The adolescent behavioral repertoire as a context for drug exposure: behavioral autarcesis at play

Prevalence and Predictors of Alcohol Use among School-Going Adolescents in Panama: A Population-Based Cross-Sectional Study

This study investigated the prevalence and predictors of alcohol use among school-going-age adolescents in Panama. Using a national school-based cross-sectional survey, data from a proportionate sample of school-going adolescents aged 13-17 years were obtained from the 2018 Panama Global School-based Student Health Survey [GSHS]. Data were analysed with a Pearson's Chi-square test and weighted binary logistic regression. The results were reported with their corresponding adjusted odds ratio (AOR) at a 95% confidence interval (CI) and level of significance set at p < 0.05. The prevalence of alcohol use among adolescents in Panama was 30.6%. The odds of alcohol use were lower among adolescents in a lower grade than those in upper grades, and lower in those who did not eat from a restaurant than those who ate from a restaurant. Further, the likelihood of alcohol use was significantly high among those who engaged in physical fights, were seriously injured, were mostly worried, and whose parents used any form of tobacco. Other results showed that the odds of alcohol use were high among sedentary respondents, those who had multiple sexual partners and those who used amphetamines. Based on the present findings, a collaborative approach (i.e., stakeholders- the Ministry of Social Development and the Ministry of Education- community-individual levels) towards the development and adherence of appropriate interventions aimed at reducing alcohol use is required in Panama. Specific preventive interventions would be fundamental in promoting a positive school climate to help reduce adolescents' alcohol use and, perhaps, other anti-social behaviours (e.g., physical fights and bullying).

Leisure activity participation in relation to alcohol purchasing and consumption in adolescence

BACKGROUND

Building upon the socioecological perspective, this study examines prospective associations linking leisure activity participation with alcohol purchasing and consumption in early adolescence.

METHODS

A total of 1763 seventh graders (age 12-13 years) were recruited from middle schools in urban Taiwan via multi-stage sampling and followed-up 1.5 years later during ninth grade. Information about leisure activities, covariates (i.e., gender, puberty development, family structure, parental educational attainment, monthly allowance, peer drinking, and childhood alcohol experience), and two outcome variables (i.e., alcohol purchasing and drinking behaviors) was gathered via web-based self-administered questionnaires. Data concerning alcohol outlets and recreational resource for each community district were retrieved from official statistics and commercial sources. Two-level hierarchical generalized linear models were used to evaluate association estimates.

FINDINGS

Five percent of ninth graders ever purchased alcohol and nearly one in seven drank alcohol on three or more occasions (i.e., occasional drinking) in the past year. Sports, unstructured, and organized leisure activities were not linked with illegal alcohol purchasing when community contexts were statistically adjusted; a higher community on-premised alcohol outlet density increased alcohol purchasing by 94% (95% CI = 1.24-3.06). In contrast, unstructured leisure activity participation at 7th grade predicted occasional drinking (adjusted Odds Ratio [aOR] = 5.52; 95% CI = 3.13-9.74). Sports participation was associated with reduced risk of occasional drinking in the communities with high unregulated alcohol outlets (aOR for interaction = 0.58; P < .001).

CONCLUSION

Our research provides insights to differential roles of leisure activity participation in shaping adolescents' commercial alcohol access and occasional drinking. Macro-social contexts should be considered in the efforts to reduce underage drinking problems through leisure activities.

PROSPER delivery of universal preventive interventions with young adolescents: long-term effects on emerging adult substance misuse and associated risk behaviors

BACKGROUND

Substance misuse and associated health-risking behaviors are prevalent in emerging adulthood. There is a knowledge gap concerning the post-high school effects of community-based delivery systems for universal preventive interventions implemented during young adolescence. This study reports effects of the PROSPER delivery system through age 19, 7.5 years past baseline.

METHODS

A cohort sequential design included 28 public school districts randomly assigned to the PROSPER partnership delivery system or usual-programming conditions. PROSPER community teams implemented a family-focused intervention in 6th grade and a school-based intervention in 7th grade. Outcomes for the age 19, post-high school report included lifetime, current, and frequency of substance misuse, as well as antisocial and health-risking sexual behaviors. Intent-to-treat, multi-level analyses of covariance of point-in-time outcomes were conducted, along with analyses of risk-related moderation of intervention effects.

RESULTS

Results showed emerging adults from PROSPER communities reported significantly lower substance misuse across a range of types of substances, with relative reduction rates of up to 41.0%. No significant findings were observed for associated antisocial and health-risking sexual behavior indices; or for lifetime rates of sexually transmitted infections. Risk-related moderation effects were non-significant, suggesting generally comparable outcomes across higher- and lower-risk subgroups of emerging adults.

CONCLUSIONS

The PROSPER delivery system for brief universal preventive interventions has potential for public health impact by reducing long-term substance misuse, with positive results extending beyond high school.

Persistence and Fadeout in the Impacts of Child and Adolescent Interventions

Many interventions targeting cognitive skills or socioemotional skills and behaviors demonstrate initially promising but then quickly disappearing impacts. Our paper seeks to identify the key features of interventions, as well as the characteristics and environments of the children and adolescents who participate in them, that can be expected to sustain persistently beneficial program impacts. We describe three such processes: skill-building, foot-in-the-door and sustaining environments. We argue that skill-building interventions should target "trifecta" skills - ones that are malleable, fundamental, and would not have developed eventually in the absence of the intervention. Successful foot-in-the-door interventions equip a child with the right skills or capacities at the right time to avoid imminent risks (e.g., grade failure or teen drinking) or seize emerging opportunities (e.g., entry into honors classes). The sustaining environments perspective views high quality of environments subsequent to the completion of the intervention as crucial for sustaining early skill gains. These three perspectives generate both complementary and competing hypotheses regarding the nature, timing and targeting of interventions that generate enduring impacts.

Who receives cannabis use offers: A general population study of adolescents

BACKGROUND

Drug use is predicated on a combination of "willingness" and "opportunity". That is, independent of any desire to use drugs, a drug use opportunity is required; be it indirect (i.e., being in a drug-use setting) or direct (i.e., receiving a direct drug offer). However, whether some youth are more likely to encounter such direct drug use opportunities is not fully known.

AIMS

We examined whether certain characteristics placed adolescents at greater risk for being offered cannabis, after accounting for a number of demographic-, contextual-, interpersonal-, and personal-level risk factors.

METHODS

We utilized data from a Norwegian school survey (n=19,309) where the likelihood of receiving cannabis offer in the past year was estimated using logistic regression models. Substantive focus was on the individual and combined effects of personal (i.e., delinquency) and interpersonal (i.e., cannabis-using close friend) risk factors. Separate models were fit for middle- and high-school students.

RESULTS

Delinquency was a significant risk factor for receiving cannabis offers, as was a cannabis-using best friend. In addition, peer cannabis use increased the risk of cannabis offers mostly for adolescents on the lower delinquency spectrum, but less so for highly delinquent adolescents. These interaction effects were primarily driven by the middle-school cohort.

CONCLUSIONS

Cannabis offers were more likely to be extended to youth of certain high-risk profiles. Targeted prevention strategies can therefore be extended to a general profile of younger adolescents with externalizing problems and cannabis-using peers.

The role of neighborhood in urban black adolescent marijuana use

BACKGROUND

The present study examined the influence of neighborhood factors on transitions in marijuana involvement during adolescence in a sample of primarily low-income, urban Black youth.

METHODS

556 Black adolescents were interviewed annually beginning in first grade as part of a longitudinal study. Latent class analysis (LCA) was used to examine stages of marijuana involvement from 6th to 9th grades. The influence of neighborhood disorder, drug activity, violent crime, safety and disadvantage on transitions in marijuana involvement was tested using latent transition analysis (LTA).

RESULTS

There was evidence for three stages of involvement: no involvement, offered, and use and problems. Involvement increased steadily during adolescence with a slightly greater risk to transition from offers to use between 6th and 7th grades. Neighborhood disorder (AOR=1.04, CI=1.00, 1.08), drug activity (AOR=1.12, CI=1.02, 1.22) and disadvantage (AOR=1.44, CI=1.10, 1.92) were associated with the transition from marijuana offers to use and problems. Neighborhood disorder (AOR=1.07, CI=1.02, 1.11), drug activity (AOR=1.19, CI=1.10, 1.29) and violent crime (AOR=1.17, CI=1.03, 1.32) were associated with transitioning rapidly from no involvement to use and problems.

CONCLUSIONS

Understanding how neighborhoods could be organized and provided with supports to discourage marijuana use and promote non-drug using behaviors should be an important goal of any prevention program in low-income, urban Black neighborhoods. Enhancing citizen participation and mobilization to address the social processes of neighborhood disorder has the potential to reduce marijuana involvement in these neighborhoods.

Peers and social network on alcohol drinking through early adolescence in Taiwan

OBJECTIVES

This study aims to identify peers and social network characteristics associated with drinking occasions through early adolescence.

METHODS

The study sample of 1808 middle school students (aged 13-15 years) in northern Taiwan was collected via a two-wave longitudinal study of the Alcohol-Related Experiences among Children (AREC). Data concerning individual sociodemographics, family characteristics, peer influence, and alcohol drinking behaviors were collected via web-based self-administered questionnaire. Building upon the maximum of five friends nominated by young respondents at 7th grade, class-based social network was first constructed via the UCINET and Pajek; the network position (i.e., member, bridge, and isolate) for each student was subsequently ascertained. Complex surveys analyses and negative binominal regression models were used to evaluate concurrent and prospective relationship estimates.

RESULTS

Effects of peers and social network were found to operate differentially by childhood alcohol experience. For the alcohol naïve youngsters, receiving higher peer's nomination at baseline was linked with subsequent increased drinking occasions (adjusted Incidence Rate Ratio [aIRR]=1.06; 95% CI=1.01-1.10), whereas having peers against alcohol drinking may reduce drinking occasions at 9th grade (aIRR=0.59; 95% CI=0.41-0.87). For the alcohol experienced youngsters, having parental alcohol offer, drinking peers, and attending classes of higher drinking norms may increase future drinking occasions by 90%, 80% and 44%, respectively.

CONCLUSIONS

Our results demonstrated that parental alcohol offer, peer norms, and social network may affect adolescent drinking occasions differentially depending on childhood drinking experience. The findings have implications for the interventions to reduce alcohol consumption in underage population.

Replication RCT of early universal prevention effects on young adult substance misuse

OBJECTIVE

For many substances, more frequent and problematic use occurs in young adulthood; these types of use are predicted by the timing of initiation during adolescence. We replicated and extended an earlier study examining whether delayed substance initiation during adolescence, resulting from universal preventive interventions implemented in middle school, reduces problematic use in young adulthood.

METHOD

Participants were middle school students from 36 Iowa schools randomly assigned to the Strengthening Families Program: For Parents and Youth 10-14 (Molgaard, Spoth, & Redmond, 2000) plus Life Skills Training (LST; Botvin, 1995, 2000), LST-only, or a control condition. Self-report questionnaires were collected at 11 time points, including 4 during young adulthood. The intercept (average level) and rate of change (slope) in young adult frequency measures (drunkenness, alcohol-related problems, cigarettes, and illicit drugs) across ages 19-22 were modeled as outcomes influenced by growth factors describing substance initiation during adolescence. Analyses entailed testing a 2-step hierarchical latent growth curve model; models included the effects of baseline risk, intervention condition assignment, and their interaction.

RESULTS

Analyses showed significant indirect intervention effects on the average levels of all young adult outcomes, through effects on adolescent substance initiation growth factors, along with Intervention × Risk interaction effects favoring the higher risk subsample. Additional direct effects on young adult use were observed in some cases. Relative reduction rates were larger for the higher risk subsample at age 22, ranging from 5.8% to 36.4% on outcomes showing significant intervention effects.

CONCLUSIONS

Universal preventive interventions implemented during early adolescence have the potential to decrease the rates of substance use and associated problems into young adulthood.

Universal family-focused intervention with young adolescents: effects on health-risking sexual behaviors and STDs among young adults

Considering the prevalence and consequences of health-risking sexual behaviors (HRSBs) and STDs among young adults, their prevention is a public health priority. Emerging etiological and prevention outcome literatures suggested study of the long-term effects of universal family-focused interventions on young adult HRSBs and STDs. Although earlier studies have demonstrated intervention impact on adolescent substance misuse, no study has examined universal family-focused intervention effects on young adult HRSBs and STDs via reductions in adolescent misuse. Sixth grade students and their families enrolled in 33 rural Midwestern schools were randomly assigned to experimental conditions. Self-report questionnaires provided data at pretest (Ns = 238, 221, and 208 for the Iowa Strengthening Families Program [ISFP], Preparing for the Drug Free Years [PDFY], and control groups, respectively), with seven data points through young adulthood (age 21). In latent growth modeling, three young adult HRSB measures (number of sexual partners, condom use, substance use with sex) and lifetime STDs were specified as distal outcomes mediated by adolescent substance initiation growth factors (average level and rate of change). Results showed that the models fit the data and, except for condom use, there were significant indirect effects, with a higher frequency of significant findings for ISFP. The model additions of direct intervention effects on young adult outcomes generally were not supported, consistent with a model positing that long-term intervention effects on young adult HRSBs and STDs outcomes are indirect. As an indication of the practical significance of long-term effects, analyses revealed relative reduction rates ranging from 6% to 46% for significant outcomes.

Benefits of universal intervention effects on a youth protective shield 10 years after baseline

PURPOSE

An earlier randomized controlled study found that a universal, family-focused preventive intervention produced protective shield effects-reduced adolescent exposures to illicit substance opportunities-among adolescents in grade 12. This study examined a follow-up assessment of the sample during young adulthood.

METHODS

A randomized controlled trial evaluated the Iowa Strengthening Families Program that was implemented in 22 rural schools (N = 446 families) when the participants were in grade six. Measures included adolescent exposure to illicit substance use and young adult lifetime substance use (age 21; N = 331). Growth curve modeling examined indirect intervention effects through growth factors of adolescent exposure.

RESULTS

Findings from this study confirm protective shield effects that mediate long-term reduction of illicit substance use (β = -.14, p = .02, Relative Reduction Rate = 28.2%).

CONCLUSIONS

The benefits of decreasing exposure to substance use during adolescence through universal interventions were supported, with positive effects extending into young adulthood.

Childhood predictors of first chance to use and use of cannabis by young adulthood

AIMS

To prospectively examine the linkage between childhood antecedents and progression to early cannabis involvement as manifest in first chance to try it and then first onset of cannabis use.

METHODS

Two consecutive cohorts of children entering first grade of a public school system of a large mid-Atlantic city in the mid 1980s (n=2311) were assessed (mean age 6.5 years) and then followed into young adulthood (15 years later, mean age 21) when first chance to try and first use were assessed for 75% (n=1698) of the original sample. Assessments obtained at school included standardized readiness scores (reading; math) and teacher ratings of behavioral problems. Regression and time to event models included covariates for sex, race, and family disadvantage.

RESULTS

Early classroom misconduct, better reading readiness, and better math readiness predicted either occurrence or timing of first chance to try cannabis, first use, or both. Higher levels of childhood concentration problems and lower social connectedness were not predictive.

CONCLUSIONS

Childhood school readiness and behavioral problems may influence the risk for cannabis smoking indirectly via an increased likelihood of first chance to use. Prevention efforts that seek to shield youths from having a chance to try cannabis might benefit from attention to early predictive behavioral and school readiness characteristics. When a youth's chance to try cannabis is discovered, there are new windows of opportunity for prevention and intervention.

Preventing substance misuse through community-university partnerships: randomized controlled trial outcomes 4½ years past baseline

BACKGROUND

Substance misuse by adolescents and related health issues constitute a major public health problem. Community-based partnership models designed for sustained, quality implementation of proven preventive interventions have been recommended to address this problem. There is very limited longitudinal study of such models.

PURPOSE

To examine the long-term findings from an RCT of a community-university partnership model designed to prevent substance misuse and related problems.

DESIGN/SETTING/PARTICIPANTS

A cohort sequential design included 28 public school districts in rural towns and small cities in Iowa and Pennsylvania that were randomly assigned to community-university partnership or usual-programming conditions. At baseline, 11,960 students participated, across two consecutive cohorts. Data were collected from 2002 to 2008.

INTERVENTION

Partnerships supported community teams that implemented universal, evidence-based interventions selected from a menu. The selected family-focused intervention was implemented with 6th-grade students and their families; school-based interventions were implemented during the 7th grade. Observations demonstrated intervention implementation fidelity.

MAIN OUTCOME MEASURES

Outcome measures were lifetime, past-month, and past-year use of a range of substances, as well as indices of gateway and illicit substance use; they were administered at baseline and follow-ups, extending to 4.5 years later.

RESULTS

Intent-to-treat, multilevel ANCOVAs of point-in-time use at 4.5 years past baseline were conducted, with supplemental analyses of growth in use. Data were analyzed in 2009. Results showed significantly lower substance use in the intervention group for 12 of 15 point-in-time outcomes, with relative reductions of up to 51.8%. Growth trajectory analyses showed significantly slower growth in the intervention group for 14 of 15 outcomes.

CONCLUSIONS

Partnership-based implementation of brief universal interventions has potential for public health impact by reducing growth in substance use among youth; a multistate network of partnerships is being developed. Notably, the tested model is suitable for other types of preventive interventions.

Universal intervention effects on substance use among young adults mediated by delayed adolescent substance initiation

In this article, the authors examine whether delayed substance initiation during adolescence, achieved through universal family-focused interventions conducted in middle school, can reduce problematic substance use during young adulthood. Sixth-grade students enrolled in 33 rural midwestern schools and their families were randomly assigned to 3 experimental conditions. Self-report questionnaires provided data at 7 time points for the Iowa Strengthening Families Program (ISFP), Preparing for the Drug Free Years (PDFY), and control groups through young adulthood. Five young adult substance frequency measures (drunkenness, alcohol-related problems, cigarettes, illicit drugs, and polysubstance use) were modeled as distal outcomes affected by the average level and rate of increase in substance initiation across the adolescent years in latent growth curve analyses. Results show that the models fit the data and that they were robust across outcomes and interventions, with more robust effects found for ISFP. The addition of direct intervention effects on young adult outcomes was not supported, suggesting long-term effects were primarily indirect. Relative reduction rates were calculated to quantify intervention-control differences on the estimated proportion of young adults indicating problematic substance use; they ranged from 19% to 31% for ISFP and from 9% to 16% for PDFY.

Universal intervention as a protective shield against exposure to substance use: long-term outcomes and public health significance

OBJECTIVES

We examined universal preventive intervention effects on adolescents' exposure to opportunities for substance use and on illicit substance use in the long term.

METHODS

Public schools (N = 22) were randomly assigned to the Iowa Strengthening Families Program (ISFP) or a control condition. We used odds ratio (OR) calculations and structural modeling to test the effects of the ISFP in the 6th grade on exposure to substance use across adolescence, as well as on 12th-grade illicit substance use occurring via reductions in exposure.

RESULTS

The ISFP was associated with reduced exposure to illicit substance use (1.25 < or = OR < or = 2.37) that was, in turn, associated with reduced 12th-grade substance use (2.87 < or = OR < or = 6.35). The ISFP also reduced the rate of increase in exposure across adolescence (B = -0.37; P < .001), which was associated with the likelihood of 12th-grade illicit substance use (B = 0.30; P = .021), with a significant indirect effect (B = -0.11; P = .048).

CONCLUSIONS

The ISFP in the 6th grade reduced substance use through a "protective shield" of reduced exposure. The relative reduction rate was 49%, which suggests that universal prevention shields can contribute to significant reductions in illicit substance use among adolescents.

Daily exercise and anabolic steroids use in adolescents: a cross-national European study

AIM

The aim of this paper is to investigate the association between anabolic steroid (AS) use and intensive physical exercise among adolescents.

DESIGN/SETTING

The 1999 cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD). Data collection by standardized methodology using anonymous self-administered questionnaires completed in the classroom.

PARTICIPANTS

National probability samples of a total of 18,430 16-year-old high school students from six European countries (Bulgaria, Croatia, Cyprus, Greece, the Slovak Republic, and the U.K.)

MEASUREMENTS

Besides AS use and physical exercise, questionnaire items selected for this study included tobacco, alcohol, and illicit drug use, indicators of other deviant behavior (self-harming thoughts and behavior, truancy, aggressive behavior), friends' use of AS, and perceived availability. Backward elimination with likelihood ratio tests was used to select the variables to be retained in a mutlifactorial model. Interactions of other independent variables with country were checked.

FINDINGS

Logistic regression analysis of lifetime AS users compared to nonusers showed that the odds of lifetime AS use are 1.4 times higher for students who exercise almost daily and 1.8 times higher for boys compared to girls. Significant associations of AS use were also found with current frequent alcohol use, lifetime use of tranquilizers/sedatives and cannabis, and with the perceptions of friends' use of AS and of easy availability of the substance.

CONCLUSION

Findings indicate that daily exercising appears to increase the risk of anabolic steroid use in adolescents. However, a more general pattern of closely interlinked deviant types of behavior, such as other drug use and aggressive behavior, is prominent. Preventive interventions are needed targeted towards adolescents involved in intensive exercise and sport. These should take into account both the idiosyncrasy and setting of the sporting culture and the special characteristics of this group.

A Systematic Review of Recent Literature on Religiosity and Substance Use

This paper contains a systematic review of articles about the relationship between religiosity/spirituality and alcohol and drug use that were published between 1997 and 2006. Summaries of methodological characteristics (e.g., study design, sample size and composition, specific dimensions of religiosity, and substances investigated) and general findings of 105 studies provide an overview of the field. The association between religiosity/spirituality and reduced risk of substance use is well established, but a well defined body of knowledge on this relationship has been slow to emerge. The development of more sophisticated instrumentation to measure religiosity and spirituality, the investigation of samples that include users of major drugs of abuse, and the integration of the study of religion and drug use into the broader literature on religion and health can help the field build upon the considerable work that has been published.

Education and race-ethnicity differences in the lifetime risk of alcohol dependence

OBJECTIVES

While lower socioeconomic status (SES) is related to higher risk for alcohol dependence, minority race-ethnicity is often associated with lower risk. This study attempts to clarify the nature and extent of social inequalities in alcohol dependence by investigating the effects of SES and race-ethnicity on the development of alcohol dependence following first alcohol use.

DESIGN

Cross-sectional analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093). Survival analysis was used to model alcohol dependence onset according to education, race-ethnicity and their interaction.

SETTING

United States, 2001-2.

RESULTS

Compared with non-Hispanic white people, age-adjusted and sex-adjusted risks of alcohol dependence were lower among black people (odds ratio (OR) = 0.70, 95% confidence interval (CI) = 0.63 to 0.78), Asians (OR = 0.65, CI = 0.49 to 0.86) and Hispanics (OR = 0.68, CI = 0.58 to 0.79) and higher among American Indians (OR = 1.37, CI = 1.09 to 1.73). Individuals without a college degree had higher risks of alcohol dependence than individuals with a college degree or more; however, the magnitude of risk varied significantly by race-ethnicity (chi(2) for the interaction between education and race-ethnicity = 19.7, df = 10, p = 0.03); odds ratios for less than a college degree were 1.12, 1.46, 2.24, 2.35 and 10.99 among Hispanics, white people, black people, Asians, and American Indians, respectively. There was no association between education and alcohol dependence among Hispanics.

CONCLUSIONS

Race-ethnicity differences in the magnitude of the association between education and alcohol dependence suggest that aspects of racial-ethnic group membership mitigate or exacerbate the effects of social adversity.

A Cross-National Comparison of Adolescent Alcohol and Drug Use Behaviors: U. S. Hispanics and Youth in the Dominican Republic

The prevalence of substance use behaviors during adolescence is an important concern in the United States and internationally. Of particular importance to the U.S. is our ability to compare prevalence estimates and trends with those of neighboring countries, particularly those that feed our immigrant population and have a circulatory migration pattern with us. One of the fastest-growing Hispanic groups is Dominicans, who are also a young group, with a third of Dominicans in the United States under age 18. However, cross-national comparisons of the substance use rates of youth in the U. S. and the Dominican Republic have not been done. Our study represents, to our knowledge, the first such comparison. We conducted a secondary data analysis comparing data from the U.S. Center for Disease Control and Prevention's (CDC) 1997 Youth Risk Behavior Survey (YRBS), a biennial survey in the U.S., to data from a survey conducted by the Ministry of Education of the Dominican Republic in 1997. The Dominican Republic survey used a similar sampling methodology and the Spanish version of the YRBS, piloted and modified to ensure linguistic and cultural appropriateness. Youth in the United States in general, and U.S. Hispanic youth in particular, consistently reported higher lifetime and recent use of alcohol, marijuana, and cocaine than youth in the Dominican Republic. Our study supports other cross-national comparisons that have found rates of substance use for youth in Latin America lower than those for youth in the United States. Cross-national comparisons of this nature help each individual country inform its social policies around prevention. They may also allow us to examine the impact of immigration, acculturation, and return migration processes on adolescent substance use in both countries.

Prevalence and correlates of substance use among South African primary care clinic patients

We aimed to assess prevalence and correlates of hazardous use of tobacco, alcohol and other drugs in a primary care population in Cape Town, South Africa. Stratified random sampling was used to select 14 of the 49 clinics in the public health sector in Cape Town, and every "nth" patient, with those ages 18-25 oversampled (N = 2,618). Data were collected from December 2003 through 2004, using the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test. Hazardous use of tobacco was most common, followed by alcohol and then other drugs. Hazardous tobacco use was associated with the 18-25 years age group, no religious involvement, high school completion, and higher stress. Hazardous alcohol use was associated with male gender, younger men, no religious involvement, employment, some high school education, and higher stress. Hazardous use of other drugs was associated with Colored (mixed) race (particularly among men), no religious involvement, employment, and stress. For all substances, women, particularly Black women, had the lowest rates of hazardous use. Although the study is cross-sectional, it does identify groups that may be at high risk of substance misuse and for whom intervention is urgent. Because prevalence of substance use is high in this population, routine screening should be introduced in primary care clinics.

Risk and protective factors for adolescent substance use: findings from a study in selected Central American countries

PURPOSE

To identify the prevalence of substance use and problems with use, and risk and protective factors at different levels of the adolescent's ecology associated with substance use among adolescents in selected Central American countries.

METHODS

Results of a survey of 17,215 students from Panama, Costa Rica, and Guatemala conducted in 2000-2001 served as the basis for the analyses. Lifetime use of alcohol, tobacco, marijuana, and five other drugs (inhalants, tranquilizers, cocaine, crack, and ecstasy), and problems with drugs and alcohol were the outcome variables. Risk factors included dysregulation, family problems with drugs/alcohol, negative family interactions, school disengagement, peer deviance, and exposure to community violence. Protective factors included a personal belief in God, positive family interactions, parent religiosity, and positive student-teacher interaction. Both hierarchical linear regression and logistic regression analyses were used to model main and interaction effects of risk and protective factors.

RESULTS

There was a linear association between number of risk and protective factors and substance use, however, risk factors were more strongly associated with substance use than were protective factors. There were significant risk-by-protective-factor interactions for alcohol and marijuana use, and for problems with drugs and alcohol. Risk interacted most consistently with a personal belief in God, but also with parent religiosity and with student-teacher communication.

CONCLUSIONS

It is important to consider risk and protective factors at different levels of an adolescent's ecology. Prevention and intervention efforts should focus on interactions adolescents have in different microsystems (e.g., with parents, teachers, and peers).

Psychosocial correlates of substance use in adolescence: a cross-national study in six European countries

AIMS

To examine the psychosocial correlates of substance use among adolescents in six European countries.

DESIGN

Cross-sectional school population survey (ESPAD) based on standardized methodological procedures.

SETTING

High schools in six European countries: Bulgaria, Croatia, Greece, Romania, Slovenia and UK.

PARTICIPANTS

Representative samples of a total sample of 16,445 high school students whose 16th birthday fell in the year of data collection.

MEASUREMENTS

Anonymous self-administered questionnaire. Self-reported substance use was measured by core items on tobacco, alcohol, marijuana and any illegal drug use. Psychosocial correlates included scales of self-esteem, depression, anomie and antisocial behavior, and items pertaining to family, school and peers.

FINDINGS

Logistic regression analyses for each potential correlate adjusted for country, taking into account the clustered sample, showed statistically significant associations with each substance use variable separately, in almost every case. Particularly strong associations were found between smoking and going out most evenings and having many friends who smoke, while cannabis and illegal drugs were strongly correlated with having friends or older siblings who used these substances. The self-esteem scale score was not correlated with substance use. Anomie and antisocial behavior were more strongly associated than depression with substance use. In the case of depression, anomie and most of the other items examined, associations were stronger for girls than for boys.

CONCLUSION

The present cross-national study identified correlates of legal and illegal substance use which extend outside specific countries, providing grounds to believe that they can be generalized. They provide evidence for the need to address both the use of the gateway drugs and deviant behavior in conjunction with environmental risk factors when designing and implementing preventive interventions in schools.

A cross-national comparison of youth risk behaviors in Latino secondary school students living in El Salvador and the USA

OBJECTIVES

As Latin Americans' exposure to the USA increases through migration patterns and US political and economic ties to their countries of origin, they become susceptible to adopting not only the cultural expressions of the USA such as fashion, but also the health-related behaviors of the US population. In assessing potential health risks for Salvadoran youth that may result from the connection between Latin Americans and the USA, this study compared the prevalence of health risk behaviors from four behavior domains (aggression and victimization, depression and suicidal ideation, substance use, and sexual behavior) between Salvadoran and US Latino secondary school students aged 14-17 years.

DESIGN

A secondary analysis was performed on two 1999 cross-sectional survey data. In the USA, results were based on 1,063 Latino high school students who answered the nationally representative Youth Risk Behavior Survey (YRBS) conducted by the Centers for Disease Control and Prevention. In El Salvador, results were based on 793 public secondary school students who answered a local YRBS survey conducted in coordination with the Ministry of Education of El Salvador.

RESULTS

The prevalence rates for aggression/victimization and for depression and suicidal ideation behaviors were similar between Salvadoran and US Latino adolescents. Substance use prevalence, however, was 10-40% higher for US Latino adolescents. While the prevalence of sexual intercourse was higher among US Latino youth (between 13 and 27% higher, depending on age), the prevalence of condom use was lower among sexually active Salvadoran youth (between 11 and 42% lower, depending on age).

CONCLUSIONS

In the context of the transnationalization of the Salvadoran population, with potential for increased influence of the USA in Salvadoran culture, these differences in risk behavior are important for targeting effective interventions for Latino adolescents in El Salvador and in the USA.

Smoking and young people's mental health

PURPOSE OF REVIEW

This review addresses the evidence on smoking and young people's mental health, reported during 2004.

RECENT FINDINGS

Research studies have confirmed the previously reported epidemiological associations of smoking with gender, race and social class, as well as suspected risk factors and antecedents. Among youths, the prevalence of smoking varies across subgroups of the population, classified by race/ethnicity and social class. Gender differences in smoking vary cross-nationally. Smoking among youths is higher when parents, siblings, or peers smoke. Smoking is also higher in youths with histories of early conduct problems, drinking and illegal drug use, depression, and suicidal behaviors. The protective role of youth involvement in sports and the lesser opportunity to smoke among youths involved in religious practice were also confirmed. Among young people, early conduct problems and associated early onset of daily smoking predict a greater likelihood of becoming nicotine dependent. The interpretation of the high smoking rate among schizophrenic patients as self-medication has been challenged by a recent study that reported that smoking predicted subsequent first hospitalization for schizophrenia. New findings suggest that young persons who experienced their first exposure to nicotine as relaxing are at elevated risk for becoming nicotine dependent.

SUMMARY

Longitudinal cohort studies and cross-sectional studies have been published on smoking and young people's mental health. These studies describe smoking correlates and identify predictors of negative outcomes of smoking, as well as predictors of nicotine dependence, smoking initiation, and smoking cessation.