Protective correlates of stages in adolescent substance use: a Swiss National Study

Adverse childhood experiences and past 30-day cannabis use among middle and high school students: The protective influence of families and schools

Exposure to adverse childhood experiences (ACEs) is a risk factor for adolescent cannabis use (CU). We explored whether family communication and school connectedness can offer direct protection (the compensatory model of resiliency) or moderating protection (the protective factors model of resiliency). Using cluster random sampling, a Youth Risk Behavior Survey (YRBS) was conducted with 5,341 middle school and 4,980 high school students in 2019. Generalized estimating equations were used to estimate whether family communication and school connectedness offered independent direct protection (multiple regression) or moderating protection (multiplicative interaction) in the relationship between ACEs and past 30-day CU. Adjusted prevalence ratios (APR) and 95% confidence intervals (95% CI) were calculated. There was a graded relationship between ACEs and past 30-day CU for all students that was particularly strong among middle school students: 1 ACE (APR = 2.37, 95% CI = 2.16, 2.62), 2 ACEs (APR = 2.89, 95% CI = 2.60, 3.23), 3 ACEs (APR = 5.30, 95% CI = 4.75, 5.90), 4 + ACEs (APR = 7.86, 95% CI = 7.13, 8.67). Results supported the compensatory model of resiliency with both family communication (middle school APR = 0.90, 95% CI = 0.88, 0.93; high school APR = 0.90, 95% CI = 0.87, 0.93) and school connectedness (middle school APR = 0.76, 95% CI = 0.72, 0.79; high school APR = 0.72, 95% CI = 0.68, 0.77) demonstrating a direct, independent protective relationship with past 30-day CU. There was no consistent evidence supporting the protective factors resiliency model.

Outcomes and Mechanisms of Change of the Strengthening Families Program in a Clinical Sample of Children and Their Families in Austria

Family context and parenting behavior have the greatest influence on children's mental health and well-being, and interventions that take the whole family system into account are promising. This study aims to evaluate the outcomes, i.e., family strength, parenting behavior, and child behavior, of the Strengthening Families Program (SFP), developed by Kumpfer which was implemented in an outpatient clinic of a community-based non-governmental organization in Austria between 2012 and 2018. Furthermore, the program's mechanism of change as formulated by the program authors (i.e., to what extent parenting behavior mediates the relationship between family strength and child behavior) was tested in this clinical sample. Instruments measuring family strength, parenting behavior, and child behavior were administered before, immediately after, and 6 months after participation in the SFP. To test the mechanisms of change, a half-longitudinal model was applied with two measurement points (before and after). A total of 62 families (50 boys, 24 girls, and 69 parents) participated in the culturally adapted SFP. Regarding the outcomes of the program, all variables yielded significant improvement in all variables. With respect to the mechanism of change, no significant association between the variables could be found. Implications for the implementation of the SFP in a clinical population and how further adaptation of the program could enhance the adherence of this target group are discussed.

Knowledge and practice of harm-reduction behaviours for alcohol and other illicit substance use in adolescents with type 1 diabetes

Objective

To survey adolescents with type 1 diabetes mellitus (T1DM) about their knowledge and application of harm-reduction recommendations when they engage in alcohol and other illicit substance use.

Methods

Cross-sectional survey and chart review of adolescents with T1DM aged 13 to 18 years.

Results

One hundred and ninety patients were approached and 164 were included in the analysis. Mean age was 15.6 years (standard deviation [SD]=1.5). Fifty-one per cent were male. Of those who reported consuming alcohol, 95% knew that they should have a friend or parent check their blood glucose in the middle of the night after drinking but only 62% reported actually doing this in practice. Similarly, 98% reported knowing that they should wear a medic alert identification but only 79% reported actually doing this. Of those who reported consuming cannabis, 14% reported forgetting to check blood glucose and 14% reported forgetting insulin when using cannabis. From the chart review, a significantly lower proportion of adolescents reported substance use during their clinic visits (alcohol 26%, tobacco 19%, illicit substance 25%) compared to the self report in the survey (alcohol 55%, tobacco 30%, illicit substance 32%).

Conclusions

Adolescents' knowledge of harm-reduction practices for the use of alcohol and other illicit substances is not always put to practice. Motivating adolescents to use their knowledge in practice is an important area to improve in diabetes self-management. Those who reported engaging in substance use in the survey had not always reported use during interactions with health care providers. This emphasizes the need for unbiased, universal education of all adolescents in the clinic.

Social integration and substance use: assessing the effects of an early intervention programme for youth

AIM

Appropriate social integration has been shown to be a protective factor against substance use among adolescents and associated negative consequences. Promoting social integration through early intervention with adolescents using substances is thus necessary and is the aim of the Identification, Assessment and Follow-up of Adolescents with Substance Use (in French, Dépistage - évaluation - parrainage d'adolescents consommateurs de substances (DEPART) programme. The present study aimed to describe this programme and its participants from 2009 to 2013 as well as to assess its effects on social integration.

METHODS

Data from 398 adolescents using substances who attended the DEPART programme were analysed.

RESULTS

The results showed that almost 80% of the adolescents admitted to the DEPART programme were boys, with a large proportion using cannabis. Globally, social integration did not increase from admission to discharge from the programme, but a shift was observed for school and professional integration. Additionally, after the intervention, we observed that social integration was more important in younger patients.

CONCLUSIONS

This study showed that adolescents with problematic substance use mostly consumed soft drugs and that those who were integrated into the DEPART programme at a younger age were more likely to be socially integrated at the end of the programme.

Illicit substance use among Tunisian college students: prevalence and risk factors

Background Illicit substance use among college students represents one of the most complicated social problems. Studying its predictors could help deal with this problem more efficiently. Aims To determine the prevalence of life time illicit substance use and its predictors among Tunisian college students. Methods A cross-sectional study was conducted in five colleges in the region of Sousse, Tunisia in the 2012-2013 school year. A sample of 556 college students responded to an anonymous self-administrated questionnaire. Collected data concerned socio-demographic characteristics and substances use. Results The mean age of students was 21.8 ± 2.2 years. Females represented 51.8% of participants. Among respondents: 31 (5.6%) had used illicit substance at least once. Cannabis was the main substance used by 26 (4.7%) students. The average age of the illicit substance use initiation was 19 (±2.5) years while it was almost 17 (±3) years for both tobacco and alcohol use initiations. Proportions of male students and academic failure were significantly more important among illicit substance users than among non users. While the most influential factors on illicit substance use were: alcohol use, tobacco use and low socioeconomic level. Conclusion This study highlights the strong association between the other risk behaviors and illicit drug use. Future interventions should focus on the whole risk behaviors simultaneously at late adolescence with regard to the environmental context.

The Deterrence Hypothesis Reexamined: Sports Participation and Substance Use among Young Adults

The widely held notion that sports participation reduces subsequent risk of substance use is evaluated with longitudinal data of a representative sample of youth when they were in their preteen and young adult years. Unlike previous inquiries into the deterrence hypothesis, the present study controls for other major factors previously found to be predictive of alcohol and drug use. Results of analyses revealed that contrary to the deterrence hypothesis, playing high school sports does not appear to be a protective factor that lowers one's involvement in young adult alcohol or drug use – with one exception. Subgroup analyses revealed that among blacks, the greater the extent of high school sports participation the less the risk of substance use. In direct contradiction to the deterrence hypothesis, playing high school sports was found to be positively associated with alcohol use for whites, even in the context of other major predictors of alcohol use. Further analyses revealed that the positive association between sports participation and alcohol use appeared to exist only for white males. The implications of these results are discussed.

Physical Activity, Sedentary Behavior and Substance Use among Adolescents in Slovenian Urban Area

Background

Studies of the relationship between leisure time physical activity, sedentary behaviour and substance use among adolescents report contradictory results. The aim of our study was to examine the association between self-reported leisure time physical activity, sedentary behaviour and alcohol, tobacco and cannabis use among adolescents in Slovenia.

Methods

Subjects consisted of 822 school children aged from 14 to 16 years, living in urban area of Ljubljana and Maribor. The data was collected using the EURO URHIS 2 survey. Logistic regressions were conducted to assess the correlation between the independent variables of physical activity; time spent watching television and using the computer, and each of the five substance use dependent variables.

Results

Frequency of daily smoking was significantly associated with leisure time physical activity, while alcohol and cannabis use were not. Watching TV ≥ 2 hours per day was associated with heavy episodic drinking in the past month, no associations were found for smoking and cannabis use. Using the computer ≥ 2 hours per day was positively associated with daily smoking, drinking alcohol in the past month, heavy episodic drinking in the past month and ever being intoxicated, while cannabis use was not.

Conclusions

These findings suggest that leisure time physical activity is associated with daily cigarette smoking, and leisure time sedentary behaviour is associated with alcohol and tobacco use among adolescents. The results of our study show the need for the formation of suitable preventive measures concerning reduced sitting time as well as leisure time physical activity targeted to adolescents.

Maturação Orbitofrontal, Marcadores Somáticos e Vulnerabilidade Precoce: para uma Hipótese Compreensiva de "Miopia Emocional" na Toxicodependência

A hipótese de “miopia emocional” constitui uma reflexão teórica de compreensão da vulnerabilidade psicológica identificada em muitos toxicodependentes. Propõe-se uma cooperação, mas não incorporação, de níveis de conhecimento em torno dos determinantes do neurodesenvolvimento, de perspectivas psicanalíticas e de vinculação e de modelos psicobiológicos das toxicodependências. Salientam-se influências ambientais sobre as mudanças na morfologia cerebral, não apenas o trauma precoce ou a privação de cuidados, mas também as decorrentes de consumos abusivos como cernes de vulnerabilidade. Propõe-se que a hipótese Damasiana dos marcadores somáticos participe nessa formulação. A parca qualidade das interações precoces pode sustentar o desligamento afetivo progressivo, a hipomaturação do cérebro social, o incremento de um padrão alexitímico e a procura urgente de sensações, todos potenciais propiciadores da busca do prazer nas drogas.

The moderating effect of family involvement on substance use risk factors in adolescents with severe emotional and behavioral challenges

OBJECTIVE

The current study longitudinally examined the moderating effects of family involvement, which previous research has shown to be a protective factor against adolescents' substance use involvement, on the associations between internalizing and externalizing problems, respectively, and substance use (alcohol, marijuana, and tobacco) and problems in a unique sample of adolescents with severe emotional and behavioral problems.

METHOD

Adolescents (n=4786) and their parents were assessed at three waves over a 1-year period as part of the SAMHSA funded Comprehensive Community Mental Health Initiative (CMHI). Multilevel growth curve models were estimated using Hierarchical Linear Modeling (HLM) to examine the associations between time-varying internalizing and externalizing problems, respectively, and substance use involvement over time as a function of family involvement at baseline.

RESULTS

Results supported the hypothesis that family involvement protects against adolescent substance use involvement by buffering the adverse effects of both internalizing and externalizing problems. Specifically, for alcohol use, family involvement buffered the negative effects of high externalizing problems. For tobacco use, family involvement buffered the negative effects of both internalizing and externalizing problems, respectively. For substance use problems, family involvement buffered the effects of only internalizing problems. Family involvement did not moderate effects of emotional and behavioral problems on marijuana use, however, a significant main effect was observed such that family involvement was negatively related to marijuana use.

CONCLUSIONS

Results suggest that the beneficial effects of family involvement on at-risk adolescents' substance use involvement are dependent on the type of emotional and behavioral problems the adolescent experiences as well as the type of substance the adolescent uses. Implications for family- and adolescent-focused treatment are discussed.

Developmental pathways linking externalizing symptoms, internalizing symptoms, and academic competence to adolescent substance use

This study extends previous research investigating the developmental pathways predicting adolescent alcohol and marijuana use by examining the cascading effects of externalizing and internalizing symptoms and academic competence in the prediction of use and level of use of these substances in adolescence. Participants (N=191) were drawn from a longitudinal study of first-born children of low-income mothers. Using data from ages 7, 9, 12, and 16 years, a series of nested two-part (semi-continuous) path models from a developmental cascade modeling framework were compared. Controlling for gender, SES, mother's age at child's birth, and minority status, we found (a) within-domain rank-order stability across time, (b) significant cross-domain effects over time, (c) higher externalizing symptoms significantly predicted use of alcohol and marijuana as well as higher levels of use in adolescence, and (d) higher levels of academic competence significantly added to the prediction of use of alcohol.

Psychosocial correlates of adolescent marijuana use: variations by status of marijuana use

INTRODUCTION

This study examined the associations between psychosocial factors and status of marijuana use: former experimentation, current occasional, and current frequent use.

METHODS

Data were collected from a nationally-representative sample of U.S. tenth-graders who participated in the 2005/6 Health Behavior in School-aged Children Study (n=1465). Multinomial regressions, run separately by gender, examined the association of risk and protective factors from the individual (life satisfaction; academic achievement; aggression, bullying) and contextual (mothers and fathers' knowledge of adolescents' activities, school climate) domains with status of marijuana use (former experimentation, current occasional use, current frequent use).

RESULTS

Former experimental and current marijuana uses were negatively associated with protective factors such as academic achievement, mothers' and fathers' knowledge of adolescents' activities, and life satisfaction, but not with positive school climate. Former experimental and current marijuana uses were positively associated with aggression and bullying perpetration. Most associations varied by gender and status of marijuana use. In adjusted analyses, aggression emerged as the sole risk factor and fathers' knowledge as the sole protective factor associated with most statuses of marijuana use, across gender.

CONCLUSION

Fathers may be particularly important in preventing adolescent marijuana use, and interventions promoting fathers' knowledge of adolescents' activities are warranted.

Project success' effects on substance use-related attitudes and behaviors: a randomized controlled trial in alternative high schools

Using a randomized controlled effectiveness trial, we examined the effects of Project SUCCESS on a range of secondary outcomes, including the program's mediating variables. Project SUCCESS, which is based both on the Theory of Reasoned Action and on Cognitive Behavior Theory, is a school-based substance use prevention program that targets high-risk students. We recruited two groups of alternative high schools in successive academic years, and randomly assigned schools in each group to either receive the intervention (n = 7) or serve as a control (n = 7). Students completed surveys prior to and following the administration of the program, and again 1 year later. Although participation in Project SUCCESS significantly increased students' perceptions of harm resulting from alcohol and marijuana use, students in the control group reported greater increases in peer support. We also found conflicting evidence in two opposing trends related to students' perceptions of the prevalence and acceptability of substance use. Therefore, the effects of Project SUCCESS on substance use-related beliefs and behaviors must be considered mixed.

Do parents and school matter? Protective factors for adolescent substance use

Protective factors may promote successful development by neutralizing the effects of negative risk factors. This paper is focused on possible protective factors of adolescent substance in a sample of high school students (N=881) in Szeged, Hungary. Data were collected in 2008. Self-administered questionnaires were applied that measured smoking, binge drinking, marijuana use and parental and school-related protective factors. Multiple regression analysis revealed that parental monitoring was a universal protective factor for adolescents. Acceptance and respect of parents' values may serve as a protection against binge drinking among adolescents. High academic achievement was a predictor of smoking and binge drinking, talking about problems with teachers and being happy with school were predictors of marijuana use. Future research is needed to clarify the altered role of parent-child relationship in adolescents' substance use.

Patterns of adolescent physical activity, screen-based media use, and positive and negative health indicators in the U.S. and Canada

PURPOSE

To examine: (1) how adolescent physical activity (PA) and screen-based media use (SBM) relate to physical and social health indicators, and (2) crossnational differences in these relationships.

METHODS

Essentially identical questions and methodologies were used in the Health Behavior in School-Aged Children cross-sectional surveys of nationally representative samples of American (N = 14,818) and Canadian (N = 7266) students in grades 6 to 10. Items included questions about frequency of PA, SBM, positive health indicators (health status, self-image, quality of life, and quality of family and peer relationships), and negative health indicators (health complaints, physical aggression, smoking, drinking, and marijuana use).

RESULTS

In regression analyses controlling for age and gender, positive health indicators were uniformly positively related to PA while two negative health indicators were negatively related to PA. However, PA was positively related to physical aggression. The pattern for SBM was generally the opposite; SBM was negatively related to most positive health indices and positively related to several of the negative health indicators. The notable exception was that SBM was positively related to the quality of peer relationships. Although there were crossnational differences in the strength of some relationships, these patterns were essentially replicated in both countries.

CONCLUSIONS

Surveys of nationally representative samples of youth in two countries provide evidence of positive physical and social concomitants of PA and negative concomitants of SBM. These findings suggest potential positive consequences of increasing PA and decreasing SBM in adolescents and provide further justification for such efforts.

Social environments and physical aggression among 21,107 students in the United States and Canada

BACKGROUND

Physical aggression is an important issue in North American populations. The importance of students' social environments in the occurrence of physical aggression requires focused study. In this study, reports of physical aggression were examined in relation to social environment factors among national samples of students from Canada and the United States.

METHODS

Students in grades 6-10 from the United States (n = 14,049) and Canada (n = 7058) who had participated in the Health Behaviour in School-aged Children Survey (HBSC) were studied. Rates of students' physical aggression were compared between the 2 countries. School, family, socioeconomic, and peer-related factors were considered as potential risk factors. A simple social environment risk score was developed using the US data and was subsequently tested in the Canadian sample.

RESULTS

Risks for physical aggression were consistently higher among United States versus Canadian students, but the magnitude of these differences was modest. The relative odds of physical aggression increased with reported environmental risk. To illustrate, US boys in grades 6-8 reporting the highest social environment risk score (5+) experienced a relative odds of physical aggression 4.02 (95% CI 2.7-5.9) times higher than those reporting the lowest score (adjusted OR for risk scores 0 through 5+ was 1.00, 1.19, 2.10, 2.01, 3.71, and 4.02, respectively, p(trend) < .001).

CONCLUSIONS

Unexpectedly, rates of physical aggression and associations between social environments and students' aggression were remarkably similar in Canada and the United States. Family, peer, and school social environments serve as risk or protective factors, with significant cumulative impact on physical aggression in both countries. Given the observed high rates and the many negative effects of aggression on long-term health, school policies aimed at the reduction of such behavior remain a clear priority.

Risky sexual behaviors, alcohol use, and drug use: a comparison of Eastern and Western European adolescents

PURPOSE

The current study examined to what extent cultural context moderated developmental processes, namely the patterns of association between low self-control, family processes and three indicators of health-compromising behaviors (risky sexual behaviors, alcohol and drug use) in two Eastern European and two Western European adolescent samples.

METHODS

School-based questionnaire data were collected from n = 7291 middle and late adolescents in Hungary, Slovenia, The Netherlands, and Switzerland. Students rated measures of self-control, family processes (closeness, support, and monitoring), and health-compromising behaviors. The data were analyzed by a series of set hierarchical regression analyses as well as follow-up z-tests for comparisons of individual regression coefficients.

RESULTS

Findings provided evidence that low self-control was positively associated with all three measures of health-compromising behaviors in a largely invariant fashion across countries. Differences were found in developmental processes, where low self-control was more weakly associated with risky sexual behaviors in samples of both Eastern European countries as compared with Western European ones, thus providing some evidence of idiosyncratic cultural norms. Results also provided evidence of mostly direct effects by family processes on measures of health-compromising behaviors. With two exceptions, no differences were observed in these effects across the four samples.

CONCLUSION

Low self-control explains variability in health-compromising behaviors, especially in alcohol and drug use. The observed differences in the link between low self-control and risky sexual behaviors may provide some evidence of distinct norms and values among Eastern European youth in comparison with Western European adolescents related to these behaviors.

Fatores associados ao consumo de álcool e drogas entre estudantes universitários

OBJETIVO: Estudos recentes mostram o uso preocupante de álcool e drogas entre universitários. O objetivo do trabalho foi verificar o grau de associação entre o estilo de vida e situação socioeconômica e o uso de álcool, tabaco, medicamentos e "drogas ilícitas" nos últimos 12 meses entre universitários. MÉTODOS: A amostra compreendeu 926 alunos da área de Ciências Biológicas de uma universidade do Município de São Paulo, os quais responderam a questionário anônimo e de auto-preenchimento em 2000 e 2001. Foram utilizados os testes de análise de variância e qui-quadrado para verificar a correlação entre o uso de substâncias e as variáveis estudadas. RESULTADOS: Entre os alunos com alguma religião, o consumo de álcool foi de 83,1%, o de tabaco, 20,7% e o de "drogas ilícitas", 24,6%, nesse período. Entre os alunos que não possuíam religião, o consumo nas três categorias foi superior nos últimos 12 meses: álcool (89,3%), tabaco (27,7%) e "drogas ilícitas" (37,7%). A renda familiar mensal mostrou-se relacionada ao uso de álcool e "drogas ilícitas" (p<0,001 para ambos). Os alunos que utilizaram tabaco e "drogas ilícitas" apresentavam mais horas livres nos dias úteis do que os alunos que não fumavam no período analisado (p=0,033 e p=0,008, respectivamente). CONCLUSÕES: O consumo de substâncias psicoativas entre os alunos estudados foi comum, indicando a necessidade de implementação de medidas para reduzir tal consumo. Alunos com renda familiar alta e sem religião podem ser considerados com maior risco de consumo de drogas nessa população.

Diverse trajectories of cocaine use through early adulthood among rebellious and socially conforming youth

This paper tests predictions of continuity and change in antisocial behavior over time as derived from population heterogeneity and life-course perspectives. These predictions are assessed with respect to a rarely studied form of delinquent/criminal behavior, cocaine use during the late-teenage and young adult years. We first examine the extent to which differential propensities toward antisocial behavior can be detected in a nationally representative sample of youth aged 14-16 in 1979. Based on self-reported delinquent and criminal activities in late adolescense, traditional cross-sectional latent-class analysis identifies three groups of antisocial/rebellious respondents and a group of non-offenders. We then follow these groups into early adulthood, examining age trajectories of cocaine usage between 1984 and 1998. Latent-class trajectory models identify clusters of respondents who show similar age trajectories of cocaine use over time and provide parameter estimates that predict membership in those clusters. In support of the population heterogeneity perspective, we find that antisocial/rebellious youth have higher probabilities of cocaine use throughout early adulthood than non-of-fending youth. There is, however, much variation in drug use patterns among the groups as they aged. In support of a life-course perspective, we find that social ties to schools, families, religion, and the labor market help differentiate youth who refrain from, maintain, or desist from using cocaine through early adulthood.

Resilience to risk-taking behaviors in impoverished African American girls: the role of mother-daughter connectedness

Rates of risk behaviors (e.g., violence, substance use) for impoverished girls are exceedingly high. Some view their future pessimistically, decreasing their resilience to avoid risky behaviors. Others resist such behaviors. Connectedness with an adult promotes this resilience, but how is unclear. The purpose of this secondary analysis was to investigate the relationships among connectedness to mother, time perspective, and resilience to risk-taking behaviors in impoverished African American girls ages 11-15. Structural equation modeling was used to cross-validate this model. In contrast to the results found in earlier studies, no direct relationship emerged between maternal connectedness and resilience. Instead, future time perspective was the key mediator between connectedness and resilience. These findings suggest that an important aspect of interventions to foster resilience to risk behaviors in young girls could be to assist their mothers in developing a connected relationship with their daughters that would promote a future time perspective.