A comparison of selected communication, social, situational, and individual factors associated with alcohol and other drugs

Perceived Risk of Harm from Marijuana Use among Youth in the USA

Perceived risk or beliefs about the harmful effects of drugs is strongly associated with marijuana use, based on nationally representative surveys and several cross-sectional studies in the United States. A review of studies that have examined perceived risk showed that perceived risk can be construed as consisting of at least four areas (physical harm, parental disapproval, peer disapproval and fear of arrest) and having several characteristics (e.g. locus of harm, level of use). Perceptions of risk vary with gender, age and other factors. Secondary data analysis based on the Monitoring the Future surveys and theNational Household Survey ofDrugAbuse were consistent with these findings from the review. Specific recommendations for prevention practitioners and researchers are presented.

Gender differences in drug resistance skills of youth in Guanajuato, Mexico

Research is limited or absent on Mexican adolescents' exposure to substance offers, ways of dealing with these offers, and possible gender differences in responses to offers. Extending U.S.-based research, this study examines how youth living in the Mexican state of Guanajuato employ the four drug resistance strategies-refuse, explain, avoid, and leave-that are part of the Keepin' It REAL evidence-based drug prevention intervention. The analysis uses cross-sectional survey data from 702 students enrolled in eight alternative secondary education sites in 2007. Participants reported the drug resistance behaviors they used to deal with offers of alcohol, cigarettes, and marijuana. Using multivariate regression, findings indicate most youth had developed repertoires of drug resistance strategies that involved multiple REAL strategies and some other strategy as well. For those receiving offers, the most common strategy was to refuse the offer with a simple "no." However, males used all the strategies significantly more often than females for situations involving cigarettes and marijuana as well as when using refuse and non-REAL strategies for alcohol. Possible reasons for the gender difference in use of strategies are discussed. The findings can help inform effective prevention programs based on teaching culturally appropriate drug resistance and communication skills.

Alcohol and Other Drug Resistance Strategies Employed by Rural Adolescents

This study seeks to identify how rural adolescents make health decisions and utilize communication strategies to resist influence attempts in offers of alcohol, tobacco, and other drugs (ATOD). Semi-structured interviews were conducted with 113 adolescents from rural school districts to solicit information on ATOD norms, past ATOD experiences, and substance offer-response episodes. Rural youths' resistance strategies were similar to previous findings with urban adolescents - refuse, explain, avoid, and leave (the REAL typology) - while unique features of these strategies were identified including the importance of personal narratives, the articulation of a non-user identity, and being "accountable" to self and others.

Culturally Specific Youth Substance Abuse Resistance Skills: Applicability across the U.S.-Mexico Border

This study tests the applicability among adolescents in Mexico of the keepin' it REAL (refuse, explain, avoid, and leave) strategies that are common and effective ways that U.S. youth resist substance use. Following a social learning, communication competence and ecological theory integrated approach, the study draws on self-reported questionnaire data from a non-probability sample of 327 adolescents attending two public high schools in Monterrey, Nuevo León. Multivariate regressions were used to test whether the respondents' use of the REAL strategies by the participants could be predicted by key demographic variables. Separate models were estimated for the frequency of use of each strategy and for different substances. Findings indicate that most adolescents in this sample utilized each of the REAL strategies as well as other strategies to respond to offers of alcohol, cigarettes, or marijuana. Mexican and U.S. youth residing close to the US border appear to use similar drug resistance strategies. Use of the strategies varied considerably by the level of exposure to offers, but only minimally by gender and age. There were no notable differences by socioeconomic status or academic performance. Implications for prevention science, social work practice and social work research are discussed in the context of the bi-national border region and the applicability and prospect for dissemination of U.S. evidence based youth substance use prevention interventions.

Substance use, resistance skills, decision making, and refusal efficacy among Mexican and Mexican American preadolescents

This article examines the relationships among resistance skills, refusal efficacy, decision-making skills, and substance use for a sample of Mexican and Mexican American 5th grade students who were attending public schools in Phoenix, Arizona. An analysis of self-report questionnaire data indicated that the likelihood that male students reported ever having used one or more substances increased as they reported a greater willingness to use passive decision-making (e.g., going along) and decreased as they reported greater refusal efficacy and a greater willingness to utilize active decision making (e.g., thoughtful processing). No significant relationships emerged between the 4 predictors and lifetime substance use among the girls. These findings support the role of social skills in substance use prevention, shed light on an understudied group, and suggest the importance of continuing to examine gender differences in skills-based interventions.

Adolescents' responses to peer smoking offers: the role of sensation seeking and self-esteem

This article deals with an important topic (youth smoking) and makes a contribution to the literature by validating existing research and extending our understanding of smoking resistance strategies. This study classified adolescent reports of their responses to cigarette smoking offers utilizing four drug refusal strategies of refuse, explain, avoid, and leave (REAL) and explored how personality factors explain adolescents' use of cigarette refusal strategies. Participants were predominantly Hispanic junior high students (6th-8th grades) from schools in the Northeast United States who participated in a survey design (N = 260). The strategy of explain was reported most frequently for initial and follow-up smoking offers. Adolescents with a greater number of friends who smoked were more likely to use the avoid strategy for initial smoking offers. Sensation seeking was positively related to the use of leave and avoid strategies for initial smoking offers and leave strategy for follow-up smoking offers. No association was found between self-esteem and use of smoking refusal strategies. Implications and directions for future research are discussed.

Drug resistance strategies and substance use among adolescents in Monterrey, Mexico

This study examined drug resistance strategies and substance use among adolescents from Monterrey, Mexico. The focus was strategies that U.S. adolescents use most often to resist using substances, including refuse (saying no), explain (declining with an explanation), avoid (staying away from situations where drugs are offered), and leave (exiting situations where drugs are offered). Using self-administered questionnaire data from a convenience sample of 327 Mexican students enrolled at two secondary schools (preparatorias), we tested whether frequent use of particular drug resistance strategies predicted actual substance use. Multiple regression results showed that different strategies were effective for different substances, that some effects were mediated by number of offers received, and that certain effects were stronger for females than for males. Students using the refuse strategy reported less cigarette use and less binge drinking; those using the avoid strategy reported less alcohol and cigarette use; and those using the leave strategy reported less binge drinking and, for females only, less marijuana use. Use of the explain strategy was not significantly related to substance use after controlling for use of other strategies. Findings are discussed in terms of Mexican cultural values and their implications for the design of prevention programs for Mexican youth. EDITORS' STRATEGIC IMPLICATIONS: Replication is necessary to evaluate some of the effects of sampling, the prevention model, implementation, and culture on these findings, but the study underscores the importance of recognizing and understanding the cultural context in which prevention programs--and the clients they serve--exist.

Immediate and short-term effects of the 5th grade version of the keepin' it REAL substance use prevention intervention

This study assessed the immediate and short-term outcomes of adapting a culturally-grounded middle school program, keepin' it REAL, for elementary school students. After curriculum adaptation, 10 schools were randomly assigned to the intervention in 5th grade with follow-up boosters in 6th grade; 13 schools were randomly assigned to the control condition, implementing the school's pre-existing substance use prevention programming. Students (n=1566) completed a questionnaire prior to curriculum implementation and follow-up questionnaires toward the end of 5th and 6th grade. The 5th grade kiR curriculum generally appeared no more effective than the control schools' programming in changing students' resistance or decision-making skills; substance use intentions, expectancies, or normative beliefs; or lifetime and recent substance use. Such findings have implications for the age appropriateness of school-based programs.

Risk factors for sexually transmitted diseases and casual sex among Chinese patients attending sexually transmitted disease clinics in Hong Kong

BACKGROUND

The risk factors for sexually transmitted diseases (STDs) and having casual sex among the Chinese people are unknown.

GOAL

The goal of the study was to estimate the prevalence of STDs and to develop a profile of risk behavior among patients attending STD clinics in Hong Kong.

STUDY DESIGN

In a clinic-based, cross-sectional study, 448 patients attending two government STD clinics were randomly sampled and interviewed by means of a structured questionnaire.

RESULTS

The prevalence of STDs was 51% (70% of men and 35% of women). Attendees who had STDs diagnosed were more likely to be male, never married, and smokers and alcohol users (ever) and to have had casual sex or sex during travel with someone not their usual partner. Those who did not always use condoms were more likely to be male and never married. Having had casual sex was reported by 63% of the respondents. Those who reported having had casual sexual encounters were more likely to have the following characteristics: male; never married; no religious belief; ever smoker and alcohol user; current STD; had sex during travel; history of STD; inconsistent condom user; and perception of being at low risk for STD. After adjustment, only male gender was associated with casual sexual encounters.

CONCLUSION

The results of this study indicated several risk factors among Chinese patients for the acquisition of STDs, for not using condoms, and for having casual sex. This information is useful in strengthening and evaluating currently available STD prevention and control strategies for the Chinese population in Hong Kong and elsewhere.

Prevalence of travel related illness amongst a group of Chinese undergraduate students in Hong Kong

BACKGROUND

Regional and global travel by Asian residents is increasing. Young people seeking new experiences through travel may be particularly at risk of a wide spectrum of health problems. This study assesses travel-associated health risks and examines the prevalence and likely impact of pretravel health advice among Chinese undergraduate students in Hong Kong.

METHODS

Year 1 and year 3 undergraduate students of the University of Hong Kong were surveyed during September to December 1996, using a structured self-administered questionnaire. A total of 1,067 subjects were required to give a power of 95% (p =.50+/-3%).

RESULTS

Of 1,197 students (514 male and 680 female) surveyed, 52% had traveled outside Hong Kong at least once within the previous 12 months. Of these travelers (n = 578), 41% had developed one or more health problems, 7% had to consult a doctor and 2% needed hospitalization during travel, and 8% developed health problems within 2 weeks of returning for which they had to consult a doctor. Most (75%) took no pretravel health advice and 48% took no travel health precautions. About half (41%) of those who received advice received this from nonexpert sources. Those more likely to develop health problems were aged over 20 years (Odds Ratio, 1.49, 95% confidence interval, 1.06-2.10), in financial difficulties (1.60, 1.02-2.51), ever-smokers (1.69, 1.03-2.77), reporting poorer current health status (1.64, 1.04-2.57). Also, those who sought health advice from nonprofessional sources (2.13, 1.03-4.01) and took precautions (1.88, 1.33-2.63) were more likely to develop health problems.

CONCLUSIONS

This study demonstrated that young Chinese adults, with the benefits of higher education, are potentially at risk of a variety of avoidable travel-related health problems. Taking pretravel health advice from nonprofessional sources was common among respondents, but taking precautions did not reduce health problems. The comprehensibility and effectiveness of the advice and appropriateness of precautions taken need scrutiny in randomized trials. Specific topics for pretravel health education that will target higher risk travelers with preventive messages need to be identified and evaluated.

Ethnic and gender differences and similarities in adolescent drug use and refusals of drug offers

This paper examines the relationship among ethnicity, gender, drug use, and resistance to drug offers among a sample of 2,622 African American, Mexican American, and White American seventh graders. A number of similarities were noted. First, these adolescents did not seem to possess large or sophisticated repertoires of offer resistance strategies. Second, most offers came from acquaintances in contrast to more intimate offers among older youths. Ethnic and gender differences were also noted. Ethnicity had significant effects on use and the offer process. Mexican Americans received more offers, used more drugs, and were more likely to be offered drugs by peer family members and at parties. European Americans were more likely to receive drug offers from acquaintances and at friends' homes and on the street. African Americans were more likely to receive offers from dating partners and parents, and in the park, and were more likely to resist offers of drugs-using explanations. Gender significantly affected drug offers and types of offers. Males were more at risk for offers and use at a younger age. Offers of drugs to males were more likely to come from parents or other males, while offers to females were more likely to come from other females or dating partners. Males also were more likely to receive drug offers that appeal to their social standing or self-image while females received either simple offers or those that minimize effects. Finally, offers of drugs to males were more likely to be made in public, while those to females were more likely to occur in private. Cultural explanations are offered for these findings.