CORK Library Watch Adolescents, Summer 2004

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...on Adolescents

www.ProjectCork.org

Summer 2004

Really underage drinkers: Alcohol use among elementary students.

Donovan JE; Leech SL; Zucker RA; Loveland-Cherry CJ; Jester JM; Fitzgerald HE et al. Alcoholism: Clinical and Experimental Research 28(2): 341-349, 2004. (42 refs.)
Despite the current societal concern with underage drinking, little attention has been paid to alcohol use within the preadolescent population. This article presents the proceedings of a symposium held at the 2003 Research Society on Alcoholism meeting in Fort Lauderdale, Florida, that was organized and chaired by John E. Donovan. The intent of the symposium was to kick start research on alcohol use among elementary school children by reviewing what is known regarding drinking in childhood. Presentations included (1) The Epidemiology of Children's Alcohol Use, by John E. Donovan; (2) The Validity of Children's Self-Reports of Alcohol Use, by Sharon L. Leech; (3) Predicting Onset of Drinking From Behavior at Three Years of Age: Influence of Early Child Expectancies and Parental Alcohol Involvement Upon Early First Use, by Robert A. Zucker; and (4) Parent, Peer, and Child Risk Factors for Alcohol Use in Two Cohorts of Elementary School Children, by Carol J. Loveland-Cherry. Presentations indicated the need for better nationwide surveillance of children's experience with alcohol; suggested that children's reports of their use of alcohol tend to be reliable and valid; supported children's alcohol use schemas and parental drinking and alcoholism at child age three as independent predictors of early onset drinking; and showed that onset of drinking before fourth or fifth grade, peer pressure, and parental norms and monitoring predict elementary student alcohol use and misuse.

A comparison of alcohol and drug disorders: Is there evidence for a developmental sequence of drug abuse? [rapid communication].

Walker DD; Venner K; Hill DE; Meyers RJ; Miller WR. Addictive Behavior 29(4): 817-823, 2004. (11 refs.)
Whereas the model of Jellinek [Q. J. Stud. Alcohol 7 (1952) 673] of a predictable progression of alcoholism is generally supported, there have been few published studies regarding the natural history of illicit drug disorders. Identification of the development of drug abuse and/or dependence can inform clinicians and researchers on issues, such as diagnosis, prognosis, assessment, and prevention. This study employed a new measure adapted from the 46 events described in Jellinek's progression of alcoholism. Nine licit and illicit substances were also included within the cardsort. Fifty-two individuals motivated to enter drug treatment by a loved one were assessed pretreatment. The drug initiation sequence reported by this sample was as follows: alcohol, tobacco, inhalants, marijuana, and then other drugs. Spearman rank correlation coefficients were conducted between the drug sample and that of Jellinek yielding a modest correlation (r=.35, P=.019). These results suggest that Jellinek's model of progression of alcoholism may also apply to the development of drug disorders. However, important differences found between the alcohol and drug progressions are discussed.

Assessing the effectiveness of community-based substance abuse treatment for adolescents.

Dasinger LK; Shane PA; Martinovich Z. Journal of Psychoactive Drugs 36(1): 27-33, 2004. (25 refs.)
The Adolescent Treatment Models initiative, a 10-site, multi modality, prospective study, was designed to evaluate adolescent substance abuse treatment outcomes and to assess the relative efficacy of different treatment models. Based upon longitudinal data gathered at multiple assessment points using a standardized instrument, treatment outcome trajectories were determined for a cohort of 1,057 adolescents from entry into substance abuse treatment until 12 months post-intake. Client outcomes on substance use and program effectiveness were explored across individual treatment programs and levels of care. Strong treatment effects, defined as a significant reduction in alcohol and other drug use at three months post-intake, were found. The reductions of greatest magnitude in relation to pretreatment use occurred among adolescents in residential treatment. Within level of care, few significant differences in treatment effects were found between programs. Relapse effects, defined as an increase in substance use at 12 months relative to three months, were observed across nearly all programs, but varied in relation to treatment modality. This is most evident among those entering residential treatment, with the highest rate of relapse occurring among adolescents in long-term residential treatment care. Despite strong evidence of treatment effectiveness, continuing care is vital to maintenance of treatment benefit.

Cannabis use, sport practice and other leisure activities at the end of adolescence.

Peretti-Watel P; Lorente FO. Drug and Alcohol Dependence 73(3): 251-257, 2004. (26 refs.)
Purpose: To study the relationship between cannabis use, sports practice and other leisure activities during adolescence, as a test for the sociological theory of deviant opportunities. Methods: A sample of 12,512 French adolescents aged 18 responded to an anonymous self-reported questionnaire in March 2001. Three logistic models (for occasional, recent and regular cannabis use) were estimated for girls and boys separately. Results: Outings and other peer-oriented activities were strongly correlated with cannabis use but this relationship depended on which levels of use were considered. Occasional use was more common among respondents who participated in many different outdoor activities. Regular use was associated with a more selective lifestyle, focusing on music-oriented outings and time spent at a friend's home in the evening. Conclusions: Our results provided empirical support for the theory of deviant opportunities. Changing patterns of lifestyle associated with transition from initiation to higher levels of use may reveal a shift from opportunities of cannabis use provided by a wide range of activities to specific activities chosen for their convenience to cannabis use. Further research will need to investigate how drug use is shaped by lifestyle, and conversely, how lifestyle influences drug use. Copyright 2004, Elsevier Science.

Cerebellar infarction in adolescent males associated with acute marijuana use.

Geller T; Loftis L; Brink DS. Pediatrics 113(4): E365-E370, 2004. (25 refs.)
Objective. To demonstrate the clinical characteristics, radiologic findings, and neuropathological features of tetrahydro-cannabinol-related posterior fossa ischemic stroke in adolescent patients. Design. A retrospective case and chart review of 3 cases encountered at a tertiary care institution over a span of 5 years. Setting. Inpatient and intensive care hospitalization units managing children and adolescents. Subjects. Male adolescent patients with ischemic cerebellar stroke after use of marijuana. Diagnostic Investigations. Computed tomography brain scans ( 3 subjects), magnetic resonance imaging brain study ( 1 subject), cerebral arteriography ( 1 subject), cerebellar biopsy ( 1 subject), and necropsy ( 2 subjects). Results. Three adolescent males had similar presentations of headache, fluctuating level of consciousness or lethargy, visual disturbance, and variable ataxia after self-administration of marijuana. They developed primary cerebellar infarctions within days after the exposure that could not be attributed to supratentorial herniation syndromes and only minimally involved brainstem structures. Conclusions. Episodic marijuana use may represent a risk factor for stroke in childhood, particularly in the posterior circulation. Early recognition of the cerebellar stroke syndrome may allow prompt neurosurgical intervention, reducing morbidity.

Children's perceptions of dangerous substances.

Pfeffer K; Wilson B. Perceptual and Motor Skills 98(2): 700-710, 2004. (12 refs.)
The aim of this research was to examine age differences in children's perceptions of dangerous substances. Children's responses to photographs of child models encountering alcohol, a syringe, medicine, glue, and household bleach were coded for recognition of substance, awareness of potential danger, and understanding of danger or harm. Responses from 59 children (28 girls and 31 boys, who were all children of the required age in an urban primary school) were compared across three age groups (6-7 years, 8-9 years, and 10-11 years). 15 to 18 of 20 children in each of three age groups recognised all the dangerous substances. Significant differences across age groups were found for awareness of the potential harm from alcohol, glue, and medicine, but not for the syringe or bleach. Children reported less serious consequences from ingesting alcohol than other substances, the consequences of sniffing glue tended to be confused with the sticking properties of glue, children's understanding of transmission of germs, disease, and AIDS through syringes was varied, and there was a tendency among the older children to underestimate the potential harm of self-administration of medicines. Findings were discussed in relation to children's concepts of danger and safety education.

Comparing outcomes of best-practice and research-based outpatient treatment protocols for adolescents.

Godley SH; Jones N; Funk R; Ives M; Passetti LL. Journal of Psychoactive Drugs 36(1): 35-48, 2004. (67 refs.)
Comparisons of well-developed practice-based interventions with research-based interventions are rare. This quasi-experimental study compares the outcomes of 274 adolescents (75% male; 63% weekly+ users; 54% dependent; 27% prior treatment; 73% with co-occurring problems) who received Chestnut Health System's best-practice Outpatient Treatment (CHS) or Cannabis Youth Treatment (CYT) research-based interventions. Ninety-five percent of participants completed follow-up interviews at three, six, nine, and 12 months after their intake GAIN interview. Initially, the CYT cohort scores indicated greater severity on several substance-related measures, while the CHS cohort scored higher on prior mental health treatment, victimization, and illegal activities measures. Adolescents in the CHS cohort were more likely to have longer lengths of stay and receive over three times as many hours of treatment. Mixed effects models revealed that CHS participants were significantly more likely to report a decrease in recovery environment risk, an increase in self-help attendance after treatment, and greater decreases in emotional problems, while CYT participants were significantly more likely to report decreases in their substance use. The results suggest that neither the best-practice nor the research-based interventions were clearly superior and call for a more rigorous randomized field experiment to better understand the differences in effectiveness between interventions.

Differential contribution of parents and friends to smoking trajectories during adolescence [rapid communication].

Vitaro F; Wanner B; Brendgen M; Gosselin C; Gendreau PL. Addictive Behavior 29(4): 831-835, 2004. (5 refs.)
The purpose of this study was to assess the relative contribution of friends' and parents' smoking on the age of smoking initiation. A sample of 812 preadolescents, who were part of an accelerated longitudinal design, participated in the study over a 4-year period. Three smoking trajectory groups were first established: an age 11Ð12 starters group (5.7% of the sample), an age 12Ð13 starters group (11.1% of the sample), and an age 13Ð14 starters group (7.9% of the sample). A fourth trajectory group included the children who had not started smoking by age 15 years and who represented the majority of the participants (75.4%). After controlling for parental education, gender, and participants' behavioral and academic maladjustment, a series of logistic regressions revealed that parents' smoking assessed during the same year predicted membership in the age 11Ð12 starters trajectory group. Both parents' and friends' smoking predicted membership in the age 12Ð13 starters group. Finally, only friends' smoking predicted membership in the age 13Ð14 starters group. The results are discussed in light of the controversy about the contribution of parents' and friends' smoking behavior to smoking initiation in adolescents

Early intervention for adolescent substance abuse: Pretreatment to posttreatment outcomes of a randomized clinical trial comparing multidimensional family therapy and peer group treatment. (review).

Liddle HA; Rowe CL; Dakof GA; Ungaro RA; Henderson CE. (I>Journal of Psychoactive Drugs 36(1): 49-63, 2004. (116 refs.)
This randomized clinical trial evaluated a family-based therapy (Multidimensional Family Therapy, MDFT Liddle 2002a) and a peer group therapy with 80 urban, low-income, and ethnically diverse young adolescents (11 to 15 years) referred for substance abuse and behavioral problems. Both treatments were outpatient, relatively brief, manual-guided, equal in intervention dose, and delivered by community drug treatment therapists. Adolescents and their parents were assessed at intake to treatment, randomly assigned to either MDFT or group therapy, and reassessed at six weeks after intake and at discharge. Results indicated that the family-based treatment (MDFT, an intervention that targets teen and parent functioning within and across multiple systems on a variety of risk and protective factors) was significantly more effective than peer group therapy in reducing risk and promoting protective processes in the individual, family, peer, and school domains, as well as in reducing substance use over the course of treatment. These results, which add to the body of previous findings about the clinical and cost effectiveness of MDFT, support the clinical effectiveness and dissemination potential of this family-based, multisystem and developmentally-oriented intervention.

Opportunities or youth smoking cessation: Findings from a national focus group study.

Balch GI; Tworek C; Barker DC; Sasso B; Mermelstein RJ; Giovino GA. Nicotine & Tobacco Research 6(1): 9-18, 2004. (33 refs.)
To identify opportunities for smoking cessation among adolescents, we conducted six computer-assisted telephone focus groups with 48 male and female high school student smokers and former smokers from six states across the United States, all aged 15-17 years, in two groups each of "established smokers," "late experimenters," and "quitters." These adolescents considered addiction to cigarettes real, powerful, stealthy, insidious, harmful, and avoidable. They considered quitting smoking achievable and desirable. Many of the established smokers and some experimenters would not consider quitting until an indefinite future, when they expected adult responsibilities to help them quit. Quitters had been encouraged by friends who did not smoke around them or offer them cigarettes; they also associated more with nonsmoking friends. Some adolescents, especially quitters, reported that parents had tried to help them quit; some smokers reported that parents had provided them with cigarettes. Some adolescents reported school rules and enforcement that made it hard to smoke; others reported school rules and enforcement that made it easy and tempting to smoke. These adolescents were not aware of the availability of professional help or interested in it. Many did not consider smoking urgent or "intense" enough for professional help. Perceptions of cessation programs were nonexistent or negative. Participants were aware of nicotine replacement therapies but less so of prescription medications. These findings suggest that it is critical to educate adolescents about what good cessation programming is and is not, why it is needed, how it might help, and where it is offered.

Adolescent heavy episodic drinking trajectories and health in young adulthood.

Oesterle S; Hill KG; Hawkins JD; Guo J; Catalano RF; Abbott RD. Journal of Studies on Alcohol 65(2): 204-212, 2004. (43 refs.)
Objective: This study examined the association of trajectories of heavy episodic drinking (at least five alcoholic drinks on one occasion) during adolescence with health status and practices at age 24. Method: Semiparametric group-bascd modeling and logistic regressions were used to analyze data from a longitudinal panel of 808 youths interviewed between 10 and 24 years of age. Results: Four distinct trajectories of adolescent heavy episodic drinking were identified: nonheavy drinkers, late onsetters, escalators and chronic heavy drinkers. Overall, young adults who did not engage in heavy episodic drinking during adolescence had the lowest occurrence of health problems and were most likely to engage in safe health behaviors at age 24. Chronic and late-onset heavy episodic drinking (hiring adolescence had negative effects on health status and practices at age 24. Adolescent chronic heavy drinkers were more likely to be overweight or obese and to have high blood pressure at age 24 than those who did not drink heavily in adolescence. Late-onset heavy drinkers were less likely to engage in safe driving practices at age 24 and were more likely to have been ill in the past year than adolescents who did not drink heavily. These health disparities remained even after current frequency of heavy episodic drinking at age 24, other adolescent drug use, ethnicity, gender and family poverty were controlled. Conclusions: Heavy episodic alcohol use during adolescence has long-term, negative health consequences. Distinct patterns of adolescent heavy drinking affect health status and practices in young adulthood differently.

The effect of parental alcohol and drug disorders on adolescent personality.

Elkins IJ; McGue M; Malone S; Iacono WG. American Journal of Psychiatry 161(4): 670-676, 2004. (36 refs.)
Objective: The relationship of parental alcohol or drug diagnosis to offspring personality was examined in a population-based sample of 17-year-old twins (568 girls and 479 boys) participating in the Minnesota Twin Family Study. Whether offspring personality characteristics 1) are specific to the type of substance use disorder in parents (alcohol versus drug) and 2) are found in high-risk offspring without substance use disorders as well as in offspring with substance use disorders was investigated. Method: Personality was assessed with the Multidimensional Personality Questionnaire; substance use disorders were assessed in person through diagnostic interviews. Results: In both male and female offspring, parental history of alcohol dependence was associated with greater negative emotionality, aggression, stress reaction, and alienation but lower well-being; parental history of drug disorders was associated with lower constraint, control, harm avoidance, and traditionalism but higher social potency. Excluding offspring with a substance use disorder had virtually no effect on the statistical significance of these findings. Conclusions: In contrast to findings in some adult samples, personality characteristics associated with a family history of substance use disorders are found even in adolescent offspring who have not yet developed these disorders themselves, suggesting that personality might be one indicator of familial risk for substance use disorders during this developmental stage. Personality profiles of offspring of parents with substance use disorders also show some diagnostic specificity, with constraint associated with parental drug abuse and negative emotionality with parental alcoholism.

Parenting practices as moderators of the relationship between peers and adolescent marijuana use.

Dorius CJ; Bahr SJ; Hoffmann JP; Harmon EL. Journal of Marriage and the Family 66(1): 163-178, 2004. (56 refs.)
Using data from a probability sample of 4,987 adolescents, we examine the degree to which closeness to mother, closeness to father, parental support, and parental monitoring buffer the relationship between peer drug use and adolescent marijuana use. The relationship between peer drug use and adolescent marijuana use was attenuated by both closeness to father and the perception that parents would catch them for major rule violations. These findings confirm the value of conceptualizing certain family characteristics as separate variables and verify that authoritative parenting may help insulate adolescents from peer pressure to use drugs.

Sleep problems in early childhood and early onset of alcohol and other drug use in adolescence.

Wong MM; Brower KJ; Fitzgerald HE; Zucker RA. Alcoholism: Clinical and Experimental Research 28(4): 578-587, 2004. (70 refs.)
Background: No prospective studies exist on the relationship between sleep problems early in life and subsequent alcohol use. Stimulated by the adult literature linking sleep problems to the subsequent onset of alcohol use disorders in some adults, we examined whether sleep problems in early childhood predicted the onset of alcohol and other drug use in adolescence and whether such a relationship was mediated by other known predictors of this relationship, namely, attention problems, anxiety/depression, and aggression in late childhood. Methods: This study is part of an ongoing longitudinal study of the development of risk for alcohol and other substance use disorders. Study participants were 257 boys from a community-recruited sample of high-risk families. Results: Mothers' ratings of their children's sleep problems at ages 3 to 5 years significantly predicted an early onset of any use of alcohol, marijuana, and illicit drugs, as well as an early onset of occasional or regular use of cigarettes by age 12 to 14. Additionally, although sleep problems in early childhood also predicted attention problems and anxiety/depression in later childhood, these problems did not mediate the relationship between sleep problems and onset of alcohol and other drug use. Conclusions: This is, to our knowledge, the first study that prospectively examines the relationship between sleep problems and early onset of alcohol use, a marker of increased risk for later alcohol problems and alcohol use disorders. Moreover, early childhood sleep problems seem to be a robust marker for use of drugs other than alcohol. Implications for the prevention of early alcohol and other drug use are discussed.

The association of caffeinated beverages with blood pressure in adolescents.

Savoca MR; Evans CD; Wilson ME; Harshfield GA; Ludwig DA. Archives of Pediatrics & Adolescent Medicine 158(5): 473-477, 2004. (19 refs.)
Objective: To assess the association between the consumption of caffeinated beverages and blood pressure in African American and white adolescents. Design: This study was part of ongoing research examining stress-induced hemodynamic responses in adolescents. African American and white adolescents (n= 159) selected foods and beverages for a 3-day sodium-controlled diet. Caffeine in these foods was used to stratify participants into 3 categories (0-50 mg/d, >50-100 mg/d, and >100 mg/d). Before menu selection, blood pressure readings were obtained. Statistical Analysis: A general linear model (multiple regression with both categorical and continuous variables) was developed to assess the effects of race, category of caffeine intake, and interaction of race and caffeine intake on systolic and diastolic blood pressure controlling for sex and body mass index (calculated as weight in kilograms divided by height in meters squared).Results: The association between systolic blood pressure and caffeine category varied by race (P=.001). African Americans consuming more than 100 mg/d of caffeine had higher systolic blood pressure readings than the groups consuming 0 to 50 mg/d (mean difference, 6.0 mm Hg; 95% confidence interval [CI], 2.3 to 9.7) or more than 50 to 100 mg/d (mean difference, 7.1 mm Hg; 95% Cl, 3.4 to 10.7). The effect on diastolic blood pressure was less pronounced (P =.08). The diastolic blood pressure of the group consuming more than 100 mg/d was 3.7 mm Hg (95% CI, 0.41. to 7.0) higher than the group consuming more than 50 to 100 mg/d and was not statistically different from the group consuming 0 to 50 mg/d (mean difference, 2.4 mm Hg; 95% CI, -0.9 to 5.8). There was no evidence that the association between diastolic blood pressure and caffeine intake varied by race (P=.80). Conclusions: For adolescents, especially African American adolescents, caffeine intake may increase blood pressure and thereby increase the risk of hypertension. Alternatively, caffeinated drink consumption may be a marker for dietary and lifestyle practices that together influence blood pressure. Additional research is needed owing to rising rates of adolescent hypertension and soft drink consumption.

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