Patterns of substance use among adolescents in and out of foster care: An analysis of linked health and child welfare administrative data

BACKGROUND

Young adults with a history of foster care have higher risk for substance use disorders. Social systems can deliver substance use prevention to youth; however, the timing of intervention delivery and how needs differ for youth in foster care are unclear.

OBJECTIVE

To compare initiation and rates of substance use among adolescents in foster care to demographically similar adolescents never in foster care as identified by the healthcare system, and identify factors associated with increased substance use.

PARTICIPANTS AND SETTING

Youth in foster care (n = 2787, ages 10-20, inclusive) and demographically matched youth never in foster care (n = 2787) were identified using linked child welfare and electronic health records from a single pediatric children's hospital and county over a five-year period (2012-2017).

METHODS

All healthcare encounters were reviewed and coded for substance use by type (alcohol, tobacco, cannabis, other). Age of first reported or documented substance use was also captured. Demographic and child welfare information was extracted from administrative records. Survival and logistic regression models were estimated.

RESULTS

In adjusted models, youth in foster care initiated substance use at earlier ages (HR = 2.50, p < .01) and had higher odds of engaging in use (AOR = 1.54; p < .01) than youth never in care. By age 12, substance use initiation was more likely while youth were in foster care than when they were not in foster care (HR = 1.42, p < .01). Placement stability and family care settings reduced odds of lifetime substance use.

CONCLUSIONS

Foster care placement is associated with substance use. Screening may be important for prevention.

The prevalence and correlates of running away among adolescents in the United States

Runaway youth may experience a myriad of challenges associated with significant risks to health and well-being. To examine the prevalence and correlates of running away from home among US youth. Annual US nationally representative samples of 8th and 10th graders between 2005 and 2017 from the Monitoring the Future study. Self-reports of nationally representative samples of 8th and 10th graders in the US Annual survey data from 8th and 10th graders spanning 2005-2017, n = 116,520. The primary outcome of this study, running away from home in the past 12 months, was examined using multivariable weighted logistic regression. Predictor measures included: parent and peer relationships, school factors (e.g., grade point average [GPA]), internalizing symptoms, externalizing behavior, and substance use (alcohol, marijuana, and cigarettes). Demographic measures in the model were grade level (8th or 10th), gender (boys or girls), parent education, and race/ethnicity. The annual prevalence of running away decreased significantly from 8.3% in 2005 to 6.1% in 2017. Demographically, running away from home was significantly lower among boys compared with girls. Multivariable logistic regression model results revealed that higher levels of parental involvement, GPA, and self-esteem are all significantly related to lower odds of running away from home. Having peers who drop out of school, going on more date nights, self-derogation, interpersonal aggression, sensation seeking, theft, and property damage, as well as past 12-month alcohol use, past 12-month marijuana use, and past 30-day cigarette use were all associated with higher odds of running away from home. Annual prevalence of running away from home has been decreasing, but still affects a large number of teens. Running away is associated with numerous challenges across social, behavioral, and health domains that can further negatively impact the health and well-being of this already vulnerable population.

Party, Academic, or Prepped for College? School Norm Profiles and Adolescent Well-being using National Data

The current study examined how schoolwide norms came together into distinct profiles and how norm profile membership was linked to adolescent well-being. Using school-level (N = 786) and student-level data (N = 174,587 12th grade students; 52% female; 64% White, 13% Latino, 12% Black, 12% other) from Monitoring the Future (MTF), we identified four distinct school profiles-average, academic, prepped-for-college, party-that had unique patterns of shared norms. Compared with average schools, academic schools (high academics and low substance use and social integration norms) were most advantageous for students, prepped-for-college schools (high academics, substance use, and social integration norms) had both benefits and drawbacks, and party schools (low academics and high substance use and social integration norms) were most detrimental.

35-Year-Old Parents Do Not Approve of 17-Year-Olds' Cigarette, Marijuana, or Alcohol Use: U.S. National Data 1993-2018

PURPOSE

Parents' attitudes about adolescent substance use likely guide their parenting behaviors. This study documents prevalence of parents' disapproval of adolescent substance use and characteristics associated with disapproval.

METHODS

Survey data from national samples of 35-year-old parents from the U.S. Monitoring the Future study were collected 1993-2018. Multivariable logistic regression examined predictors of disapproving attitudes about substance use by a hypothetical 17-year-old child, including occasional marijuana use or drunkenness, and regular cigarette, marijuana, or alcohol use.

RESULTS

Across all cohorts, rates of disapproving attitudes ranged from 93.7% disapproving of getting drunk occasionally to 97.2% disapproving of regular cigarette use, with some erosion in disapproval for some substances across cohorts. Parents' own recent abstinence from substance use predicted greater odds of disapproval.

CONCLUSIONS

The overwhelming majority of 35-year-old parents disapprove of adolescent substance use. Prevention and public health messaging can support parenting by sharing this important information.

Forecasting future prevalence and gender differences in binge drinking among young adults through 2040

BACKGROUND

Binge drinking among adolescents and young adults has changed over time, but patterns differ by age and gender. Identifying high-risk groups to target future efforts at reducing drinking in this population remains a public health priority. Forecasting methods can provide a better understanding of variation and determinants of future binge drinking prevalence.

METHODS

We implemented regression-based forecasting models to estimate the prevalence and gender differences in binge drinking among cohort groups of U.S. young adults, ages 18, 23-24, and 29-30 through 2040. Forecasting models were adjusted for covariates accounting for changes in demographic, Big-5 social roles (e.g., residential independence), and drinking norms and related substance use, to understand the drivers of forecasted binge drinking estimates.

RESULTS

From the last observed cohort group (years varied by age) through 2040, unadjusted binge drinking prevalence was forecasted to decrease from 26% (95% CI: 20, 33%) (2011-15) to 11% (95% CI: 4, 27%) at age 18, decrease from 38% (95% CI: 30, 45%) (2006-2010) to 34% (95% CI: 18, 55%) at ages 23/24, and increase from 32% (95% CI: 25, 40%) (2001-2005) to 35% (95% CI: 16, 59%) at ages 29/30. Gender-stratified forecasts show a continuation in the narrowing of binge drinking prevalence between young men and women, though the magnitude of narrowing differs by age. Estimated trends were partially explained by changing norms regarding drinking and other substance use, though these indirect effects explained less of the total trend as age increased.

CONCLUSIONS

Understanding how covariates influence binge drinking trends can guide public health policies to leverage the most important determinants of future binge drinking to reduce the harm caused by binge drinking from adolescence to adulthood.

Substance use patterns in 9-10 year olds: Baseline findings from the adolescent brain cognitive development (ABCD) study

BACKGROUND

The Adolescent Brain Cognitive Development ™ Study (ABCD Study®) is an open-science, multi-site, prospective, longitudinal study following over 11,800 9- and 10-year-old youth into early adulthood. The ABCD Study aims to prospectively examine the impact of substance use (SU) on neurocognitive and health outcomes. Although SU initiation typically occurs during teen years, relatively little is known about patterns of SU in children younger than 12.

METHODS

This study aims to report the detailed ABCD Study® SU patterns at baseline (n = 11,875) in order to inform the greater scientific community about cohort's early SU. Along with a detailed description of SU, we ran mixed effects regression models to examine the association between early caffeine and alcohol sipping with demographic factors, externalizing symptoms and parental history of alcohol and substance use disorders (AUD/SUD).

PRIMARY RESULTS

At baseline, the majority of youth had used caffeine (67.6 %) and 22.5 % reported sipping alcohol (22.5 %). There was little to no reported use of other drug categories (0.2 % full alcohol drink, 0.7 % used nicotine, <0.1 % used any other drug of abuse). Analyses revealed that total caffeine use and early alcohol sipping were associated with demographic variables (p's<.05), externalizing symptoms (caffeine p = 0002; sipping p = .0003), and parental history of AUD (sipping p = .03).

CONCLUSIONS

ABCD Study participants aged 9-10 years old reported caffeine use and alcohol sipping experimentation, but very rare other SU. Variables linked with early childhood alcohol sipping and caffeine use should be examined as contributing factors in future longitudinal analyses examining escalating trajectories of SU in the ABCD Study cohort.

Cohort effects on gender differences in alcohol use in the United States: How much is explained by changing attitudes towards women and gendered roles?

Gender differences in binge drinking have converged in recent cohorts, due in part to faster decreases in consumption among boys in adolescence, and faster increases in consumption among women in young to middle adulthood. Changes in education and occupation explain a portion, but not all, of these differences; the present study examines how attitudes about gender, religion and family additionally explain cohort effects in binge drinking by sex. Data were drawn from the Monitoring the Future panel studies, including >54,000 participants who were high school seniors from 1976 through 2006, followed to age 29/30 from 1988 through 2016. The main effect relationship between cohort and binge drinking was assessed, and 28 items on gender, religion and family were evaluated to determine if mediation criteria were met; mediation models assessed direct and indirect effects. Results indicated that gender, religion and family attitudes and beliefs among US adults across the 20 th and 21 st centuries have shifted dramatically but not monotonically. US adolescents and adults have largely become less religious; some attitudes on women and family have become less conservative and some more. Among men, views on marriage showed the largest mediation effects; agreeing with the statement 'one partner is too restrictive' mediated 3.35% of the cohort effect (95% C.I. 2.42, 4.31) and 'couples should live together before they are married' mediated 1.6% of the cohort effect (95% C.I. -2.37, -0.8). Among women, declines in religious service attendance mediated 2.0% of cohort effects in binge drinking (95% C.I. -3.03, -1.09), as well as similar family attitudes as men. In conclusion, changes in social roles, as well as some gender, and religious views, partially mediate cohort effects on binge drinking for men and women. The dynamic changes in how adolescents and adults view family and gender are important components of alcohol epidemiology.

Baseline brain function in the preadolescents of the ABCD Study

The Adolescent Brain Cognitive Development (ABCD) Study® is a 10-year longitudinal study of children recruited at ages 9 and 10. A battery of neuroimaging tasks are administered biennially to track neurodevelopment and identify individual differences in brain function. This study reports activation patterns from functional MRI (fMRI) tasks completed at baseline, which were designed to measure cognitive impulse control with a stop signal task (SST; N = 5,547), reward anticipation and receipt with a monetary incentive delay (MID) task (N = 6,657) and working memory and emotion reactivity with an emotional N-back (EN-back) task (N = 6,009). Further, we report the spatial reproducibility of activation patterns by assessing between-group vertex/voxelwise correlations of blood oxygen level-dependent (BOLD) activation. Analyses reveal robust brain activations that are consistent with the published literature, vary across fMRI tasks/contrasts and slightly correlate with individual behavioral performance on the tasks. These results establish the preadolescent brain function baseline, guide interpretation of cross-sectional analyses and will enable the investigation of longitudinal changes during adolescent development.

Multifinality, equifinality, and fanning: Developmental concepts and statistical implications

Multifinality, equifinality, and fanning are important developmental concepts that emphasize understanding interindividual variability in trajectories over time. However, each concept implies that there are points in a developmental window where interindividual variability is more limited. We illustrate the multifinality concept under manipulations of variance in starting points, using both normal and zero-inflated simulated data. Results indicate that standardized estimates and effect sizes are inflated when predicting components of growth models with limited interindividual variance, which could lead to overinterpretation of the practical importance of findings. Conceptual implications are considered and recommendations are provided for evaluating developmental changes in common situations that researchers may encounter.

Comparing prevalence estimates of concussion/head injury in U.S. children and adolescents in national surveys

BACKGROUND AND OBJECTIVES

Reports on pediatric lifetime concussions/head injuries (LCHI) from national surveys have offered estimates on prevalence that range from 2.5% to 18% in the general population. The purpose of this study is to examine national surveys to compare methodologies and limitations pertaining to LCHI data collection.

METHODS

Three nationally representative surveys that measure LCHI in children, including the National Survey of Children's Health, the National Health Interview Survey, and the Monitoring the Future Survey were examined. Children were grouped by ages 3-17 years and adolescent ages 13-17 years, stratified by selected demographic characteristics. Participants in the surveys included parents (NSCH and NHIS) and adolescents (MTF survey). The primary outcome measure is an estimate of LCHI in children.

RESULTS

Estimates of prevalence of LCHI ranged from 3.6% to 7.0% for children ages 3-17 years and from 6.5% to 18.3% for adolescents 13-17 years. Survey modality, question wording, and respondent may contribute to differing estimates. Prevalence showed consistent variation by age, sex, and race/ethnicity across surveys. Associations were inconsistent between LCHI and insurance status, parental education, and household primary language.

CONCLUSIONS

Although there are methodological differences in capturing pediatric LCHI across surveys, the prevalence estimates and correlational associations generated can offer awareness about the burden of these injuries and insights to research and clinical care.

When does attrition lead to biased estimates of alcohol consumption? Bias analysis for loss to follow-up in 30 longitudinal cohorts

OBJECTIVES

Survey nonresponse has increased across decades, making the amount of attrition a focus in generating inferences from longitudinal data. Use of inverse probability weights [IPWs] and other statistical approaches are common, but residual bias remains a threat. Quantitative bias analysis for nonrandom attrition as an adjunct to IPW may yield more robust inference.

METHODS

Data were drawn from the Monitoring the Future panel studies [twelfth grade, base-year: 1976-2005; age 29/30 follow-up: 1987-2017, N = 73,298]. We then applied IPW imputation in increasing percentages, assuming varying risk differences [RDs] among nonresponders. Measurements included past-two-week binge drinking at base-year and every follow-up. Demographic and other correlates of binge drinking contributed to IPW estimation.

RESULTS

Attrition increased: 31.14%, base-year 1976; 61.33%, base-year 2005. The magnitude of bias depended not on attrition rate but on prevalence of binge drinking and RD among nonrespondents. The probable range of binge drinking among nonresponders was 12-45%. In every scenario, base-year and follow-up binge drinking were associated. The likely range of true RDs was 0.14 [95% CI: 0.11-0.17] to 0.28 [95% CI: 0.25-0.31].

CONCLUSIONS

When attrition is present, the amount of attrition alone is insufficient to understand contribution to effect estimates. We recommend including bias analysis in longitudinal analyses.

Medical Use and Misuse of Prescription Opioids in US 12th-Grade Youth: School-Level Correlates

BACKGROUND AND OBJECTIVES

Opioid misuse and overdose remains a leading US public health concern, and many youth are first exposed to opioids via medical use. In this study, we examine school-level prevalence and correlates of medical use and misuse of prescription opioids among US 12th-grade students.

METHODS

A sample of 228 507 US 12th-graders in 1079 public and private schools from 2002 to 2017 from the Monitoring the Future study was used to identify school-level prevalence and correlates associated with medical use and misuse of prescription opioids.

RESULTS

The past-year prevalence of prescription opioid misuse was 7.6% and ranged from 0% to 73% across US high schools. Lifetime medical use of prescription opioids was 16.9% and ranged from 0% to 85% across US high schools. The odds of prescription opioid misuse were higher at schools with higher proportions of male students, more white students, higher rates of marijuana use, and more medical use of prescription opioids. Students attending schools with the highest rates of medical use of prescription opioids had 57% increased odds of past-year prescription opioid misuse compared with schools with no medical use (adjusted odds ratio = 1.57, 95% confidence interval = 1.35-1.83); this association was found to weaken in recent years.

CONCLUSIONS

Differences exist in the prevalence of prescription opioid misuse among US high schools. The association between greater school-level medical use of prescription opioids and higher prevalence of prescription opioid misuse, although declining, indicates a key risk factor to target for prevention efforts.

Association of Family Member Detention or Deportation With Latino or Latina Adolescents' Later Risks of Suicidal Ideation, Alcohol Use, and Externalizing Problems

IMPORTANCE

Policy changes since early 2017 have resulted in a substantial expansion of Latino or Latina immigrants prioritized for deportation and detention. Professional organizations, including the American Academy of Pediatrics, American Medical Association, and Society for Research in Child Development, have raised concerns about the potentially irreversible mental health effects of deportations and detentions on Latino or Latina youths.

OBJECTIVE

To examine how family member detention or deportation is associated with Latino or Latina adolescents' later mental health problems and risk behaviors.

DESIGN, SETTING, AND PARTICIPANTS

Survey data were collected between February 14 and April 26, 2018, and between September 17, 2018, and January 13, 2019, and at a 6-month follow-up from 547 Latino or Latina adolescents who were randomly selected from grade and sex strata in middle schools in a suburban Atlanta, Georgia, school district. Prospective data were analyzed using multivariable, multivariate logistic models within a structural equation modeling framework. Models examined how family member detention or deportation within the prior 12 months was associated with later changes in suicidal ideation, alcohol use, and clinical externalizing symptoms, controlling for initial mental health and risk behaviors.

EXPOSURE

Past-year family member detention or deportation.

MAIN OUTCOMES AND MEASURES

Follow-up reports of suicidal ideation in the past 6 months, alcohol use since the prior survey, and clinical level of externalizing symptoms in the past 6 months.

RESULTS

A total of 547 adolescents (303 girls; mean [SD] age, 12.8 [1.0] years) participated in this prospective survey. Response rates were 65.2% (547 of 839) among contacted parents and 95.3% (547 of 574) among contacted adolescents whose parents provided permission. The 6-month follow-up retention rate was 81.5% (446 of 547). A total of 136 adolescents (24.9%) had a family member detained or deported in the prior year. Family member detention or deportation was associated with higher odds of suicidal ideation (38 of 136 [27.9%] vs 66 of 411 [16.1%]; adjusted odds ratio, 2.37; 95% CI, 1.06-5.29), alcohol use (25 of 136 [18.4%] vs 30 of 411 [7.3%]; adjusted odds ratio, 2.98; 95% CI, 1.26-7.04), and clinical externalizing behaviors (31 of 136 [22.8%] vs 47 of 411 [11.4%]; adjusted odds ratio, 2.76; 95% CI, 1.11-6.84) at follow-up, controlling for baseline variables.

CONCLUSION AND RELEVANCE

This study suggests that recent immigration policy changes may be associated with critical outcomes jeopardizing the health of Latino or Latina adolescents. Since 95% of US Latino or Latina adolescents are citizens, compromised mental health and risk behavior tied to family member detention or deportation raises concerns regarding the association of current immigration policies with the mental health of Latino and Latina adolescents in the United States.

Diverging Trends in the Relationship Between Binge Drinking and Depressive Symptoms Among Adolescents in the U.S. From 1991 Through 2018

PURPOSE

From 1991 to 2018, binge drinking among U.S. adolescents has precipitously declined; since 2012, depressive symptoms among U.S. adolescents have sharply increased. Binge drinking and depressive symptoms have historically been correlated, thus understanding whether there are dynamic changes in their association informs prevention and intervention.

METHODS

Data were drawn from the U.S. nationally representative cross-sectional Monitoring the Future surveys (1991-2018) among school-attending 12th-grade adolescents (N = 58,444). Binge drinking was measured as any occasion of more than five drinks/past 2 weeks; depressive symptoms were measured with four items (e.g., belief that life is meaningless or hopeless), dichotomized at 75th percentile. Time-varying effect modeling was conducted by sex, race/ethnicity, and parental education.

RESULTS

In 1991, adolescents with high depressive symptoms had 1.74 times the odds of binge drinking (95% confidence interval 1.54-1.97); by 2018, the strength of association between depressive symptoms and binge drinking among 12th-grade adolescents declined 24% among girls and 25% among boys. There has been no significant relation between depressive symptoms and binge drinking among boys since 2009; among girls, the relationship has been positive throughout most of the study period, with no significant relationship from 2016 to 2017.

CONCLUSIONS

Diverging trends between depressive symptoms and alcohol use among youth are coupled with declines in the strength of their comorbidity. This suggests that underlying drivers of recent diverging population trends are likely distinct and indicates that the nature of comorbidity between substance use and mental health may need to be reconceptualized for recent and future cohorts.

The Long-Term Associations Between Direct and Threatened Physical Violence in Adolescence and Symptoms of Substance Use Disorders During the Mid-30s

OBJECTIVE

Most studies linking physical victimization and substance use have focused on concurrent or temporally proximal associations, making it unclear whether physical victimization has a sustained impact on substance use problems. We examined the long-term associations between adolescent physical victimization and symptoms of substance use disorders in adulthood, controlling for intermediating victimization during young adulthood and several control variables.

METHOD

Data were obtained from the Monitoring the Future Study (N = 5,291). Women and men were recruited around age 18 and surveyed biennially through age 30, and again at 35. Past-year physical victimization (threatened physical assaults, injurious assaults) was measured regularly from age 18 to 30. Alcohol and cannabis use symptoms (e.g., withdrawal, tolerance) were assessed at age 35. Controls were measured in adolescence (e.g., prior substance use) and young adulthood (e.g., marriage). Interactions examined whether associations varied by sex.

RESULTS

When we controlled for adolescent substance use, adolescents who were threatened with injury or who sustained physical injuries as a result of violence had more alcohol use symptoms at age 35 than nonvictims. However, when victimization during young adulthood was statistically accounted for, only victimization during young adulthood was associated with age-35 alcohol use symptoms. The effects of young adult victimization, but not adolescent victimization, were stronger for women. Victimization was mostly unrelated to age-35 cannabis use symptoms.

CONCLUSIONS

Adolescents who are threatened with physical assaults or injured by physical assaults have significantly more alcohol use symptoms in their mid-30s than nonvictimized adolescents, but these associations are completely explained by subsequent victimization during young adulthood.

More Bored Today Than Yesterday? National Trends in Adolescent Boredom From 2008 to 2017

PURPOSE

Boredom is an accepted part of adolescence. Developmental and contextual factors are likely to conspire to increase boredom during adolescence, which, in turn, relates to health risk behaviors. However, literature is lacking in the developmental course of boredom across adolescence as well as historical variation in boredom. The present study used multicohort nationally representative samples of U.S. secondary school students to identify historical trends and grade level differences in boredom overall and by sex.

METHODS

The present study includes 8th, 10th, and 12th graders from 2008 to 2017 who completed the Monitoring the Future self-report survey (n = 106,784). Joinpoint was used to identify historical trends in boredom and linear regression to identify grade level differences.

RESULTS

Boredom increased historically both across and within grades with girls generally demonstrating greater increases than boys. Across grade, boredom appears to peak in 10th grade for boys and decrease across grade for girls.

CONCLUSIONS

Study findings indicate boredom has been increasing among adolescents over the past several years, with greater increases among girls. Increases may be concomitant with recent increases in mental health difficulties, suggesting that the overarching psychosocial profile of U.S. adolescents is becoming less optimal. Findings also suggest boredom peaks in 10th grade overall although when analyzing separately by sex, girls' boredom declines from 8th to 12th grade. It is clear that boredom is a worthy target for intervention both in clinical and prevention contexts.

Image processing and analysis methods for the Adolescent Brain Cognitive Development Study

The Adolescent Brain Cognitive Development (ABCD) Study is an ongoing, nationwide study of the effects of environmental influences on behavioral and brain development in adolescents. The main objective of the study is to recruit and assess over eleven thousand 9-10-year-olds and follow them over the course of 10 years to characterize normative brain and cognitive development, the many factors that influence brain development, and the effects of those factors on mental health and other outcomes. The study employs state-of-the-art multimodal brain imaging, cognitive and clinical assessments, bioassays, and careful assessment of substance use, environment, psychopathological symptoms, and social functioning. The data is a resource of unprecedented scale and depth for studying typical and atypical development. The aim of this manuscript is to describe the baseline neuroimaging processing and subject-level analysis methods used by ABCD. Processing and analyses include modality-specific corrections for distortions and motion, brain segmentation and cortical surface reconstruction derived from structural magnetic resonance imaging (sMRI), analysis of brain microstructure using diffusion MRI (dMRI), task-related analysis of functional MRI (fMRI), and functional connectivity analysis of resting-state fMRI. This manuscript serves as a methodological reference for users of publicly shared neuroimaging data from the ABCD Study.

Recent increases in depressive symptoms among US adolescents: trends from 1991 to 2018

BACKGROUND

Mental health problems and mental health related mortality have increased among adolescents, particularly girls. These trends have implications for etiology and prevention and suggest new and emerging risk factors in need of attention. The present study estimated age, period, and cohort effects in depressive symptoms among US nationally representative samples of school attending adolescents from 1991 to 2018.

METHODS

Data are drawn from 1991 to 2018 Monitoring the Future yearly cross-sectional surveys of 8th, 10th, and 12th grade students (N = 1,260,159). Depressive symptoms measured with four questions that had consistent wording and data collection procedures across all 28 years. Age-period-cohort effects estimated using the hierarchical age-period-cohort models.

RESULTS

Among girls, depressive symptoms decreased from 1991 to 2011, then reversed course, peaking in 2018; these increases reflected primarily period effects, which compared to the mean of all periods showed a gradual increase starting in 2012 and peaked in 2018 (estimate = 1.15, p < 0.01). Cohort effects were minimal, indicating that increases are observed across all age groups. Among boys, trends were similar although the extent of the increase is less marked compared to girls; there was a declining cohort effect among recently born cohorts, suggesting that increases in depressive symptoms among boys are slower for younger boys compared to older boys in recent years. Trends were generally similar by race/ethnicity and parental education, with a positive cohort effect for Hispanic girls born 1999-2004.

CONCLUSIONS

Depressive symptoms are increasing among teens, especially among girls, consistent with increases in depression and suicide. Population variation in psychiatric disorder symptoms highlight the importance of current environmental determinants of psychiatric disorder risk, and provide evidence of emerging risk factors that may be shaping a new and concerning trend in adolescent mental health.

Cross-national variation in the subjective wellbeing of youth in low and middle income countries: The role of structural and micro-level factors

Subjective wellbeing (i.e. life satisfaction and happiness) impacts youth's social, economic and political participation. Prior studies have documented cross-national variation in subjective wellbeing of adults but there is a lack of data on the prevalence and correlates of subjective wellbeing among youth in low and middle income countries. This paper utilizes data from an international dataset - Multiple Indicator Cluster Surveys to assess the influence of structural and micro-level factors on the subjective wellbeing of youth (ages 15 - 24) in 29 countries or regions in Eastern Europe, Latin America, Asia and Africa. We find that within countries, global life satisfaction and happiness are associated with age, education attainment, place of residence, marital status, household wealth and exposure to mass media. Significant interactions between age, gender and education are observed. However, none of the country level development indicators account for cross-national variation in youth's SWB although there is some indication that income inequities between countries may influence youth's SWB. The findings underscore the need for objective measures of subjective wellbeing to understand the conditions in LMICs.

Joint Effects of Age, Period, and Cohort on Conduct Problems Among American Adolescents From 1991 Through 2015

Although arrest rates among juveniles have substantially decreased since the 1990s, US national trends in conduct problems are unknown. Population variation in conduct problems would imply changes in the social environment, which would include emergent or receding risk factors. In the present study, we separated age, period, and cohort effects on conduct problems using nationally representative surveys of 375,879 US students conducted annually (1991-2015). The summed score of 7 items measuring the frequency of conduct problems was the outcome. Conduct problems have decreased during the past 25 years among boys; the total amount of the decrease was approximately 0.4 standard deviations (P < 0.01), and by item prevalence, the total amount of the decrease was 8%-11%. Declines are best explained by period effects beginning approximately in 2008, and a declining cohort effect beginning among those born after 1992, which suggests not only declines in population levels, but more rapid declines among younger cohorts of boys. Trends were also consistent with age-period-cohort effects on evenings spent out, which suggest a possible mechanism. Conduct problems among girls were lower than boys and did not demonstrate trends across time. These changes may reflect the changing nature of adolescence toward less unsupervised interaction.

The developmental course of community service across the transition to adulthood in a national U.S. sample

Despite the importance of community service for the well-being of individuals and communities, relatively little is known about the developmental course of community service during the transition to adulthood (TTA). This study tested competing hypotheses about change in community service across the TTA by estimating latent growth models from Ages 18 to 26 in a national U.S.

SAMPLE

Analyses tested for cohort differences in community service and for individual differences in developmental trajectories by socioeconomic status, gender, grades, religiosity, race/ethnicity, college expectations, and college degree attainment. Using Monitoring the Future data from 1976 to 2011, the best-fitting latent growth model for community service was quadratic: Community service declined from Ages 18 to 24 and leveled off thereafter. Cohort differences in intercepts indicated that Age 18 community service increased over historical time; developmental declines in community service were consistent over 4 decades. Parent education predicted higher Age 18 community service but not growth parameters. Community service trajectories varied by gender, high school grades, religiosity, college expectations, and educational attainment, although all groups declined. Findings contribute to civic developmental theory by clarifying age and cohort effects in community service. Rising levels of community service at Age 18 may reflect heightened focus on service in high schools or the role of other socialization forces, yet these increases do not mitigate the decline across the TTA. We highlight the need for rethinking the ways in which institutions and communities can better support youth community service during the TTA. (PsycINFO Database Record

Competitive sports participation in high school and subsequent substance use in young adulthood: Assessing differences based on level of contact

The objective of this analysis is to examine how participation in different types of competitive sports (based on level of contact) during high school is associated with substance use 1 to 4 years after the 12^th grade. The analysis uses nationally representative samples of 12^th graders from the Monitoring the Future Study who were followed 1 to 4 years after the 12^th grade. The longitudinal sample consisted of 970 12^th graders from six recent cohorts (2006-2011). The analyses found that respondents who participated in at least one competitive sport during the 12^th grade had greater odds of binge drinking during the past two weeks (AOR = 2.04; 95% CI = 1.43, 2.90) 1 to 4 years after the 12^th grade, when compared to their peers who did not participate in sports during their 12^th grade year. Moreover, respondents who participated in high-contact sports (i.e., football, ice hockey, lacrosse, and wrestling) had greater odds of binge drinking (AOR = 1.80; 95% CI = 1.18, 2.72) and engaging in marijuana use during the past 30 days (AOR = 1.81; 95% CI = 1.12, 2.93) 1 to 4 years after the 12^th grade when compared to their peers who did not participate in these types of sports during their 12^th grade year. Accordingly, the findings indicate important distinctions in sport participation experiences on long-term substance use risk that can help inform potential interventions among young athletes.

Longitudinal Pathways to Educational Attainment for Youth in Mexican and Central American Immigrant Families

Mexican and Central American-origin youth in immigrant families, the fastest growing segment of the K-12 school population, experience considerably worse educational outcomes than do youth from other Latino national origins and other racial and ethnic backgrounds. Socioeconomic factors, as well as length of U.S. residence, have important implications for youth's academic success. The present study uses longitudinal structural equation modeling techniques to identify how parents' socioeconomic status (SES) and youth's length of U.S. residence are associated with adolescent academic outcomes and, in turn, educational attainment in adulthood. The sample included 1,207 Mexican- and Central American-origin youth participants in the Children of Immigrants Longitudinal Study (CILS). Youth completed surveys at times corresponding roughly to ages 13 to 15 (Time 1), 16 to 18 (Time 2), and 23 to 25 (Time 3). When compared with youth with a longer duration of U.S. residence, young people who had lived in the U.S. for less than 5 years at Time 1 reported higher educational attainment at Time 3 by way of a better grade-point average (GPA) and higher educational expectations at Time 1. Parent SES was associated directly and indirectly with higher educational attainment through youth's greater educational expectations at Times 1 and 2. Although recent immigrant youth experienced sharper declines in GPA and educational expectations from Time 1 to Time 2 than youth with a longer duration of U.S. residence, newcomer youth's early academic success appears to have lasting benefits for educational attainment.

Association of State Recreational Marijuana Laws With Adolescent Marijuana Use

IMPORTANCE

Historical shifts are occurring in marijuana policy. The effect of legalizing marijuana for recreational use on rates of adolescent marijuana use is a topic of considerable debate.

OBJECTIVE

To examine the association between the legalization of recreational marijuana use in Washington and Colorado in 2012 and the subsequent perceived harmfulness and use of marijuana by adolescents.

DESIGN, SETTING, AND PARTICIPANTS

We used data of 253 902 students in eighth, 10th, and 12th grades from 2010 to 2015 from Monitoring the Future, a national, annual, cross-sectional survey of students in secondary schools in the contiguous United States. Difference-in-difference estimates compared changes in perceived harmfulness of marijuana use and in past-month marijuana use in Washington and Colorado prior to recreational marijuana legalization (2010-2012) with postlegalization (2013-2015) vs the contemporaneous trends in other states that did not legalize recreational marijuana use in this period.

MAIN OUTCOMES AND MEASURES

Perceived harmfulness of marijuana use (great or moderate risk to health from smoking marijuana occasionally) and marijuana use (past 30 days).

RESULTS

Of the 253 902 participants, 120 590 of 245 065(49.2%) were male, and the mean (SD) age was 15.6 (1.7) years. In Washington, perceived harmfulness declined 14.2% and 16.1% among eighth and 10th graders, respectively, while marijuana use increased 2.0% and 4.1% from 2010-2012 to 2013-2015. In contrast, among states that did not legalize recreational marijuana use, perceived harmfulness decreased by 4.9% and 7.2% among eighth and 10th graders, respectively, and marijuana use decreased by 1.3% and 0.9% over the same period. Difference-in-difference estimates comparing Washington vs states that did not legalize recreational drug use indicated that these differences were significant for perceived harmfulness (eighth graders: % [SD], -9.3 [3.5]; P = .01; 10th graders: % [SD], -9.0 [3.8]; P = .02) and marijuana use (eighth graders: % [SD], 5.0 [1.9]; P = .03; 10th graders: % [SD], 3.2 [1.5]; P = .007). No significant differences were found in perceived harmfulness or marijuana use among 12th graders in Washington or for any of the 3 grades in Colorado.

CONCLUSIONS AND RELEVANCE

Among eighth and 10th graders in Washington, perceived harmfulness of marijuana use decreased and marijuana use increased following legalization of recreational marijuana use. In contrast, Colorado did not exhibit any differential change in perceived harmfulness or past-month adolescent marijuana use following legalization. A cautious interpretation of the findings suggests investment in evidence-based adolescent substance use prevention programs in any additional states that may legalize recreational marijuana use.

How does state marijuana policy affect US youth? Medical marijuana laws, marijuana use and perceived harmfulness: 1991-2014

AIMS

To test, among US students: (1) whether perceived harmfulness of marijuana has changed over time, (2) whether perceived harmfulness of marijuana changed post-passage of state medical marijuana laws (MML) compared with pre-passage; and (3) whether perceived harmfulness of marijuana statistically mediates and/or modifies the relation between MML and marijuana use as a function of grade level.

DESIGN

Cross-sectional nationally representative surveys of US students, conducted annually, 1991-2014, in the Monitoring the Future study.

SETTING

Surveys conducted in schools in all coterminous states; 21 states passed MML between 1996 and 2014.

PARTICIPANTS

The sample included 1 134 734 adolescents in 8th, 10th and 12th grades.

MEASUREMENTS

State passage of MML; perceived harmfulness of marijuana use (perceiving great or moderate risk to health from smoking marijuana occasionally versus slight or no risk); and marijuana use (prior 30 days). Data were analyzed using time-varying multi-level regression modeling.

FINDINGS

The perceived harmfulness of marijuana has decreased significantly since 1991 (from an estimated 84.0% in 1991 to 53.8% in 2014, P < 0.01) and, across time, perceived harmfulness was lower in states that passed MML [odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.75-0.97]. In states with MML, perceived harmfulness of marijuana increased among 8th graders after MML passage (OR = 1.21, 95% CI = 1.08-1.36), while marijuana use decreased (OR = 0.81, 95% CI = 0.72-0.92). Results were null for other grades, and for all grades combined. Increases in perceived harmfulness among 8th graders after MML passage was associated with ~33% of the decrease in use. When adolescents were stratified by perceived harmfulness, use in 8th graders decreased to a greater extent among those who perceived marijuana as harmful.

CONCLUSIONS

While perceived harmfulness of marijuana use appears to be decreasing nationally among adolescents in the United States, the passage of medical marijuana laws (MML) is associated with increases in perceived harmfulness among young adolescents and marijuana use has decreased among those who perceive marijuana to be harmful after passage of MML.

Convergence and Obfuscation: A Rejoinder to Osipow and to Laplante, Coallier, Sabourin, and Martin

Our previous critique of Martin, Sabourin, Laplante, and Coallier (1991) included 10 serious criticisms of their methods and conclusions regarding the dimensionality of the Career Decision Scale (CDS). Although the quantity of the Laplante, Coallier, Sabourin, and Martin (1994) response was not bad (i.e., they attempted to address 7 of the 10 criticisms), the quality of their response was disappointing because it confused fact with fiction, and included a wealth of extraneous and irrelevant material. Nothing in their response convinced (or even tempted) us to retract any of our original criticisms. Most importantly, the equivalence of their French version of the CDS with the English version was still not demonstrated, our four-factor model was still not disconfirmed, and their model testing procedures remain suspect (e.g., for some undisclosed reason, Laplante et al. (1994) and Martin et al. (1991) are at odds as to whether they accepted their one-factor model). Based on our findings (as well as those of Martin et al. [1991]— despite their conclusions, their findings support our model), the fact remains that our four-factor model provided the best fit among the several models tested, indicating firm support for the multidimensionality of the CDS. We found ourselves in substantial agreement with Osipow (1994), and we urge him to refine the CDS by adding dimension-specific items and revising double-barreled items.

Unidimensionality Versus Multidimensionality of the Career Decision Scale: A Critique of Martin, Sabourin, Laplante, and Coallier

During the past 15 years the Career Decision Scale (CDS) has been used primarily to assess degree of indecision. Controversy has arisen around the issue of whether it should thus be considered a unidimensional measure or whether it is a multidimensional measure of several dimensions of career indecision. Although a number of studies reported significant empirical support for the multidimensionality of the CDS, a study by Martin, Sabourin, Laplante, and Coallier (1991) claimed to present evidence supporting its unidimensionality. The present study refutes those claims by demonstrating serious methodological and conceptual errors and omissions in the findings of Martin et al. (1991) and by presenting further empirical evidence in support of multidimensionality.

Parental Support, Mental Health, and Alcohol and Marijuana Use in National and High-Risk African-American Adolescent Samples

African-American adolescents experience disproportionate rates of negative consequences of substance use despite using substances at average or below-average rates. Due to underrepresentation of African-American adolescents in etiological literature, risk and protective processes associated with their substance use require further study. This study examines the role of parental support in adolescents' conduct problems (CPs), depressive symptoms (DSs), and alcohol and marijuana use in a national sample and a high-risk sample of African-American adolescents. In both samples, parental support was inversely related to adolescent CPs, DSs, and alcohol and marijuana use. CPs, but not DSs, partially mediated the relation of parental support to substance use. Results were consistent across the national and high-risk samples, suggesting that the protective effect of parental support applies to African-American adolescents from a range of demographic backgrounds.

Contribution of Adolescence to the Life Course: What Matters Most in the Long Run?

Our wish is for more long-term longitudinal studies specifically designed to demonstrate the importance of adolescence in the life course. Specifically, we wish for our science to document as rigorously as possible the individual and contextual characteristics and experiences that matter the most during adolescence for long-term adult health and well-being. Recent research has shown the early childhood effects on adult outcomes, including effects from intervention programs, bringing needed scientific evidence to inform social policy about the importance of optimizing early development. In most of these efforts, there is little emphasis on adolescence, and thus there is little understanding about the effects of adolescence over and above the effects of childhood on adult outcomes. Our view is that adolescence matters a great deal for long-term health and well-being and we summarize what it will take to make our wish come true.

Predicting Young Adult Degree Attainment by Late Adolescent Marijuana Use

PURPOSE

The purpose of this study was to assess whether infrequent and frequent marijuana use at age 19/20 years predicts receipt of educational degrees by the mid-20s, independent of confounding age 18 adolescent risk factors.

METHODS

Data were from the Monitoring the Future study, an annual nationally representative survey of high school seniors followed into adulthood. Thirteen cohorts (1990-2002) of high school seniors were followed longitudinally to their mid-20s (n = 4,925; 54% female). We used logistic regression and propensity score matching with successive inclusion of age 18 risk factors and substance use to compare age 19/20 frequent marijuana users (six or more occasions in past 30 days) to nonusers, frequent users to infrequent users (1-6 occasions), and infrequent users to nonusers on their likelihood of degree attainment by the mid-20s.

RESULTS

Frequent marijuana users were less likely than infrequent users and nonusers to earn bachelor's degrees, even after controlling for a host of age 18 risk factors (e.g., family socioeconomic background, academic performance, educational expectations, truancy). However, these differences were reduced in magnitude to statistical nonsignificance when we controlled for age 18 substance use. Across analyses, the proportion reaching this educational milestone did not differ significantly between infrequent users and nonusers.

CONCLUSIONS

Results support a growing body of work suggesting that frequent marijuana use predicts a lower likelihood of postsecondary educational attainment, and this difference may originate during secondary school.

Longitudinal associations between smoking and depressive symptoms among adolescent girls

Adolescence is an important period for initiation of smoking and manifestation of depression, which are often comorbid. Researchers have examined associations between depressive symptoms and smoking to elucidate whether those with increased depressive symptoms smoke more to self-medicate, whether those who smoke experience increased subsequent depressive symptoms, or both. Collectively, there have been mixed findings; however, studies have been limited by (1) cross-sectional or short-term longitudinal data or (2) the use of methods that test associations, or only one direction in the associations, rather than a fully-reciprocal model to examine directionality. This study examined the associations between smoking and depressive symptoms in a sample of adolescent girls using latent dual change scores to model (1) the effect of smoking on change in depressive symptoms, and simultaneously (2) the effect of depressive symptoms on change in smoking across ages 11-20. Data were from a cohort-sequential prospective longitudinal study (N = 262). Girls were enrolled by age cohort (11, 13, 15, and 17 years) and were primarily White (61 %) or African American (31 %). Data were restructured by age. Every 6 months, girls reported depressive symptoms and cigarette use. Results indicated that controlling for sociodemographic characteristics, higher levels of smoking predicted a greater increase in depressive symptoms across adolescence. These findings suggest that a higher level of cigarette smoking does contribute to more depressive symptoms, which has implications for prevention of depression and for intervention and future research.

The great sleep recession: changes in sleep duration among US adolescents, 1991-2012

BACKGROUND

Average nightly sleep times precipitously decline from childhood through adolescence. There is increasing concern that historical shifts also occur in overall adolescent sleep time.

METHODS

Data were drawn from Monitoring the Future, a yearly, nationally representative cross-sectional survey of adolescents in the United States from 1991 to 2012 (N = 272 077) representing birth cohorts from 1973 to 2000. Adolescents were asked how often they get ≥7 hours of sleep and how often they get less sleep than they should. Age-period-cohort models were estimated.

RESULTS

Adolescent sleep generally declined over 20 years; the largest change occurred between 1991-1995 and 1996-2000. Age-period-cohort analyses indicate adolescent sleep is best described across demographic subgroups by an age effect, with sleep decreasing across adolescence, and a period effect, indicating that sleep is consistently decreasing, especially in the late 1990s and early 2000s. There was also a cohort effect among some subgroups, including male subjects, white subjects, and those in urban areas, with the earliest cohorts obtaining more sleep. Girls were less likely to report getting ≥7 hours of sleep compared with boys, as were racial/ethnic minorities, students living in urban areas, and those of low socioeconomic status (SES). However, racial/ethnic minorities and adolescents of low SES were more likely to self-report adequate sleep, compared with white subjects and those of higher SES.

CONCLUSIONS

Declines in self-reported adolescent sleep across the last 20 years are concerning. Mismatch between perceptions of adequate sleep and actual reported sleep times for racial/ethnic minorities and adolescents of low SES are additionally concerning and suggest that health education and literacy approaches may be warranted.

Trends in use of marijuana and attitudes toward marijuana among youth before and after decriminalization: the case of California 2007-2013

BACKGROUND

This analysis examines decriminalization as a risk factor for future increases in youth marijuana acceptance and use. Specifically, we examine marijuana-related behaviors and attitudes of 8th, 10th, and 12th graders in California as compared to other U.S. states during the years before and after California passed legislation in 2010 to decriminalize marijuana.

METHODS

Data come from Monitoring the Future, an annual, nationally representative survey of 8th, 10th, and 12th grade students.

RESULTS

In 2012 and afterwards California 12th graders as compared to their peers in other states became (a) 25% more likely to have used marijuana in the past 30 days, (b) 20% less likely to perceive regular marijuana use as a great health risk, (c) 20% less likely to strongly disapprove of regular marijuana use, and (d) about 60% more likely to expect to be using marijuana five years in the future. Analysis of 10th graders raises the possibility that the findings among 12th graders may reflect a cohort effect that was set into place two years earlier.

CONCLUSION

These results provide empirical evidence to support concerns that decriminalization may be a risk factor for future increases in youth marijuana use and acceptance.

Social role patterning in early adulthood in the USA: adolescent predictors and concurrent wellbeing across four distinct configurations

The decade following secondary school is pivotal in setting the stage for adulthood functioning and adjustment. We identify four social role configurations of early adults in their mid-20s using latent class analyses in two nationally representative samples of American youth in their last year of secondary education (modal age 18) who were followed longitudinally into adulthood (age 25/26). We focus on the big five social role domains of early adulthood: education, residential status, employment, cohabitation/marriage, and parenthood. Aims were to identify latent classes of social role configurations in early adulthood, examine demographic and late adolescent educational predictors of these classes, and explore contemporaneous health and adjustment correlates focusing on life satisfaction, economic independence, and substance use. Four classes with very similar characteristics and prevalence were identified in the two cohorts who were born 12 years apart: Educated Students without Children (8% in 80s cohort/9% in 90s cohort); Working Singles Living with Parents (16%/18%); Educated Workers without Children (45%/46%); and Married Workers with Children (31%/27%). Late adolescent demographic and educational variables and mid-20s variables were related to class membership. Results evidenced notable similarities (and some differences) across cohorts. Discussion focuses on how roles facilitate or inhibit each other and the potential diversity of optimal patterns of transitions to adulthood.

Prevalence and characteristics of substance abuse treatment utilization by U.S. adolescents: national data from 1987 to 2008

OBJECTIVE

Although many adolescents use and abuse illicit drugs, few of those who could benefit from substance abuse treatment ever receive these services. The present study examines the prevalence of utilization of substance abuse treatment in national samples of adolescents over the past 22 years and identifies characteristics associated with receipt of these services.

METHOD

Monitoring the Future data on lifetime utilization of substance abuse treatment was available for 12th grade students who reported any lifetime illicit drug use from 1987 to 2008 (N=25,537). After describing the prevalence of treatment utilization over this time period, logistic regression was used to examine potential predictors of treatment utilization.

RESULTS

The overall prevalence of treatment utilization has remained relatively unchanged over the past 22 years. In multivariable models, adolescents reporting a greater frequency of lifetime use of marijuana or cocaine were more likely to receive substance abuse treatment. Additionally, substance abuse treatment utilization was more likely in those who received other mental health services.

CONCLUSION

Despite increased evidence for the effectiveness of substance abuse treatment, utilization of these services by adolescents has remained low and relatively stable over the past 22 years. Attempts to increase utilization of substance abuse treatment services would likely benefit from building on existing connections with mental health treatment.

Planned Versus Unplanned Risks: Evidence for Subtypes of Risk Behavior in Adolescence

Risk behavior escalates during adolescence, contributing to substantial morbidity and mortality. This study examined whether individual differences in personality and neurocognitive function previously shown to be associated with overall frequency of risk behavior are differentially related to two proposed subtypes of adolescent risk behavior: planned and unplanned. Adolescents (N = 69, 49% male, M = 15.1 years, SD = 1.0), completed a battery of self-report measures and neurocognitive tasks. Several personality and neurocognitive variables predicted membership in the planned versus unplanned risk group: perceiving the benefits of risk behaviors to outweigh risks, more accurately identifying beneficial choices in a modified Iowa Gambling Task (IGT), and performing more advantageously on the IGT and the Game of Dice Task. This study supports the hypothesis that planned versus unplanned risk behavior comprise distinct subtypes in adolescence. Understanding the mechanisms underlying these subtypes may inform prevention programs targeting specific contributors to adolescent risk behavior.

Underage alcohol use: summary of developmental processes and mechanisms: ages 16-20

Late adolescence (i.e., the age-group between 16 and 20 years) is characterized by significant changes in neurological and cognitive processes, behavioral and social functioning, and relational and physical contexts as the individual moves toward adulthood. In this age-group, major role transitions affect almost every aspect of life. Moreover, brain development continues-and with it the development of cognitive functions, working memory, emotional and behavioral self-regulation, and decisionmaking. The adolescent's social and emotional development also continues to evolve, affecting interactions with parents, siblings, peers, and first romantic relationships. All of these changes impact drinking behavior during late adolescence, and, in fact, alcohol use, binge drinking, and heavy drinking are particularly prevalent in youth ages 16-20. Determining the common trajectories of drinking behavior in this age-group is important for understanding how adolescent alcohol use helps shape adult outcomes and for identifying risk and protective factors. It also is important to study the short- and long-term consequences of adolescent alcohol use and abuse, including alcohol's effects on the developing adolescent brain and accomplishment of important developmental tasks of this age.

A developmental perspective on alcohol and youths 16 to 20 years of age

Late adolescence (ie, 16-20 years of age) is a period characterized by escalation of drinking and alcohol use problems for many and by the onset of an alcohol use disorder for some. This heightened period of vulnerability is a joint consequence of the continuity of risk from earlier developmental stages and the unique neurologic, cognitive, and social changes that occur in late adolescence. We review the normative neurologic, cognitive, and social changes that typically occur in late adolescence, and we discuss the evidence for the impact of these transitions on individual drinking trajectories. We also describe evidence linking alcohol abuse in late adolescence with neurologic damage and social impairments, and we discuss whether these are the bases for the association of adolescent drinking with increased risks of mental health, substance abuse, and social problems in adulthood. Finally, we discuss both the challenges and successes in the treatment and prevention of adolescent drinking problems.

Emergence of socioeconomic inequalities in smoking and overweight and obesity in early adulthood: the national longitudinal study of adolescent health

OBJECTIVES

We examined whether socioeconomic inequalities in smoking and overweight and obesity emerged in early adulthood and the contribution of family background, adolescent smoking, and body mass index to socioeconomic inequalities.

METHODS

Using data from the National Longitudinal Study of Adolescent Health we employed multinomial regression analyses to estimate relative odds of heavy or light-to-moderate smoking to nonsmoking and of overweight or obesity to normal weight.

RESULTS

For smoking, we found inequalities by young adult socioeconomic position in both genders after controlling for family background and smoking during adolescence. However, family socioeconomic position was not strongly associated with smoking in early adulthood. For overweight and obesity, we found socioeconomic inequalities only among women both by young adult and family socioeconomic position after adjusting for birthweight, other family background, and body mass index during adolescence.

CONCLUSIONS

Socioeconomic inequalities in smoking emerged in early adulthood according to socioeconomic position. Among women, inequalities in overweight or obesity were already evident by family socioeconomic position and strengthened by their own socioeconomic position. The relative importance of family background and current socioeconomic circumstances varied between smoking and overweight or obesity.

Risk and promotive factors in families, schools, and communities: a contextual model of positive youth development in adolescence

OBJECTIVE

Emerging evidence about optimal youth development highlights the importance of both reducing negative behavior and promoting positive behavior. In our study we tested a contextual model derived from positive youth-development theory by examining the association of family, school, and community risk and promotive factors, with several outcome indices of both positive and negative adolescent development.

METHODS

A sample of 42305 adolescents aged 11 to 17 (51% girls) was drawn from the 2003 National Survey of Children's Health. Survey item composites were formed representing promotive and risk factors in the family (eg, closeness, aggression) and school and community (eg, community connectedness, school violence). Outcome composites reflected positive (social competence, health-promoting behavior, self-esteem) and negative (externalizing, internalizing, academic problems) developmental outcomes. Ordinary least squares regression was used to test the overall model.

RESULTS

Between 0.10 and 0.50 of the variance in each outcome was explained by the contextual model. Multiple positive family characteristics were related to adolescent social competence and self-esteem, as well as lowered levels of internalizing and externalizing behavior and academic problems. Family communication, rules about television, and parents' own healthy behavior were related to adolescent health-promoting behavior. School and community safety were associated with increased social competence and decreased externalizing behavior. School violence was related to adolescent internalizing and externalizing behavior, as well as academic problems and lower self-esteem.

CONCLUSIONS

Our results support the proposition that healthy adolescent development has roots in multiple contexts. Youth who were involved in contexts that provided positive resources from important others (ie, parents, schools, and communities) not only were less likely to exhibit negative outcomes, but also were more likely to show evidence of positive development. These findings provide important implications for intervention and prevention efforts and, more generally, for the promotion of positive, competent, and healthy youth development.

Treating adolescents together or individually? Issues in adolescent substance abuse interventions

This article summarizes the proceedings of a symposium, chaired by Peter Monti and cochaired by Tracy O'Leary, that was presented at the 2001 RSA Meeting in Montreal, Quebec. The aim of this symposium was to present data on group- and individual-based interventions for adolescent alcohol and substance abuse, with a discussion of the implications of research findings bearing on developmental considerations when working with adolescents and young adults. Elizabeth J. D'Amico, PhD, reviewed recent findings on adolescents' choice of type of substance abuse treatment. Jennifer L. Maggs, PhD, presented a developmental perspective on this issue. Tracy O'Leary, PhD, presented data on enhancing motivational interviewing with the presence of a supportive peer for college students cited for alcohol infractions. Mary E. Larimer, PhD, presented 1-year follow-up results of the Greeks 2000 Project, a 5-year longitudinal study designed to evaluate the efficacy of an alcohol abuse prevention program provided to college students who were entering a pledge class (first year) of Greek houses. Barbara McCrady, PhD, a noted expert on the treatment of couples for substance abuse problems, served as discussant.