Do Parents Still Matter? The Impact of Parents and Peers on Adolescent Electronic Cigarette Use

PurposeVaping among adolescents has reached epidemic levels. Identifying factors associated with electronic cigarette (e-cigarette) use initiation could inform prevention programming. This study examined whether parental attitudes toward e-cigarettes impacted adolescent e-cigarette use intentions, positive expectancies of use, and actual use when accounting for adolescent attitudes and peer norms. Parents' negative attitudes toward e-cigarettes were expected to reduce teen e-cigarette use intentions. Low e-cigarette use intentions were expected to mediate the association between parental attitudes and teen e-cigarette use. Peer norms were expected to be associated with positive expectancies. Positive expectancies were expected to mediate the association between peer norms and teen e-cigarette use.MethodsA sample of e-cigarette naïve adolescents (n = 176, aged 14–17 years, 52% female, 82% Latinx/Hispanic) and their parents were assessed. Parents and adolescents rated harm associated with e-cigarette use. Adolescents reported their perceptions of peer e-cigarette norms, intentions, positive expectancies, and e-cigarette use. Cross-sectional models were estimated for e-cigarette use intentions and positive expectancies. Prospective mediation models (n = 142) characterized pathways to e-cigarette use.ResultsParents' attitudes toward e-cigarettes were associated with weaker intentions. Intentions mediated the association between parental attitudes and e-cigarette use. Adolescents reporting favorable e-cigarette peer norms endorsed more positive expectancies. Positive expectancies did not mediate the association between peer norms and e-cigarette use.ConclusionsParents actively shape adolescent e-cigarette use even when accounting for peer norms and adolescent attitudes. Involving parents in prevention programming may help reduce vaping among teens. These associations should be examined with a larger and more diverse sample.     

Parental solicitation,parental control,child disclosure,and substance use: native and immigrant Dutch adolescents

Objectives. The present study examined whether the relation of parental solicitation, parental control, and child disclosure with adolescent alcohol and cannabis use is similar for native and non-Western immigrant Dutch adolescents.

Design. Questionnaire data from two study-samples were used with a combined sample of 705 adolescents (mean age 16.2 years; 47.2% female; 25.2% non-Western immigrant background).

Results. Native Dutch adolescents reported more weekly alcohol use than immigrant adolescents, while rates of cannabis use by native and immigrant adolescents were similar. Immigrant females reported lower levels of parental solicitation and child disclosure, but higher levels of parental control than native females. There were no differences in the sources of parental knowledge between native and immigrant males. Regression analyses showed no significant interaction effects of parental solicitation, parental control, or child disclosure with ethnic background for both alcohol and cannabis use (all p values?>?.05).

Conclusion. Despite mean level differences in various factors, we did not find evidence of an interaction effect of the sources of parental knowledge with ethnic background on alcohol and cannabis use. This suggests that theories and prevention strategies focusing on these sources of parental knowledge in relation to substance use can be applicable to both native and immigrant Dutch adolescents.     

Environmental stressors, low well-being, smoking, and alcohol use among South African adolescents

This is the first study to examine the pathways from environmental stressors to substance use among a sample of South African adolescents (N = 2195). The study objective was to assess how environmental stressors might affect cigarette smoking and alcohol use among South African adolescents, and to focus on one mechanism, low well-being, which might mediate this association. Participants consisted of 2195 Black, mixed ancestry ("Colored"), Indian, and White youth, aged 12-17 years old (mean age = 14.6; SD = 1.8), recruited via a multi-stage stratified sampling procedure in Durban, Cape Town, and Johannesburg, South Africa. Data were collected via individual in-person structured interviews, administered by trained interviewers in the participant's preferred language. Structural equation modeling was used to analyze the interrelationships of environmental stressors (violent victimisation, legal and illegal drug availability) and low well-being (depressive symptoms, low self-esteem, health problems) with respect to adolescent cigarette smoking and alcohol use. The results supported our hypotheses: Environmental stressors were related to low well-being which, in turn, was linked to both adolescent smoking and alcohol use. There were also direct pathways from environmental stressors to both adolescent smoking and alcohol use. Smoking and alcohol use were significantly correlated. The findings suggest that environmental stressors may be associated with diminished psychological and physical well-being, as well as smoking and alcohol use, among South African adolescents. Longitudinal research is warranted to further understand the interrelationship of environmental stressors, low well-being, and adolescent substance use, so that these issues may be addressed by South African programmes and policies.     

Area Deprivation Affects Behavioral Problems of Young Adolescents in Mixed Urban and Rural Areas: The TRAILS Study

PurposeBehavioral problems occur more frequently among adolescents in deprived areas, but most evidence concerns urbanized areas. Our aim was to assess the impact of area deprivation and urbanization on the occurrence and development of behavioral problems among adolescents in a mixed urban and rural area and to examine the contributory factors.MethodsWe obtained data from the first two waves (n = 2,230; mean ages, 11.5 and 13.5 years respectively; response at follow-up, 96.4%) of the TRacking Adolescents' Individual Lives Survey (TRAILS). TRAILS is a prospective study of adolescent mental health in a mixed urban and rural region of the Netherlands. We assessed adolescent behavioral problems using the parent-reported Child Behavior Checklist (CBCL), the adolescent-reported Youth Self-Report (YSR) and the Antisocial Behavior Scale (ABS). Living areas were categorized into tertiles of deprivation. We further collected data on child temperament, perceived rearing style, parental socioeconomic position (education, income and occupation), family composition, and parental mental health history.ResultsAt baseline, adolescents living in the most deprived tertile more frequently had elevated behavioral problem scores than those from the least deprived tertile on the CBCL (11.2% against 7.1%), YSR (11.9% against 6.9%), and ASB (11.5% against 7.4%) (all p < .05). Socioeconomic position explained half of the differences due to area deprivation. Other familial and parental characteristics did not significantly contribute to the explanation of observed area differences.ConclusionsAs in highly urbanized areas, behavioral problems occur more frequently among adolescents in deprived mixed rural and urban areas. Urbanization has little effect on these area differences.     

Risk and Protective Factors for Adolescent Substance Use: Findings from a Study in Selected Central American Countries

PurposeTo identify the prevalence of substance use and problems with use, and risk and protective factors at different levels of the adolescent’s ecology associated with substance use among adolescents in selected Central American countries.MethodsResults of a survey of 17,215 students from Panama, Costa Rica, and Guatemala conducted in 2000–2001 served as the basis for the analyses. Lifetime use of alcohol, tobacco, marijuana, and five other drugs (inhalants, tranquilizers, cocaine, crack, and ecstasy), and problems with drugs and alcohol were the outcome variables. Risk factors included dysregulation, family problems with drugs/alcohol, negative family interactions, school disengagement, peer deviance, and exposure to community violence. Protective factors included a personal belief in God, positive family interactions, parent religiosity, and positive student-teacher interaction. Both hierarchical linear regression and logistic regression analyses were used to model main and interaction effects of risk and protective factors.ResultsThere was a linear association between number of risk and protective factors and substance use, however, risk factors were more strongly associated with substance use than were protective factors. There were significant risk-by-protective-factor interactions for alcohol and marijuana use, and for problems with drugs and alcohol. Risk interacted most consistently with a personal belief in God, but also with parent religiosity and with student-teacher communication.ConclusionsIt is important to consider risk and protective factors at different levels of an adolescent’s ecology. Prevention and intervention efforts should focus on interactions adolescents have in different microsystems (e.g., with parents, teachers, and peers).     

Risk and Protective Factors Distinguishing Profiles of Adolescent Peer and Dating Violence Perpetration

PurposeViolence profiles were created on the basis of whether adolescents used violence against both peers and dates, against dates but not peers, against peers but not dates, or against neither peers nor dates. We determined (1) whether risk and protective factors from five domains (individual attributes and behaviors, the peer, family, school, and neighborhood contexts), based primarily on social learning and social control theories, were associated with violence profiles, (2) whether factors distinguishing profiles varied by gender, and (3) which of the domains was most important in distinguishing profiles.MethodsData are from adolescents in grades 8 through 10 from schools in three nonmetropolitan Counties (n = 2,907).ResultsAdolescents who used violence against both peers and dates used more of each type of violence compared with those who used only one type of violence. They also had more maladaptive risk and protective scores than adolescents perpetrating only peer violence or neither type of violence, although they had few differences from those perpetrating only dating violence. Most social learning theory risk factors and social control theory protective factors distinguished the profiles as did psychological attributes and substance use. Factors distinguishing profile membership were generally the same for boys and girls, although some associations were stronger for boys than for girls. The model fit statistics suggest that the individual attributes and behaviors and the peer context models fit the data the best.ConclusionsSuggestions for developing theoretically based interventions for preventing both peer and dating violence are presented.     

Parental and Peer Influences on the Risk of Adolescent Drug Use

Using a probability sample of 4,230 adolescents from grades 7–12, we used negative binomial regression to estimate the effects of peer and six family variables on the risk of adolescent drug use. Peer drug use had relatively strong effects of adolescent drug use. Parental drug attitudes, sibling drug use, and adult drug use had significant direct effects net of peer influences. In addition, they had significant indirect effects that were mediated by peer drug use. The influences of parental monitoring, attachment to mother, and attachment to father were statistically significant but relatively small. The findings applied to alcohol, binge drinking, cigarettes, marijuana, and other illicit drugs. Editors' Strategic Implications: The authors interpret their findings as being more consistent with social learning than social control theory. This research, although cross-sectional and limited to adolescents' self-reports, contributes to a growing literature on the direct and indirect influences of parents on their teens' substance use rates. It speaks to the need for school- and community-based prevention efforts to focus on families as well as peers.     

A Longitudinal Study of Sexual Risk Behavior Among the Adolescent Children of HIV-Positive and HIV-Negative Drug-Abusing Fathers

PurposeThis is a longitudinal study of the precursors of sexual risk behavior among a cohort of adolescent children of HIV-positive and HIV-negative drug-abusing or drug-dependent fathers.MethodsIndividual structured interviews were administered to 296 drug-abusing or drug-dependent fathers, 43% of whom were HIV positive, and an adolescent child of each father (mean age = 16.3 years; SD = 2.8). Adolescents were reinterviewed approximately 1 year later, at Time 2.ResultsStructural equation modeling showed multiple direct and indirect pathways from psychosocial factors to adolescent sexual risk behavior (sexually active, number of sexual partners, and frequency of condom use). Greater paternal drug addiction and infection with HIV/AIDS, and the youth's perception of environmental hostility (discrimination and victimization), were both related to increased adolescent maladjustment and substance use. Greater paternal drug addiction and infection with HIV/AIDS also were associated with a weaker father–child mutual attachment, which was linked with increased adolescent maladjustment and substance use. Greater perceived environmental hostility (discrimination and victimization), a weak father–child relationship, and greater adolescent maladjustment and substance use had direct pathways to adolescent sexual risk behavior.ConclusionsFindings suggest complex interrelationships among paternal, environmental, social, personal, and substance use factors as longitudinal predictors of sexual risk behavior in children whose fathers abuse or are dependent upon drugs. The importance of perceived environmental hostility, the father–child relationship, and adolescent maladjustment and substance use may have implications for public policy as well as prevention and treatment programs.     

Does the influence of peers and parents on adolescents' drunkenness differ between Roma and non-Roma adolescents in Slovakia?

Background. Roma adolescents have been shown to use less alcohol than non-Roma adolescents. This could be due to the protective influences of peers and parents.

Objective. The purpose of this study was to explore differences in the levels of peer and parental influence and their effects on drunkenness between Roma and non-Roma adolescents.

Design. Data were obtained in Eastern Slovakia from 330 Roma (mean age=14.50; 48.5% boys) and 722 non-Roma (mean age=14.86; 53.2% boys) primary school pupils. We analysed data on adolescent drunkenness (being drunk at least once in the past four weeks), parental monitoring (parents knowing with whom their children are when they go out) and peer influence (best friend drinking alcohol at least once a week) using logistic regression.

Results. Roma adolescents self-reported more parental monitoring and less peer influence when compared with their non-Roma counterparts (p<0.001). Less parental monitoring contributed to the probability of drunkenness only among girls (OR/CI: 4.17/2.00–8.69). This effect of parental monitoring was not modified by ethnicity. Peer influence affected drunkenness in both boys (OR/CI: 3.34/1.91–5.85) and girls (4.84/2.55–9.19), but there was no significant interaction of ethnicity with peer influence.

Conclusion. While both boys and girls seem to be sensitive to peer influence, only girls appear to be sensitive to parental monitoring in regard to drunkenness. Stronger parental monitoring and weaker peer influence partially explain the lower prevalence of drunkenness among Roma adolescents, whereas the effects of these factors per level do not vary between Roma and non-Roma adolescents.     

Variation in Sexual Behaviors in a Cohort of Adolescent Females: The Role of Personal,Perceived Peer,and Perceived Family Attitudes

PurposeLittle is known about how adolescent sexual behaviors develop and the influence of personal or perceived social attitudes. We sought to describe how personal, perceived peer, and perceived family attitudes toward adolescent sexual activity influence sexual behaviors of adolescent females' over time.MethodsBetween the years of 1999 and 2006, 358 English-speaking female adolescents, aged 14–17 years, were recruited from three urban adolescent clinics. Participants completed quarterly and annual questionnaires over a span of 4 years. Primary outcomes included engagement in any of the following eight sexual behaviors: kissing, having breasts touched, having genitals touched, touching partners' genitals, oral giving, oral receiving, anal, or vaginal sex. Three attitudinal scales assessed personal importance of abstinence, perceived peer beliefs about when to have sex, and perceived family beliefs that adolescent sex is negative. We used generalized estimating equations to identify predictors of each sexual behavior and compared whether personal, perceived peer, or perceived family attitudes predicted sexual behaviors over time.ResultsThe odds of reporting each sexual behavior increased with age but were lower among those whose personal or perceived family attitudes were less positive. Participants' personal attitudes toward adolescent sex were the strongest predictor of engagement in all eight sexual behaviors even after controlling for perceived peer and perceived family attitudes.ConclusionsFemale adolescent's personal attitudes toward abstinence appear to be the strongest predictor of engagement in a variety of sexual behaviors. Efforts to influence adolescent attitudes toward abstinence may be an important approach to reducing sexual behaviors that increase the risk of pregnancy and sexually transmitted infections.     

Promising to wait: Virginity pledges and adolescent sexual behavior

PurposeThe current study examined the association between formal and non-formal virginity pledges and the initiation of genital play, oral sex, and vaginal intercourse among adolescents.MethodsLogistic regressions controlling for age, gender, race, expectancies, academic achievement, contraceptive education, perceived peer pledging behavior, and parental and peer attitudes were conducted to examine the relationship between pledging behavior and genital play, oral sex, and vaginal intercourse. A total of 870 adolescents aged 12–16 from 10 counties in northern and southern California participated in the current study.ResultsThe findings indicate that making a private pledge or promise to oneself to wait to have sexual intercourse until one is older reduces the likelihood that adolescents will engage in sexual intercourse and oral sex. The effect persists even when controlling for socio-demographic variables. Making a formal pledge did not appear to have an effect on sexual behavior.ConclusionsThe findings raise questions about the effectiveness of formal virginity pledges in preventing adolescent sexual behavior. The findings suggest that sexual health programs may be more effective if they encourage young people to make a personal commitment to delay the onset of sex, foster social norms supportive of delaying sex, and raise awareness of how early sexual initiation may threaten future plans.     

Understanding Adolescent Parenthood From a Multisystemic Perspective

PurposeThis study examined the associations between social, behavioral, and environmental factors and adolescent parenthood.MethodsWe analyzed data from a subsample of participants, 18–30 years of age (n = 7,937), who took part in the 2001–2002 National Epidemiologic Study on Alcohol and Related Conditions, a nationally representative survey of adults. An extended Cox proportional hazards model was used to model time until becoming an adolescent parent (i.e., age at which first child was born if ≤18 years). Predictor variables of interest included initiation of alcohol, marijuana, cocaine, and daily cigarette use, age of earliest conduct disorder symptom, having a parent with alcohol and/or drug problems, parental death, divorce and/or separation, race/ethnicity, and gender.ResultsSeveral variables were associated with adolescent parenthood, including initiation of daily cigarette smoking, age of first antisocial/conduct disorder symptom, and race/ethnicity. Parental alcohol/drug problems and parental death were also associated with adolescent parenthood for women. A significant interaction between initiation of daily cigarette smoking and ethnicity was present for women. Daily cigarette smoking was associated with adolescent parenthood to a greater degree than nondaily cigarette smoking for white and Hispanic women but not African American women. No significant associations were found between adolescent parenthood and initiation of drinking, marijuana, or cocaine and parental divorce/separation.ConclusionsPrevention efforts should focus on adolescents who are at highest risk of adolescent parenthood.     

Peer Influences: The Impact of Online and Offline Friendship Networks on Adolescent Smoking and Alcohol Use

PurposeOnline social networking sites (SNSs) have become a popular mode of communication among adolescents. However, little is known about the effects of social online activity on health behaviors. The authors examined the use of SNSs among friends and the degree to which SNS activities relate to face-to-face peer influences and adolescent risk behaviors.MethodsLongitudinal egocentric friendship network data along with adolescent social media use and risk behaviors were collected from 1,563 10th-grade students across five Southern California high schools. Measures of online and offline peer influences were computed and assessed using fixed-effects models.ResultsThe frequency of adolescent SNS use and the number of their closest friends on the same SNSs were not significantly associated with risk behaviors. However, exposure to friends' online pictures of partying or drinking was significantly associated with both smoking (β = .11, p < .001) and alcohol use (β = .06, p < .05). Whereas adolescents with drinking friends had higher risk levels for drinking, adolescents without drinking friends were more likely to be affected by higher exposure to risky online pictures (β = −.10, p < .05). Myspace and Facebook had demographically distinct user characteristics and differential effects on risk behaviors.ConclusionsExposure to risky online content had a direct impact on adolescents' risk behaviors and significantly interacted with risk behaviors of their friends. These results provide evidence that friends' online behaviors should be considered a viable source of peer influence and that increased efforts should focus on educating adolescents on the negative effects of risky online displays.     

Individual and Country-Level Effects of Cannabis-Related Perceptions on Cannabis Use. A Multilevel Study Among Adolescents in 32 European Countries

PurposeThe present article investigated individual and aggregated effects of cannabis-related perceptions and other cannabis-related indicators on 12-month cannabis use prevalence and frequency among 15–16 year olds using multilevel analysis across 32 European countries.MethodsData on cannabis use, perceptions of availability, risks and friends’ use as well as socio-demographic characteristics were taken from the 2007 European School Survey Project on Alcohol and Other Drugs. At the country level, aggregated measures of the perceptions were used. Data on cannabis price and 12-month cannabis use prevalence in the total population were taken from the World Drug Report. The analytical sample comprised 86,107 students (82.5% of the overall 2007 international database).ResultsStrong and persistent individual-level effects were identified for perceived availability, perceived harm, and the number of cannabis using friends. The effects on cannabis use prevalence and frequency were more pronounced than country-level effects. At the country level, aggregated perceived peer consumption and population prevalence were significant predictors, whereas price was not found to be related to both outcome variables. The association between perceived friends’ use and cannabis use was moderated by aggregated perceived availability.ConclusionsProximal influences related to the immediate social situation seem to be more strongly associated with cannabis use than do distal influences related to social contexts, emphasizing the importance of personal attitudes and perceptions in substance use behavior. Prevention programs may focus on informing adolescents about the potential risks of cannabis and on correcting misperceptions of social norms. Policy measures may target on reducing visibility of drug use.     

Alcohol Use Among Rural Middle School Students: Adolescents,Parents, Teachers,and Community Leaders’ Perceptions*

BACKGROUND: Although rural adolescents use of alcohol is at some of the highest rates nationally, rural adolescent alcohol use has not been studied extensively. This study examines how community attitudes and behaviors are related to adolescent drinking in rural environments. METHODS: Data were gathered in 22 rural communities in the Upper Midwest (North Dakota, South Dakota, Wisconsin, and Wyoming). Surveys were collected from 1424 rural sixth‐ to eighth‐grade adolescents and 790 adults, including parents, teachers, and community leaders. Census data were also collected. RESULTS: Drinkers differed from nondrinkers by the following factors: higher perceptions of peer, parental, and overall community drinking, as well as lower levels of parental closeness and religiosity. Factors distinguishing binge and nonbinge drinkers were increased drinking to reduce stress, drinking to fit in, perceptions of peer drinking, and perceived lack of alternatives to drinking. Parents were significantly less likely to perceive adolescent alcohol use as a problem than other community adults; school officials were most likely to perceive it as a problem. Parental perceptions were also the least correlated to actual adolescent use, while adolescent perceptions were the most highly correlated. CONCLUSIONS: Community fac tors such as overall prevalence of drinking, community support, and controls against drinking are important predictors of reported use in early adolescence. School officials were more likely to view adolescent alcohol use as a problem than were parents. School officials’ perceptions of adolescent use were also more related to actual adolescent use than were parental perceptions of adolescent use.     

Longitudinal influence of perceptions of peer and parental factors on African American adolescent risk involvement

To explore the long-term contributions of perceived peer and parental influences on adolescent risk and protective behaviors (sexual involvement, condom use, and drug use), we assessed self-reported behaviors and perceptions of peer risk involvement and parental supervision and communication among 383 low-income, urban African Americans aged 9 to 15 years at baseline over a 4-year, period. Baseline perceptions of peer sexual involvement were significantly associated with youth sexual behavior at baseline and were predictive of sexual involvement through all 4 years of follow-up. Perceived parental monitoring was inversely correlated with sexual involvement ment through 3 years of follow-up. Perceptions of peer condom use were associated with increased levels of condom use at baseline and through 6 months of follow-up. Positive parental communication was correlated with increased condom use. Drug use was higher among youths who perceived peers or family members to be using drugs and was inversely correlated with increased parental monitoring and supervision. Stepwise regression revealed peer and parental influences for all three behaviors. Perceptions of both peer and parental behaviors influence long-term risk and protective behaviors of adolescents. Therefore, parents should be included in adolescent riskreduction intervention efforts. Inclusion of friends and/or changing youth perceptions of peer involvement may also be effective intervention strategies.     

Joint Consideration of Distal and Proximal Predictors of Premature Mortality Among Serious Juvenile Offenders

PurposeJuvenile offenders are at heightened risk of death in adolescence and young adulthood compared to adolescents in the general population. The current study extends previous research by testing the joint contributions of distal (historical and demographic characteristics) and proximal (closer to the time of the death) predictors of mortality. We also tested whether proximal variables were potential mediators of the effects of distal variables on mortality.MethodsParticipants were 1,354 serious juvenile offenders, 45 (3.32%) of whom were deceased by the completion of the study. Data were collected through self-reports and official records.ResultsSignificant distal predictors of mortality were being African-American and having a history of substance use disorder. Proximal predictors that added significantly to prediction included gun carrying, gang membership, and substance use problems. Potential mediators of the effects of substance use disorder history were continuing substance use problems and gang membership. However, proximal variables could not explain the heightened risk for African-Americans.ConclusionsGang membership, gun carrying, and substance use problems are risk factors for early mortality among juvenile offenders, but they do not explain the elevated risk for death among African-Americans. Thus, further research is needed to understand the mechanisms underlying risk for premature death among African-American adolescent offenders.     

A Prospective Study of Intraindividual and Peer Influences on Adolescents' Heterosexual Romantic and Sexual Behavior

Theories and empirical studies of adolescent sexual behavior have identified the contributions of personal attributes and social experiences; however, it is rare that models have clarified developmental pathways to adolescent sexual behavior that include (1) factors assessed prior to and early in adolescence and (2) dyadic experiences in adolescence that provide the opportunity for sexual behavior (i.e., dating). Using data from a prospective study, structural equation modeling was used to test a model predicting adolescent sexual behavior at age 19, denoted by the number of lifetime sexual partners. Predictors examined were sociability and impulsivity assessed at 30 months of age, physical characteristics and experiences with peers measured at age 12-13, the age of first romantic relationship, and frequency of alcohol use at age 16. The pathway to greater sexual involvement was marked by some desired personal attributes (e.g., sociability) and peer experiences (e.g., higher quality friendships). These associations were mediated, however, by earlier initiation of romantic relationships and more frequent use of alcohol in middle adolescence. Earlier initiation of romantic relationships and more frequent alcohol use were predicted by greater sociability and less impulsivity in childhood, higher quality friendships and greater peer acceptance in early adolescence, and a more mature appearance and physical attractiveness (among females) at age 13. The findings imply a complex pathway that leads to a greater accumulation of sexual partners by age 19. This pathway begins in childhood and includes individual qualities, peer acceptance, romantic relationships, and alcohol use.     

Family Factors Associated With Suicide Attempts Among Chinese Adolescent Students: A National Cross-Sectional Survey

PurposeTo determine the prevalence and associated family factors of suicide attempts among junior and/or senior high school students, so as to provide bases for preventive measures of suicide in China.MethodsA total of 13,512 students from 32 junior and/or senior high schools in grades 7 to 11 in eight cities of China participated in a self-administered anonymous survey to report their frequency of suicide attempts during the past year. Sociodemographic characteristics, tobacco, and alcohol use in the past 30 days were asked. Stressful family life events were used to evaluate the subjects' family characteristics.ResultsOverall, 2.7% (338/12,470) in-school adolescents reported a suicide attempt during the past year, girls significantly more often than boys. Considered independently, all stressful family life events were strongly associated with increased risk for self-reported suicide attempts. When taking sociodemographic characteristics, life style, and all the five family factors selected from factor analysis into consideration, there was a significant independent impact of three family factors on increasing suicide attempts risk among adolescents. The most notable risks were derived from improper parental rearing behavior, separation from parents, and social problems of the family members. However, neither poor material conditions of family life nor family member's adversity contribute significantly to the risk.ConclusionsThis study not only indicates that suicide attempt is a significant public health issue among in-school adolescents in China, but also confirms that adolescents with family problems commonly manifest suicide attempts, which highlights the importance of considering family environmental factors when assessing suicide risk.