The effects of social anxiety on alcohol and cigarette use across adolescence: Results from a longitudinal twin study in Finland

Are Depressive and Anxiety Symptoms Differentially Associated with Alcohol Use Behaviors: Multivariate Behavioral Genetic Analyses

This study examined whether adolescent depressive and anxiety symptoms were differentially associated with alcohol use behaviors, and how these associations were explained by genetic, shared, and nonshared environmental influences. Participants were from the Nonshared Environment and Adolescent Development project of same-sex twin/sibling pairs from 720 families. Twin/sibling depressive and anxiety symptoms were measured by self-report at Time 1 (Mage = 13.71 years, range = 9-18 years). Alcohol initiation and alcohol use severity were measured by self-report three years after Time 1 (age range = 12-21 years). Phenotypic Cholesky models were used to estimate the variance of depressive symptoms and the unique variance of anxiety symptoms (independent of depressive symptoms), and how these variances were associated with alcohol initiation and alcohol use severity. Biometric Cholesky models then estimated contributions of genetic, shared and nonshared environmental influences to these variances and covariances. Antisocial behaviors were included in all analyses to account for their associations with depressive symptoms, anxiety symptoms and alcohol use behaviors. Analyses were conducted using the full, the younger half, and the older half of the sample to explore age differences in all associations. Depressive or anxiety symptoms were not associated with alcohol use behaviors after controlling for variance shared with antisocial behaviors, although age-specific analyses suggested some potential effects to explore in future studies for late adolescence. To conclude, longitudinal associations between depressive or anxiety symptoms and alcohol use behaviors during adolescence were mainly driven by the general psychopathology factor shared between internalizing and externalizing problems.

Time Spent on Social Media and the Risk of Substance Use Among US Adolescents

BACKGROUND AND OBJECTIVES

Adolescence is a period marked by increased risk of substance use and extensive social media engagement. Investigating the link between social media usage and substance use among adolescents is crucial for developing effective interventions and public health policies.

METHODS

This study utilized data from the Population Assessment of Tobacco and Health (PATH) study, focusing on adolescents aged between 12 and 17 years old who reported no substance use at Wave 2. Participants were followed from Wave 2 through Wave 5. At baseline (Wave 2), daily time spent on social media use was reported, and past 30-day (P30D) substance use (e.g., alcohol, tobacco products, marijuana, and non-med drug use) was assessed in subsequent waves (Waves 3-5). Generalized Estimating Equation (GEE) models were used to analyze self-reported daily time spent on social media and P30D substance use, adjusting for demographic and time-varying covariates.

RESULTS

The study included 4769 adolescents, with nearly half identifying as male (47.0%) and as non-Hispanic white (49.1%). Over 75% of participants reported spending at least 30 min on social media daily. In adjusted models, a dose-response relationship was observed between time spent on social media and the odds of subsequent tobacco use. For alcohol and marijuana use, the association followed a curvilinear pattern, with the highest odds among adolescents who spent 30 min to 3 h per day on social media. For nonmedical drug use, a significant association was observed only for those spending 3-6 h on social media daily, who had nearly twice the odds of nonmedical drug use, compared to non-users.

CONCLUSIONS

The present study is among the first to quantify the association between daily time spent on social media and the risk of using substances, such as alcohol, cannabis, tobacco products, and illicit drugs in the US adolescent cohort. Social media could be leveraged for targeted interventions and public health initiatives aimed at reducing substance use in this population.

Distinct characteristics of social anxiety among youths with childhood sexual abuse: A latent profile analysis

BACKGROUND

Childhood sexual abuse (CSA) is one type of childhood trauma that has long-term effects on physical and mental health, predisposing to social anxiety.

OBJECTIVE

This study attempted to investigate the characteristics of different subgroups of social anxiety among youths with CSA experiences.

PARTICIPANTS AND SETTING

83,219 participants were recruited in a cross-sectional study from 63 colleges and universities in Jilin Province, China.

METHODS

The main variables were measured by a series of self-report questionnaires. Latent profile analysis was used to classify different subgroups of social anxiety, and multiple logistic regression was employed to investigate factors influencing transitions between different subgroups.

RESULTS

3022 (3.63 %) youths who suffered from CSA (46.8 % were male, Mage = 19.57, SD = 1.76) could be divided into four subgroups of social anxiety: low-risk social anxiety (16.4 %), medium-risk social anxiety with high public speaking anxiety (30.3 %), medium-risk social anxiety with no prominent characteristics (22.9 %), and high-risk social anxiety (30.4 %). Shy bladder and bowel and virtual life orientation increased the level of social anxiety from low to medium and high risk. Smoking and drinking were more prevalent in the low- and medium-risk subgroups than in the high-risk subgroup.

CONCLUSIONS

There was heterogeneity in different subgroups of social anxiety among youths with CSA experiences. Potential targeted prevention and intervention suggestions could be beneficial in mitigating the risk of social anxiety and further preventing the aggravation of risk between subgroups.

Cannabis use and its psychosocial correlates among school-going adolescents in Sierra Leone

BACKGROUND

In Sierra Leone, adolescents are increasingly engaging in risky activities, including cannabis use, which can lead to substance abuse, poor academic performance, and psychotic symptoms. This study aims to investigate the prevalence and associated factors of cannabis use among school-going adolescents in the country.

METHOD

Data for the study was sourced from the 2017 Sierra Leone Global School-based Student Health Survey (GSHS), a nationally representative survey conducted among adolescents aged 10-19 years using a multistage sampling methodology. A weighted sample of 1,467 adolescents in Sierra Leone was included in the study. The study utilised bivariate and multivariable logistic regression analysis to identify factors linked to cannabis use, presenting results using adjusted odds ratios and 95% confidence intervals.

RESULTS

The prevalence of cannabis use was 5.1% [3.0,8.6] among school-going adolescents in Sierra Leone. School-going adolescents who attempted suicide [aOR = 6.34, 95% CI = 1.71-23.45], used amphetamine [aOR = 15.84, 95% CI = 7.94-31.62] and were involved in sexual risk behaviour [aOR = 5.56, 95% CI = 2.18-14.20] were more likely to be associated with cannabis use.

CONCLUSION

In Sierra Leone, a small but non-trivial minority of students use cannabis. Ever-used amphetamines or methamphetamines, suicidal attempts, and sexual risk behaviour were the factors associated with cannabis use in Sierra Leone. The development of school-based health intervention programmes is crucial to address the risk factors associated with cannabis use among school-going adolescents.

Alcohol use among in-school adolescents in Sierra Leone

OBJECTIVE

To examine the prevalence of alcohol use and its associated factors among in-school adolescents in Sierra Leone.

DESIGN

Data for the study was sourced from the 2017 Sierra Leone Global School-Based Student Health Survey, a nationally representative survey conducted among in-school adolescents aged 10-19 years using a multistage sampling methodology. Percentages were used to present the prevalence of alcohol use among in-school adolescents. Multivariable binary logistic regression analysis was performed to examine the factors associated with alcohol use among in-school adolescents. The results were presented using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI).

SETTING

Sierra Leone.

PARTICIPANTS

A weighted sample of 1730 in-school adolescents in Sierra Leone.

OUTCOME MEASURE

Current alcohol use.

RESULTS

The prevalence of alcohol use among in-school adolescents was 10.7% (7.3, 15.3). In-school adolescents in senior secondary schools were more likely to use alcohol compared with those in junior secondary school (aOR=2.13; 95% CI 1.37, 3.30). The odds of alcohol use was higher among in-school adolescents who were truant at school relative to those who were not (aOR=2.24; 95% CI 1.54, 3.26). Also, in-school adolescents who were bullied (aOR=1.85; 95% CI 1.24, 2.76), ever engaged in sexual intercourse (aOR=2.06; 95% CI 1.39, 3.06), and used marijuana (aOR=3.36; 95% CI 1.72, 6.53) were more likely to use alcohol compared with those who were not. However, in-school adolescents who reported that their parents understood their problems (aOR=0.52; 95% CI 0.33, 0.82) had a lower likelihood of consuming alcohol.

CONCLUSION

Our study has shown that alcohol use is prevalent among in-school adolescents in Sierra Leone. Grade level, experiences of being bullied, history of sexual intercourse, truancy at school, and previous use of marijuana were the factors influencing alcohol use among in-school adolescents. The findings emphasise the necessity of creating school-based health interventions in Sierra Leone that can effectively identify in-school adolescents potentially vulnerable to alcohol-related issues. Also, existing policies and programmes aimed at reducing alcohol use among in-school adolescents need to be strengthened.

Drinking Motives, Alcohol Misuse, and Internalizing and Externalizing Psychopathology across College: A Cross-Lagged Panel Study

Background: Drinking motives are strong proximal predictors of alcohol use behaviors and may represent a mediational mechanism by which different individual predispositions toward internalizing or externalizing psychopathology lead to the development of alcohol misuse. However, whether the association is due to a causal relationship or a shared etiology (i.e., confounding) is difficult to determine and may change across developmental periods. Methods: This study leveraged a cross-lagged panel design to disentangle the nature of the relationships between self-report measures of drinking motives, alcohol misuse, and internalizing and externalizing psychopathology in a 4-year longitudinal sample of college students (N = 9,889). Results: Results pointed to a putative causal effect of drinking motives on early binge drinking frequency, but the direction of effect later reversed, reflecting a possible developmental shift during college. On the other hand, the relationships between drinking motives and internalizing/externalizing psychopathology appeared to be driven by shared etiology rather than direct causal mechanisms. Conclusions: These findings highlight the distinct and important role of drinking motives in the etiology of alcohol misuse and have implications for the application of tailored prevention and treatment strategies.

Internalizing and externalizing subtypes of alcohol misuse and their relation to drinking motives

BACKGROUND

Several typologies have proposed two etiological pathways involved in the development of alcohol misuse which are associated with the internalizing and externalizing domains of psychopathology, respectively. This study's aim was to investigate this typology in a young adult sample, and test whether drinking motives, specifically drinking for negative or positive reinforcement, may provide a plausible mechanism characterizing these pathways.

METHOD

Mixture modeling was conducted on a set of internalizing (anxiety, depression, neuroticism), externalizing (antisocial behavior, conscientiousness, sensation seeking, drug use), and alcohol misuse items (binge drinking, alcohol use disorder symptoms [AUDsx]) measured by self-report in a sample of 9,807 college students. Linear regression and chi-square tests were used to determine how latent class membership was associated with drinking motives, demographics, and personality characteristics.

RESULTS

The model identified 3 latent classes: a Low Risk class (70%), an Internalizing class (19%) with elevated levels of internalizing traits/symptoms and AUDsx, and an Externalizing class (10%) with elevated levels of externalizing traits/symptoms and both binge drinking and AUDsx. All drinking motives were substantially elevated in the Internalizing and Externalizing (vs Low Risk) classes (p < 3.0E-10), while positive reinforcement motives were specifically elevated in the Externalizing (vs Internalizing) class (p < 2.0E-55). Personality comparisons further emphasized the relevance of class distinctions.

CONCLUSIONS

These findings provide additional support for both a specific internalizing and a broadband externalizing association with subtypes of alcohol misuse. Drinking motives may be useful intermediate indicators of these different risk processes.

Investigating the reciprocal temporal relationships between tobacco consumption and psychological disorders for youth: an international review

OBJECTIVE

To investigate reciprocal temporal relationships between tobacco consumption and psychological disorders for youth.Design: Review DATA SOURCES: Five databases (PubMed, Embase, Scopus, CINAHL and PsycINFO) on 26 September 2019 and updated on 11 May 2021, indexing tobacco, mental illness and longitudinal.Study selection: Methods used consensus and multiple reviewers.

INTERVENTIONS

Cohort studies (n=49) examining tobacco and selected psychological disorders (depression, anxiety, bipolar, psychosis, borderline personality disorder) among youth, and systematic reviews (n=4) of these relationships met inclusion criteria.

PRIMARY AND SECONDARY OUTCOME MEASURES

Effect of tobacco on psychological disorders and effect of psychological disorders on tobacco.

DATA EXTRACTION AND SYNTHESIS

Independent extraction by the first author and checked by final author. Joanna Briggs Institute Critical Appraisal Tools were used for all studies.Included studies had moderate-to-high appraisal scores. We synthesised findings using vote counting for effect direction and descriptive data.

RESULTS

Fifty-three studies were included in the review. Thirteen of 15 studies showed a positive effect direction of tobacco on depression (p<0.001). Six of 12 studies showed a positive effect direction of depression on tobacco (p=0.016). Six of eight studies showed a positive effect direction of tobacco on anxiety (p=0.016). Eleven of 18 studies showed a positive effect direction of anxiety on tobacco (p=0.003). No effect between tobacco and bipolar, or tobacco and psychosis was found. No studies examined tobacco and borderline personality disorder.

CONCLUSIONS

Reciprocal relationships existed between tobacco and both depression and anxiety for youth, though causality is unconfirmed. No positive effect direction was found between tobacco and psychosis, perhaps because nicotine has conflicting effects on psychosis. For other relationships examined, evidence was weak because of low number of studies. More research to inform prevention and early intervention is needed.

PROSPERO REGISTRATION NUMBER

CRD42020150457.

Predicting Alcohol Dependence Symptoms by Young Adulthood: A Co-Twin Comparisons Study

Co-twin comparisons address familial confounding by controlling for genetic and environmental influences that twin siblings share. We applied the co-twin comparison design to investigate associations of adolescent factors with alcohol dependence (AD) symptoms. Participants were 1286 individuals (581 complete twin pairs; 42% monozygotic; and 54% female) from the FinnTwin12 study. Predictors included adolescent academic achievement, substance use, externalizing problems, internalizing problems, executive functioning, peer environment, physical health, relationship with parents, alcohol expectancies, life events, and pubertal development. The outcome was lifetime AD clinical criterion count, as measured in young adulthood. We examined associations of each adolescent domain with AD symptoms in individual-level and co-twin comparison analyses. In individual-level analyses, adolescents with higher levels of substance use, teacher-reported externalizing problems at age 12, externalizing problems at age 14, self- and co-twin-reported internalizing problems, peer deviance, and perceived difficulty of life events reported more symptoms of AD in young adulthood (ps < .044). Conversely, individuals with higher academic achievement, social adjustment, self-rated health, and parent-child relationship quality met fewer AD clinical criteria (ps < .024). Associations between adolescent substance use, teacher-reported externalizing problems, co-twin-reported internalizing problems, peer deviance, self-rated health, and AD symptoms were of a similar magnitude in co-twin comparisons. We replicated many well-known adolescent correlates of later alcohol problems, including academic achievement, substance use, externalizing and internalizing problems, self-rated health, and features of the peer environment and parent-child relationship. Furthermore, we demonstrate the utility of co-twin comparisons for understanding pathways to AD. Effect sizes corresponding to the associations between adolescent substance use, teacher-reported externalizing problems, co-twin-reported internalizing problems, peer deviance, and self-rated health were not significantly attenuated (p value threshold = .05) after controlling for genetic and environmental influences that twin siblings share, highlighting these factors as candidates for further research.

An analysis of within-subject and population level risk related to substance use and mental health outcomes among adolescents in the PATH study

INTRODUCTION

The objective of this study was to understand how adolescent substance use patterns may lead to negative mental health outcomes.

METHODS

Data from adolescents (12-17 years old at baseline, Wave 1) who participated in the first 3 waves of the Population Assessment of Health and Tobacco (PATH) study were used. Self-reported data on past 30-day substance use and internalizing/externalizing problems were used to conduct within-subject (fixed-effects model) and population-averaged (GEE model) analyses.

RESULTS

In both within-subject and between-subject analyses, the use of other illicit drugs (e.g., opioids, cocaine, prescription drugs for non-medical use) was positively associated with internalizing problems (within-subject estimate, AOR: 1.65, 95 % CI = 1.36-2.01; between-subject estimate, AOR: 1.53, 95 % CI = 1.32-1.78) and alcohol use was positively associated with externalizing problems (within-subject estimate, AOR: 1.66, 95 % CI = 1.43-1.93; between-subject estimate, AOR: 1.67, 95 % CI = 1.48-1.89). Additionally, within-subject analysis suggested that alcohol, marijuana, and other illicit drugs were associated with increased odds of comorbid internalizing and externalizing problems (ranging from marijuana, AOR: 1.18, - alcohol, AOR: 1.58).

DISCUSSION

Using within-subject and between-subject comparisons, this study demonstrated associations between adolescent substance use and internalizing and externalizing problems. Results suggest not only the need for individual level assessment and early intervention, but also the development and implementation of public health policy aimed at preventing or mitigating the negative effects of substance use in adolescence to promote improved mental health outcomes for this at-risk group.

Comorbidity of substance misuse with anxiety-related and depressive disorders: a genetically informative population study of 3 million individuals in Sweden

BACKGROUND

Causes of the comorbidity of substance misuse with anxiety-related and depressive disorders (anxiety/depression) remain poorly known. We estimated associations of substance misuse and anxiety/depression in the general population and tested them while accounting for genetic and shared environmental factors.

METHODS

We studied individuals born in Sweden 1968-1997 (n = 2 996 398) with follow-up in nationwide register data for 1997-2013. To account for familial effects, stratified analyses were conducted within siblings and twin pairs. Substance misuse was defined as ICD-10 alcohol or drug use disorder or an alcohol/drug-related criminal conviction. Three dimensions of ICD-10 anxiety and depressive disorders and a substance misuse dimension were identified through exploratory factor analysis.

RESULTS

Substance misuse was associated with a 4.5-fold (95% CI 4.50-4.58) elevated risk of lifetime generalized anxiety/depression, 4.7-fold (95% CI 4.63-4.82) elevated risk of panic disorder and agora/social phobia, and 2.9-fold elevated risk of phobias/OCD (95% CI 2.82-3.02) as compared to those without substance misuse. The associations were attenuated in within-family analyses but we found elevated risks in monozygotic twin pairs discordant for substance misuse as well as significant non-shared environmental correlations. The association between anxiety/depression and substance misuse was mainly driven by generalized anxiety/depression, whereas other anxiety/depression dimensions had minor or no independent associations with substance misuse.

CONCLUSIONS

Substance misuse and anxiety/depression are associated at the population level, and these associations are partially explained by familial liabilities. Our findings indicate a common genetic etiology but are also compatible with a potential partially causal relationship between substance misuse and anxiety/depression.

The Role of Anxiety in Smoking Onset, Severity, and Cessation-Related Outcomes: a Review of Recent Literature

PURPOSE OF REVIEW

Anxiety is one of the most common mental health conditions globally and co-occurs with smoking at a markedly high rate. The present review offers a narrative overview of the most recent research on the role of anxiety in smoking onset, maintenance, and cessation-related outcomes. Additionally, given the rise in electronic cigarette use, we review the emerging literature on the influence of anxiety on e-cigarette use.

RECENT FINDINGS

Evidence across studies varied as to the role of anxiety or anxiety symptoms in smoking behavior. The most consistent findings suggested that those with anxiety are more likely to be a smoker, supporting a high rate of co-occurrence across these conditions. Less consistent evidence was observed for the association between anxiety and onset, indicators of severity, and cessation outcomes. Although there is robust evidence for an association between smoking and anxiety, there were considerable discrepancies for the precise role of anxiety in smoking onset, severity, and cessation outcomes. Future work utilizing more sophisticated methodologies is needed to identify causal relations as well as putative moderators and mediators of the anxiety-smoking relation.

Which adolescent factors predict alcohol misuse in young adulthood? A co-twin comparisons study

BACKGROUND AND AIMS

Research on adolescent predictors of later alcohol misuse is typically conducted on samples of singletons, and associations may be confounded by between-family differences. To address potential confounding, we applied a co-twin comparison design to evaluate whether differences between co-twins in a wide array of adolescent risk factors predicted differences in young adult alcohol misuse.

DESIGN

Longitudinal study in which associations between characteristics of the sample as adolescents were used to predict young adult alcohol misuse in individual-level analyses and co-twin comparisons.

SETTING

Finland.

PARTICIPANTS

A total of 3402 individuals (1435 complete twin pairs; 36% monozygotic; 57% female) from the FinnTwin12 study.

MEASUREMENTS

The young adult alcohol misuse outcome was a composite score of alcohol use and intoxication frequency. Adolescent predictors included factor scores representing academic performance, substance use, externalizing problems, internalizing problems, peer environment, physical health and relationship with parents; and single measures tapping alcohol expectancies, life events and pubertal development.

FINDINGS

In individual-level analyses, individuals with higher adolescent substance use, externalizing problems, time with friends, peer deviance, sports involvement, sleeping difficulties, parental discipline, positive alcohol expectancies and difficulty of life events reported higher alcohol misuse in young adulthood (Ps < 0.019, R²  = 0.0003-0.0310%). Conversely, those with higher adolescent internalizing problems, parent-child relationship quality and time with parents reported lower alcohol misuse (Ps < 0021, R²  = 0.0018-0.0093%). The associations with adolescent substance use and alcohol expectancies remained significant in co-twin comparisons (Ps < 0.049, R²  = 0.0019-0.0314%). Further, academic performance emerged as a significant predictor, such that individuals with higher grades compared with their co-twin reported higher young adult alcohol misuse (Ps < 0.029, R²  = 0.0449-0.0533%).

CONCLUSIONS

Adolescent substance use, positive alcohol expectancies and higher academic performance appear to be robust predictors of later alcohol misuse.

The association between early life mental health and alcohol use behaviours in adulthood: A systematic review

This systematic review aims to summarise current evidence on the association between early life mental health and alcohol use behaviours in adulthood. Peer-reviewed publications were located by searching EMBASE, Medline, PsycINFO, and the ISI Web of Science up to 31 October 2018. Prospective longitudinal studies reporting associations between externalising problems (EXT), internalising problems (INT), depression, anxiety before age 18, and alcohol use behaviours (alcohol consumption, heavy/problematic drinking, alcohol use disorder) after age 18 were included. After screening 17259 articles, 36 articles met the inclusion criteria. Information extracted included strength of associations, age when mental health and alcohol use behaviours were measured, sex differences in the association, and other sample characteristics. 103 tests in 23 articles were identified on the externalising domain and 135 tests in 26 articles on the internalising domain. 37 out of 103 tests reported positive associations between EXT and alcohol use behaviours. The likelihood of observing positive associations was higher for more severe alcohol use outcomes, but this trend disappeared among high-quality studies. Findings on associations between internalising domain and alcohol use varied across their subtypes. INT tended to be negatively associated with alcohol consumption but positively associated with more severe outcomes (heavy/problematic drinking, alcohol use disorder). Depression tended to be positively associated with alcohol outcomes, while no clear association between anxiety and alcohol outcomes was evident. Variation of the association across developmental timing, sex, culture, historical period was explored where appropriate. Great heterogeneity in the current literature calls for greater attention to view the relationship developmentally.

FinnTwin12 Cohort: An Updated Review

This review offers an update on research conducted with FinnTwin12 (FT12), the youngest of the three Finnish Twin Cohorts. FT12 was designed as a two-stage study. In the first stage, we conducted multiwave questionnaire research enrolling all eligible twins born in Finland during 1983-1987 along with their biological parents. In stage 2, we intensively studied a subset of these twins with in-school assessments at age 12 and semistructured poly-diagnostic interviews at age 14. At baseline, parents of intensively studied twins were administered the adult version of the interview. Laboratory studies with repeat interviews, neuropsychological tests, and collection of DNA were made of intensively studied twins during follow-up in early adulthood. The basic aim of the FT12 study design was to obtain information on individual, familial and school/neighborhood risks for substance use/abuse prior to the onset of regular tobacco and alcohol use and then track trajectories of use and abuse and their consequences into adulthood. But the longitudinal assessments were not narrowly limited to this basic aim, and with multiwave, multirater assessments from ages 11 to 12, the study has created a richly informative data set for analyses of gene-environment interactions of both candidate genes and genomewide measures with measured risk-relevant environments. Because 25 years have elapsed since the start of the study, we are planning a fifth-wave follow-up assessment.

Cannabis and amphetamine use and its psychosocial correlates among school-going adolescents in Ghana

BACKGROUND

The aim of this study was to examine the prevalence of cannabis and amphetamine use and to determine its associated factors among school-going adolescents in Ghana.

METHOD

The 2012 Ghanaian Global School-based Student Health Survey on 3632 adolescents aged 11-19 years (mean = 15.1 years; SD = 1.4) was used. Participants for this study were sampled from selected junior (JHS) and senior high schools (SHS) in all the 10 administrative regions of Ghana. A two-stage cluster sampling design was used to select 25 senior high schools to represent all the 10 regions of Ghana. Information was collected with a self-administered structured questionnaire that contained information on demographics, alcohol, tobacco and other drug use, violence, and a range of other health-related behaviours.

RESULTS

The result showed that past-month cannabis use was 5.3% and lifetime amphetamine use was 7.1% among students. In multivariate model, after controlling for other variables, school truancy and current cigarette smoking were associated with both past-month cannabis and lifetime amphetamine use. The number of close friends was associated with only past-month cannabis use. School environment factors (bullying victimisation and having been attacked) and parental substance use were associated with lifetime amphetamine use.

CONCLUSION

This study identified a number of risk factors, including parental substance use and various risk behaviours, for both past-month cannabis and lifetime amphetamine use. School-based health intervention programmes should be developed taking into consideration the risk factors associated with cannabis and amphetamine use among school-going adolescents.

Associations of child and adolescent anxiety with later alcohol use and disorders: a systematic review and meta-analysis of prospective cohort studies

BACKGROUND AND AIMS

Despite a wealth of literature, the relationship between anxiety and alcohol use remains unclear. We examined whether (a) child and adolescent anxiety is positively or negatively associated with later alcohol use and disorders and (b) study characteristics explain inconsistencies in findings.

DESIGN AND SETTING

We conducted a systematic review of 51 prospective cohort studies from 11 countries. Three studies contributed to a meta-analysis. We searched PubMed, Scopus, Web of Science and PsycINFO databases, and studies were included if they met the following criteria: English language publication, human participants, anxiety exposure (predictor variable) in childhood or adolescence and alcohol outcome at least 6 months later.

PARTICIPANTS

Study sample sizes ranged from 110 to 11 157 participants. Anxiety exposure ages ranged from 3 to 24 years, and alcohol outcome ages ranged from 11 to 42 years.

MEASUREMENTS

Ninety-seven associations across 51 studies were categorized by anxiety exposure (generalized anxiety disorder, internalizing disorders, miscellaneous anxiety, obsessive compulsive disorder, panic disorder, separation anxiety disorder, social anxiety disorder and specific phobias) and alcohol use outcome (drinking frequency/quantity, binge drinking and alcohol use disorders).

FINDINGS

The narrative synthesis revealed some evidence for a positive association between anxiety and later alcohol use disorders. Associations of anxiety with later drinking frequency/quantity and binge drinking were inconsistent. Type and developmental period of anxiety, follow-up duration, sample size and confounders considered did not appear to explain the discrepant findings. The meta-analysis also showed no clear evidence of a relationship between generalized anxiety disorder and later alcohol use disorder (odds ratio = 0.94, 95% confidence interval = 0.47-1.87).

CONCLUSIONS

Evidence to date is suggestive, but far from conclusive of a positive association between anxiety during childhood and adolescence and subsequent alcohol use disorder.

Psychiatric Diagnoses Differ Considerably in Their Associations With Alcohol/Drug-Related Problems Among Adolescents. A Norwegian Population-Based Survey Linked With National Patient Registry Data

The aim of this study was to examine alcohol/drug use and problems across psychiatric diagnoses and to what extent associations between each psychiatric diagnosis and alcohol/drug use and problems were independent from the potential confounding effects of psychiatric comorbidity, socioeconomic status, sex and age. We used a dataset comprising a linkage between a large population-based and cross-sectional study among Norwegian adolescents (the youth@hordaland conducted in 2012) and national registry-based data on specialist mental health care use during the 4 years prior to the survey (2008 to 2011). The study sample included 16 to 19 year olds who participated in the youth@hordaland survey and consented to the linkage with patient registry data (n = 9,408). Among these, 853 (9%) had received specialist mental health care and comprised the clinical group, while the rest (n = 8,555) comprised the comparison group. The main outcome variables were several self-reported indicators for alcohol/drug use, including any alcohol use, frequent alcohol intoxication, high-level alcohol consumption, and lifetime illicit drug use, as well as one indicator for potential alcohol/drug-related problems: a positive CRAFFT-score. Adolescents receiving specialist mental health care (n = 853) reported more frequently alcohol/drug use and problems compared to adolescents not receiving these services (Cohens d's ranging from 0.09 to 0.29, all p ≤ 0.01). Anxiety, depression, conduct disorders, eating disorders, ADHD, and trauma-related disorders were all associated with single measures of alcohol/drug use and problems, with odds ratios (ORs) ranging from 1.58 to 4.63, all p < 0.05) in unadjusted models. Trauma-related disorders, depression and conduct disorders were also positively associated with higher scores on a combined indicator of alcohol/drug use and problems (ORs ranging from 1.89 to 3.15, all p < 0.01), even after the full adjustment from psychiatric comorbidity and sociodemographic variables (adjusted odds ratios ranging from 1.61 to 2.79, p < 0.05). These results suggest that alcohol/drug use and problems were slightly more common among adolescents who received specialist mental health care during the past 4 years compared with the general adolescent population, and adolescents with trauma-related disorders, depression and conduct disorders were high-risk groups for alcohol/drug use and problems.

Real-time social stress response and subsequent alcohol use initiation among female adolescents

Adolescents who are particularly sensitive to social stress may be vulnerable to earlier alcohol consumption and related problems. Although a small literature supports this contention, previous studies mostly relied on retrospective self-report. The current study used discrete-time survival analysis (DTSA) to test whether real-time social stress responding (via laboratory induction) and social anxiety symptoms predicted 12-month alcohol onset in an alcohol-naïve sample of young female adolescents. Anxiety elicited by the task was expected to predict greater and earlier rates of alcohol incidence, particularly among girls with higher levels of self-reported social anxiety symptoms. Participants were 104 community-recruited girls (ages 12-15 years) who completed a modified Trier Social Stress Test and questionnaires; follow-up calls were conducted at 3, 6, 9, and 12 months after the laboratory visit. Self-reported anxiety was assessed in response to the stressor following acclimation (baseline), instruction (anticipation), and speech (posttask). By 12 months, 30.8% of the sample had consumed a full alcoholic beverage. The DTSA revealed that girls with higher levels of social anxiety and greater elevations in anticipatory (but not posttask) anxiety compared to baseline had earlier alcohol initiation. This is the first study to examine the role of both laboratory-induced anxious responding and retrospective reports of social anxiety as prospective predictors of alcohol incidence. These preliminary findings suggest that adolescent girls who are more sensitive to social stress may be at risk for experimenting with alcohol earlier than their peers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).