An exploratory study of the relationship between parental attitudes and behaviour and young people's consumption of alcohol

Alcohol use among Croatian adolescents: the alignment of 13-year-old and 15-year-old girls with boys, and the impact of the COVID-19 pandemic

AIM

To determine age and gender patterns of alcohol use among Croatian pupils and assess whether alcohol use was associated with factors related to school, peers, family, and the COVID-19 pandemic.

METHODS

Data were collected from the 2022 Health Behavior in School-aged Children cross-sectional study conducted in Croatia involving 5338 pupils. Pearson χ2 test and multivariate logistic regression were performed.

RESULTS

At the age of 11, boys were drinking alcohol more than girls (P<0.001), while 13- and 15-year-old girls aligned with boys. Lifetime alcohol use was positively associated with schoolwork pressure in 11-year-old girls (OR 3.28, CI 1.36-7.75) and boys (OR 1.87, CI 1.03-3.37). The COVID-19 pandemic negatively affected mental health in 13- (OR 2.21, 1.56-3.13) and 15-year-old girls (OR 1.50, CI 1.01-2.23), and life in 15-year-old boys (OR 1.83, 1.03-3.27). Recent alcohol use was positively associated with hospitalization of a close family member for COVID-19 in 11-year-old girls (OR 2.35, 1.05-5.28), low peer support in 13-year-old boys (OR 1.49, 1.01-2.20), difficult communication with father in 15-year-old girls (OR 1.49,1.05-2.12), negative COVID-19 impact on mental health in 13-year-old girls (OR 1.67,1.13-2.47), and negative COVID-19 impact on life in 15-year-old boys (OR 1.79, 1.08-2.98). Lifetime drunkenness was positively associated with negative COVID-19 impact on mental health in 13- (OR, 2.03,1.28-3.21) and 15-year-old girls (OR 2.12, 1.49-3.01), and with positive or neutral COVID-19 impact on life in 15-year-old girls (OR 0.65, 0.43-0.97).

CONCLUSION

Preventive activities should offer support systems to minimize the negative COVID-19 impact, with special attention to girls' needs.

Social and Environmental Predictors of Youth Alcohol and Cannabis Initiation Risk: The Moderating Role of Family History of Substance Use Disorders

BACKGROUND

The social and local-home environment impacts youth's likelihood of early substance use initiation (SUI). Yet, it is unknown whether protective or risk factors are salient for all forms of youth SUI, or may be specific to certain substances (e.g., alcohol, cannabis). Additionally, certain family factors - such as having a family history of SUD (FH+)-may exacerbate risk for and mitigate protection from alcohol (AUI) and cannabis (CUI) use initiation.

OBJECTIVES

Using a longitudinal cohort of 387 adolescents, we aimed to understand how the link between social and local-home factors on AUI and CUI was moderated by FH status.

RESULTS

Results indicated that affiliating with risky peers significantly increased the risk of AUI and CUI, but that this relationship was not moderated by FH status. On the other hand, the link between mother-youth relationship quality and CUI, was potentially moderated by FH status such that being FH+ attenuated the protective effect of a positive relationship with parents on SUI.

CONCLUSIONS

This research could provide evidence that youth who are at risk of early SUI, particularly those who are FH+, may benefit from programs designed to reduce affiliation with risky peers.

Parent/caregiver attitudes, motivations and behaviours in relation to alcohol use among offspring aged 13-18 years: a qualitative study

BACKGROUND

Parental alcohol consumption and alcohol-related behaviour play a critical role in shaping adolescent alcohol use, but comparatively little is known about the perspectives of parents regarding adolescent alcohol use from qualitative studies in England. This study aimed to explore parental views and attitudes towards alcohol use during adolescence, among their offspring and among young people in general.

METHODS

Twenty-three parents (21 mothers, 2 fathers) of children aged 13-18 years were recruited via schools, workplaces and community settings, predominantly in the West of England (n = 19) between 2017 and 2018. Data were collected via in-depth one-to-one interviews and analysed thematically, using an inductive, constructionist approach.

RESULTS

Five major themes were identified in the data: (1) the parental alcohol environment, (2) balance and acceptance, (3) influences of the parental approach, (4) boundaries and parental monitoring, and (5) wider influences shaping young people's behaviour. Overall, parents were aware of the risks and consequences of alcohol use and the wide range of influences shaping drinking behaviour, and expressed broad disapproval of alcohol use among young people. However, adolescent alcohol use was viewed as inevitable, and set within a context of a tolerant drinking culture. Many parents therefore chose a balanced and reluctantly accepting approach. This approach was determined by weighing disapproval of drinking against consistency with wider culture and parental behaviour, support for autonomy of the child, and avoidance of social sanctions. Parents' responses were also determined by a desire to protect the parent-child relationship, maintain an open, communicative and trusting relationship, and ultimately limit risk and minimise harm. Various boundaries and strategies were employed to this end, including care around role modelling, gradual introductions to alcohol, boundaried provision, clear risk reduction messaging and parental monitoring.

CONCLUSIONS

Parents employ a range of mechanisms to reduce alcohol-related risk and to balance harms of alcohol use among their offspring against adolescent behavioural norms. A downward shift in community consumption and changing socio-cultural norms could alter the accepting context in which parents are required to navigate adolescent alcohol use.

Does parental permissiveness toward cigarette smoking and alcohol use influence illicit drug use among adolescents? A longitudinal study in seven European countries

PURPOSE

Adolescents' perceptions of parental norms may influence their substance use. The relationship between parental norms toward cigarette and alcohol use, and the use of illicit substances among their adolescent children is not sufficiently investigated. The purpose of this study was to analyze this relationship, including gender differences, using longitudinal data from a large population-based study.

METHODS

The present study analyzed longitudinal data from 3171 12- to 14-year-old students in 7 European countries allocated to the control arm of the European Drug Addiction Prevention trial. The impact of parental permissiveness toward cigarettes and alcohol use reported by the students at baseline on illicit drug use at 6-month follow-up was analyzed through multilevel logistic regression models, stratified by gender. Whether adolescents' own use of cigarette and alcohol mediated the association between parental norms and illicit drug use was tested through mediation models.

RESULTS

Parental permissive norms toward cigarette smoking and alcohol use at baseline predicted adolescents' illicit drug use at follow-up. The association was stronger among boys than among girls and was mediated by adolescents' own cigarette and alcohol use.

CONCLUSION

Perceived parental permissiveness toward the use of legal drugs predicted adolescents' use of illicit drugs, especially among boys. Parents should be made aware of the importance of norm setting, and supported in conveying clear messages of disapproval of all substances.

The Significance of School-based Programs, School-based Activities, and Community-Based Activities Against Marijuana Use Among Adolescents

Background: Marijuana use among adolescents is concerning in the United States, meanwhile, the effectiveness of school-based programs is inconclusive. This study examines the impact of school-based programs, school-based activities, and community-based activities on marijuana use among adolescents. Methods: A binary logistic regression analysis was conducted, using a sample of 16,509 adolescents (age = 12 to 17, male = 51.3%, White = 60.1%, Hispanic = 21.4%, African American = 14.7%, and Asian American = 3.9%) from the 2013 National Survey on Drug Use and Health (NSDUH). Results: Results of the main effects revealed that school-based programs, school-based activities, and community-based activities were deterrent factors against marijuana use among adolescents. Adolescents are less likely to use marijuana if they participate in school-based programs, school-based activities, and community-based activities. Conclusion: The findings of this study have implications for schools and those making educational policy.

Addictions in Spanish College Students in Confinement Times: Preventive and Social Perspective

Diverse studies have shown that a significant percentage of the Spanish university population suffers from different addictions. They are both a personal and public health problem if there is not a greater awareness of the risks involved and if the appropriate prevention measures are not taken, among them educational ones. In this context, a descriptive and explanatory cross-sectional study was conducted during the first half of June 2020, coinciding with the period of confinement that occurred in Spain during the first wave of the COVID-19 pandemic. Given that this is such an exceptional time, the main objective of this study was to obtain information especially on students’ substance consumption and possible addictions at this time. Knowing the specific situation of this problem in that specific situation may allow for comparative studies in the future. The sample was composed of 310 university students from 14 Spanish universities. The instrument used in the research was the ASSIST questionnaire, developed by the WHO for the detection of alcohol, tobacco, and substance consumption. As result, a moderate and high risk was observed mainly in the following substances: alcohol (36.2%), tobacco (33.2%), cannabis (22.9%), and sedatives (10.3%). Through the logistic regression of the set of drugs, it has been proven that, on the one hand, the addiction to cocaine and sedatives in the family environment and age, on the other hand, are the main predictive variables of drug consumption. The existence of polysubstance abuse was also determined. These data show the need for educational bodies and university institutions to promote awareness, sensitization, and health education programs to deal with this important problem, especially in extraordinary situations, such as the one referred to, which could increase this consumption.

Social, economic and family factors associated with binge drinking in Spanish adolescents

BACKGROUND

The main aim of this study was to determine the socioeconomic and family factors associated with binge drinking (BD) in Spanish adolescents who participated in a web-based computer intervention for the prevention of binge drinking known as Alerta Alcohol.

METHODS

Longitudinal analyses were carried out in a sample of Andalusian adolescents aged 15 to 19 enrolled in public schools, which was part of a two-arm cluster randomized controlled trial with an intervention group (IG) who received the Alerta Alcohol programme and a control group (CG) who did not receive any active intervention. Panel count data and the following econometric procedures were used: negative binomial, a two-part model and a finite mixture model. The endogenous variable in all models was the number of BD occasions in the last 30 days. A total of 1247 subjects in the pre-intervention period, with an average age of 16.8 years, plus 612 adolescents in the follow-up period (4 months later), were included in the analysis.

RESULTS

In relation to findings, being older (≥ 17 years old), having more pocket money and higher family alcohol consumption were associated with greater BD. By contrast, subjects who completed the questionnaire on Wednesday, Thursday or Friday, further from the previous weekend, indicated a lower number of BD occasions.

CONCLUSIONS

Our results suggest the need to include families, especially parents and siblings, in interventions aimed at preventing alcohol use among adolescents, given the association shown between BD and both family alcohol consumption and weekly pocket money or availability of money to adolescents. Given the findings with regard to age, future research aimed at intervening in early adolescence to prevent BD would be justified.

TRIAL REGISTRATION

(ClinicalTrials.gov): NCT03288896. Registration date: September 20, 2017. "Retrospectively registered".

Binge eating and binge drinking behaviors: the role of family functioning

Binge eating and binge drinking are two of the most common health-risk behaviors among young people showing to frequently co-occur in nonclinical samples of adolescent boys and girls. The present study examined the role of different dimensions of family functioning in binge behaviors among adolescents. One thousand and twenty young to late adolescents (507 girls and 517 boys) with ages ranging from 16 to 22 years participated in the study and completed a survey of self-report measures. Our findings showed that adolescents who binge eat and drink and adolescents who only binge eat perceived a lower quality of family functioning with lower levels of cohesion, flexibility, communication, satisfaction and higher degree of disengagement compared to adolescents who do not binge and adolescents who only binge drink. Only adolescents who engage in both binge behaviors reported higher levels of chaotic style compared to other binge groups. Furthermore, living in families poorly flexible, highly disengaged and with communication problems among members resulted as risk factors for binge eating behavior. Results suggest the importance for prevention programs to be based on an integrated approach focused on improving family environment such as the ability in changing family structure to deal effectively with developmental problems and defining clear home rules adolescents may stand on.

Adolescent and Parent Knowledge, Attitudes, and Perceptions of Harm of Household Controlled Medications

Introduction: Adolescents learn knowledge, attitudes, and behaviors from their parents, yet little is known about how these attributes are associated with management of household controlled prescription medications. We aimed to assess adolescent and parent: 1) knowledge and attitudes regarding household controlled medications, including previous healthcare counseling; 2) perceptions of harm of medication misuse and diversion; and 3) potential associations of these attributes with household management. Methods: This was a cross-sectional study with paired data using brief, online, confidential surveys of adolescents and parents via an adolescent medicine clinic associated with a large academic center. Eligible adolescents were aged 12-18 years old with at least one controlled prescription medication in the home. Data collection and analysis occured in 2017-2018. Results: Of the 243 adolescent-parent dyads, many adolescents and parents had: low knowledge (15%; 6%), risky attitudes (31%; 32%), received healthcare counseling on safe management of controlled medications (30%; 96%), and low perceived harm of adolescent diversion (39%; 49%). Parents practicing unsafe household management were 2.4 (95% CI = 1.3, 4.3) times as likely to have risky attitudes. Adolescents with families practicing unsafe medication management were 3.7 (95% CI = 1.1, 10.4) times as likely to have low perceptions of harm from diversion. Conclusions: Many adolescents and parents have low knowledge, risky attitudes, and low perceptions of harm of adolescent diversion, some of which are associated with unsafe household medication management. Providers should aim to utilize interventions to improve these attributes for adolescents and parents to enhance safe household medication management.

A systematic review of parent based programs to prevent or reduce alcohol consumption in adolescents

BACKGROUND

Adolescent alcohol consumption is an issue of ongoing concern and programs targeting parents have been identified as an important component in minimizing and preventing alcohol related harm in adolescents. This paper aims to evaluate existing parent based alcohol education programs with a focus on understanding parent specific outcomes including parental attitudes, parent-child communication, alcohol specific rule setting and parental monitoring; study quality, the extent of stakeholder engagement in program design and the level of theory application.

METHOD

A systematic review of electronic databases EBSCO, Emerald, ProQuest, PubMed, Ovid, ScienceDirect, Taylor and Francis and Web of Science was conducted from database inception to August 2019. A total of 4288 unique records were retrieved from the eight databases. Studies were included if they evaluated school based alcohol education programs that included a parent component and detailed outcome measures associated with parent data. The methodological quality of the included studies was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool.

RESULTS

In total 17 studies qualified for assessment, detailing 13 individual parent programs. Of these, ten programs demonstrated positive effects in at least one parent reported outcome measure. Stakeholder engagement during the design of programs was lacking with the majority of programs. One third of the programs did not report theory use and when theory was used reporting was weak with three programs applying theory, five testing theory and none building theory. According to the EPHPP tool, overall ten programs were rated as weak, three as moderate and none as strong.

CONCLUSION

Future studies are recommended to further enhance the effectiveness of parental programs by improving study quality, increasing stakeholder engagement and increasing the level of theory application and reporting.

Epidemiology of alcohol-related emergency hospital admissions in children and adolescents: An e-cohort analysis in Wales in 2006-2011

OBJECTIVE

Harmful levels of alcohol consumption in young people are prevalent and of increasing public concern in the western world. Rates of alcohol-related emergency hospital admissions in children and young people between 10 to 17 years were described, and the reasons for these admissions and their association with socio-demographic factors were examined.

METHODS

E-cohort data were extracted from the Secure Anonymised Information Linkage Databank, which contained alcohol-related emergency hospital admissions (N = 2968) from 2006 to 2011 in children and adolescents aged 10 to 17 years in Wales. A generalised linear mixed model was fitted using a log-link with a population offset to the data to calculate incident rate ratios (IRRSs).

RESULTS

There was a general decreasing trend from 2006 to 2011 in the number and rate of alcohol-related emergency hospital admissions; the mean age of admission was 15.4 (standard deviation 1.4) years. In each of the four youngest age groups (10-13,14,15,16 years), females had higher IRRs than males. Males had slightly higher IRR compared to females only in the oldest age group (17 years). IRRs increased with increasing deprivation. The majority (92%) of the admissions lasted one day and most of the admissions (70%) occured during the last three days of the week with a peak on Saturday. The length of stay in hospital was longer in cases when self-harm were present. Multiple admissions showed high prevalance of serious self-harm cases in females. The number of admissions with injuries and falls were higher for males than females.

CONCLUSION

Female children and adolescents were more likely to be admitted to hospital for alcohol-related reasons. These data illustrate the significant burden of alcohol-related harm in young people and highlight the need for interventions and policies that promote safe drinking practices among young people to prevent future alcohol-related harm during the life-course.

Contributions of parenting styles and parental drunkenness to adolescent drinking

Objective:

To estimate the association of parental drunkenness and parenting style with alcohol consumption among adolescents and the contributions of parental drunkenness and parenting style to the prevalence of binge drinking among adolescents.

Method:

Cross-sectional survey of a representative sample of secondary students aged 13 to 18 from 27 Brazilian state capitals (n=17,028). Private and public schools were included. A self-report questionnaire collected data on adolescents’ alcohol drinking behavior, parenting styles, and parenting and peer models of drunkenness.

Results:

Non-authoritative parenting style and parental drunkenness are associated with binge drinking among adolescents. Authoritarian, indulgent, and negligent parenting styles were associated with 1.50-, 2.51-, and 2.82-fold increases in prevalence of adolescent binge drinking, and parental drunkenness, with a 1.99-fold increase. The non-authoritative parenting style made a larger contribution than parental drunkenness to adolescent binge drinking.

Conclusions:

Non-authoritative parenting style and parental drunkenness seem to play an important role in adolescents’ binge drinking behavior. At the population level, parenting style appears associated with a greater contribution to this behavior among adolescents. Prevention strategies targeting parental drunkenness may be bolstered if a broader approach including parenting styles is in place.

Parents who exit and parents who enter. Family structure transitions, child psychological health, and early drinking

This paper seeks to extend prior research by exploring whether family structure transition is associated with an increase in early alcohol consumption and whether this association is mediated by; children's socio-emotional problems, providing information on whether the effects of the transition; differ according to the number of changes, the family's initial status, or the time of exposure. The; data have been drawn from the UK Millennium Cohort Study to explore associations framed with; a life-course approach. Our findings suggest that types of family transitions (such as distinguishing; parental exits from and parental entrances to the family) are more important than the number of; family changes during childhood. The results show that moving from a two-parent household to a single-parent household directly increased the probability of being a frequent alcohol consumer among early adolescent boys, whereas the indirect effect on girls was found via socio-emotional difficulties. Our findings also show an increase in socio-emotional and behavioural difficulties in boys due to the entrance of a step-parent only if the transition occurred in the earliest childhood. Indeed, a sensitivity analysis of the time to which the children were exposed to the transition to a new family structure showed stronger effects for those who experienced a family structure change in the early life course, consistent with the cumulative disadvantage process.

Trends in alcohol use among young people according to the pattern of consumption on starting university: A 9-year follow-up study

AIM

To identify differences in Risky Consumption (RC) and Binge drinking (BD) trends in students who already followed these patterns of alcohol consumption on starting university and those who did not, and also to try to understand what leads students to engage in these types of behaviour at university.

MATERIAL AND METHODS

Cohort study among university students in Spain (n = 1382). BD and RC were measured with the Alcohol Use Disorders Identification Test at ages 18, 20, 22, 24 and 27 years. Multilevel logistic regression for repeated measures was used to calculate the adjusted Odds Ratios (ORs).

RESULTS

The prevalence rates of RC and BD were lower throughout the study in students who did not follow these patterns of consumption at age 18. For RC and BD, the differences at age 27 years, expressed as percentage points (pp), were respectively 24 pp and 15 pp in women and 29 pp and 25 pp in men. Early age of onset of alcohol use increased the risk of engaging in RC and BD patterns at university, for men (OR = 2.91 & 2.80) and women (OR = 8.14 & 5.53). The same was observed in students living away from the parental home for BD (OR = 3.43 for men & 1.77 for women). Only women were influenced by having positive expectancies for engaging in RC (OR = 1.82) and BD (OR = 1.96).

CONCLUSIONS

The prevalence rates of both RC and BD at age 27 years were much higher among university students who already followed these patterns of consumption at age 18 years, with the differences being proportionally higher among women. Focusing on the age of onset of alcohol consumption and hindering access to alcohol by minors should be priority objectives aimed at preventing students from engaging in these patterns of alcohol consumption at university.

School, Peer and Family Relationships and Adolescent Substance Use, Subjective Wellbeing and Mental Health Symptoms in Wales: a Cross Sectional Study

Positive relationships with family, friends and school staff are consistently linked with health and wellbeing during adolescence, though fewer studies explore how these micro-systems interact to influence adolescent health. This study tests the independent and interacting roles of family, peer and school relationships in predicting substance use, subjective wellbeing and mental health symptoms among 11-16 year olds in Wales. It presents cross-sectional analyses of the 2013 Health Behaviour in School-aged Children survey, completed by 9055 young people aged 11-16 years. Multilevel logistic regression analyses are used to test associations of family communication, family support, relationships with school staff, school peer connectedness, and support from friends, with tobacco use, cannabis use, alcohol use, subjective wellbeing and mental health symptoms. Positive relationships with family and school staff were consistently associated with better outcomes. Support from friends was associated with higher use of all substances, while higher school peer connectedness was associated with better subjective wellbeing and mental health. Better relationships with school staff were most strongly associated with positive subjective wellbeing, and fewer mental health symptoms where pupils reported less family support. Support from friends was associated with higher cannabis use and worse mental health among pupils with lower family support. Relationships with family and school staff may be important in protecting young people against substance use, and improving wellbeing and mental health. Interventions focused on student-staff relationships may be important for young people with less family support. Interventions based on peer support should be mindful of potential harmful effects for pupils with less support from family.

Personal Values as a Mediator of Relations Between Perceived Parental Support and Control and Youth Substance Use

BACKGROUND

Tobacco and marijuana smoking are very popular in adolescence and there is a high rate of comorbidity between them, even in young adulthood. Parental support and control may hinder involvement in the use of these substances by promoting conventional values among adolescents.

OBJECTIVES

The present study investigates the relations between family functioning (parental support and control) and psychoactive substance use (tobacco and marijuana smoking) and determines whether these relationships are mediated by personal values (in terms of disapproval of deviance and beliefs about the importance of school, health and religion).

METHODS

175 Italian late adolescents (17 to 20 years old) participated in this two-wave longitudinal study. Data were collected at school through an anonymous questionnaire.

RESULTS

Greater parental control and support were directly associated with lower adolescent tobacco and marijuana use; adolescent acceptance of conventional values mediated the association between parenting and adolescent marijuana use.

CONCLUSION

Findings emphasize the influence of family relationships throughout adolescence. The transmission of conventional values to adolescents may be a critical mechanism through which parenting protects adolescents from substance use, especially marijuana use.

Ecological perspectives on youth alcohol consumption in the Kuala Lumpur conurbation: a place-based study in Malaysia

Objective The objectives of this study were to investigate the patterns of alcohol consumption and ecological factors influencing those patterns in the Klang Valley. The study focuses on youth from the Chinese, Indian and Malay ethnic groups in Malaysia, resident in urban and semi-urban areas of the Klang Valley. Methods Data were collected with a combination of interviews and self-administered questionnaires available in Bahasa Malaysia and English were adapted from the Centers for Disease Control (CDC) Youth Risk Behavior Survey. The study sample consisted of 326 respondents: 103 Malays, 111 Chinese and 112 Indians. There were 171 males and 155 females, with mean age of 20.56 and 20.59 years, respectively, were identified by convenience sampling in six sites. Results A combination of at least one family member and one friend who consumed alcohol was a significant driver of alcohol use: 80% in this category had tried alcohol; 55% were current drinkers; and 35% were binge drinkers. With at least one family member, the respective figures were 72%, 48%, and 30%; and with at least one friend, but no family pattern of consumption, the figures dropped to 64%, 42% and 26%, respectively. With respect to ethnicity, 72% of Chinese youth had tried alcohol or were current drinkers (49%). The figure was lower for Indian youth (47% and 37%, respectively) and Malay youth (15% and 9%, respectively). In the binge drinking category, however, the highest figures were from the Indian youth (31%) followed by Chinese youth (23%) and significantly less in Malay youth (5%). Alcohol consumption was consistently higher among males: 54% had tried alcohol, 44% were current drinkers, and 30% were binge drinkers, compared to 36%, 18% and 9% of female youth, respectively. Conclusion Family alcohol consumption patterns were most strongly associated with consumption patterns which varied across the three ethnic groups. Family education regarding family influence on youth's alcohol consumption patterns is warranted.

Adolescent drinking in different contexts: What behaviors do parents control?

Previous research suggests that the context in which drinking occurs contribute to specific alcohol-related problems. In the current study we assessed how often adolescents attended different contexts in which they could drink, how often they drank in those contexts, and whether drinking patterns and parental monitoring were related to alcohol use in those contexts. We collected survey data from 1,217 adolescents 15-18 years of age in 24 midsized California cities. Measures included past-year frequencies of attending and drinking in restaurants, bars/nightclubs, and outdoor places, typical hours spent at home (i.e., own home or someone else's home), perceptions of parental control and disclosure to parents about free time activities, and demographics. Multilevel zero-inflated negative binomial models were used to assess associations between drinking patterns, parental control, and disclosure and frequency of attending and drinking in specific contexts. There were large variations in attending contexts in which drinking could take place. More frequent drinking was related to less time spent at home, while heavier drinking was associated with more time spent at home. Parental control was related to less frequent attendance at bars/nightclubs, and disclosure to less frequent involvement in outdoor activities and spending more time at home. Among drinkers, frequencies of attendance were strongly related to frequencies of drinking in all contexts except the home. Parental control and disclosure were related to more frequent drinking at restaurants and exposure to bars/nightclubs and drinking at outdoor activities. Parental monitoring may reduce exposure to risks by shifting adolescent contexts for alcohol use.

School and Parent Factors Associated With Steroid Use Among Adolescents

BACKGROUND

Steroid use among adolescents is an increasing health concern. Literature examining factors related to steroid use is limited.

METHODS

We investigated steroid use among 9th through 12th grade adolescents in the Greater Cincinnati area. A total of 38,414 adolescents completed the PRIDE Questionnaire. Associations between demographics, school factors, parent factors, sport participation, and steroid use were examined.

RESULTS

A total of 2.6% of adolescents reported using steroids in the past year. Most prevalent was steroid use among male, Junior/Senior, African-American, and Hispanic adolescents. Rates of steroid use differed significantly based on school and parent factors, but not sport participation. Adolescents who reported attendance at schools that frequently set and enforced rules for drug use or whose parents frequently set rules for drug use were at decreased odds for steroid use. School communication about drug use was negatively associated with steroid use.

CONCLUSIONS

School administration and staff, as well as parents, are uniquely positioned to deter steroid use among adolescents. Findings suggest that limiting steroid screening to student athletes might miss a substantial proportion of the population at risk. Thus, broad-based screening and prevention programs may be more effective than programs targeting student athletes alone.

Parental solicitation, parental control, child disclosure, and substance use: native and immigrant Dutch adolescents

OBJECTIVES

The present study examined whether the relation of parental solicitation, parental control, and child disclosure with adolescent alcohol and cannabis use is similar for native and non-Western immigrant Dutch adolescents.

DESIGN

Questionnaire data from two study-samples were used with a combined sample of 705 adolescents (mean age 16.2 years; 47.2% female; 25.2% non-Western immigrant background).

RESULTS

Native Dutch adolescents reported more weekly alcohol use than immigrant adolescents, while rates of cannabis use by native and immigrant adolescents were similar. Immigrant females reported lower levels of parental solicitation and child disclosure, but higher levels of parental control than native females. There were no differences in the sources of parental knowledge between native and immigrant males. Regression analyses showed no significant interaction effects of parental solicitation, parental control, or child disclosure with ethnic background for both alcohol and cannabis use (all p values > .05).

CONCLUSION

Despite mean level differences in various factors, we did not find evidence of an interaction effect of the sources of parental knowledge with ethnic background on alcohol and cannabis use. This suggests that theories and prevention strategies focusing on these sources of parental knowledge in relation to substance use can be applicable to both native and immigrant Dutch adolescents.

Predictors of Sexual Activity in Haitian-American Adolescents

This study examined the impact of individual, peer, family, school, and neighborhood level variables on sexual activity among 276 Haitian-American adolescents. Differences between those who were sexually active and those who were not were analyzed using Chi square and t tests. Significant factors at p ≤ 0.1 were entered into logistic regression for the full group and for girls-only. Half of males and 36.6 % of females were sexually active. The multivariable model revealed that adolescents were more likely to be sexually active if they reported delinquent behaviors; had sexually active friends; and were living with only one parent, friends or relatives. For girls, living with both parents was protective against sexual activity, while substance use and emotional distress were risk factors. No language or acculturation measures were associated with sexual activity. Haitian-American adolescents may benefit from interventions that focus on gender-specific, contextual and cultural factors to prevent early sexual activity.

A qualitative investigation of the role of the family in structuring young people's alcohol use

BACKGROUND

Few qualitative studies have investigated young people's perspectives around influences on substance use. We aimed to examine young people's understandings, attitudes and experiences around alcohol, tobacco and cannabis use and factors influencing substance use behaviour.

METHODS

Qualitative interview study involving 28 young people (13 males and 15 females) aged 18-20 years, recruited purposively on the basis of substance use, who were participating in the Avon Longitudinal Study of Parents and Children. Interviews were conducted at participants' homes or at local cafés. Audio data were transcribed verbatim, systematically coded and analysed inductively using a constant comparative approach.

RESULTS

Parental attitudes and behaviours and the nature of communication emerged as critical factors structuring young people's alcohol use. Initiation of alcohol use was frequently mediated by parents early in adolescence, with the home recounted as a primary site of early drinking experiences. Later in adolescence, young people perceived a more permissive stance towards alcohol use, with broad acceptance of high levels of consumption and recognition of drinking as a cultural norm during adolescence. In contrast, young people reported a more prohibitive and discouraging stance from their parents towards tobacco and cannabis use, and the use of these substances appeared to be of greater parental concern.

CONCLUSIONS

Interventions involving parents or guardians have a critical role to play in the prevention of harms arising from alcohol use during adolescence. However, such interventions are needed in conjunction with individual, school, community and environmental interventions to shift cultural norms across the population and to facilitate effective prevention.

Family Dynamics May Influence an Individual's Substance Use Abstinence Self-Efficacy

BACKGROUND

Previous work on substance use suggests the influence of family dynamics on emotion regulation.

OBJECTIVE

The present study examined the role of family in substance use recovery. It is of importance to examine whether conflict with various family members influences an individual's abstinence self-efficacy.

METHODS

We examined individual abstinence self-efficacy scores and lifetime conflict with mother, father, and siblings in a sample of 200 women who had been justice involved.

RESULTS

We found that conflict with mother was the best predictor of abstinence self-efficacy compared to conflict with father and conflict with siblings. Individuals who indicated having conflict with mother over their lifetime had lower confidence that they could abstain from use in potentially emotionally triggering situations.

CONCLUSIONS/IMPORTANCE

These findings suggest that family dynamics, specifically lifetime conflict with mother, do play a role in an individual's confidence to regulate emotions in high-risk relapse situations without turning to substances. Limitations include using abstinence self-efficacy as a proxy for emotion regulation and not directly measuring emotion regulation. Examining family relationships may be especially important in the treatment of women in recovery from substance use.

Parental monitoring and family relations: associations with drinking patterns among male and female Mexican students

INTRODUCTION

Parental monitoring and family relations are recognized as protective factors for youth alcohol use. The purpose of this study was to investigate perceived parental monitoring and family relations among subgroups of Mexican youths with different patterns of drinking behaviors and consequences.

METHODS

A latent profile analysis (LPA) identified profiles of drinking behavior in a cross-sectional survey of entering first year university students. Multinomial regression examined associations between parental monitoring, family relations and drinking profiles among 22,224 students.

RESULTS

Both lower perceived parental monitoring and weaker perceived family relations were associated with heavier drinking profiles among males and females, but more strongly associated with female than male heavier drinking profiles. Being older, having parents with lower education, and not living with parents were also associated with lower parental monitoring and weaker family relations. There was a general trend of lower parental monitoring and weaker family relations as the profiles increased from Non/Infrequent-No Consequences to Excessive-Many Consequences Drinkers. Lower perceived parental monitoring and weaker perceived family relations were more strongly associated with drinking profiles among females than among males. Both the parental monitoring and family relations scales had similar associations with drinking profiles.

CONCLUSIONS

Findings suggest that drinking norms and values may contribute to any protective influences of parental monitoring and family relations on Mexican youths' drinking. Research about changes in drinking norms, contextual factors, and youth-parent trust would inform the utility of parental monitoring or family relations as protective strategies against alcohol misuse among Mexican and Mexican American youths and also youths from other backgrounds.

Social factors associated with readiness for sexual activity in adolescents: a population-based cohort study

Various factors are associated with sexual activity in adolescence and it is important to identify those that promote healthy and adaptive romantic and sexual development. The objectives of this study were to describe rates of early sexual intercourse (before 16 years) and sexual readiness in adolescence and to assess the extent to which these were social patterned. We prospectively studied nearly 5,000 15-year-olds from the Avon Longitudinal Study of Parents and Children, a UK birth cohort. Between 2006 and 2008, female and male participants answered a computer assisted interview about romantic and sexual behaviors in the last year. Predictors of sexual intercourse and readiness for sexual intercourse were examined across a range of sociodemographic measures. Overall, 17.7% (95% CI 16.7%, 18.9%) of participants reported having had sexual intercourse in the last year, with more girls than boys reporting sexual experience (risk ratio 1.30, 95% CI 1.15, 1.47). Of these, one-third of both male and female were classed as unready because they were unwilling, lacking in autonomy, felt regret or had not used contraception. There was strong evidence of social patterning for sexual activity with higher rates for young people from poorer homes, with lower social class, and with younger, less educated mothers. In contrast, among 860 young people who had had sexual intercourse, there was no clear evidence of associations between social factors and sexual readiness. The lack of social patterning in sexual readiness supports the provision of comprehensive education to develop life skills for adolescents across all social groups.

Gender differences in the prediction of parental servings of alcohol to adolescents and youth drunkenness

This longitudinal study, funded by the Swedish National Institute of Public Health, explored gender differences in predictors of parental servings of alcohol to youth and youth drunkenness. Data were collected from 1,752 Swedish 7th-grade youth and their parents, at three occasions between 2007 and 2010. Measurements included youth alcohol use, parental warmth, and parental control. Two-level logistic regressions showed that 15-year-old girls are more likely to be served alcohol at home compared to boys, and that there are some gender differences in predictors of drunkenness. Limitations and implications of the findings are discussed and areas for future research identified.

A pilot feasibility cluster randomised controlled trial of screening and brief alcohol intervention to prevent hazardous drinking in young people aged 14–15 years in a high school setting (SIPS JR-HIGH)

Background

Approximately 33% of 15- to 16-year-olds in England report alcohol intoxication in the past month. This present work builds on the evidence base by focusing on Alcohol Screening and Brief Intervention (ASBI) to reduce hazardous drinking in younger adolescents.

Objectives

To explore the feasibility and acceptability of a future definitive cluster randomised controlled trial (cRCT) of ASBI in a school setting to staff, young people and parents; to explore the fidelity of the interventions as delivered by school learning mentors; to estimate the parameters for the design of a definitive cRCT of brief alcohol intervention, including rates of eligibility, consent, participation and retention at 12 months; and to pilot the collection of cost and resource-use data to inform the cost-effectiveness/utility analysis in a definitive trial.

Setting

Seven schools across one geographical area in North East England.

Methods

Feasibility of trial processes, recruitment and retention and a qualitative evaluation examined facilitators and barriers to the use of ASBI approaches in the school setting in this age group. A three-arm pilot cRCT (with randomisation at the school level) with qualitative evaluation to assess the feasibility of a future definitive cRCT of the effectiveness and cost-effectiveness of ASBI in a school setting, with an integrated qualitative component. The trial ran in parallel with a repeated cross-sectional survey, which facilitated screening for the trial.

Participants

Year 10 school pupils (aged 14–15 years).

Interventions

Young people who screened positive on a single alcohol screening question, and consented to take part, were randomised to one of three groups: (1) feedback that their drinking habits may be risky and provision of an advice leaflet (control condition,n = two schools); (2) feedback as for the control condition plus a 30-minute brief interactive session, which combined structured advice and motivational interviewing techniques, delivered by the school learning mentor (intervention 1,n = two schools); or (3) feedback as for the control condition plus a 30-minute brief interactive session as for intervention 1 plus a 60-minute session involving family members delivered by the school learning mentor (intervention 2,n = three schools). Young people were followed up at 12 months.

Main outcome measures

Feasibility and acceptability.

Randomisation

Randomisation was carried out at the school level. Randomisation achieved balance on two school-level variables (numbers of pupils in school year and proportion receiving free school meals).

Blinding

School staff, young people and researchers were not blind to the intervention allocated.

Results

A total of 229 young people were eligible for the trial; 182 (79.5%) were randomised (control,n = 53; intervention 1,n = 54; intervention 2,n = 75). Of the 75 randomised to intervention 2, 67 received intervention 1 (89%). Eight received both intervention 1 and intervention 2 (11%). In total, 160 out of 182 were successfully followed up at 12 months (88%). Interviews were carried out with six school lead liaisons, 13 learning mentors, 27 young people and seven parents (n = 53). Analysis shows that the school setting is a feasible and acceptable place to carry out ASBI, with learning mentors seen as suitable people to do this. Intervention 2 was not seen as feasible or acceptable by school staff, parents or young people.

Outcomes/conclusions

It is feasible and acceptable to carry out a trial of the effectiveness and cost-effectiveness of single-session ASBI with young people in the school setting, with learning mentors delivering the intervention. Future work should include a definitive study that does not include a parental arm.

Trial registration

Current Controlled Trials ISRCTN07073105.

Funding

The National Institute for Health Research Public Health Research programme.

Familias: Preparando la Nueva Generación: A Randomized Control Trial Testing the Effects on Positive Parenting Practices

OBJECTIVES

This article reports the effects of a culturally grounded parenting intervention to strengthen positive parenting practices.

METHOD

The intervention was designed and tested with primarily Mexican origin parents in a large urban setting of the southwestern United States using an ecodevelopmental approach. Parents (N = 393) were randomly assigned three treatment conditions: (1) a parenting and youth intervention, (2) a youth only intervention, or (3) a control group. A measurement model for positive parenting was first evaluated using confirmatory factor analysis, followed by structural equation modeling to estimate the effects of the intervention on positive parenting (i.e., baseline to follow-up).

RESULTS

As hypothesized, parents in the intervention group reported higher rates of positive parenting compared to parents in youth-only condition.

CONCLUSION

The results are promising and add to growing evidence that interventions tailored to the cultural characteristics and environments of parents and their children can strengthen positive parenting.

Preventing substance misuse: study protocol for a randomised controlled trial of the Strengthening Families Programme 10-14 UK (SFP 10-14 UK)

BACKGROUND

Prevention of alcohol, drug and tobacco misuse by young people is a key public health priority. There is a need to develop the evidence base through rigorous evaluations of innovative approaches to substance misuse prevention. The Strengthening Families Programme 10-14 is a universal family-based alcohol, drugs and tobacco prevention programme, which has achieved promising results in US trials, and which now requires cross-cultural assessment. This paper therefore describes the protocol for a randomised controlled trial of the UK version of the Strengthening Families Programme 10-14 (SFP 10-14 UK).

METHODS/DESIGN

The trial comprises a pragmatic cluster randomised controlled effectiveness trial with families as the unit of randomisation, with embedded process and economic evaluations. Participating families will be randomised to one of two treatment groups - usual care with full access to existing services (control group), or usual care plus SFP 10-14 UK (intervention group). The trial has two primary outcomes - the number of occasions that young people report having drunk alcohol in the last 30 days, and drunkenness during the last 30 days, both dichotomised as 'never' and '1-2 times or more'. The main follow-up is at 2 years past baseline, and short-term and intermediate outcomes are also measured at 9 and 15 months.

DISCUSSION

The results from this trial will provide evidence on the effectiveness and cost-effectiveness of an innovative universal family-based substance misuse prevention programme in a UK context.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN63550893.

Psychological dysregulation during adolescence mediates the association of parent-child attachment in childhood and substance use disorder in adulthood

OBJECTIVE

This prospective study tested the hypothesis that psychological dysregulation in mid-adolescence (age 16) mediates the association between parent-child attachment in late childhood (age 10-12) and development of substance use disorder (SUD) in adulthood (age 22).

METHOD

The Youth Attachment to Parents Scale (YAPS) was developed in 10-12-year-old boys and girls (N = 694) at baseline residing in western Pennsylvania. Psychological dysregulation was measured by the neurobehavior disinhibition trait. Substance use was assessed at ages 10-12, 12-14, 16 and 19. SUD was diagnosed at age 22 using the Structured Clinical Interview for DSM Disorders. The mediation of parent-child attachment and SUD by neurobehavior disinhibition was tested separately for mothers and fathers while controlling for baseline substance use.

RESULTS

Psychological dysregulation mediates the association between attachment to mothers and SUD, and partially mediates the association between attachment to fathers and SUD. Significant mediation effects remains after controlling for baseline substance use.

CONCLUSION

Optimal prevention of SUD should include ameliorating both psychological dysregulation predisposing to SUD and quality of the parent-child relationship.

Parental monitoring and alcohol use among Mexican students

Parental monitoring has been described as a protective factor and useful strategy to prevent substance misuse among youths. The aim of this study was to examine whether perceived parental monitoring influences frequency of alcohol use, age of drinking onset and risky drinking among entering public high school and university students in Mexico City. The study is a cross-sectional survey of entering first year students in the high school and university school system of a large public university in Mexico City conducted during registration at the beginning of the school year. In 2008, of 34,840 students accepted to the affiliated high schools, 28,996 students (51.8% female) completed the alcohol survey and of 37,683 students accepted into university 30,084 students (51.5% female) completed the alcohol survey. The findings suggest that compared to students with higher perceived parental monitoring those reporting lower perceived parental monitoring were more likely to report risky behavior. They were more likely to be ever drinkers, frequent drinkers, have earlier age of onset and high AUDIT scores. Overall, higher parental monitoring was strongly associated with being female and lower parental monitoring with being male. Our findings suggest that more research on parental monitoring as a protective strategy against alcohol misuse is needed. Research focusing on cultural factors including gender and age-related norms and familismo would increase knowledge of the association of parental monitoring and alcohol use among Mexican youths, Mexican American youths and potentially youths from other Hispanic backgrounds.

Genetic and environmental predictors of latent trajectories of alcohol use from adolescence to adulthood: a male twin study

BACKGROUND

Adolescence is characterized by higher levels of novelty-seeking and risk-taking behavior, including initiation of alcohol use. Also, there is considerable heterogeneity in the change and continuity of alcohol use over time, which emphasizes the need to examine factors predicting alcohol use and the patterns of use over time.

METHODS

Retrospective data on average monthly alcohol use and risk and protective factors were obtained through interviews and questionnaires in 1,560 adult male twins. Latent class growth analysis in Mplus was performed on data of alcohol use over ages 15 to 36. Second, logistic regression analyses were used to associate risk and protective characteristics with membership in distinct latent trajectories of alcohol use.

RESULTS

Six trajectories of alcohol use were identified, varying in the level of alcohol use, the rate of change in use in early adolescence and the persistence of use into adulthood. Genetic risk of externalizing disorder and peer deviance showed the greatest risks for unfavorable alcohol trajectories with higher levels of use and higher rates of early increase in use. Parental monitoring and involvement in social activities showed protective effects. Involvement in religious activities was strongly associated with reduced persistence of high-level drinking in univariate but not multivariate regression analyses.

CONCLUSIONS

Risk and protective factors impacted differentially on level of alcohol use, rate of increase in use during adolescence, and persistence of heavy alcohol use over time. Insight into the different ways in which predictors impact on alcohol use is relevant for the development of new intervention strategies. For this purpose, causality of the associations should be further examined.

Racial/ethnic differences in the influence of cultural values, alcohol resistance self-efficacy, and alcohol expectancies on risk for alcohol initiation

Prior research has reported racial/ethnic differences in the early initiation of alcohol use, suggesting that cultural values that are central to specific racial/ethnic groups may be influencing these differences. This 1-year longitudinal study examines associations between two types of cultural values, parental respect (honor for one's parents) and familism (connectedness with family), both measured at baseline, and subsequent alcohol initiation in a sample of 6,054 (approximately 49% male, 57% Hispanic, 22% Asian, 18% non-Hispanic White, and 4% non-Hispanic Black) middle school students in Southern California. We tested whether the associations of cultural values with alcohol initiation could be explained by baseline measures of alcohol resistance self-efficacy (RSE) and alcohol expectancies. We also explored whether these pathways differed by race/ethnicity. In the full sample, adolescents with higher parental respect were less likely to initiate alcohol use, an association that was partially explained by higher RSE and fewer positive alcohol expectancies. Familism was not significantly related to alcohol initiation. Comparing racial/ethnic groups, higher parental respect was protective against alcohol initiation for Whites and Asians, but not Blacks or Hispanics. There were no racial/ethnic differences in the association between familism and alcohol initiation. Results suggest that cultural values are important factors in the decision to use alcohol and these values appear to operate in part, by influencing alcohol positive expectancies and RSE. Interventions that focus on maintaining strong cultural values and building strong bonds between adolescents and their families may help reduce the risk of alcohol initiation.

Relação entre violência física, consumo de álcool e outras drogas e bullying entre adolescentes escolares brasileiros

O objetivo deste estudo foi identificar a associação entre o consumo de álcool e outras drogas e o bullying com o envolvimento em situações de violência física entre adolescentes de 13 a 15 anos, em escolas públicas e privadas das capitais brasileiras e do Distrito Federal. Foram analisados os dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2009. Para análise dos dados foi utilizada a regressão logística. A prevalência de envolvimento em situações de violência física foi 12,9% maior no sexo masculino. Em ambos os sexos, foram observadas associações entre violência física e ser vítima de bullying com o uso de drogas ilícitas e efeito potencializado do consumo de álcool e drogas. Para o sexo masculino, o uso de álcool mostrou associação significante com violência física. Morar o pai ou ambos os genitores na residência apresentou associação inversa para violência física no sexo feminino. O conhecimento de fatores associados à violência física entre adolescentes é importante para auxiliar estratégias de promoção da saúde e da cultura de paz, rompendo com a ideia de que a violência entre adolescentes é algo banal e esperado.

Towards a public health approach to parenting programmes for parents of adolescents

BACKGROUND

Poor parenting practices have been associated with adolescent emotional and behavioural problems which are potentially preventable. Parenting interventions that are based on behavioural and social learning theories have been repeatedly shown to be effective. However, few evidence-based parenting programmes are implemented and sustained at a population level. Little research is available on supporting the general population of parents during the adolescent years. Further, a substantial research-practice gap exists regarding the impact of a universal approach to parenting programmes for parents of adolescents.

METHOD

This article will first examine the effects of parenting practices on adolescent outcome. Afterwards, it addresses the effectiveness of parenting programmes for parents of adolescents. Finally, it discusses the need for a public health approach to parenting programmes.

Parental relationship satisfaction in French young adults associated with alcohol abuse and dependence

Alcohol consumption is a major risk factor for disease in developed countries. In addition to genetic susceptibility, alcohol consumption is shaped by one's social and family environment. With data from 2009, we examined associations between satisfaction with familial relationships and alcohol abuse and dependence using a national sample of 1101 French young adults aged 22-35. Alcohol-related problems were measured with the Alcohol Use Disorders Identification Test (AUDIT). Main exposure variables included young adults' self-report of satisfaction with parental relationships. In adjusted logistic regression models, having a poor relationship with one's mother (OR=1.8, 95%CI 1.0-3.6) or father (OR=1.8, 95% CI 1.0-3.2) was associated with alcohol abuse and dependence. Gender stratified analyses indicated unsatisfactory maternal relationships were associated with alcohol problems in women (OR=2.6, 95%CI 1.1-6.6); unsatisfactory paternal relationships were suggestive of alcohol abuse in men (OR=2.0, 95%CI 0.9-4.7), but not in women. Non-cohabitation with a romantic partner was associated with an almost three-fold increase of alcohol abuse and dependence in men (OR=2.8, 95% CI 1.6-4.8). The quality of parental relationships may be important for alcohol abuse, particularly when the parent is the same gender. Family-centered approaches may be considered in prevention efforts to reduce problem drinking in French young adults.

Family functioning and binge drinking among Italian adolescents

Limited studies have sought to describe binge drinking among adolescents and even fewer studies have attempted to examine whether family functioning, family communication and satisfaction could be associated with alcohol abuse. Our sample was made up of 726 Italian adolescents between the ages of 16 and 18. According to previous research, adolescents were categorized into non-drinkers, social, binge and heavy drinkers. Results showed that social, binge and heavy drinkers differ in terms of some drinking variables, family functioning, family communication and satisfaction.

Predicting alcohol consumption during the month before and after beginning college

Background

We sought to determine predictors of drinking the month before and after beginning college, as well as changes in drinking between these two periods among adjudicated students. We conducted these analyses to inform individual and university-wide approaches to addressing underage drinking, particularly among the heaviest drinkers.

Methods

The sample consisted of 143 students entering college, adjudicated during their first semester, and interviewed during the same semester. The sample consisted of 43% women. Drinking data were collected through the Time-Line Follow-Back interview.

Results

The average number of drinking days (DD) during the first month of college was 7.0 (SD = 4.7), the average number of drinks per drinking day (DDD) was 7.4 (SD = 3.4), and the average volume of standard drink units consumed during this month was 56.3 (SD = 51.2). Students had volunteered for a two-year college facilitation study, and had been invited to participate after receiving a citation for violating university alcohol policies. Analyses consisted of nine backward elimination regression analyses with nine variables entered as predictors (one was a control variable). Age of first intoxication was related to every dependent measure. Men had a higher August DDD, September DDD, and September volume than women. Roommate drinking level was associated with September DDD and September volume. Out-of-state students had a lower August volume than in-state students. High school rank was inversely related to September drinking days. SAT score, declared major status, and fraternity/sorority status were not related to drinking according to these multivariate analyses.

Conclusions

Results suggest that approaches to underage drinking for adjudicated students may need to be tailored according to age of first intoxication. Results also suggest the drinking level of the heaviest drinking roommate may moderate individual level interventions. Further, interventions applied to an entire dorm room may prove efficacious. Results also suggest that high school rank, rather than SAT scores, should be used as college entry criteria to yield a drier incoming class. Results may not generalize to non-adjudicated students.