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...on Adolescents
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www.ProjectCork.org
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Winter 2004
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A period of increased susceptibility to cigarette
smoking among high school students.
Filice GA; Hannan PJ; Lando HA; Joseph AM. Journal
of School Health 73(7): 272-278, 2003. (31 refs.)
Cross-sectional surveys of randomly selected high school students were
conducted in October 1999 and in May 2000 to measure awareness of youth-led
tobacco prevention efforts. A secondary goal of the surveys was to learn
about tobacco use and attitudes. Respondents who never smoked cigarettes
were asked if they had made a firm commitment to not smoke, and respondents
who had not made such a commitment were considered susceptible. Among ninth
graders, susceptibility increased from 31% in October to 47% in May, while
susceptibility decreased from October to May for students in more advanced
grades (p = 0.03, interaction of linear trends). Susceptibility was more
common among students who felt smoking produced social benefits (OR 1.59,
95% CI 1.22 - 2.08) or who were tolerant of tobacco company behavior (OR
1.65, 95% CI 1.23 - 2.21), and less common among students who felt short-term
adverse effects of cigarette smoking on health or hygiene were important
to them (OR 0.74, 95% CI 0.56 - 0.97). Further studies should confirm the
increase in susceptibility and its underlying mechanisms. Whether associated
with ninth grade or with the first year in a new school, this previously
unrecognized period of heightened susceptibility might represent an important
opportunity for prevention.
Copyright 2003, American School Health Association.
A review of 25 long-term adolescent tobacco and other drug use prevention
program evaluations.
Skara S; Sussman S. Preventive Medicine 37(5): 451-474, 2003. (68
refs.)
Background. Although the initial effectiveness of psychosocial strategies
programming in preventing smoking and other drug abuse among adolescents
has been well established through literature reviews and meta-analyses,
much less evidence exists for the long-term follow-up success of these
interventions. The primary goal of this paper, therefore, is to summarize
the effectiveness of published program evaluation studies that have followed
adolescents across the transitional period between junior high and high
school for a period of at least 2 years. Methods. Studies for inclusion
in this review were accessed primarily through a computerized search of
Medline, Healthstar, and PsychINFO databases. Intervention studies that
met five core criteria were retained for review. Two authors independently
abstracted data on study characteristics. methodology, and program outcomes.
Results. Search results yielded 25 studies suitable for examination. The
majority of these studies reported significant program effects for long-term
smoking. alcohol. and marijuana outcomes, while indicating a fairly consistent
magnitude of program effects. Conclusions. This review provides long-term
empirical evidence of the effectiveness of social influences programs in
preventing or reducing substance use for up to 15 years after completion
of programming. However, this conclusion is still somewhat tenuous given
the lack of significant program effects reported in several studies and
the great variability that existed in the level of internal and external
validity across all studies.
Copyright 2003, American Health Foundation.
Comparison of naltrexone and placebo in treatment of alcohol dependence
of adolescents.
Niederhofer H; Staffen W; Mair A. Alcoholism Treatment Quarterly 21(2):
87-95, 2003. (29 refs.)
This study assesses the efficacy and safety of long-term naltrexone treatment
in alcohol dependence of adolescents. In a double-blind, placebo-controlled
study, thirty patients, age 15 to 19 years, with chronic or episodic alcohol
dependence were randomly allocated to treatment with naltrexone (50mg daily)
or placebo for 90 days. Patients were assessed on the day treatment started
and on days 30 and 90 by interview, self-report, questionnaire, and laboratory
screening. At the end of treatment, 20 naltrexone treated and 10 placebo
treated patients had been continuously abstinent (p = 0.0069). Naltrexone
is an effective and well-tolerated pharmacological adjunct to psychosocial
and behavioral treatment programs for the treatment of adolescent alcohol-dependent
patients.
Copyright 2003, Haworth Press.
Early unsupervised drinking - reducing the risks. The School Health
and Alcohol Harm Reduction Project.
Mcbride N; Farringdon F; Midford R; Meuleners L; Phillips M. Drug and
Alcohol Review 22(3): 263-276, 2003. (37 refs.)
The School Health and Alcohol Harm Reduction Project (SHAHRP) aimed to
reduce alcohol-related harm by enhancing students' abilities to identify
and deal with high-risk drinking situations and issues. The SHAHRP study
involved a quasi-experimental research design, incorporating intervention
and control groups and measuring change over a 32-month period. The study
occurred in metropolitan, government secondary schools (13 - 17-year-olds)
in Perth, Western Australia. The 14 intervention and control schools involved
in the SHAHRP study represent approximately 23% of government secondary
schools in the Perth metropolitan area. The sample was selected using cluster
sampling, with stratification by socio-economic area, and involved over
2300 intervention and control students from junior secondary schools. The
retention rate of the study was 75.9% over 32 months. The intervention
incorporated evidence-based approaches to enhance potential for behaviour
change in the target population. The intervention was a classroom-based
programme, with an explicit harm minimization goal, and was conducted in
two phases over a 2-year period. The results were analysed by baseline
context of alcohol use to assess the impact of the programme on students
with varying experience with alcohol. Knowledge and attitudes were modified
simultaneously after the first phase of the intervention in all baseline
context of use groups. The programme had little behavioural impact on baseline
supervised drinkers; however, baseline non-drinkers and unsupervised drinkers
were less likely to consume alcohol in a risky manner, compared to their
corresponding control groups. In line with programme goals, early unsupervised
drinkers from the intervention group were also significantly less likely
to experience harm associated with their own use of alcohol compared to
the corresponding control group. Unsupervised drinkers experienced 18.4%
less alcohol-related harm after participating in both phases of the programme
and this difference was maintained (19.4% difference) 17 months after the
completion of the programme. This study indicates that a school drug education
programme needs to be offered in several phases, that programme components
may need to be included to cater for the differing baseline context of
use groups, and that early unsupervised drinkers experience less alcohol-related
harm after participating in a harm reduction programme.
Copyright 2003, Australian Medical and Professional Society
on Alcohol and Other Drugs.
Adolescent substance use, sexual behavior, and metropolitan status:
Is "urban" a risk factor?
Levine SB; Coupey SM. Journal of Adolescent Health 32(5): 350-355,
2003. (12 refs.)
The goal of this study was to determine if urban or "metropolitan" youth
are at greater risk of engaging in risk behaviors than suburban or rural
youth. The research data were derived from the national school-based Youth
Risk Behavior Survey (YRBS), an anonymous questionnaire, self-administered
by students in grades 9 through 12. This survey employs a multistage cluster
sample to produce a nationally representative sample of high school students.
The following results of the study were seen: (1) in 1999, a finding that
metropolitan status was not a significant determining factor for involvement
in risk behaviors; (2) no significant differences in specific risk factors
between rural and suburban youth (in combination, "nonurban youth"); and
(3) no significant differences in risk behaviors on bivariate or multivariate
analyses. It is suggested that metropolitan or urban status has little
if any association with engagement of adolescents in substance use and
sexual risk behaviors and that urban adolescents do not engage in these
risk behaviors any more frequently than nonurban adolescents.
Copyright 2003, Society for Adolescent Medicine.
Examining delinquency in adolescents differentially prenatally exposed
to alcohol: The role of proximal and distal risk factors.
Lynch ME; Coles CD; Corley T; Falek A. Journal of Studies on Alcohol 64(5):
678-686, 2003. (40 refs.)
Objective: An association has been reported between prenatal alcohol exposure
and delinquent behavior in adolescents. Problems are believed to be particularly
significant for those who were exposed prenatally but do not have full
fetal alcohol syndrome (FAS). The goals of this study were (1) to examine
the relation between a range of levels of prenatal exposure and delinquent
behavior in a community sample and (2) to examine the effect of other current
risk factors, in addition to prenatal exposure, on delinquent behavior.
Method: In this study, 250 low income, predominantly black youths (mean
age = 15.1 years) and their primary caregivers participated in an evaluation
that included measures of delinquency, life stress, substance use, behavior
problems, parenting practices, negative peer influence, caregiver substance
use and the dysmorphia characteristic of FAS. Three groups were drawn from
a sample initially seen at birth: Alcohol-exposed and dysmorphic (n = 39),
alcohol-exposed, nondysmorphic (n = 77) and nonexposed controls (n = 48).
A special education contrast group (n = 84) was recruited at adolescence
to control for disability status. Results: The exposure groups did not
differ from controls on measures of variety and frequency of delinquent
behavior; boys engaged in a wider range of delinquent acts than girls did.
Regression analysis for the full sample revealed that higher adolescent
life stress, higher self-reported drug use and lower parental supervision
were significantly related to a wider range of delinquent acts. Conclusions:
Other current influences should be considered in addition to prenatal alcohol
exposure in interpreting the development of delinquency in alcohol-exposed
adolescents. These results demonstrate the importance of examining risk
factors and controlling effects of sociocultural influences and disability
status when working with clinical samples.
Copyright 2003, Alcohol Research Documentation, Inc. Used
with permission.
Media and marijuana: A longitudinal analysis of news media effects
on adolescents' marijuana use and related outcomes, 1977-1999.
Stryker JE. Journal of Health Communication 8(4): 305-328, 2003.
(86 refs.)
This study examined how aggregate levels of news coverage about marijuana
have impacted adolescents' marijuana behavior generally, and through the
intervening variables of personal disapproval and perceived harmfulness
of marijuana, two variables that existing research has identified as significant
predictors of adolescent marijuana use at the aggregate level. It was hypothesized
that news coverage of reasons why people should not use marijuana would
cause increase in aggregate marijuana abstinence, perceived harmfulness,
and personal disapproval. Conversely, news coverage of positive aspects
of marijuana use would cause decreases in marijuana abstinence, perceived
harmfulness, and personal disapproval. Results of distributed lagged time-series
regression and non-linear modeling offered support for two of the three
proposed hypotheses. Aggregate media coverage explained a significant portion
of the variation in adolescents' abstinence from marijuana use over time.
It also explained a significant portion of the variation in personal disapproval
of marijuana. Personal disapproval was found to partially mediate the relationship
between media coverage and marijuana abstinence. Implications for the conceptualization
of media effects on health behaviors are discussed.
Copyright 2003, Taylor and Francis, Inc.
Problematic alcohol and cannabis use in adolescence: Risk of serious
adult substance abuse?
Stenbacka M. Drug and Alcohol Review 22(3): 277-286, 2003. (52 refs.)
The aim of this longitudinal study was to investigate the problematic use
of alcohol, cannabis or both in adolescence, identifying various risk factors
for adult alcohol and drug abuse. The study included 7577 18-year-old men
conscripted in 1969 - 70. At enrolment, they completed two questionnaires
about alcohol and drug use, social background, behavioural factors and
health conditions. Data on adult alcohol and substance abuse were obtained
from official registers up to 1996. A combination of problematic alcohol
use and cannabis use in adolescence ( > 10 times) was associated more strongly
with both adult alcohol abuse (RR = 6.56, 95% CI 4.24 - 9.83) and drug
abuse (RR = 19.37, 95% CI 11.16 - 32.30) than adolescent use of cannabis
or alcohol alone. When stratifying for different risk factors, the combination
of both problematic alcohol use and cannabis use had higher relative risks
of both outcomes than alcohol or cannabis use alone. In multivariate analyses,
tobacco smoking was associated most strongly (RR = 2.26, 1.58 - 3.24) with
adult alcohol abuse, and a combination of problematic alcohol use and cannabis
use ( < 10 times) in adolescence was associated most strongly with adult
drug abuse (RR = 5.60, 95% CI 2.92 - 10.75). Adolescent use of both cannabis
and alcohol seems to be a more serious problem than adolescent use of either
alcohol or cannabis alone with regard to escalation to adult alcohol and
drug abuse. This is important knowledge for prevention of adult abuse.
Special effort should be made to reach those who mix risky alcohol use
and cannabis use in late adolescence.
Copyright 2003, Australian Medical and Professional Society
on Alcohol and Other Drugs.
Psychiatric disorders among older adolescents treated in emergency
departments on weekends: A comparison with a matched community sample.
Kelly TM; Donovan JE; Cornelius JR; Bukstein OG; Delbridge TR; Clark DB. Journal
of Studies on Alcohol 64(5): 616-622, 2003. (24 refs.)
Objective: This study was undertaken to explore the characteristics of
young patients treated in emergency departments (EDs) who follow through
with an evaluation for psychiatric disorders as defined in the Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and
to investigate differences in rates of psychiatric disorders between ED-treated
adolescents and demographically similar adolescents recruited from the
community. Method: Sixty three older adolescents (40 males) who were treated
at two urban university hospital EDs were matched one-to-one on age, gender
and race with 63 adolescents recruited from the community for participation
in studies at an alcohol research center. Comprehensive psychiatric interviews
were conducted with both groups. Results: ED-treated adolescents were diagnosed
with higher rates of current alcohol use disorders (AUDs), current drug
use disorders and current major depression than were community controls.
The ED sample had a particularly high rate of the DSM-IV "hazardous use" of
alcohol symptom. ED-treated adolescents also had a higher rate of lifetime
comorbid alcohol use disorders and drug use disorders, as well as a higher
rate of lifetime comorbid alcohol use disorders and major depression, compared
with the community controls. Conclusions: Adolescents who are treated in
EDs should be routinely assessed for the presence of AUD, drug involvement
and depressive disorders.
Copyright 2003, Alcohol Research Documentation, Inc. Used
with permission.
Smoking cessation interventions for adolescents" A systematic review.
(review).
Garrison MM; Christakis DA; Ebel BE; Wiehe SE; Rivara FP. American Journal
of Preventive Medicine 25(4): 363-367, 2003. (34 refs.)
Objective: To conduct a systematic review of controlled trials for adolescent
smoking cessation. Methods: Online bibliographic databases were searched
as of June 2002, and reference lists from review articles and the selected
articles were also reviewed for potential studies. The methodology and
findings of all retrieved articles were critically evaluated. Data were
extracted from each article regarding study methods, intervention studied,
outcomes measured, and results. Results: The abstracts or full-text articles
of 281 relevant studies were examined, of which six met the selection criteria.
Included were three school-based studies, a study in pregnant adolescent
girls, a hospital-based study, and a trial of laser acupuncture. All three
of the school-based studies reported significant impacts on cessation rates,
although only one of these was a randomized trial. None of the studies
had follow-up times of >5.2 months. Conclusions: There is very limited
evidence demonstrating efficacy of smoking-cessation interventions in adolescents,
and no evidence on the long-term effectiveness of such interventions. Smoking-cessation
interventions that have proven most effective in adults, such as nicotine
replacement and antidepressant use, have not been studied in adolescents
in a controlled manner.
Copyright 2003, American College of Preventive Medicine.
Treatment outcomes among adolescents with substance abuse problems:
The relationship between comorbidities and post-treatment substance involvement.
Shane PA; Jasiukaitis P; Green RS. Evaluation and Program Planning 26(4):
393-402, 2003. (53 refs.)
This study examines comorbid mental disorders in relation to post-treatment
outcomes (12 months post-intake) among adolescents (N = 419) who entered
three residential drug treatment programs. When contrasted with youths
who had no comorbid mental disorders or youths with a single comorbid condition,
those with combined internalizing and externalizing disorders (mixed comorbidity)
had higher levels of substance-related problems and poly-drug use at entry
to treatment, and poorer outcomes, e.g. relapse, particularly evident for
drugs other than alcohol or marijuana. A significantly higher proportion
of those with mixed comorbidity were admitted to short term residential
treatment, as compared to long term residential care. However, the effects
of comorbidity were independent of both planned and actual length of stay,
suggesting that comorbidities can negatively impact treatment outcome in
multiple ways, apart from length of stay. Since co-occurring problems appear
to profoundly limit treatment effectiveness, treatment strategies that
address comorbidity are needed to improve outcomes.
Copyright 2003, Pergamon Press.
Why do they do it? A qualitative study of adolescent drinking and driving.
Nygaard P; Waiters ED; Grube JW; Keefe D. Substance Use & Misuse 38(7):
835-863, 2003. (21 refs.)
Despite a decline in the prevalence of fatal traffic crashes involving
adolescent drinking drivers in recent years, underage drinking and driving
(DD) and riding with drinking drivers (RWDD) remain serious problems. This
article reports the findings of a qualitative study investigating the influence
of beliefs and expectancies on adolescents' decisions to participate in
DD or RWDD. Forty-four adolescents, who in a previous survey admitted to
having been involved in either DD or RWDD, were interviewed in 2000 about
their experiences concerning either driving after drinking or getting into
a car with a driver who had been drinking. Findings indicate that adolescent
DD and RWDD are complex behaviors. Expectancies and control beliefs do
not seem to influence the decision, whereas normative beliefs to some extent
do. However, findings also indicate that increased enforcement of the laws
may be helpful in preventing young people from getting involved in drinking
and driving.
Copyright 2003, Marcel Dekker, Inc.
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