n = 201; 79 males and 122 females) who completed the survey during practice. These analyses examined whether hazardous drinking level and other personal covariates (gender, race, and athlete status) predicted the 2 weight-conscious drinking behaviors of interest. Results: Among the subsample of students who drank, the same proportion of participants indicated weight-conscious drinking behavior for weight loss and weight-conscious drinking behavior for intoxication (both 24.9%; n = 122). In the multivariate analyses, students with higher hazardous drinking scores and females were significantly more likely to report engaging in both weight-conscious drinking behaviors. In those analyses, neither weight-conscious drinking behavior varied by athlete status. Conclusions: In this sample of college students, hazardous drinking most predicted weight-conscious drinking behavior and superseded gender and athlete status. In response, college health professionals should consider evidenced-based approaches to address hazardous drinking.     

Internalizing Risk Factors for College Students' Alcohol use: A Combined Person- and Variable-Centered Approach

Background: Most studies that investigate internalizing problems (i.e., depression and anxiety symptoms) and alcohol use disorders use variable-centered approaches, losing important information about differences among individuals. Objectives: To group college students by different profiles of alcohol-use risk factors using a person-centered cluster analysis in two separate samples. Methods: Questionnaires were used in both studies to assess positive expectancies regarding alcohol use, coping motives for alcohol use, and symptoms of depression and anxiety. In the first study (2012), we collected information about past month alcohol use, including frequency and binge drinking episode (n = 171). In the second study (2013), we also included measures of externalizing behaviors and negative alcohol-related consequences (n = 526). Results: In Study 1, the cluster analysis identified four groups of students who displayed different patterns of risk: a low-risk group, moderate cognitions/low internalizing cluster, a high internalizing/low coping motives group of drinkers, and a high internalizing/high coping motives cluster of drinkers. This fourth group showed high levels of depression, moderate anxiety, high positive expectancies and coping motives for alcohol use, and reported the highest frequency of alcohol use. Study 2 replicated the findings from the previous study. Three groups of individuals were identified, replicating the low-risk cluster, the moderate cognitions/low internalizing cluster, and the internalizing cluster of drinkers from Study 1. Participants in the latter cluster endorsed the highest number of negative consequences of alcohol use. Conclusions: Results from both studies highlight the importance of tailoring alcohol abuse prevention efforts to a subgroup young adult who endorse internalizing symptoms.     

Is gender relevant only for problem alcohol behaviors? An examination of correlates of alcohol use among college students

This study examined correlates of alcohol use: substance-use coping, drinking to "feel high," and depressive symptoms as related to drinking behaviors in males and females. A sample of 266 female and 140 male college students from a private and public college were surveyed. Males reported more frequent alcohol use, alcohol-related problems, binge drinking, substance-use coping, and drinking to "feel high." There were no gender differences in self-reported depressive symptoms. Alcohol-use frequency and binge drinking were both accounted for by substance-use coping and drinking to "feel high" among males and females. However, alcohol-related problems were accounted for by males' frequency of alcohol use and drinking to "feel high," whereas females' problems were accounted for by frequency of alcohol use and depressive symptoms. Findings indicate that motivation for drinking is a more robust correlate of alcohol-related problems among males, while depressive symptomatology is a more relevant correlate of alcohol-related problems among females.     

Gender differences in the relationship between alcohol use and anxiety symptoms among Nigerian college students

Few studies have addressed the effect of gender on the relationship between alcohol and anxiety. Students in a Nigerian university, grouped into five separate categories of alcohol use completed the Zung's Self Rating Anxiety Scale. Although a non-linear "J shaped" relationship was found between alcohol use and anxiety symptoms among males, a linear relationship was found among females. Women tend not to share the positive effect moderate alcohol use confers on anxiety status. This gender difference may be an important consideration when planning preventive strategies for alcohol related problems in Nigerian youths.     

Psychological Risk Factors for Alcohol,Cannabis, and Various Tobacco Use among Young Adults: A Longitudinal Analysis

Background: Alcohol, cannabis, and tobacco use are prevalent in young adults and may be differentially related to psychological symptoms characterized as externalizing or internalizing. Objectives: This study examined the use of alcohol, cannabis, and various tobacco products in relation to externalizing (ADHD) versus internalizing factors (depression, anxiety), hypothesizing alcohol and cannabis use are associated with externalizing factors whereas tobacco use is related to internalizing factors. Methods: Data from a 2-year longitudinal study of 2,397?US college students (aged 18–25) launched in 2014 were analyzed. Adult ADHD Self-Report Scale, Patient Health Questionnaire-9 item (assessing depressive symptoms), and the Zung Self-Rating Anxiety Scale scores were examined in relation to subsequent past 30-day use of alcohol, cannabis, and tobacco products (cigarettes, little cigars/cigarillos, smokeless tobacco, e-cigarettes, hookah), as well as nicotine dependence per the Hooked on Nicotine Checklist. Results: Participants were 20.49 (SD = 1.93) years old, 64.7% female, and 65.5% White. In multivariable analyses, greater ADHD symptoms predicted alcohol and cannabis use (p = .042 and p = .019, respectively). Cigarette and little cigar/cigarillo use were predicted by greater depressive (p = .001 and p = .002, respectively), and anxiety symptoms (p = .020 and p = .027, respectively). Nicotine dependence was correlated with greater anxiety symptoms (p = .026). Counter to hypotheses, smokeless tobacco use was predicted by greater ADHD symptoms (p = .050); neither e-cigarette nor hookah use were predicted by these psychological symptoms. Conclusions/Importance: Research examining risk factors for tobacco use must distinguish among the various tobacco products. Moreover, interventions may need to differentially target use of distinct substances, including among the range of tobacco products.     

An Examination of Gender Differences in the Association of Adolescent Substance use with Eating and Weight Loss Attitudes

Objective: To assess gender differences in the relationship between eating and weight loss attitudes (EWAs), and 30-day tobacco and alcohol use among adolescents, while controlling for potential confounds (age, country of birth, psychological distress, pubertal development, peer alcohol and tobacco use, and sexual activity). Methods: School students aged between 11 and 17 years (N = 10,273) from high schools in the State of Victoria (Australia) completed surveys in class under conditions of anonymity and confidentiality. Results: The interaction between EWAs and gender was significant for tobacco use but not for alcohol use, indicating that the effect of EWAs on tobacco use, but not alcohol use, vary by gender. Conclusions: Tobacco use was related to EWAs in adolescent females but not males, and this is consistent with the possibility that females use tobacco in an instrumental fashion to control weight. Implications and Contribution: Female adolescents high in eating and weight loss attitudes were more likely to engage in tobacco use. In contrast, eating and weight loss attitudes were not related to male tobacco use. These results point to the potential importance of developing gender-specific approaches towards addressing problematic behaviors in adolescent populations.     

The gender specific mediational pathways between parenting styles,neuroticism, pathological reasons for drinking,and alcohol-related problems in emerging adulthood

Mediational links between parenting styles, neuroticism, pathological reasons for drinking, alcohol use and alcohol-related problems were tested. A two-group SEM path model with 441 (216 female, 225 male) college students was examined. In general, pathological reasons for drinking mediated the impact of neuroticism on alcohol use and alcohol-related problems. A different pattern of relationships was found for each of the two genders. Perceptions of having an authoritarian father were positively linked to higher levels of neuroticism among males but this pattern was not found among females. For males, neuroticism mediated the impact of having an authoritarian father on pathological reasons for drinking with pathological reasons for drinking mediating the impact of neuroticism on alcohol-related problems. Perceptions of having a permissive father were linked to lower levels of neuroticism in females (but have been found as a consistent risk factor for other pathways to alcohol use elsewhere). Compared with other work in this area, these findings indicate parental influences regarding vulnerabilities for alcohol use may be specific to parent–child gender matches for some pathways and specific to one parent (irrespective of child gender) for other pathways.     

Concussion History,Hazardous Drinking,and BrAC Levels Among a Sample of Bar Patrons, 2015

Background: Alcohol consumption and experiencing a concussion are positively correlated. Concussion history has not been examined previously in any alcohol field study (i.e., conducted in a natural setting). Objective: To better understand the relationship between concussion history and alcohol consumption. Methods: We conducted two anonymous field studies among a 2015 sample of bar patrons (N = 544; 62.5% males) in a college town to assess concussion history and two alcohol consumption measures: (1) breath alcohol concentration (BrAC) levels and (2) hazardous drinking scores (based on the AUDIT-C). Next, we conducted a logistic regression analysis to predict concussion history using the two alcohol consumption measures and other potential covariates (i.e., age, gender, race, college student status). Results: Among participants in our sample, the average BrAC level was.070 (SD =.053) and the average hazardous drinking score was 4.7 (SD = 2.5). Less than half of participants indicated that they had experienced a concussion in their lifetime (235; 43.2%). The logistic regression model indicated that hazardous drinking scores were significantly, positively associated with having experienced a concussion, whereas other covariates (i.e., BrAC, age, gender, race, college student status) did not significantly predict concussion history. Conclusions/Importance: Hazardous drinkers were more likely to have experienced a concussion. Therefore, the relationship found in this sample, between hazardous drinking behavior and concussion history, points to hazardous drinking as a possible risk factor for having had a concussion in the past.     

PTSD Symptom Severity,Cannabis, and Gender: A Zero-Inflated Negative Binomial Regression Model

Introduction: In the general population, significant relations have been shown between experienced trauma and cannabis use. Approximately three out of four college students report experiencing at least one-lifetime traumatic event, putting them at greater risk for developing substance use disorder (SUD), and college students report using cannabis to cope with negative effect and stress. However, PTSD symptom severity predicting cannabis use in the college population has not been investigated. Methods: This cross-sectional survey study investigated the relation between PTSD symptom severity and cannabis use, and explored the moderating effect of gender on this relation, using a non-directional, exploratory analysis, in a sample of college students (N?=?536; 68% female). Due to excessive zero values in the primary outcome, a zero-inflated negative binomial regression model was used. Results: Gender predicted number of cannabis using days [incidence rate ratio (IRR) = 2.17; 95%CI = 1.41, 3.35; p < .001]. The probability of being a cannabis user was moderated by gender [odds ratio (OR) = 0.96; 95%CI= 0.93, 0.99; p?=?.026], such that for males, as PTSD symptom severity increased, likelihood of being a cannabis user increased. This relation was not supported in females, however. Conclusion/Implication: Discussion includes the potential role of the endocannabinoid system, social norms, and motives in gender differences in PTSD-related cannabis use, and explores the self-medication hypothesis in this context.     

Gender,Acculturation, and Alcohol Consumption among Mexican Americans

Objective: This study examines the relationship between level of acculturation and drinking status among Mexican American males and females in three northern California cities. Method: The data analyzed were collected through the use of a telephone survey. The sample size is 932. Results: Our results show that acculturation has a direct effect on drinking status for women in the sample but not for men. At low levels of acculturation, our results show the expected difference in drinking status by gender; with high abstention rates for women and low abstention rates for males. At high levels of acculturation there is a convergence in drinking status with females approximating the proportion of male drinkers In the sample. Additionally, acculturation was associated with “heavier” drinking for females while place of birth was associated with “heavier” drinking for males. Conclusions: Studies of drinking patterns and related problems need to consider these factors.     

Acculturation,hazardous drinking and depressive symptomatology among Hispanics enrolled in a clinical trial

Background: Among Hispanics in USA, lower acculturation level has been found to be protective against alcohol abuse and depression. However, this relationship may not hold within at-risk samples. The prevalence and co-occurrence of hazardous drinking and depressive symptoms and their relationship to acculturation were examined among Hispanics enrolled in a study to reduce heavy drinking. At enrolment, all the participants reported past-month heavy drinking (one or more occasions of >4/5 drinks for females/males, and average weekly consumption >7/14 drinks per week). We explored whether gender moderated the effects of acculturation on hazardous drinking and depressive symptoms. Methods: Participants (N?=?100) completed measures at baseline. Results: Eighty-nine percent of participants met criteria for hazardous alcohol use as assessed by the AUDIT and of those, 55% (n?=?49) also reported elevated depressive symptoms. Of those who reported elevated depressive symptoms, nearly all (94%) met AUDIT criteria for hazardous drinking. Acculturation was not related to hazardous drinking or depressive symptoms in the full sample. Highly acculturated women reported more hazardous drinking than less acculturated women. Acculturation was not associated with hazardous drinking in men, but less acculturated men reported higher levels of depression than highly acculturated men. Discussion: Depression should be assessed in alcohol interventions for Hispanics. Alcohol interventions should be tailored for acculturation level and gender to improve relevance and efficacy. Clinical Trial Registration #NCT01996280.     

Relations between Positive Temperament,Substance Use,and Internalizing Problems among Adolescents and Young Adults with and without Medical Conditions

Background: Substance use problems are prevalent during emerging adulthood and may be particularly harmful for individuals with medical conditions. Understanding the role of positive temperament in substance use for adolescents and young adults (AYAs) may facilitate the identification of intervention and prevention targets given the complex relations between positive emotions and substance use. Objective: To examine whether components of positive temperament differentially relate to substance use in a sample of AYAs with and without medical conditions. Internalizing problems were examined as a secondary outcome given their comorbidity with substance use. Method: In a cross-sectional study that took place in 2015–2016, 494 AYAs (M_age = 19.30 years, SD = 1.33, 73% female) who were enrolled in college completed online questionnaires in a laboratory regarding their levels of positive temperament (i.e., high intensity pleasure and positive affect) as well as their substance use and internalizing problems. The primary analyses were conducted using structural equation modeling. Results: For healthy AYAs, high intensity pleasure was positively associated with drug and alcohol use problems and positive affect was negatively associated with drug use problems. Among AYAs with medical conditions, high intensity pleasure was positively associated with alcohol use problems. Positive affect was negatively associated with internalizing problems for both groups. Conclusions/Importance: Findings identify paths between components of temperament and substance use and internalizing problems that may inform prevention and intervention efforts tailored to the unique and overlapping needs of AYAs with a range of healthcare demands.     

Do outcomes after behavioral couples therapy differ based on the gender of the alcohol use disorder patient?

ObjectiveThis naturalistic study (conducted from 1992 to 1998) of behavioral couples therapy (BCT) compared female and male alcohol use disorder (AUD) patients on improvement and on drinking and relationship outcomes after BCT. We also evaluated gender differences on presenting clinical problems and extent of BCT participation.MethodParticipants were 103 female and 303 male AUD patients (98.5% alcohol dependence, 1.5% alcohol abuse) and their heterosexual partners, mostly White in their forties. Couples received 20–22 BCT sessions over 5–6 months. Drinking outcomes were percentage days abstinent (PDA) and alcohol-related problems. Relationship outcome was Dyadic Adjustment Scale. Outcome data were examined at baseline, post-treatment, and 6- and 12-month follow-up. Presenting problems were demographics, alcohol problem severity, illicit drug use, emotional distress, and relationship adjustment. BCT participation was BCT attendance and BCT-targeted behaviors.ResultsWe found few differences between female and male patients, who did not differ on improvement and outcomes after BCT. Both females and males showed significant large effect size improvements through 12-month follow-up on PDA and alcohol-related problems, and significant small to medium effect size improvements on relationship adjustment. Both females and males had high levels of BCT participation. Gender differences in presenting clinical problems (females being lower on age, years problem drinking, and baseline PDA, and higher on emotional distress) did not translate into gender differences in response to BCT.ConclusionResults showed no support for the suggestion that BCT might lead to greater improvement and better outcomes for female than male AUD patients on drinking or on relationship outcomes.     

The Relationship Between Parent Drinking and Adolescent Drinking: Differences for Mothers and Fathers and Boys and Girls

Background: Gender differences in the relationship between parent drinking and adolescent drinking are poorly understood. As parental alcohol use is a primary early exposure to alcohol for adolescents, it is important to understand how consequences may differ for adolescent males and females. Objectives: The aim of this paper was to examine gender differences in the relationship between mother’s and father’s heavy episodic drinking, and its combination, and adolescent drinking. Methods: The sample included 2,800 14–15?year olds (48.9% female) living in two-parent households from the Longitudinal Study of Australian Children. The adolescent outcome measure was having had an alcoholic drink in the past year. Mothers and fathers self-reported their frequency of heavy episodic drinking. Covariates included parents’ education, smoking, non-English-speaking background, and symptoms of psychological distress. Logistic regression was used to examine the hypotheses. Results: After adjustment for covariates, both mothers’ and fathers’ heavy episodic drinking significantly increased the likelihood of adolescent drinking. Moreover, fathers’ heavy drinking was more strongly related to adolescent drinking for girls. However, there were no gender differences in the relationship between mothers’ drinking and adolescent drinking, and the combination of mothers’ and fathers’ drinking was not more risky than heavy drinking in either parent alone. Conclusions: Parent heavy episodic drinking is a risk factor for adolescent drinking, after controlling for potential confounding variables. Results suggest that girls may be especially vulnerable to parent heavy drinking in early adolescence. This variation should be considered in the design and evaluation of family-based interventions to prevent adolescent drinking.     

Gender,Depressive Symptoms,and Daily Cigarette Use

Objective: It is widely known that cigarette use and depressive symptoms co-occur during adolescence and young adulthood and that there are gender differences in smoking initiation, progression, and co-occurrence with other drug use. Given that females have an earlier onset of depressive symptoms while males have an earlier onset of cigarette use, this study explored the possible bidirectional development of cigarette use and depressive symptoms by gender across the transition from adolescence to young adulthood. Gender differences in the stability and crossed effects of depressive symptoms and cigarette smoking during the transition to young adulthood, controlling for other known risk factors, were examined using a nationally representative longitudinal sample. Methods: A bivariate autoregressive multi-group structural equation model examined the longitudinal stability and crossed relationships between a latent construct of depressive symptoms and cigarette smoking over four waves of data. Data for this study came from four waves of participants (N = 6,501) from the National Longitudinal Survey of Adolescent Health. At each of four waves, participants completed a battery of measures including questions on depressive symptoms and an ordinal measure of number of cigarettes smoked per day. Results: The best-fitting bivariate autoregressive models were gender-specific, included both crossed and parallel associations between depressive symptoms and cigarette use during the transition to adulthood, and controlled for wave-specific parental smoking, alcohol use, and number of friends who smoke. For females, greater depressive symptoms at each wave, except the first one, were associated with greater subsequent cigarette use. There were bidirectional associations between depressive symptoms and cigarette use only for females during young adulthood, but not for males. Conclusions: The development of depressive symptoms and cigarette use from adolescence and into young adulthood follows similar patterns for males and females. Controlling for the correlation and stability between initial levels of depressive symptoms and cigarette use from adolescence into young adulthood, there remains a crossed association between cigarette use and depressive symptoms specific to females during young adulthood. The findings suggest that prevention interventions focused on mental health should include warnings that cigarette use may exacerbate depressive symptoms.     

Predicting Suicide Ideation for Substance Users: The Role of Self-Esteem,Abstinence, and Attendance at 12-Step Meetings

This study tested if a three-way interaction between gender, abstinence, and self-esteem could predict the occurrence of suicidal thoughts in a sample of drug users who are one year post-treatment. It was expected that those who resolved their drug and alcohol problems and had higher self-esteem would have a lower risk of suicide ideation than those who had resolved their drug and alcohol problems (e.g. were abstinent) and had lower self-esteem, and that this effect would be stronger for women than men. Using a 3-step hierarchical logistic regression, results indicated a significant 2-way interaction between self-esteem and abstinence in the predicted direction, and no effect for gender. However, it was also found that those who had lower levels of self-esteem, regardless of abstinence or continued use, had virtually identical odds of suicidal ideation. Further, increased frequency of attendance at AA/NA meetings also predicted a higher risk of suicide ideation. This suggests that careful assessment of depression symptoms or suicidal ideation for drug users seeking assistance be completed before automatically urging attendance at 12-step meetings. Implications for clinical work with clients are presented.     

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.