The Impact of Motivation to Change on Substance Use Among Adolescents in Treatment

ABSTRACT

Clinicians emphasize the importance of motivation to change for effecting recovery from substance abuse disorders. However, little is known about motivation to change substance-abusing behavior among adolescents or its impact on treatment outcomes. The present research examines motivation to change among youth admitted to publicly funded substance abuse services and its influence on treatment outcomes. Data are based on interviews with 129 youth between 12 and 18 years of age. Multilevel (HLM) analyses are used to assess the relationship between substance use and motivation to change at the time of treatment admission and roughly one year later. Results suggest that more serious substance users are motivated better to change at the outset of treatment and experience more rapid declines in substance use after treatment begins.     

Tobacco Use Prevalence and Factors Associated with Tobacco Use in New U.S. Army Personnel

ABSTRACT

This study examined the prevalence of tobacco use and factors associated with pre-military service cigarette and smokeless tobacco use. From January 2000 to December 2006, military students arriving for Advanced Individual Training at the U.S. Army Ordnance School completed a questionnaire that asked about their use of tobacco products. The prevalence of smokeless tobacco use from 2000 to 2006 for women generally decreased, as did the number of cigarettes smoked per day by men. For men and women, factors associated with cigarette use included younger age, Caucasian race, and use of smokeless tobacco. Factors associated with smokeless tobacco use among men included younger age, Caucasian race, and cigarette use. For women, cigarette use was the only factor associated with smokeless tobacco use. The identified factors in this study could be used to establish strategies in the future to reduce tobacco use in the military.     

Application of the Protection Motivation Theory in predicting cigarette smoking among adolescents in China

Reducing tobacco use among adolescents in China represents a significant challenge for global tobacco control. Existing behavioral theories developed in the West — such as the Protection Motivation Theory (PMT) — may be useful tools to help tackle this challenge. We examined the relationships between PMT factors and self-reported cigarette smoking behavior and intention among a random sample of vocational high school students (N = 553) in Wuhan, China. Tobacco-related perceptions were assessed using the PMT Scale for Adolescent Smoking. Among the total sample, 45% had initiated cigarette smoking, and 25% smoked in the past month. Among those who never smoked, 15% indicated being likely or very likely to smoke in a year. Multiple regression modeling analysis indicated the significance of the seven PMT constructs, the four PMT perceptions and the two PMT pathways in predicting intention to smoke and actual smoking behavior. Overall, perceived rewards of smoking, especially intrinsic rewards, were consistently positively related to smoking intentions and behavior, and self-efficacy to avoid smoking was negatively related to smoking. The current study suggests the utility of PMT for further research examining adolescent smoking. PMT-based smoking prevention and clinical smoking cessation intervention programs should focus more on adolescents' perceived rewards from smoking and perceived efficacy of not smoking to reduce their intention to and actual use of tobacco.     

Drug Use Patterns and Risk Factors of Adolescents with Physical Disabilities

This study examined demographic, behavioral, and attitudinal variables and drug use in adolescents with physical disabilities as measured by the Primary Prevention Awareness, Attitude and Usage Scales (PPAAUS). When compared to the same age students in the general population, the students with physical disabilities responded differently. A chi-square analysis was performed between drug use and demographic, behavioral, and attitudinal variables. Results found for physically disabled students drug use correlated at p <. 05 with feelings toward school, negative disruptive behaviors, reported activities attended, and reported grade average.     

Association of Depression and Suicidality with Electronic and Conventional Cigarette Use in South Korean Adolescents

Background: The prevalence of Korean adolescents with depression was 25.1% in 2017, and the suicide rate among Korean teens increased from 4.2 deaths per 100,000 in 2015 to 4.9 deaths per 100,000 in 2016, suggesting that a high prevalence of depression and suicide among adolescents is a serious social problem in South Korea. Owing to the rapid growth of e-cigarettes in the last several years, it is important for research on smoking and mental health to distinguish different uses of tobacco products. Objectives: To examine the relationship between depression and suicidality among Korean adolescents, classified into nonusers, conventional-cigarette-only users, e-cigarette-only users, and dual users. Methods: Data were examined from the 2017 Korean Youth Risk Behavior Web-based Survey. The study included 62,276 students. A multivariate logistic regression was performed to assess the association of depression and suicidality with electronic and conventional cigarette use. Results: There were significant differences among the users: dual users had a higher prevalence of depression and suicidality for both lifetime and current use; e-cigarette-only users had higher levels of depression and suicidality than nonusers; and among female adolescents, conventional-cigarette-only users, e-cigarette-only users, and dual users had a higher prevalence of depression and suicidality than male adolescents. Conclusions: This is the first study to assess the association of depression and suicidality with conventional and e-cigarette use using a nationally representative Korean adolescent sample. These findings suggest an urgent need for evaluation of and intervention for e-cigarette use by health professionals providing smoking cessation programs for adolescents.     

Sense of Coherence and Tobacco Use Myths Among Adolescents as Predictors of At-Risk Youth Cigarette Use

We examined the association between a general construct of wellness beliefs, sense of coherence, and a specific measure of tobacco-related beliefs, tobacco use myths, as predictors of two smoking-related outcome measures—next year smoking expectation and last 30-day smoking. Self-report questionnaires were administered to 710 adolescents attending California continuation high schools at baseline and at 1-year follow-up between 2006 and 2008. Cross-sectionally, predictor and outcome measures were correlated. However, in longitudinal analyses, only tobacco use myths predicted change in outcome measures. We speculate that future smoking interventions among adolescents would achieve relatively efficacious outcomes by targeting specific health beliefs instead of global health beliefs. The study's limitations are noted.     

Dual Tobacco Use among College Students: Contexts of Use,Self-Perceptions,and Attitudes Toward Quitting

Aggressive marketing of smokeless tobacco (SLT) appears to have led to an increase in dual tobacco use. The current study examines the situational contexts, self-perceptions, and cessation attitudes/behaviors that relate to dual use. Participants (N = 1,242) at a large, Southwestern university completed a self-report measure of demographic and tobacco use variables in 2010. Data were analyzed using chi-square and one-way ANOVA techniques. Findings suggest that type of tobacco use varies by setting and that dual users are more likely than sole users to perceive themselves as regular tobacco users. Limitations and implications for future research and interventions are discussed.     

Sequential Progression of Substance Use Among Homeless Youth: An Empirical Investigation of the Gateway Theory

We examined the sequence of substance-use initiation in 375 street youth (age 13–21) who were interviewed from 1994–99 in Seattle, Washington. Based on the “gateway theory,” participants were categorized into six profiles to describe the order in which they initiated use of various substances (i.e., alcohol, marijuana, other drugs), or classified as nonprogressors if they had not tried all three classes of drugs. Youth progressing in the hypothesized gateway order (i.e., alcohol preceding marijuana, followed by other drugs) initiated their use at an earlier age than youth who had not progressed through all three substance classes. However, there was no relationship between a substance initiation profile and current substance-use. Implications include the recognition that street youth may follow different patterns of use than normative groups, and that interventions geared toward youth who use substances heavily must include contextual factors, in addition to substance-use history.     

Media Exposure and Tobacco,Illicit Drugs,and Alcohol Use Among Children and Adolescents: A Systematic Review

ABSTRACT

The authors systematically reviewed 42 quantitative studies on the relationship between media exposure and tobacco, illicit drug, and alcohol use among children and adolescents. Overall, 83% of studies reported that media was associated with increased risk of smoking initiation, use of illicit drugs, and alcohol consumption. Of 30 studies examining media content, 95% found a statistically significant association between increased media exposure and negative outcomes. Similarly, of the 12 studies evaluating the quantity of media exposure, 67% reported an association with a negative outcome. Overall, all 17 of the identified longitudinal studies supported a causal association between media exposure and negative outcomes over time. The evidence was strongest for links between media exposure and tobacco use; it was moderate for illicit drug use and alcohol use. Substantial variability in methodological rigor across studies and expanding definitions of media exposure contribute to persistent gaps in the knowledge base.     

Integrated Theory of Planned Behavior With Extrinsic Motivation to Predict Intention Not to Use Illicit Drugs by Fifth-Grade Students in Taiwan

This study assessed the effects of a model that integrated the theory of planned behavior (TPB) with extrinsic motivation (EM) in predicting the intentions of fifth-grade students to not use illicit drugs. A cluster-sampling design was adopted in a cross-sectional survey (N = 571). The structural equation modeling results showed that the model attained an acceptable overall fit and explained 85% of the variance in intention. The EM variables influenced intention through subjective norms and perceived behavioral control. Study findings support the proposed TPB-EM model and show that EM can foster a social cognitive mechanism that indirectly affects intention.     

Alcohol and Cigarette Use Among Warsaw Adolescents: Factors Associated With Risk and Resilience

Background: Youth in Poland are at notable risk for substance use. Guided by resiliency theory, we examine if developmental risk and promotive factors are associated with substance abuse risk. Objectives: We examined the association between adolescent cigarette and alcohol use and related risk and promotive factors including maternal support, neighbors' informal social control, friends' acceptance of substance use, and alcohol and cigarette use by nonparental adults. Method: Data were collected from a random sample of 13- to 14-year-old students attending Warsaw middle schools (N = 3029). We used hierarchical regression models and examined compensatory and protective models of resilience, controlling for sociodemograhic factors. Results: Our results indicated that friends' acceptance of substance use and perceived drug use among nonparental adults was associated with increased risk cigarette and alcohol use among youth. We found that maternal support moderated the relationship between friends' acceptance of substance use and cigarette use (protective model of resilience). Thus, mother support buffered the negative effects of friends' acceptance of substance use on youths' cigarette use. Neighbor's informal social control and maternal support were associated with reduced risk of alcohol use (compensatory model of resilience). Conclusion: Collectively, results of the study support compensatory and protective models of resilience in a large representative sample of Warsaw adolescents.     

Bipolar Disorder in a Population of Adolescents with Alcohol Use Disorders

ABSTRACT

Objectives: The objective of this paper is to present the prevalence of Bipolar Disorder (BPD) in a population of adolescents and young adults with alcohol use disorders (AUD) and to compare salient alcohol use, mood, and diagnostic variables between adolescents with BPD, those with Major Depressive Disorder (MDD), and those with AUD without a mood disorder.

Methods: The subjects were 452 adolescents and young adults, age 12.9 to 28.3 years, who met DSM-IV criteria for a lifetime history of either alcohol abuse or alcohol dependence. DSM-IV psychiatric and AUD diagnoses were obtained by semi-structure interviews (K-SADS and SCID) to discern the possible effect of comorbid BPD on alcohol and other drug variables, we compared adolescents or young adults who met DSM-IV criteria for concurrent BPD and AUD with adolescents with MDD plus AUD and those with AUD and no mood disorder. Following one-way ANOVA comparing across the 3 groups, we proceeded with post hoc analysis comparing the BPD+AUD group with either the MDD + AUD or AUD only group.

Results: 6.4% of the subjects met criteria for BPD. While there were no differences between groups on the alcohol consumption variables, subjects with BPD had a significantly earlier onset of an AUD diagnosis than either the MDD group or the AUD only group. The BPD + AUD group had a significantly greater percentage of subjects meeting criteria for alcohol dependence than the AUD only group.

Conclusions: Comorbid mood disorders, particularly Bipolar Disorder, may have an important effect on alcohol and substance use variables and diagnosis. More research is needed to determine the effect of treatments for mood disorder on both mood and substance use variables.     

School Factors and Alcohol Use: The Moderating Effect of Nativity in a National Sample of Latino Adolescents

Background: School is an important developmental context for adolescents and may be related to adolescent alcohol use. Less is known as to whether the relationships between school factors and alcohol use differ between Latino youth born outside of the United States versus those born in the United States. Objective: The aim of this study is to test nativity as a moderator of the relationship between school factors and alcohol use among Latino adolescents. Methods: This study used data from Waves I and II of the National Longitudinal Study of Adolescent Health (Add Health) to test nativity as a moderator of the relationship between school factors and alcohol use in a subsample of Latino adolescents. Results: Results found that during adolescence, nativity moderates the relationship between school connectedness and Wave I alcohol use. For those born outside of the United States, school connectedness was not related to alcohol use. Significant main effects emerged for grades in school and truancy. Better grades were associated with less alcohol use, while truancy was associated with greater alcohol use. The longitudinal relationships between school factors and Wave II alcohol use were not statistically significant. Conclusions: School connectedness is a contemporaneous risk factor for alcohol use among those born in the United States. Prevention efforts that address school contextual factors may be important for all Latino students to reduce engagement in alcohol use and optimize well-being.     

Factors Associated with Recent-Onset Injection Drug Use among Drug Users in Pakistan

Seventy-two recent-onset injection drug users and 241 non-injection drug users were recruited in Quetta and Lahore, Pakistan, in 2003. Trained interviewers administered questionnaires regarding drug use behaviors and perceived changes in drug cost/supply. Logistic regression identified independent correlates of recent-onset injection. In Lahore, a perceived increase in drug cost was associated with higher odds of recent-onset injection, with no association in Quetta. Recent-onset injection was also associated with family history of drug use, group drug use, and sharing snorting/chasing tools. Changes in perception of the drug supply may be associated with recent-onset injection drug use. Familial/social influences were also associated with recent-onset injection, suggesting peer-led interventions could discourage transition to injection drug use.     

Adolescent Waterpipe Use is Associated with Greater Body Weight: The Irbid-TRY

Background: Adult waterpipe smokers are at increased risk of obesity. However, it is unclear if adolescents, who are at the epicenter of the global waterpipe epidemic, are at similar risk. Objective: Therefore, the current study examined the waterpipe smoking relationship with obesity among adolescents. Methods: A sample of 2,313 boys and girls in grades 7–10 were surveyed about waterpipe and cigarette use in Jordan. Weight, body mass index (BMI), waist circumference, waist-to-hip ratio, and waist-to-height ratio were measured. Obesity indices were assessed as a function of smoking status (never used tobacco, current waterpipe only, current cigarettes only, and current dual smoking) as well as frequency of use of each tobacco product. Results: About 51.5% of adolescents smoked waterpipe whereas 29.8% were overweight/obese. Students who smoked waterpipe weekly had twofold greater odds of being obese than never-smokers (OR = 2.14; 95% CI = 1.08–4.21). Approximately 12% of students currently smoked waterpipe but not cigarettes, 2% smoked cigarettes but not waterpipe, and 11% smoked both. Body weight and age- and gender-specific BMI were greater for waterpipe and dual users compared to never users, especially for dual vs. never users (58.6 ±.8 vs. 55.6 ±.4 and.48 ±.07 vs..29 ±.03, respectively; p <.005). Conclusions: For dual users, greater frequency of tobacco use was associated with greater weight and BMI. Waterpipe and dual use is associated with greater obesity, BMI, and body weight among Jordanian adolescents. Given the rising epidemics of both tobacco use and obesity among Middle Eastern adolescents, the clustering of these risk factors warrants public health action.     

Teachers' Perceptions of Tobacco Use Prevention Education (TUPE) Programs in Florida: Relations with Perceived Barriers and Other Contextual Factors

ABSTRACT

Data were collected via brief telephone surveys from two statewide random samples of middle school teachers (n = 296) and high school teachers (n = 282) responsible for tobacco use prevention education (TUPE) in Florida. Cluster analysis was used to classify teachers based on their levels of support of, commitment to, and perceived effectiveness of TUPE programs. Between-cluster differences in teachers' perceptions of TUPE were significantly associated with perceived barriers and features of school contexts, although these relationships were more consistent among middle school teachers than among high school teachers. The implications of these findings for the effective delivery of TUPE programming to adolescents at different developmental levels are discussed.     

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.     

Alcohol Consumption Among Turkish Adolescents: An Empirical Test of General Strain Theory

Using data drawn from the 2008 Youth in Europe Survey, the current study examined alcohol consumption among Turkish adolescents through the lens of Agnew's general strain theory (GST). Although considerable attention has been paid to alcohol consumption among adolescents, extant research has remained limited to Western countries. Similarly, much of the support for GST was derived from research conducted in the United States. The current study explores factors associated with alcohol consumption in Turkey and tests the generalizability of GST. Results from ordinal logistic regression analyses indicated that, except for family strain, specific kinds of strain were significantly associated with drinking behavior without any mediating effect that could emanate from students’ negative affective states.