The relationship between employment and substance use among students aged 12 to 17

Age, gender and socioeconomic patterns of awareness and usage of e-cigarettes across selected WHO region countries: evidence from the Global Adult Tobacco Survey

OBJECTIVES

The study explores the awareness and e-cigarette use by demographic and socio-economic characteristics of selected 14 Global Adult Tobacco Survey (GATS) countries.

DESIGN

Cross-sectional.

SETTING

14 countries.

PARTICIPANTS

Surveyed population ≥15 years selected through multi-stage cluster sampling.

PRIMARY AND SECONDARY OUTCOME MEASURES

We selected 14 countries from 6 different WHO regions where GATS was conducted in different years during 2011-2017.

RESULTS

Awareness and usage of e-cigarette were highest in Greece and lowest in India. Females were less aware of e-cigarette across ages. The gender gap in awareness is wide in Greece post 50 years of age, while the gap is distinct in early ages in Kazakhstan and Qatar. The gender difference in use of e-cigarette was negligible in most of the countries except among the younger cohorts of Russia, Philippines Malaysia and Indonesia. Relatively higher prevalence of e-cigarette smoking among females in the older adult age was observed in some of the Asian countries like India. Multivariate analysis indicates that those who were younger, male, residing in urban areas, current tobacco smokers were more likely to use e-cigarette than their counterparts. Though prevalence of e-cigarette use increased with wealth and education, such pattern is not strong and consistent. Promotional advertisement plays important role in higher use of e-cigaratte. The predicted national prevalence of e-ciragette use was highest in Malaysia .

CONCLUSIONS

E-cigarette use is more among urban adults, current smokers, males and in countries with promotional advertisement of e-cigarette. Area specific interventions are needed to understand the nature of e-cigarette use. Russia, Ukraine, Costa Rica and Mexico need better understanding to explore whether e-cigaratte use is an indulgence to new mode of addiction, as youth being highly likely to adopt this practice.

Prevalence and factors associated with substance use among HIV positive youth attending HIV care and treatment centers in Dodoma, Tanzania

BACKGROUND

Substance use among people living with HIV is associated with poor health, social, and psychological outcomes. This study assessed the prevalence of substance use and associated factors among youth attending HIV care and treatment centers (CTCs) in Dodoma, Tanzania.

METHODS

This cross-sectional study was carried out in Dodoma, Tanzania, from February to April 2020 among youth aged 15-24 attending HIV CTCs. Data was collected using sociodemographic, WHO ASSIST Version 3.0, BDI II, and SERAD questionnaires. Data analysis was done using Stata 17. Descriptive statistics were used to summarize continuous and categorical variables. Univariable and multivariable logistic regression analyses were conducted to determine factors independently associated with substance use.

RESULTS

The prevalence of substance use was relatively low (6.6%). Older youth (20 to 24 years) were 2% less likely to use substances compared to the younger ones (15 to 19 years) (AOR: 0.07; 95% CI 0.01, 0.83). There were statistically significant decreasing odds of substance use with every year increase in age at HIV diagnosis (OR: 1.66; 95% CI 1.14, 2.41). Being unemployed was statistically significantly associated with decreased odds of substance use among this population (OR: 0.03; 95% CI 0.02, 0.33). Youth who had detectable viral loads were significantly more likely to use substances compared to those with undetectable viral loads (AOR: 12.9; 95% CI 1.07, 156.05).

CONCLUSIONS

Despite the low prevalence of substance use found in this study, it is important to note that late age of HIV diagnosis, employment, and detectable viral load negatively impacted HIV positive youth with regards to substance use. It is recommended that CTCs emphasize routine screening for substance use among youth who have detectable viral loads.

Does substance use by family members and community affect the substance use among adolescent boys? Evidence from UDAYA study, India

Background

Substance use among adolescents is risky behavior that had emerged as a concern in both developed and developing countries. Evidence revealed that substance use is more frequent among those adolescents whose immediate family members (parents, siblings and grandparents) also indulge in such consumption; however, scarce literature is present in the Indian context. Therefore, the present study examined whether substance use among family members and in the community is associated with the substance use behavior of adolescent boys in Uttar Pradesh and Bihar.

Method

We used the data for 5969 adolescent boys aged 10–19 years from the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey conducted in 2016. A three-level random intercept logit model was utilized to understand the association of adolescent substance use behavior with familial and community context.

Results

We found that 16% of adolescent boys were using any substance (tobacco or alcohol or drug). The substance use was significantly higher among adolescent boys who were school dropouts (40%) than those who were currently in school. The prevalence of substance use is also high among those who were working (35%). Moreover, 19, 24 and 28% of the adolescents come from families where at least one of the family members consumed tobacco, alcohol and drugs, respectively. The odds of substance use were 2.13 times [CI:1.44–3.17] higher among those adolescent boys whose family members also indulged in substance use. Moreover, the likelihood of substance use was 1.24 times [CI:1.01–1.68] higher among the adolescent boys who come from a community with high substance use. Additionally, the risk of substance use is more likely among adolescent boys belonging to the same household of the same community.

Conclusion

It is evident that exposure to substance use in the family and community increases the likelihood of substance use among adolescent boys. There is a need for household- and community-level programmatic interventions to alleviate the risk of substance use among adolescents.

Prevalence of and Factors Associated with Club Drug Use among Secondary Vocational Students in China

To understand the prevalence of and factors associated with club drug use among Chinese secondary vocational students, a nationally representative survey was conducted. The multistage cluster sampling strategy was employed to select participants. A total of 9469 students from eleven secondary vocational schools in five cities completed self-reported questionnaires, which included information on club drug use, sociodemographic variables, individual factors, as well as peer and family related factors. The data were separately analyzed with Poisson regression models for female and male students. The overall lifetime prevalence of club drug use was 2.7% (258/9469), and male students had higher prevalence than female students (3.5% vs. 1.9%, p < 0.001). Female and male students shared four risk factors (i.e., having ever smoked, perceiving social benefit expectancies, peer drug using and perceiving peer's approval of drug use) and one protective factor (i.e., having medium or high levels of refusal skills) for club drug use. Moreover, family drug using and having a part-time job were two additionally independent risk factors for club drug use among male students. These findings indicate that the problem of club drug use among Chinese secondary vocational students is worthy of attention. The prevention of club drug use should address multiple risks and protective factors on individual, peer and family levels.

Young drivers vs. non-drivers: are there differences in behaviour?

BACKGROUND

Traditionally, a first step toward independence for a North American youth has been to obtain a driver's licence. Licensure can be associated with freedom and independence to provide teens opportunities to participate in conventional and health-enhancing behaviours, such as school, work, sporting events and other social activities, and/or provide opportunities to engage in unconventional, risk taking and health compromising behaviours. Yet, recent trends show that youth are delaying getting their licence.

OBJECTIVE

The purpose of this study was to use the constructs of conventional and unconventional behaviours identified in Problem Behaviour Theory (PBT) under the behaviour system to examine whether driver licensure status in youth was associated with conventional, health-enhancing behaviours or unconventional, health compromising, risky behaviours.

METHOD

Data were derived from the 2015 and 2017 cycles of the Ontario Student Drug Use Survey (OSDUHS). Analyses are based on a subsample of students who were at least 16 years of age. Included measures: driver's licence (at least a G1 - the first stage of a 3-stage graduated licensing system), conventional behaviours (academic performance, school connectedness, employment, physical activity, and sleep), unconventional behaviours (tobacco use, cannabis use, alcohol use, binge drinking, hazardous drinking, problematic drug use, screen time, and number of antisocial behaviours), and control factors (age, sex, region, family Socio-Economic Status (SES)).

RESULTS

67.97 % of youth 16-19 years of age obtained a driver's licence. Of the sample, 71.80 % of males, 75.05 % not living in the Greater Toronto Area (GTA), and 70.86 % of youth with an average family SES received their driver's licence. In regression analyses, older youth, males, and youth not living in the GTA had significantly higher odds of obtaining a driver's licence than younger youth, females, and youth living in the GTA. Conventional behaviours that were significantly positively associated with licensure status included youth who had high academic achievement, good social connectedness, and who were employed. Unconventional behaviours that were significantly positively associated with licensure status included alcohol use and binge drinking.

DISCUSSION

In agreement with Problem Behaviour Theory, the results show that youth who obtain their licence show limited problematic lifestyle or 'proneness' (Gohari, 2019). Alcohol use and binge drinking were significantly associated with youth obtaining a driver's licence but hazardous drinking was not. This study suggests that a driver's licence for youth could both control but also instigate unconventional behaviours as identified by PBT. A driver's licence could also provide opportunities for conventional behaviours associated with education and school connectedness. However, the independence provided by a driver's licence could offer youth unsupervised social opportunities to drink and binge drink that may be health-compromising. Thus, based on PBT, licensure status is associated with both conventional behaviours, as well as problem behaviours associated with alcohol use.

Migration Intentions and Alcohol Use Among Adolescents in West-Central Mexico

This study explores the association between migration intentions and alcohol use among west-central Mexico adolescents living in high migration communities. This study used the baseline data from the Family Migration and Early Life Outcomes (FAMELO) project (N = 1286), collected in 2018. We used multiple imputations to address missingness and propensity score matching to reduce the selection bias. We also conducted subgroup analyses to compare gender difference (i.e., boys vs. girls) on the relationship between migration intention and alcohol use. The findings show that for the whole sample, youth with migration intentions had significant higher odds (OR = 1.78; p = .010) of having a lifetime drinking experience when compared to youth who reported no interest in living abroad, but this association remained significant only for boys (OR = 2.14; p = .010). This study makes an important contribution to our understanding of the etiology of migration intentions and alcohol use for adolescents living in sending migration communities. The findings have specific alcohol prevention, policy, and future research implications in Mexico and the U.S.

Prevalence and Determinants of Substance Use Among Indigenous Tribes in South India: Findings from a Tribal Household Survey

BACKGROUND

Indigenous populations have higher substance use than non-indigenous populations. Current evidence on indigenous substance use is largely derived from national household surveys, while there are no specifically designed, culturally specific methodological studies available to determine the prevalence of substance abuse among the indigenous tribes. The present study examined the prevalence and predictors of alcohol use, smoking, and betel quid chewing among indigenous tribes in South India.

METHOD

We conducted a cross-sectional population-based random survey of 2186 tribal households in the Wayanad District, Kerala. A self-prepared, pilot-tested structured interview schedule was used to collect information on sociodemographic variables and substance use. Multivariate logistic regression models were used to examine the sociodemographic predictors of substance use.

RESULTS

The overall prevalence of current alcohol use, current smoking and daily betel quid use was 17.2%, 18.8% and 47.6% respectively. Consistently, male gender (alcohol use OR = 13.55; smoking OR = 3.42; betel quid use OR = 1.65), increasing age (OR = 1.32; OR = 1.01; OR = 1.03), Paniya tribe status (OR = 2.24; OR = 1.39; OR = 5.38) and employment status being working (OR = 2.07; OR = 1.77; OR = 1.26) increased the risk of alcohol use, smoking and betel quid chewing. Furthermore, having 'no formal education' was associated with smoking (OR = 1.35), and betel quid chewing (OR = 3.27).

CONCLUSION

Substance use was high among the indigenous tribes. The male gender, increasing age, Paniya tribe and working status significantly influenced alcohol use, smoking and betel quid chewing. The results underscore the need for indigenous specific de-addiction policies and programmes, alongside a consideration of the critical sociodemographic predictors.

Why now? Examining antecedents for substance use initiation among African American adolescents

Current adolescent substance use risk models have inadequately predicted use for African Americans, offering limited knowledge about differential predictability as a function of developmental period. Among a sample of 500 African American youth (ages 11-21), four risk indices (i.e., social risk, attitudinal risk, intrapersonal risk, and racial discrimination risk) were examined in the prediction of alcohol, marijuana, and cigarette initiation during early (ages 11-13), mid (ages 16-18), and late (ages 19-21) adolescence. Results showed that when developmental periods were combined, racial discrimination was the only index that predicted initiation for all three substances. However, when risk models were stratified based on developmental period, variation was found within and across substance types. Results highlight the importance of racial discrimination in understanding substance use initiation among African American youth and the need for tailored interventions based on developmental stage.

Male-Dominated Occupations and Substance Use Disorders in Young Adulthood

This article examined associations between male-dominated occupations and substance use disorders in young adulthood, accounting for adolescent experiences of work intensity (more than 15 hr a week at 16 to 17 years of age) and substance use (i.e., smoking, heavy drinking, cannabis, and illicit drug use). The moderating effects of biological sex and coming from a family with a low socioeconomic status (SES) were also assessed. Data were from a 10-year prospective study of community-based youth aged 12-18 in 2003 (T1; N = 662; 48% male; M_age = 15.5, SD = 1.9). Their occupations at ages 22-29 were categorized so that higher scores indicated more male-dominated occupations. Young adults in male-dominated occupations (more than 75% males) had lower education, worked in less prestigious occupations, and earned higher hourly wages than those in the other gendered-occupation groups. Work intensity in high school was associated with substance use at ages 18-25 and substance use was also associated with alcohol- and cannabis-use disorder symptoms and illicit drug use in young adulthood (ages 22-29). Adding to these effects, employment in a male-dominated occupation was associated with more cannabis-use disorder symptoms for the low, but not the high SES group. Public health messages need greater focus on preventing substance use disorders among individuals employed in male-dominated jobs in young adulthood. Efforts to promote self-assessment of problematic substance use and motivation to change may be particularly important for young workers.

Associations between Work Experience and Betel Nut, Alcohol, or Tobacco Use among Low-Income Taiwanese Students from Middle School to University

Background: Research suggests that young working students are at higher risk for substance use. However, most studies have focused on students from middle-class families, with few investigations conducted on substance use by students from low-income families. Objective: To examine the associations between work experience and betel nut, alcohol, or tobacco (BAT) use among Taiwanese students from low-income families. Methods: The data for this cross-sectional study were derived from the fourth wave of the Taiwan Panel Study of Children and Youth survey which provides primary data on low-income families. A total of 3,350 low-income students aged 12-25 years old from middle school to university participated. The χ² test was performed to examine differences in sociodemographic characteristics and BAT use between employed and unemployed students. Multivariate logistic regression was used to examine the associations between work status, work intensity, monthly income, occupation, and BAT use. Results: Employed students displayed higher BAT use than those who were unemployed. Increased BAT use was also associated with higher work intensity (except for betel nut use), higher monthly income, and specific occupations (such as service or manual work). Conclusions: Employment is independently associated with a higher risk of BAT use among low-income Taiwanese students. Work intensity and specific occupational fields may offer insights into formulating relevant preventive measures for these students.

Association of Nonmedical Prescription Opioid Use With Subsequent Heroin Use Initiation in Adolescents

IMPORTANCE

There is concern that nonmedical prescription opioid use is associated with an increased risk of later heroin use initiation in adolescents, but to our knowledge, longitudinal data addressing this topic are lacking.

OBJECTIVE

To determine whether nonmedical prescription opioid use is associated with subsequent initiation of heroin use in adolescents.

DESIGN, SETTING, AND PARTICIPANTS

This prospective longitudinal cohort study conducted in 10 high schools in Los Angeles, California, administered 8 semiannual surveys from 9th through 12th grade that assessed nonmedical prescription opioid use, heroin use, and other factors from October 2013 to July 2017. Students were baseline never users of heroin recruited through convenience sampling. Cox regression models tested nonmedical prescription opioid use statuses at survey waves 1 through 7 as a time-varying and time-lagged regressor and subsequent heroin use initiation across waves 2 to 8 as the outcome.

EXPOSURES

Self-reported nonmedical prescription opioid use (past 30-day [current] use vs past 6-month [prior] use without past 30-day use vs no past 6-month use) at each wave from 1 to 7.

MAIN OUTCOMES AND MEASURES

Self-reported heroin use initiation (yes/no) during waves 2 to 8.

RESULTS

Of 3298 participants, 1775 (53.9%) were adolescent girls, 1563 (48.3%) were Hispanic, 548 (17.0%) were Asian, 155 (4.8%) were African American, 529 (16.4%) were non-Hispanic white, and 220 (6.8%) were multiracial. Among baseline never users of heroin in ninth grade with valid data (3298 [97% of cohort enrollees]; mean [SD] age, 14.6 [0.4] years), the number of individuals with outcome data available at each follow-up ranged from 2987 (90.6%) to 3200 (97.0%). The mean per-wave prevalence of prior and current nonmedical prescription opioid use from waves 1 to 7 was 1.9% and 2.7%, respectively. Seventy students (2.1%) initiated heroin use during waves 2 to 8. Prior vs no (hazard ratio, 3.59; 95% CI, 2.14-6.01; P < .001) and current vs no (hazard ratio, 4.37; 95% CI, 2.80-6.81; P < .001) nonmedical prescription opioid use were positively associated with subsequent heroin use initiation. For no, prior, and current nonmedical prescription opioid use statuses at waves 1 to 7, the estimated cumulative probabilities of subsequent heroin use initiation by wave 8 (42-month follow-up) were 1.7%, 10.7%, and 13.1%, respectively. In covariate-adjusted models, associations were attenuated but remained statistically significant and current nonmedical prescription opioid use risk estimates were stronger than corresponding associations of nonopioid substance use with subsequent heroin use initiation.

CONCLUSIONS AND RELEVANCE

Nonmedical prescription opioid use was prospectively associated with subsequent heroin use initiation during 4 years of adolescence among Los Angeles youth. Further research is needed to understand whether this association is causal.

Employment and Marijuana Use Among Washington State Adolescents Before and After Legalization of Retail Marijuana

PURPOSE

The purpose of the study was to describe associations between employment and marijuana use among adolescents 2 years before passage of 2012 ballot initiative and 2 years after the implementation of retail recreational marijuana sales took place in Washington.

METHODS

We used 2010 and 2016 data from Washington's statewide school-based Healthy Youth Survey, which is completed by more than 76,000 youth annually and representative of 8th, 10th, and 12th graders in public schools. We used "difference-in-differences" regression to estimate the odds of current, past 30-day marijuana use by working status and hours worked per week compared with nonworking youth.

RESULTS

Working adolescents in all grades had higher prevalence of recent marijuana use compared with nonworking adolescents. Youth working in formal settings, such as retail and service sectors, were more likely to use marijuana than nonworking and youth working in informal settings, such as babysitting. Between 2010 and 2016, marijuana use decreased significantly among working and nonworking 8th and 10th graders. Among working 12th graders, marijuana use increased significantly over time relative to nonworking youth (adjusted odds ratio: 1.34, 95% confidence interval: 1.22-1.48). Associations were stronger for youth who worked more hours per week.

CONCLUSIONS

Working youth were more likely to use marijuana before and after Washington's legalization of retail marijuana. Legalization was associated with increases in marijuana use specifically among 12th-grade working youth. States legalizing marijuana may consider implementing interventions to support healthy behaviors among working youth.

Factors associated with family violence against adolescents based on the results of the National School Health Survey (PeNSE)

The study analyzes factors associated with family aggression against adolescents. Data from the National School Health Survey for 2015 were analyzed, and the prevalence of physical aggression per family was calculated according to four blocks. The bivariate analysis was performed, calculating the unadjusted Odds Ratio (OR) within each block and the multivariate regression. Familial aggression was reported by 14.5%. The variables associated with the model were: female, black, yellow, brown, mothers with no higher educational level, adolescent workers (OR 2.10 CI 95% 1.78-2.47). In the family context, they remained associated with aggression, lack of parents "understanding" (OR 1.71 CI95% 1.63 -1.80) and their intrusion into adolescent's privacy (OR 1.80 CI95% 1.70 -1, 91). Report of missing school (OR1.43 CI95% 1.36-1.50). Among the behaviors: smoking (OR 1.23 CI95% 1.12-1.34), alcohol (OR 1.49 CI95% 1.41-1.57), drug experience (OR 1.24 CI95% 1, 15-1,33), early sexual intercourse (OR 1.40 CI95% 1.33 -1.48), reports of loneliness, insomnia and bullying (ORa 2.14 CI95% 2.00-2.30). It is concluded by the association between violence and gender, greater victimization of girls, living in unfavorable social and family contexts.

Mental disorders and drug use in victims of the armed conflict in three cities in Colombia

Introduction: Violence in its different forms increases the risk of mental disorders and the use of drugs. Objectives: To assess the prevalence of mental disorders, and the use and abuse of drugs, as well as associated factors in victims of forced displacement in three cities in Colombia. Materials and methods: We conducted a prevalence study with 1.026 participants between 13 and 65 years old. Participants completed four surveys: the World Health Organization World Mental Composite International Diagnostic Interview, the World Health Organization Alcohol Use and Disorders Identification Test, a survey on drug use based on the Inter-American System of Uniform Drug-Use Data under the Inter-American Drug Abuse Commission of the Organization of American States, and a survey on aspects related to forced displacement. Data were analyzed using the SPSS™, version 21, software. Results: Lifetime prevalence of mental disorders was 17.7% for specific phobia, 16.4% for major depression, 9.9% for post-traumatic stress disorder, 8.9% for oppositional defiant disorder, 7.2% for separation anxiety disorder, 5.8% for conduct disorder, and 5.6% for attention deficit disorder. The lifetime prevalence of alcohol use was 68.7%; 31,3% for tobacco; 11,2% for marihuana; 3.5% for cocaine; 2.0% for coca paste (basuco); 2.5% for non-prescription anxiolytic drugs, 2.3% for inhalants, and 0.7% of participants had injected drugs. Presenting any mental disorder was associated with being female (OR=1,61 IC95%: 1,21-2,14) and experiencing more than one forced displacement (OR=1,47 IC95%: 1,05-2,05). The use of any drug was associated with being male (OR=5,38 IC95%: 2,35-12,34). Conclusions: Compared to the general population, our study population exhibited high prevalence of mental disorders and drug use, emerging as a public health issue that calls for the design of plans and the implementation of programs aimed at recovering the mental health and well-being of this population.

The Magnitude and Determinants of Emotional-Behavioral Problems in Working Adolescents in Turkey

OBJECTIVE

Working adolescents are at a greater risk of mental disorders than are non-working adolescents. The present study was aimed at determining the magnitude and determinants of emotional and behavioral problems in working adolescents.

METHODS

This cross-sectional study was conducted with 343 adolescents attending two vocational training centers in the province of Balikesir between January 2016 and March 2016. The data were collected with the Personal Information Form, and the Strengths and Difficulties Questionnaire. In the analysis, descriptive statistics, the t-test, Mann Whitney U test and one way ANOVA were used.

RESULTS

In the study of the adolescents, 16.9% were determined to have abnormal emotional and behavioral problems. Of the participating adolescents, girls, those with physical illnesses, living in fragmented families, perceiving their economic status as good, having fathers with primary school education and/or having mothers with high school or higher education had significantly higher emotional and behavioral problem scores (p<0.05).

CONCLUSION

In this study, approximately one-fifth working Turkish adolescents had abnormal mental status. Based on the aforementioned results, it can be suggested to develop intervention programs for the prevention, early diagnosis and treatment of emotional and behavioral problems in working adolescents.

Evaluation of the effects of a designated program on illegal drug cessation among adolescents who experiment with drugs

BACKGROUND

Studies indicate that adolescent-onset drug users experience a greater likelihood of dependence that continues into adulthood. The importance of early intervention was evident in treating adolescents before their substance use progressed. We examined the effectiveness of an intervention program that prevents students who experiment with drugs from reusing them.

METHODS

The study was based on 10 out of 18 invited schools that were randomly assigned to either the intervention group (5 schools, n = 43) or the comparison group (5 schools, n = 41). The intervention group received an E-course program that comprised a main intervention course (12 sessions) and a booster course (2 sessions). By reducing the burden of teaching content during the 14 sessions, the in-class counselor had opportunities for face-to-face discussions with students on their ambivalence toward quitting illegal drugs. The comparison group received the conventional didactic drug prevention course (2 sessions). Outcomes in terms of stress management, refusal skills, pros of drug use, cons of drug use, and drug use resistance self-efficacy were measured via structured questionnaires conducted thrice: at baseline, after the main intervention sessions, and after the booster sessions. A linear mixed model (LMM) was employed to investigate the effects of time and groups on the outcome variables with group, time, and group × time as fixed effects. Subjects and schools were selected as random effects in order to consider both within-subject and within-school correlations.

RESULTS

There was a significant group × time interaction with regard to stress management, refusal skills, pros of drug use, and drug use resistance self-efficacy, excluding cons of drug use. The intervention group displayed better stress management compared to the comparison group after the booster intervention. Similar between-group differences were identified in that the intervention group displayed better refusal skills and drug use resistance self-efficacy compared to that of the comparison group. The intervention group favored using drugs less (a decrease in the pros of drug use score) compared to the comparison group after the booster intervention.

CONCLUSIONS

Our program provided an example of the results of early intervention among students who experiment with illegal drugs.

Early Initiation of Substance Use as an Indicator of Problematic Substance Use Among Young Men Who Have Sex with Men (YMSM)

BACKGROUND AND OBJECTIVES

Much research has documented that young men who have sex with men (YMSM) are at higher risk for substance use-related problems. This study examined the age of substance use initiation and it's relationship to current substance use-related problems among substance-using YMSM.

DESIGN AND METHODS

A cross-sectional survey of 191 YMSM (aged 18 to 29) with recent histories of prescription drug misuse was conducted in Philadelphia in 2012-13. Participants were surveyed about age of initiation of cigarette smoking, alcohol use to the point of intoxication, marijuana, prescription, and illicit drugs, and about alternate modes of prescription drug administration. The severity of participants' current substance use related problems was measured using the Drug Abuse Screening Test (DAST-10).

RESULTS

Mean age of initiation was 14.6 years for cigarette smoking, 15.3 years for alcohol use to the point of intoxication, 15.2 years for marijuana, 16.8 years for prescription drugs, and 17.9 years for illicit drugs. Use of 2 or more substances by the age of 15 was reported by 56% of the participants. Odds of substance-related problems were significantly greater among those who reported earlier initiation of alcohol, prescription drugs, or polysubstance use. Odds of prescription drug misuse via altered routes of administration were significantly greater among participants with earlier onset of alcohol, marijuana, prescription, illicit drugs, or polysubstance use.

DISCUSSION AND CONCLUSIONS

This study demonstrates that earlier initiation of substance use is associated with higher risk of substance-related problems among substance-using YMSM. Early interventions addressing substance use initiation could benefit this population.

NEET adolescents grown up: eight-year longitudinal follow-up of education, employment and mental health from adolescence to early adulthood in Mexico City

The purpose is to examine the socio-demographic and mental health outcomes in early adulthood of those who as adolescents were not in education, employment or training, termed NEET, compared to their counterparts who studied, worked, or both. One thousand and seventy-one youth residing in Mexico City participated in a representative, prospective, longitudinal 8-year two-Wave cohort study. At Wave I the participants were aged 12-17 and at Wave II aged 19 and 26. The Composite International Diagnostic Interview assessed psychiatric disorders, substance use and abuse, suicidal behavior, interpersonal relationships, employment and education. The main finding of this study is that being NEET in adolescence was associated with several socio-demographic and mental health outcomes in early adulthood, above and beyond baseline socioeconomic disadvantage and mental health compared to their peers, particularly their peers who studied only or studied and worked. NEET youth were not that different from their peers who worked exclusively highlighting the protective value of keeping youth in school. The strongest differences between NEET youth and all their peer groups were their increased risks of incident suicidal behaviors. Social policies are needed for creating more educational opportunities, greater support for retention of students, and programs to facilitate the transition from school to the labor market considering cultural attitudes towards life trajectory expectations.

The prevalence and associated factors of new psychoactive substance use: A 2016 Thailand national household survey

Introduction

Analyzing the situation and risk factors associated with using new psychoactive substances (NPS) is essential for preventing and controlling health consequences. This study explored the prevalence and associated factors of NPS use in the Thai population.

Methods

This descriptive study was conducted in participants (N = 30,411, mean age = 42.4 ± 13.4 years, range = 15–64 years, 50.3% women) from urban and rural areas of Thailand. The participants were chosen using multistage sampling for large populations. The data were collected in July–December 2016 and analyzed using frequency, percentage, mean, standard deviation, chi-square, multiple logistic regression, and odds ratio with 95% confidence intervals (CI).

Results

The prevalence of lifetime NPS use was 49.7% (95% CI, 49.1–51.3), past-year use was 31.3% (95% CI, 30.8–31.8), and current (past-month) use was 14.9% (95% CI, 14.5–15.3). Among current users, 29.5% were habitual users (over 20 days). The factors associated with current NPS use were sex (male/female) (adjusted odds ratio [AOR] = 1.145; 95% CI, 1.075–1.221; p < 0.001), age group (25–64/15–24 years) (AOR = 1.126; 95% CI, 1.090–1.358; p < 0.001), educational attainment (elementary or secondary education and higher) (AOR = 1.634; 95% CI, 1.529–1.747; p < 0.001), and employment status (AOR = 1.842; 95% CI, 1.683–2.016; p < 0.001).

Conclusions

The prevalence of NPS use in Thailand is high, which reflects abuse behavior that could potentially harm users. Understanding the prevalence and risk factors of NPS use could benefit policymakers.

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The prevalence of new psychoactive substance use in Thailand is high.

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One-third of current users of new psychoactive substances were habitual users.

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Sex and employment status were associated with new psychoactive substance use.

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Substance use was more prevalent in employed people than in the unemployed.

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The use of new psychoactive substances without prescription was higher among women.

Risk of alcohol dependence: prevalence, related problems and socioeconomic factors

The present study evaluated the possible alcohol dependence and related problems among adolescents and determined possible associations with socioeconomic factors and gender. A cross-sectional study was conducted with a representative sample of 936 adolescents aged 15 to 19 years enrolled at public and private schools in the city of Belo Horizonte, Brazil. Data related to alcohol consumption and associated problems were collected using the Alcohol Use Disorder Identification Test (AUDIT). The Social Vulnerability Index (SVI), mother's schooling and type of school were used to assess socioeconomic factors. Statistical analysis involved the chi-square test (p < 0.05) and Poisson regression. The prevalence of possible dependence was 16.4%, 52.1% reported concern of a family member regarding the adolescent's alcohol consumption. Female adolescents were less likely to exhibit possible dependence in comparison to males. Participants with living in a low vulnerability area were more likely to consume alcohol in comparison to those living in underprivileged areas. The results of the present study demonstrate that possible dependence was significantly associated with the male gender and low social vulnerability.

Part-Time Employment and Problem Behaviors: Evidence From Adolescents in South Korea

This study explores the impact of adolescent part-time work experience on problem behaviors in the South Korean context. To achieve this, propensity score matching (PSM) analyses were employed based on data from the Korean Education Employment Panel (KEEP). Results indicate that adolescents' part-time employment during their secondary school years had significantly undesirable effects on drinking and smoking, even after preexisting differences between the two groups (i.e., those adolescents who participated in part-time work and those who did not) were controlled by PSM. However, an insignificant difference was detected in the likelihood of running away from home. Implications of the results are discussed in terms of changes in the meanings of adolescence and of participating in part-time work in South Korea.

Drinking, Cigarette Smoking, and Employment Among American College Freshmen at a Four-Year University

BACKGROUND

For American college students, alcohol and cigarette use are important health concerns, and employment concurrent with school attendance is on the rise. Given the lifelong importance of employment and substance use trajectories begun in college, parsing out the relationship between the two is meaningful.

OBJECTIVES

This study's purpose is to determine whether employment during college is associated with substance use.

METHODS

Cross-sectional associations between employment (work hours, earnings) and substance use (drinking frequency, drinking quantity, smoking frequency) were estimated using partial proportional odds models in a sample of N = 1457 freshmen attending a large, public 4-year university in 2011, after accounting for demographics, personality, social environment, and parental influences.

RESULTS

Working 10 more hours and earning $50 more per week as a freshman had modest positive associations with higher smoking frequency and with moderate drinking frequency and quantity prior to adjustment. After adjustment, work hours remained modestly associated with moderate drinking frequency and quantity. No adjusted associations were found among employment measures and smoking or between weekly earnings and drinking frequency. Different relationships emerged for moderate versus heavy alcohol use frequency and quantity.

CONCLUSIONS

Both employment and substance use are commonplace among college freshmen. After extensive controls for potential confounders, the relationship between the two appears modest. Employment may yet play a role in college student substance use, but work hours and earnings are likely only small parts of a larger web of influences on drinking and smoking.

Associação do trabalho infantil com transtornos de comportamento do tipo introversão e extroversão: um estudo transversal no Sul do Brasil

Resumo Objetivo avaliar a associação entre trabalho infantil e transtornos de comportamento do tipo introversão e extroversão. Métodos estudo transversal com entrevistas domiciliares e aplicação do Child Behavior Check List em 1.608 jovens de 10 a 13 anos e 1.530 jovens de 14 a 17 anos da área urbana de Pelotas, Sul do Brasil. Resultados a prevalência do trabalho foi de 7,3% entre os mais jovens e de 20,7% entre os de mais idade, e a de transtornos de comportamento, de introversão, 25%, e de extroversão, 22%, sem diferença por idade. Análise multivariada (Poisson), estratificada por idade, mostrou associação entre extroversão e trabalho, com prevalência maior entre os mais novos e menor entre os mais velhos. Extroversão associou-se diretamente, nos mais novos, com serviços domésticos e construção civil, e inversamente, nos mais velhos, com serviços não domésticos. Não houve associação com introversão em nenhuma das faixas de idade. Para os mais velhos, o trabalho foi protetor para extroversão, em particular nos serviços não domésticos, porém há possibilidade de causalidade reversa. Discussão o prejuízo ao comportamento na faixa de 10 a 13 anos indica a necessidade de erradicação do trabalho infantil, com atenção especial ao serviço doméstico e à construção civil; o trabalho de adolescentes mais velhos em serviços não domésticos pode trazer benefícios ao comportamento.

Do Adolescent Smokers Use E-Cigarettes to Help Them Quit? The Sociodemographic Correlates and Cessation Motivations of U.S. Adolescent E-Cigarette Use

Purpose.

To examine the sociodemographic traits of adolescent e-cigarette users and whether e-cigarettes are used as cessation aids among adolescent smokers.

Design.

The study had a cross-sectional design.

Setting.

Study setting was the United States.

Subjects.

A probability sample of 15,264 adolescents in grades 6 through 12 was used.

Measures.

The study measured self-reported lifetime e-cigarette use and recent conventional cigarette use, desire to quit, and number of recent quit attempts (among conventional cigarette smokers), and factors hypothesized to be related to e-cigarette use (e.g., race/ethnicity, age, friendships with smokers).

Analysis.

Logistic regression was used to assess e-cigarette use among (1) all adolescents and (2) conventional cigarette smokers as a function of quit desire and attempts.

Results.

Descriptive analyses show 3.2% of respondents had used e-cigarettes. E-cigarette use is significantly lower for females (adjusted odds ratio [OR], .70), non-Hispanic black youth (adjusted OR, .37), and Mexican-American youth (adjusted OR, .56), and higher for those who smoke conventional cigarettes (adjusted OR, 58.44) or have friends who smoke (adjusted OR, 2.38). Among conventional cigarette smokers, neither desire to quit nor recent quit attempts is significantly associated with e-cigarette use.

Conclusions.

E-cigarette use is more common among certain adolescent subgroups than others and does not appear to be part of a cessation regimen among conventional cigarette smokers wishing to quit. More regulatory and prevention efforts are needed, especially for certain adolescent subpopulations.

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

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

Delineating prototypical patterns of substance use initiations over time

AIMS

The purpose of this paper is to discover patterns of drug use initiations over time through a multiple event process survival mixture model (MEPSUM model), a novel approach for substance use and prevention research.

DESIGN

The MEPSUM model combines survival analysis and mixture modeling-specifically latent class analysis-to examine individual differences in the timing of initiation and cumulative risk of substance use over time, and is applied to cross-sectional survey data on drug initiations.

SETTING

Data are drawn from the 2009 National Survey on Drug Use and Health.

PARTICIPANTS

The survey includes responses from 55 772 individuals (52.05% female).

MEASUREMENTS

The age of first use of nine different types of substances are examined, including alcohol, tobacco, cocaine and non-medical use of prescription drugs.

FINDINGS

It is argued that six patterns parsimoniously describe the population's risk of initiating different substances over time, described colloquially as general abstainers; early, late and progressive soft drug users; and early and late hard drug users. Both gender and ethnicity significantly predict the patterns, with Caucasians and males having a higher risk for the hard drug-using patterns. The MEPSUM model produced stable results in this application, as the patterns are validated in a split-sample design.

CONCLUSIONS

The MEPSUM model provides a statistical framework from which to evaluate patterns of risk for drug initiations over time and predict substance use trajectories relevant to public health interventions. The patterns that result from the model can be used as outcomes for subsequent investigations of etiological and mediating mechanisms.

Youth unemployment and economic recession in Spain: influence on health and lifestyles in young people (16-24 years old)

OBJECTIVES

To explore health status and lifestyles in young Spanish people in 2006 and 2012, the changes between these 2 years and the influence of employment status on health and lifestyles in this period.

METHODS

Cross-sectional analysis of the Spanish National Health Surveys 2006 and 2011/12 in people 16-24 years old (3701). Regression analyses for pooled cross-sectional data were developed. Employment status was considered as explanatory variable of health (self-rated health, diagnosed morbidity and mental disorders) and lifestyles (overweight, tobacco and alcohol consumption).

RESULTS

Male unemployment was associated with poor self-rated health (OR 1.88; CI 95 % 1.00-3.53), mental disorders (OR 2.42; CI 95 % 1.02-5.76) and tobacco consumption (OR 1.62; CI 95 % 1.00-2.62). During the economic recession, young people presented better health results than in 2006. Unemployed who had never worked consumed less tobacco and alcohol than short-term unemployed.

CONCLUSIONS

Unemployment was associated in young men with poor self-rated health, mental illness and tobacco consumption. Despite the economic recession, young people presented better self-rated health, diagnosed morbidity and mental health in 2012 than in 2006, especially in women.

Labor in early life, vulnerability for health in Brazilian schoolchildren: National Adolescent School-based Health Survey (PeNSE 2012)

OBJECTIVE

This study describes exposure labor among Brazilian 9th grade students from public and private schools and investigates socio-demographic characteristics, behaviors, violent situations and psychosocial factors associated with labor among adolescents.

METHODS

The present study included 108,984 students from the National Adolescent School-based Health Survey carried out in 2012. Variables were grouped into sociodemographic characteristics, behavioral factors, violent situations and psychosocial aspects. Associations between labor and several health risk variables were identified by multiple logistic regression analysis, after adjustment for sex and age.

RESULTS

Approximately 13% of the students reported having a job: 17.4% of them were male. The chance of working was lower between females and individuals whose fathers' have incomplete superior education. Students who worked had greater chances to smoke (OR = 2.26; 95%CI 2.04 - 2.51), drink alcohol, use illicit drugs (OR = 2.63; 95%CI 2.29 - 3.02), drive motorized vehicles (OR = 2.15; 95%CI 2.03 2.27), have sexual intercourse (OR = 2.10; 95%CI 1.99 - 2.24), suffer physical violence (OR = 1.57; 95%CI 1.46 1.68), engage in fights (OR = 1.65; 95%CI 1.55 - 1.76), feel lonely (OR = 1.26; 95%CI 1.17 - 1.36) and report sleeping problems (OR = 1.46; 95%CI 1.34 - 1.60). They also have lower chances of having close friends (OR = 0.78; 95%CI 0.68 - 0.90).

CONCLUSION

The prevalence of labor among students is high. Socioeconomical disadvantages increase the chances of early working. Early working is also associated to health damaging behavior, violent situations, sleeping problems, and social isolation. Adolescents who study and work experiment expositions that may affect distinct health dimensions and perpetuate disadvantages over lifetime.

RCT of a promising vocational/employment program for high-risk juvenile offenders

Juvenile offenders with substance use problems are at high risk for deleterious long-term outcomes. This study evaluated the capacity of a promising vocational and employment training program in the building sector (i.e., Community Restitution Apprenticeship-Focused Training, CRAFT) to mitigate such outcomes through enhanced employment and education. Participants were 97 high-risk juvenile offenders (mean age=15.8 years) randomized to CRAFT versus education as usual (EAU) intervention conditions. Multi-method procedures measured employment, education, substance use, mental health, and criminal outcomes through a 30-month post-baseline follow-up. CRAFT was significantly more effective than EAU at increasing rates of youth employment and GED attendance. Intervention effects were not observed, however, for months employed, hours worked, or hourly wage. Measures of youth substance use, mental health symptoms, and criminal activity showed no favorable or iatrogenic effects. The potential of CRAFT was modestly supported, and suggestions were made for future research.

Proximal to distal correlates of the patterns of illicit drug use among night school students in Taiwan

This epidemiological study aimed to investigate illicit drug use by vocational high school night-class students in Taiwan to identify hypothesized proximal and distal factors associated with drug use patterns. Between September 2010 and January 2011, a randomized sample was drawn from 33 vocational high school night classes, enrolling 1079 students already employed outside campus. Subjects completed a validated self-reported questionnaire measuring proximal factors (biological, psychological, and behavioral) and distal factors (living with parents, parents' or siblings' use of legal substances, supervision by primary guardian, and perceived peer influence on drug use). Age, greater sensation-seeking behavior and legal substances use (i.e., tobacco and betel nuts) increased odds of being identified as experimental or regular users versus non-drug users. Higher rates of rule-breaking behavior were associated with increased odds of being identified as experimental users versus non-drug users. Among distal factors, only perceived peer influence on drug use was significantly associated with experimental and regular drug use. Proximal and distal factors were associated with drug use patterns among vocational high school night-class students. Influence factors identified may help vocational high school officials design effective illicit drug intervention programs for students with different drug use patterns.

Developmental timing of first drug treatment and 10-year patterns of drug use

To examine the developmental timing of first drug treatment and its associations with 10-year drug use patterns, pooled data (N=1318) from four longitudinal studies conducted in California was used to compare individuals first treated during young adulthood (26%) to those first treated at an older age. Treatment timing was associated with particular participant characteristics and experiences. Matched data showed that most people in both age groups exhibited a low level of drug use after first treatment, albeit fewer who were first treated during young adulthood maintained a low drug use level over time. Receipt of more drug treatment over 10 years was associated with maintenance of low drug use levels among those first treated as young adults, but not among those first treated as older adults. Developmental timing of first drug treatment interacts with subsequent treatment experiences in ways that impact the course of drug use.

Employment Trajectories: Exploring Gender Differences and Impacts of Drug Use

This study investigated the impact of drug use on employment over 20 years among men and women, utilizing data on 7,661 participants in the National Longitudinal Survey of Youth. Growth mixture modeling was applied, and five distinct employment trajectory groups were identified for both men and women. The identified patterns were largely similar for men and women except that a U-shape employment trajectory was uniquely identified for women. Early-initiation drug users, users of "hard" drugs, and frequent drug users were more likely to demonstrate consistently low levels of employment, and the negative relationship between drug use and employment was more apparent among men than women. Also, positive associations between employment and marriage became more salient for men over time, as did negative associations between employment and childrearing among women. Processes are dynamic and complex, suggesting that throughout the life course, protective factors that reduce the risk of employment problems emerge and change, as do critical periods for maximizing the impact of drug prevention and intervention efforts.

Child and adolescent labor and smoking: a cross-sectional study in southern Brazil

This cross-sectional study assessed the association between smoking and child and adolescent labor among 3,269 individuals 10 to 17 years of age in Pelotas, Rio Grande do Sul State, in southern Brazil (excluding higher income census tracts) in 1998. Adjusted hierarchical analysis was performed using Poisson regression. Prevalence of child labor was 13.8%. Current smoking prevalence was 6.3% in the sample as a whole (15.7% among working versus 3.4% among non-working children). In the multivariate analysis, smoking was significantly associated with child labor, with a prevalence ratio of 1.75 (95%CI: 1.30-2.36). Smoking was also associated with family characteristics (lower maternal schooling, mother currently without husband/partner, household members with alcohol or drug problems, single mother, and history of serious injuries), and the children's characteristics (age greater than 16 years, inadequate school performance, and externalizing behavior). The findings point to smoking as one of the harmful consequences of child labor and suggest the workplace as an appropriate target for smoking prevention.

Migration intentions and illicit substance use among youth in central Mexico

This study explored intentions to emigrate and substance use among youth (ages 14-24) from a central Mexico state with high emigration rates. Questionnaires were completed in 2007 by 702 students attending a probability sample of alternative secondary schools serving remote or poor communities. Linear and logistic regression analyses indicated that stronger intentions to emigrate predicted greater access to drugs, drug offers, and use of illicit drugs (marijuana, cocaine, inhalants), but not alcohol or cigarettes. Results are related to the healthy migrant theory and its applicability to youth with limited educational opportunities. The study's limitations are noted.

College student employment and drinking: a daily study of work stressors, alcohol expectancies, and alcohol consumption

We examined the within-person relationships between daily work stressors and alcohol consumption over 14 consecutive days in a sample of 106 employed college students. Using a tension reduction theoretical framework, we predicted that exposure to work stressors would increase alcohol consumption by employed college students, particularly for men and those with stronger daily expectancies about the tension reducing properties of alcohol. After controlling for day of the week, we found that hours worked were positively related to number of drinks consumed. Workload was unrelated to alcohol consumption, and work-school conflict was negatively related to consumption, particularly when students expressed strong beliefs in the tension reducing properties of alcohol. There was no evidence that the effects of work stressors were moderated by sex. The results illustrate that employment during the academic year plays a significant role in college student drinking and suggest that the employment context may be an appropriate intervention site to address the problem of student drinking.

Association of MDMA/ecstasy and other substance use with self-reported sexually transmitted diseases among college-aged adults: a national study

OBJECTIVES

MDMA/ecstasy use among college students has increased and reportedly leads to risky sexual behaviours. However, little is known about its association with sexually transmitted diseases (STDs). To evaluate this public health concern, this study examined the association between substance use (particularly MDMA) and self-reported STDs (chlamydia, gonorrhoea, herpes and syphilis) among college students and non-students aged 18-22 years (n=20,858).

STUDY DESIGN

A cross-sectional data analysis of a national survey.

METHODS

Data were drawn from the 2005-2006 National Surveys on Drug Use and Health; a nationally representative survey of non-institutionalized Americans. Self-reported STDs and substance use were assessed by the audio computer-assisted self-interviewing method. The association between MDMA use and STDs was determined while taking into account young adults' use of other substances, healthcare utilization and sociodemographic characteristics.

RESULTS

Overall, 2.1% of college students and 2.5% of non-students reported contracting an STD in the past year. MDMA use in the past year was not associated with STDs. Among non-students, onset of MDMA use before 18 years of age increased the odds of past-year STDs. In both groups, alcohol use, marijuana use, female gender and African American race increased the odds of both past-year and lifetime STDs. Additional analyses indicated that, regardless of college-attending status, greater odds of past-year STDs were noted among users of alcohol and drugs, and users of alcohol alone, but not among users of drugs alone.

CONCLUSIONS

Alcohol use is a robust correlate of STDs. Irrespective of college-attending status, young women and African Americans have a higher rate of STDs than young men and Whites.

Substance use and delinquency among fifth graders who have jobs

BACKGROUND

Working for pay is associated with substance use and delinquency among older adolescents, although information is scant about younger youth who work. This study investigates associations between self-reports of having a job and substance use and delinquent behaviors in a sample of U.S. 5th graders.

METHODS

A total of 5147 5th graders and their parents from three large metropolitan areas were assessed in a cross-sectional survey between Fall 2004 and Summer 2006. Multivariate regression was used to estimate associations between having a job and substance use and delinquency. Analyses were conducted in Fall 2007.

RESULTS

Twenty-one percent of 5th graders reported having a job, with most working <5 hours per week. Typical jobs included yard work, babysitting, and cleaning. In multivariate models that controlled for demographic characteristics, household composition, and household income, having a job was significantly associated with past-30-day use of tobacco (OR=2.2), alcohol (OR=1.7), and marijuana (OR=3.1). Having a job was also significantly associated with ever being in a fight (OR=1.5) and with running away from home (OR=1.8). Further analyses indicated that the associations between holding a job and delinquency outcomes were driven largely by young workers who worked >2 hours per week.

CONCLUSIONS

Among 5th graders, having a job was associated with substance-using behaviors and delinquency. Clinicians should consider asking young patients whether they work, and stress to parents the importance of monitoring the work activities, workplaces, and associates of their children.

Using State Child Labor Laws to Identify the Causal Effect of Youth Employment on Deviant Behavior and Academic Achievement

On the basis of prior research findings that employed youth, and especially intensively employed youth, have higher rates of delinquent behavior and lower academic achievement, scholars have called for limits on the maximum number of hours per week that teenagers are allowed to work. We use the National Longitudinal Survey of Youth 1997 to assess the claim that employment and work hours are causally related to adolescent problem behavior. We utilize a change model with age-graded child labor laws governing the number of hours per week allowed during the school year as instrumental variables. We find that these work laws lead to additional number of hours worked by youth, which then lead to increased high school dropout but decreased delinquency. Although counterintuitive, this result is consistent with existing evidence about the effect of employment on crime for adults and the impact of dropout on youth crime.

Personal and interpersonal risk factors in the consumption of illicit drugs by marginal adolescents and young people from juvenile gangs

Marginal populations are groups which are known to present higher risks of drug consumption. It is possible to identify adolescents and young people from juvenile gangs that constitute this group. The purpose of this study was to analyze the effect of personal and interpersonal risk factors of drug consumption in 175 marginal adolescents and young people who belong to juvenile gangs in Mexico. Results showed a significant effect of personal factors on drug use, with an estimated variation of 26.1%. The factors that presented the highest rates were: gender, age and mental problems. The interpersonal factors (relationships with friends who have maladaptive behaviors and inappropriate relationships with parents) showed an effect with an estimated variation of 15%. These results will allow for reflection and, in the future, the elaboration of adequate preventive programs aimed at this group of young people.

Non-prescribed use of pain relievers among adolescents in the United States

BACKGROUND

We examined gender-specific prevalences, patterns, and correlates of non-prescribed use of pain relievers - mainly opioids - in a representative sample of American adolescents (N=18,678).

METHODS

Data were drawn from the public use data file of the 2005 U.S. National Survey on Drug Use and Health, a survey of non-institutionalized American household residents. The patterns of non-prescribed use of prescription pain relievers were examined, and logistic regression procedures were conducted to identify correlates of non-prescribed use.

RESULTS

Approximately one in 10 adolescents aged 12-17 years reported non-prescribed use of pain relievers in their lifetime (9.3% in males and 10.3% in females). The mean age of first non-prescribed use was 13.3 years, which was similar to the mean age of first use of alcohol and marijuana but older than the age of first inhalant use. Among all non-prescribed users, 52% reported having used hydrocodone products (Vicodin, Lortab, Lorcet, and Lorcet Plus, and hydrocodone), 50% had used propoxyphene (Darvocet or Darvon) or codeine (Tylenol with codeine), and 24% had used oxycodone products (OxyContin, Percocet, Percodan, and Tylox). Approximately one quarter (26%) of all non-prescribed users had never used other non-prescribed or illicit drugs. There were gender variations in correlates of non-prescribed use.

CONCLUSIONS

Use of non-prescribed pain relievers occurs early in adolescence. Research is needed to understand whether early use of non-prescribed pain relievers is related to later drug use.

Associations among physical activity, health indicators, and employment in 12th grade girls

OBJECTIVES

This study compared physical activity, sedentary behaviors, and other health indicators between 1381 employed and nonemployed 12th grade girls.

METHODS

The girls were from 22 high schools in South Carolina (2002-2003); 56% of the girls were African American, and the mean age was 17.7 (0.6) years. Physical activity and sedentary behaviors were measured using the 3-Day Physical Activity Recall (3DPAR). Fitness, depressive symptoms, and smoking behavior were assessed.

RESULTS

Fifty percent of the girls were employed, and on average, employed girls worked 9.6 30-minute blocks per day. Girls who worked reported significantly (p < or = 0.001) higher average total metabolic equivalents (METs) (mean [M] 66.4, SE 0.5) than girls who did not work (M 59.5, SE 0.5). Also, a higher percent of girls who worked reported 2+ blocks of moderate to vigorous physical activity (MVPA) (89.3%), and fewer (20.2%) reported 4+ blocks of electronic media (EM) compared with girls who did not work (MVPA 62.7%, EM 41.7%). After on-the-job activity was subtracted, total METs for girls who worked was reduced to 48.0 (SE 0.4), and only 48.5% reported 2 or more blocks on average of MVPA. No significant differences (p > 0.05) were found between girls who reported working (W) and those who did not (NW) for body mass index (BMI) (W: M 25.2, SE 0.2; NW: M 24.6, SE 0.2), depression scores (W: M 14.4, SE 0.5; NW: M 14.4, SE 0.5), fitness (W: M 11.3 kg . m/min/kg, SE 0.2; NW: M 11.7 kg . m/min/kg, SE 0.2), or smoking during the past 30 days (W: 18.5%; NW: 17.4%).

CONCLUSIONS

Nearly one third of employed high school girls' total physical activity occurred while they were at work. Employed girls also spent less time using electronic media. Employment was not associated with fitness, smoking, or depressive symptoms in 12th grade girls.

The role of spending money and drinking alcohol in adolescent smoking

AIMS

Previous studies have shown inconsistent findings with regard to the association between amount of spending money and adolescent smoking. Drinking alcohol may be a mediator of the association between spending money and adolescent smoking. However, no studies have examined this potential role. The objective of this study was to investigate the association between amount of spending money and adolescent smoking and the potential mediation role of alcohol use in this association.

DESIGN

The 2003 Ontario Student Drug Use Survey of students in grades 7-12.

MEASUREMENTS

Multivariable logistic, probit and linear regression models were used to investigate the association between amount of spending money and smoking, and the contribution of drinking alcoholic beverages to this relationship.

FINDINGS

Spending money was associated positively with experimental smoking, current smoking and daily consumption of cigarettes (P < 0.01). The analysis adjusted for confounders showed that students with spending money > or =$20/week were significantly more likely to be experimental smokers, students with > or =$30/week were significantly more likely to be current smokers and students with > or =$60/week smoked significantly more cigarettes/day (P < or = 0.05), compared to students with <$10/week. Alcohol use was an important mediator, responsible for 81% of the association of spending money with experimental smoking, 38% with current smoking and 37% with daily consumption of cigarettes.

CONCLUSIONS

Amount of spending money was associated significantly and positively with smoking among adolescents, and alcohol use mediated this association. Integrated tobacco prevention programs may be more effective, and increasing taxes on cigarettes and alcohol would increase price sensitivity among youth and protect against adolescent smoking.

Substance use, education, employment, and criminal activity outcomes of adolescents in outpatient chemical dependency programs

Although the primary outcome of interest in clinical evaluations of addiction treatment programs is usually abstinence, participation in these programs can have a wide range of consequences. This study evaluated the effects of treatment initiation on substance use, school attendance, employment, and involvement in criminal activity at 12 months post-admission for 419 adolescents (aged 12 to 18) enrolled in chemical dependency recovery programs in a large managed care health plan. Instrumental variables estimation methods were used to account for unobserved selection into treatment by jointly modeling the likelihood of participation in treatment and the odds of attaining a certain outcome or level of an outcome. Treatment initiation significantly increased the likelihood of attending school, promoted abstinence, and decreased the probability of adolescent employment, but it did not significantly affect participation in criminal activity at the 12-month follow-up. These findings highlight the need to address selection in a non-experimental study and demonstrate the importance of considering multiple outcomes when assessing the effectiveness of adolescent treatment.

Análise de fatores associados à não aceitação da vacina contra hepatite B em adolescentes escolares de baixa renda

Para avaliar os fatores de predição da não adesão à vacina contra o vírus da hepatite B (VHB) em adolescentes escolares de baixa renda da Região Metropolitana de Goiânia, Goiás, 304 indivíduos suscetíveis ao VHB, matriculados em duas escolas, foram entrevistados e a vacina contra hepatite foi oferecida. Somente 195 (64%) adolescentes aceitaram a primeira dose da vacina. Por outro lado, 182/195 (93,3%) receberam o esquema completo. Verificou-se que fatores escolares exerceram um papel na aceitação da vacina, uma vez que a escola B e turno noturno foram independentemente associados à não adesão à vacina. Os achados deste estudo ratificam a baixa aceitação da vacina contra hepatite B em adolescentes e evidenciam a necessidade de programas de educação em saúde para sensibilização desse grupo em relação à vacinação, e reforçam a importância de estratégias de imunização na escola para o cumprimento do esquema completo da vacina contra o VHB nesta população-alvo.