A cluster randomised controlled trial of an adolescent smoking cessation intervention: Short and long-term effects.
Dalum P; Paludan-Muller G; Engholm G; Kok G. Scandinavian Journal of Public Health 40(2): 167-176, 2012. (20 refs.)
Background: There is a lack of effective smoking cessation interventions which have a high reach among adolescent smokers. Method: We conducted a randomised controlled trial of an adolescent smoking cessation intervention for students aged 15-21 at 22 continuation schools in Denmark. The intervention was a minimal intervention based on events with short counselling and a range of self-help materials. Our 1-month follow up consisted of 514 baseline daily smokers and the 14-month follow up of 369 daily smokers. Results: We found positive short-term effects regarding smoking cessation (adjusted OR 4.50, 95% CI 1.20-16.86), self-efficacy (p=0.01), and intentions to quit (p=0.004). However, none of these effects were maintained at 1-year follow up. The intervention was successful in reaching more than half of all daily smokers in the target group with more than 30% receiving counselling at least once in the intervention period. Conclusions: This trial shows that a "minimal" intervention can produce short-term effects but that this approach is insufficient in producing long-term effects.
Copyright 2012, Sage Publications.
Would vaccination against nicotine be a cost-effective way to prevent smoking uptake in adolescents?
Gartner CE; Barendregt JJ; Wallace A; Hall WD. Addiction 107(4): 801-809, 2012. (44 refs.)
Aims: We used epidemiological modelling to assess whether nicotine vaccines would be a cost-effective way of preventing smoking uptake in adolescents. Design, Setting, Participants and Measurements We built an epidemiological model using Australian data on age-specific smoking prevalence; smoking cessation and relapse rates; life-time sex-specific disability-adjusted life years lived for cohorts of 100,000 smokers and non-smokers; government data on the costs of delivering a vaccination programme by general practitioners; and a range of plausible and optimistic estimates of vaccine cost, efficacy and immune response rates based on clinical trial results. We first estimated the smoking uptake rates for Australians aged 12-19 years. We then used these estimates to predict the expected smoking prevalence in a birth cohort aged 12 in 2003 by age 20 under (i) current policy and (ii) different vaccination scenarios that varied in cost, initial vaccination uptake, yearly re-vaccination rates, efficacy and a favourable vaccine immune response rate. Findings: Under the most optimistic assumptions, the cost to avert a smoker at age 20 was $44,431 [95% confidence interval (CI) $40,023-49,250]. This increased to $296,019 (95% CI $252,307-$355,930) under more plausible scenarios. The vaccine programme was not cost-effective under any scenario. Conclusions: A preventive nicotine vaccination programme is unlikely to be cost-effective. The total cost of a universal vaccination programme would be high and its impact on population smoking prevalence negligible. For these reasons, such a programme is unlikely to be publicly funded in Australia or any other developed country.
Copyright 2012, Society for the Study of Addiction to Alcohol and Other Drugs.
Actions speak louder than words: An experiment on the impact of peers discouraging young adult smoking.
Harakeh Z; Vollebergh WAM. European Addiction Research 17(6): 316-320, 2011. (20 refs.)
This study investigates whether antismoking peer pressure and/or nonsmoking peers are protective factors and decrease young adults' likelihood to smoke. An experiment was conducted among 59 daily-smoking young adults aged 16-24 years. The experiment consisted of four conditions. During the session, the confederate and participant sat in a camper van and had to do a 30-min joint music task. The participants' smoking behavior was observed during this task. The results of Poisson log-linear analysis, controlling for participants' carbon monoxide level and gender, showed that young adults smoked fewer cigarettes in the presence of a nonsmoking model pressuring the young adult not to smoke compared to a heavy-smoking model not using any pressure. At the same time, the results of Fisher's exact test indicated that the total number of cigarettes smoked did not differ significantly for nonsmoking peers verbally pressuring the young adult not to smoke compared to nonsmoking peers not verbally pressuring the young adult. Our findings indicate that the protective effect of peer influence merely lies in that the peer does not smoke. Therefore, antismoking programs and policy should focus specifically on reducing exposure to smoking peers.
Copyright 2011, Karger.
Concurrent binge drinking and depression among Canadian youth: Prevalence, patterns, and suicidality.
Archie S; Kazemi AZ; Akhtar-Danesh N. Alcohol 46(2): 165-172, 2012. (51 refs.)
This study compared differences in risk for suicidality among youth living in the community who met criteria for comorbid depression and binge drinking, depression without binge drinking, and binge drinking without depression relative to a reference group with neither condition. Logistic regression analysis was used to analyze data from the Canadian Community Health Survey, Cycle 3.1 (CCHS 3.1, 2005): a cross-sectional survey of respondents from the Canadian population. To restrict the sample to youth, respondents were excluded who were younger than 15 or older than 24 years. Over 17,000 respondents were assessed to determine whether they met criteria for depression, binge drinking, the comorbid condition, or neither condition (reference group). Binge drinking was defined as five drinks or more on an occasion. The 12-month prevalence rates for comorbid binge drinking and depression were 2.7% for male respondents and 2.1% for female respondents. When adjusted for demographic factors and when compared with the reference group, the risk of suicidality was increased for the depressed group (odds ratio [OR] 5.23, 95% confidence interval [CI]: 3.34-8.2) and the comorbid group (OR 6.28, 95% CI: 3.68-10.70), but not for the binge-drinking group. With the exception of increasing age, sociodemographic factors were not correlates of comorbidity. In conclusion, binge drinking was not associated with an increased risk of suicidality among Canadian youth living in the community, although depression and comorbidity were associated with suicidality.
Copyright 2012, Elsevier Science.
Drinking frequency as a brief screen for adolescent alcohol problems.
Chung T; Smith GT; Donovan JE; Windle M; Faden VB; Chen CM et al. Pediatrics 129(2): 205-212, 2012. (28 refs.)
Objective: Routine alcohol screening of adolescents in pediatric settings is recommended, and could be facilitated by a very brief empirically validated alcohol screen based on alcohol consumption. This study used national sample data to test the screening performance of 3 alcohol consumption items (ie, frequency of use in the past year, quantity per occasion, frequency of heavy episodic drinking) in identifying youth with alcohol-related problems. Methods: Data were from youth aged 12 to 18 participating in the annual National Survey on Drug Use and Health from 2000 to 2007. The screening performance of 3 alcohol consumption items was tested, by age and gender, against 2 outcomes: any Diagnostic and Statistical Manual, Fourth Edition alcohol use disorder symptom ("moderate"-risk outcome), and a diagnosis of Diagnostic and Statistical Manual, Fourth Edition alcohol dependence ("high"-risk outcome). Results: Prevalence of the 2 outcomes increased with age: any alcohol use disorder symptom ranged from 1.4% to 29.2%; alcohol dependence ranged from 0.2% to 5.3%. Frequency of drinking had higher sensitivity and specificity in identifying both outcomes, compared with quantity per occasion and heavy episodic drinking frequency. For both outcomes, results indicate the utility of similar cut points for drinking frequency for males and females at each age. Age-specific frequency cut points, however, are recommended for both moderate-and high-risk outcomes to maximize screening performance. Conclusions:: Drinking frequency provides an empirically supported brief screen to efficiently identify youth with alcohol-related problems.
Copyright 2012, American Academy of Pediatrics.
Groups can jeopardize your health: Identifying with unhealthy groups to reduce self-uncertainty.
Hogg MA; Siegel JT; Hohman ZP. Self and Identity 10(3, special issue): 326-335, 2011. (59 refs.)
Adolescents often engage in behaviors posing significant risks to their health (e.g., substance abuse, sexual promiscuity). One explanation is that adolescence is a developmental phase characterized by impulsiveness and poor judgment of contingencies and risk. We present an alternative uncertainty-identity theory analysis that focuses on adolescence as a period of identity transition. Adolescents are confronted by significant uncertainty about who they are and how they should behave, and they largely turn to their peers to ground their sense of self. They engage in risky health practices because these behaviors define adolescent groups that provide a highly distinctive sense of self and identity that is validated and imbued with prestige by their peers. We asses empirical support for this analysis, and suggest factors that may protect adolescents from uncertainty-motivated identification with unhealthy groups.
Copyright 2011, Psychology Press.
Illuminating the relationship between bullying and substance use among middle and high school youth.
Radliff KM; Wheaton JE; Robinson K; Morris J. Addictive Behaviors 37(4): 569-572, 2012. (16 refs.)
The increased prevalence and negative impact of bullying and substance use among youth has been established independently in the literature; however, few researchers have examined the association between involvement in bullying and substance use across middle and high school youth. Thus, the aim of this study was to examine the self-reported prevalence of bullying and substance use (alcohol, cigarettes, and marijuana) among youth in middle and high school. Middle and high school students from 16 school districts across a large metropolitan area (N = 78,333) completed a school-based survey. Scales were created to examine involvement in bullying, victimization, and substance use. A link between involvement in bullying and substance use was evident. Youth involved in bullying were more likely than students not involved in bullying to use substances, with bully-victims reporting the greatest levels of substance use. Differences at the school level and across status (i.e., bullies, victims, and bully-victims) are discussed. Implications for practice and prevention and intervention programs are offered. Findings support the need for continued research into risky behaviors, such as substance use, that are correlated with bullying behavior and may contribute to an increase in negative outcomes.
Copyright 2012, Elsevier Science.
Is there a low-risk drinking level for youth? The risk of acute harm as a function of quantity and frequency of drinking.
Thompson KD; Stockwell T; Macdonald S. Drug and Alcohol Review 31(2, special issue): 184-193, 2012. (44 refs.)
Introduction and Aims. Drinking guidelines have rarely provided recommendations for different age groups despite evidence of significant age effects on alcohol consumption and related risks. This study attempted to quantify the degree of risk associated with lower levels of consumption for people under 25 years of age, with the broader purpose of informing the development of Canadian low-risk drinking guidelines. Design and Methods: A random community-based sample of 540 youth aged 16-23 (54.4% female) completed an interview concerning alcohol consumption patterns and a broad range of acute health and social harms. Logistic regression analyses were designed to test whether there were discernible thresholds of risk as a function of both gender and age. Results. A significant proportion of young people consumed in excess of adult drinking limits recommended by the Centre for Addiction and Mental Health (CAMH) to minimise risk of alcohol-related harm. Compared with abstainers, rates of reported harm increased linearly with increasing frequency and quantity levels. However, problems were most strongly associated with consumption in excess of two drinks per occasion and a frequency of more than once a week. No independent effects of age or gender were identified. Discussion and Conclusions. The CAMH guidelines for adult drinkers do not adequately address acute risks for young people. More specific guideline recommendations for young people could be considered with a more prominent focus on drinking quantity (one to two drinks per occasion), and a recommended frequency of consumption (once a week).
Copyright 2012, Wiley-Blackwell.
Nonmedical use of prescription medications: A longitudinal analysis with adolescents involved in child welfare.
Cheng TC; Lo CC. Children and Youth Services Review 34(4): 859-864, 2012. (66 refs.)
This study evaluated a sample of 1005 adolescents involved in the child welfare system, looking for risk and protective factors in their nonmedical use of prescription medications. It comprised a secondary data analysis of longitudinal records extracted from the National Survey of Child and Adolescent Well-Being (NSCAW), and it employed generalized estimating equations. Its multivariate results indicate that such use of medications in the past 30 days was (a) associated positively with misuse of prescribed drugs prior to NSCAW participation and with time involved in the child welfare system, as well; but (b) associated negatively with parental monitoring and feeling close to parents. Implications for services and research are discussed.
Copyright 2012, Elsevier Science.
Policy responses to multiple risk behaviours in adolescents.
Hale DR; Viner RM. Journal of Public Health 34(1): 111-119, 2012. (65 refs.)
Adolescence has long been considered a period of increased risk behaviour. This supposition has been supported by a wealth of empirical evidence and recently, health risk behaviours have been identified as a key mechanism for the general deterioration of adolescent health relative to other age groups. Research regarding adolescent risk behaviour suggests that there are often strong links between individual risk behaviours. The mechanisms for these associations have been attributed to common risk and protective factors, as well as gateway effects stemming from increased accessibility to additional risk behaviours. This has important implications for policy interventions designed to reduce risk behaviours in adolescence. Not only does a multiple risk behaviour approach increase the effectiveness of individual risk behaviour policy, but it is also conducive to a more cohesive, coherent and efficient approach to adolescent risk in general. Several examples of cohesive policy responses to multiple risk behaviours have emerged, but generally, policy remains segregated into individual risk domains. With increasing evidence for the effectiveness of integrated approaches, multiple risk behaviours require consideration to design and implement effective and efficient policy responses.
Copyright 2012, Oxford University Press.
Risk and protective factors for alcohol and marijuana use among African-American rural and urban adolescents.
Clark TT; Nguyen AB; Belgrave FZ. Journal of Child & Adolescent Substance Abuse 20(3): 205-220, 2011. (38 refs.)
The purpose of this study was to examine individual, family, peer, and community risk and protective factors associated with past-30-days alcohol and marijuana use among African-American adolescents living in rural and urban communities. This study used data collected from 907 tenth-and twelfth-grade African-American students who completed the 2005 Community Youth Survey. Peer and individual risk/protective factors were more influential for urban youths while family and community risk/protective factors were more influential for rural youths. This pattern held for alcohol and marijuana use. Implications for substance use prevention programming are discussed.
Copyright 2011, Taylor & Francis.
Risky decision-making: An fMRI study of youth at high risk for alcoholism.
Cservenka A; Nagel BJ. Alcoholism: Clinical and Experimental Research 36(4): 604-615, 2012. (57 refs.)
Background: Adolescents with a family history of alcoholism (FHP) are at risk for developing an alcohol use disorder (AUD), and some studies indicate that FHP individuals show deficits in executive functioning. The ability to make adaptive decisions is one aspect of successful executive functioning that is often measured during risk-taking tasks; however, this behavior has not been examined in FHP youth. As impaired decision-making could predispose FHP youth to make poor choices related to alcohol use, the current study examined the neural substrates of risk-taking in FHP adolescents and their family history negative (FHN) peers. Methods: Thirty-one (18 FHP, 13 FHN) youth between 13 and 15 years old were included in this study. All youth had used little to no alcohol prior to study involvement. Functional magnetic resonance imaging was used to examine the neural substrates of risk-taking during the Wheel of Fortune (WOF) decision-making task (Ernst et al., 2004) in FHP and FHN youth. Results: FHP youth did not differ from FHN youth in risk-taking behavior, but showed less brain response during risky decision-making in right dorsolateral prefrontal cortex and right cerebellar regions compared with FHN peers. Conclusions: Despite no behavioral differences on the WOF decision-making task, FHP youth exhibited atypical neural response during risk-taking compared with FHN peers. Atypical brain activity, in regions implicated in executive functioning could lead to reduced cognitive control, which may result in risky choices regarding alcohol use. This could help explain the higher rates of AUDs seen in FHP adolescents. Further examination of risky behavior and associated brain response over the course of adolescence is necessary to characterize the vulnerabilities of FHP youth in the absence of alcohol abuse.
Copyright 2012, Research Society on Alcoholism.
Strengthening Families Program (10-14): Effects on the family environment.
Riesch SK; Brown RL; Anderson LS; Wang K; Canty-Mitchell J; Johnson DL. Western Journal of Nursing Research 34(3): 340-376, 2012. (66 refs.)
This study examined whether parent-youth dyads participating in the Strengthening Families Program 10-14 (SFP 10-14) would demonstrate greater postprogram family cohesion, communication, involvement, and supervision and if youth would report less alcohol, tobacco, and other drugs involvement in contrast to a comparison group. From 16 randomly selected schools, we recruited 167 parent-youth dyads: 86 from intervention and 81 from comparison schools. The intention-to-treat analysis found one significant change in family environment. Considering dose, it was found that among dyads receiving a full dose, all the outcomes were in the expected direction and effect sizes were moderate. Among dyads receiving a partial dose, 10 of 18 outcomes were in the direction opposite than expected. Youth participation in alcohol, tobacco, and other drugs was very low and did not differ postprogram. Although the expected outcomes were not realized, findings descriptive of dosage effects make a valuable contribution to the field. Study of factors that distinguish intervention completers from noncompleters is recommended.
Copyright 2012, Sage Publications.
Substance use and adolescent sexual activity.
Acworth A; de Roos N; Katayama H. Applied Economics 44(9): 1067-1079, 2012. (25 refs.)
Using the National Longitudinal Survey of Youth 1997, we examine the relationship between initiating substance use and youth sexual behaviour. We employ a combination of panel data and propensity score matching techniques to control for observed and unobserved heterogeneity. The results indicate striking differences across gender. For males, initiating alcohol or marijuana use is positively and significantly associated with the likelihood of engaging in sexual intercourse and uncontracepted sexual intercourse. For females, in contrast, there is no robust evidence for such links.
Copyright 2012, Taylor & Francis.
Sustained decreases in risk exposure and youth problem behaviors after installation of the Communities That Care prevention system in a randomized trial.
Hawkins JD; Oesterle S; Brown EC; Monahan KC; Abbott RD; Arthur MW et al. Archives of Pediatrics & Adolescent Medicine 166(2): 141-148, 2012. (56 refs.)
Objective: To test whether the Communities That Care (CTC) prevention system reduced levels of risk and adolescent problem behaviors community-wide 6 years after installation of CTC and 1 year after study-provided resources ended. Design: A community randomized trial. Setting: Twenty-four small towns in 7 states, matched within state, randomly assigned to control or intervention condition in 2003. Participants: A panel of 4407 fifth-grade students was surveyed annually through 10th grade from 2004 to 2009. Intervention: A coalition of community stakeholders received training and technical assistance to install CTC, used epidemiologic data to identify elevated risk factors and depressed protective factors in the community, and implemented programs to address their community's elevated risks from a menu of tested and effective programs for youths aged 10 to 14 years, their families, and schools. Outcome Measures: Levels of risk and incidence and prevalence of tobacco, alcohol, and other drug use; delinquency; and violent behavior by grade 10. Results: Mean levels of targeted risks increased less rapidly between grades 5 and 10 in CTC than in control communities and were significantly lower in CTC than control communities in grade 10. The incidence of delinquent behavior, alcohol use, and cigarette use and the prevalence of current cigarette use and past-year delinquent and violent behavior were significantly lower in CTC than in control communities in grade 10. Conclusions: Using the CTC system can produce enduring reductions in community-wide levels of risk factors and problem behaviors among adolescents beyond the years of supported implementation, potentially contributing to long-term public health benefits.
Copyright 2012, American Medical Association.
Toxicity of energy drinks. (review).
Wolk BJ; Ganetsky M; Babu KM. Current Opinion in Pediatrics 24(2): 243-251, 2012. (86 refs.)
Purpose of review: 'Energy drinks', 'energy shots' and other energy products have exploded in popularity in the past several years; however, their use is not without risk. Caffeine is the main active ingredient in energy drinks, and excessive consumption may acutely cause caffeine intoxication, resulting in tachycardia, vomiting, cardiac arrhythmias, seizures, and death. The effects of chronic high-dose caffeine intake in children and adolescents are unknown. Caffeine may raise blood pressure, disrupt adolescent sleep patterns, exacerbate psychiatric disease, cause physiologic dependence, and increase the risk of subsequent addiction. Recent findings: Coingestion of caffeine and ethanol has been associated with increased risk-taking behaviors, harm to adolescent users, impaired driving, and increased use of other illicit substances. The toxicity of ingredients often present in energy drinks, such as taurine, niacin, and pyridoxine, is less well defined. Recent and significant literature describing adverse events associated with energy drink use are reviewed. Summary: Although prior studies have examined the effects of caffeine in adolescents, energy drinks should be considered a novel exposure. The high doses of caffeine, often in combination with ingredients with unknown safety profiles, mandates urgent research on the safety of energy drink use in children and adolescents. Regulation of pediatric energy drink use may be a necessary step once the health effects are further characterized.
Copyright 2012, Lippincott, Williams & Wilkins.
Ten-year stability and variability, drinking patterns, and impairment in community youth with diagnostic orphan status of alcohol dependence.
Grabitz M; Behrendt S; Klotsche J; Buehringer G; Lieb R; Wittchen HU. Addictive Behaviors 37(4): 399-406, 2012. (50 refs.)
Objective: Some adolescents and young adults who do not fulfill criteria for DSM-IV alcohol abuse (AA) report symptoms of DSM-IV alcohol dependence (AD) below the diagnostic threshold (diagnostic orphans, DOs; 1 or 2 symptoms). Contemporarily, little is known on the long-term stability, risk of progression to AD, impairment, and drinking patterns possibly associated with this status in the first decades of life. Aim: (1) To identify prevalence rates of the DO status from adolescence to early adulthood. To investigate (2) stability and variability of the DO status over time and (3) associations between DO status, drinking patterns and impairment in comparison to subjects with AA, with AD, or without any symptoms. Method: N = 2039 community subjects (aged 14-24 years at baseline) were assessed at baseline and at about four and ten years after baseline. DSM-IV AUD diagnoses were obtained with the DIA-X/M-CIDI. Results: About 11-12% of the sample was classified as DOs at all waves. Over a period of ten years, 18% of DOs were stable in their diagnosis and additional 10% progressed to AD. DOs were comparable to subjects with AA in drinking patterns, impairment and stability of diagnostic status. DOs progressed to AD significantly more often than AA. AD was associated with highest levels in all outcomes of interest. Conclusions: The DO status in adolescence and early adulthood is associated with considerable stability, risk of progression and problematic alcohol intake. In consequence, it can be meaningful for the timely identification of early stages of clinically relevant alcohol problems. For subjects with DO status early specific interventions are required.
Copyright 2012, Elsevier Science.
Very young adolescents and alcohol: Evidence of a unique susceptibility to peer alcohol use.
Kelly AB; Chan GCK; Toumbourou JW; O'Flaherty M; Homel R; Patton GC et al. Addictive Behaviors 37(4): 414-419, 2012. (45 refs.)
Aim: The aim of this study is to examine the susceptibility of very young adolescents (10-12 years of age) to peer alcohol-related influences, compared to older adolescents (13-14 years of age). Methods: The analysis sample consisted of 7064 adolescents in grade 6 (modal age 11) or grade 8 (modal age 13) from 231 schools in 30 communities across three Australian States. Key measures were adolescent reports of alcohol use (past 30 days) and the number of peers who consume alcohol without their parent's awareness. Control variables included parent alcohol use, family relationship quality, pubertal advancement, school connectedness, sensation seeking, depression, length of time in high school, as well as age, gender, father/mother education, and language spoken at home. A multi-level model of alcohol use was used to account for school-level clustering on the dependent variable. Results: For both groups, the number of peers who consumed alcohol was associated with alcohol use, but Grade 6 students showed a unique susceptibility to peripheral involvement with peer drinking networks (having one friend who consumed alcohol). Conclusion: The results point to the importance of monitoring and responding to comparatively minor shifts in the proportion of peers who use alcohol, particularly among very young adolescents.
Copyright 2012, Elsevier Science.
Youth substance use in a context of family homelessness.
Bannon WM; Beharie N; Olshtain-Mann O; McKay MM; Goldstein L; Cavaleri MA et al. Children and Youth Services Review 34(1): 1-7, 2012. (45 refs.)
Objective: This study examines the relationship between family processes and youth substance use debuts among a sample of youth residing in urban family homeless shelters. Method: Data regarding shelter experiences, youth and family characteristics, and the use of three substances (i.e., cigarettes, alcohol, and marijuana) were gathered from a sample of youth (11-14 years) and their respective parents residing in an urban family homeless shelter system. Multinomial logistic regression analysis was used to examine the influences on youth substance use. Results: Of the 198 youth included in the statistical analysis, 72% (n = 143) reported no substance use debuts, while 18% (n = 35) indicated one and 10% (n = 20) indicated two to three substance use debuts. Within the final model, greater substance use debut was associated with being older (13-14 vs. 11-12; OR = 7.5; 95% CI = 1.8-30.9) and stressors exposure (OR = 4.8; 95% CI = 1.5-14.7). Furthermore, youth of adult caretakers that reported low levels of the three family processes considered were almost four and a half more likely (OR = 4.4: 95% CI = 1.2-16.5) to have made two to three substance use debuts. Conclusions: Family processes may be a particularly important intervention target toward reducing the rate of substance use among youth residing in urban family homeless shelters.
Copyright 2012, Elsevier Science.