The Importance of the Community Context in the Epidemiology of Early Adolescent Substance Use and Delinquency in a Rural Sample

Considerable research has demonstrated that substance use and delinquency during early adolescence can have long-term negative health consequences. As the correlates of these behaviors cross levels and contexts, it is likely that a social ecological approach will provide insight to inform community prevention. This approach informs the present study, which focuses on developing a multiple-method measurement strategy to examine associations among community risks, resources, and rates of early adolescent substance use and delinquency in 28 rural and small town communities. Measures include five domains of community risk, four domains of community resources, and population rates of early adolescent substance use and delinquency. Results demonstrated that several measures of context were significantly associated with community rates of adolescent substance use and delinquency, and different risks and resources appear important for different outcomes. Multiple associations were curvilinear, and interactions may also be important. Findings suggest that it may be worthwhile to create and test new intervention strategies that target community factors in the pursuit of prevention.     

Adolescent Substance Use: Preliminary Examinations of School and Neighborhood Context

In considering the influences of microsystems on adolescent substance use, familial and peer contexts have received the most extensive attention in the research literature. School and neighborhood settings, however, are other developmental contexts that may exert specific influences on adolescent substance use. In many instances, school settings are organized to provide educational services to students who share similar educational abilities and behavioral repertoires. The resulting segregation of students into these settings may result in different school norms for substance use. Similarly, neighborhood resources, including models for substance use and drug sales involvement, may play an important role in adolescent substance use. We briefly review literature examining contextual influences on adolescent substance use, and present results from two preliminary studies examining the contribution of school and neighborhood context to adolescent substance use. In the first investigation, we examine the impact of familial, peer, and school contexts on adolescent substance use. Respondents were 283 students (ages 13 to 18) from regular and special education classrooms in six schools. Although peer and parental contexts were important predictors of substance use, school norms for drug use accounted for variance in adolescent use beyond that explained by peer and parental norms. Data from a second study of 114 adolescents (mean age = 15) examines neighborhood contributions to adolescent substance use. In this sample, neighborhood indices did not contribute to our understanding of adolescent substance use. Implications for prevention are presented.     

Rural adolescent aggression and parental emotional support

Preliminary research findings suggest important distinctions between rural and urban adolescent aggression risk and protective factors. Despite these potentially important differences, most of the existing research on adolescent aggression has utilized urban samples. The current study examines the direct association between parental emotional support and rural adolescent aggression, and whether adolescent psychopathology and substance abuse mediate this association. Multi-method measurement (self-report, parent report, and behavioral observations) were employed in measuring aggression and emotional support variables with rural, nonadjudicated adolescents (N=62) and their mothers or stepmothers. Results indicated that parental emotional support has an indirect influence on adolescent aggression. Adolescent substance abuse was completely mediated by adolescent grade-point average, indicating no significant direct impact on aggression. Adolescent psychopathology significantly mediated the relationship between parental emotional support and adolescent aggression. Particular items contributed substantially to this mediating association, making certain characteristics, rather than a specific diagnosis, relevant to psychopathology's mediating impact. These characteristics include cognitive perception of others as critical or hostile, emotional anxiousness in social situations, and behavioral persistence in social interactions despite these perceptions.     

Adapting School-Based Substance Use Prevention Curriculum Through Cultural Grounding: A Review and Exemplar of Adaptation Processes for Rural Schools

A central challenge facing twenty-first century community-based researchers and prevention scientists is curriculum adaptation processes. While early prevention efforts sought to develop effective programs, taking programs to scale implies that they will be adapted, especially as programs are implemented with populations other than those with whom they were developed or tested. The principle of cultural grounding, which argues that health message adaptation should be informed by knowledge of the target population and by cultural insiders, provides a theoretical rational for cultural regrounding and presents an illustrative case of methods used to reground the keepin’ it REAL substance use prevention curriculum for a rural adolescent population. We argue that adaptation processes like those presented should be incorporated into the design and dissemination of prevention interventions.     

The role of the self‐fulfilling prophecy in young adolescents' responsiveness to a substance use prevention program

This research examined whether naturally occurring self‐fulfilling prophecies influenced adolescents' responsiveness to a substance use prevention program. The authors addressed this issue with a unique methodological approach that was designed to enhance the internal validity of research on naturally occurring self‐fulfilling prophecies by experimentally controlling for prediction without influence. Participants were 321 families who were assigned to an adolescent substance use prevention program that either did or did not systematically involve parents. Results showed that parents' perceptions about the value of involving parents in adolescent substance use prevention predicted adolescents' alcohol use more strongly among families assigned to the prevention program that systematically involved parents than to the one that did not. The theoretical and practical implications of these findings are discussed.     

Longitudinal predictors of weapon involvement in middle adolescence: Evidence from the UK Millennium Cohort Study

This study uses longitudinal data from the UK Millennium Cohort Study (N = 13,277) to examine the childhood and early adolescence factors that predict weapon involvement in middle adolescence, which in this study is exemplified by having carried or used a weapon. It finds that childhood experiences of low family income and domestic abuse between parents predict weapon involvement at age 17 years. Other predictors include childhood externalizing problems and self-harm in early adolescence. Further early adolescent behaviors and experiences that predict weapon involvement are own substance use, peer substance use, school exclusion, and high levels of electronic gaming. These findings provide concrete areas for targeting risk factors both in childhood and the early adolescent period, with an indication that early intervention and prevention are likely to reduce the need for later action.     

The Relationship Between Family Factors and Adolescent Substance Use in Rural, Suburban, and Urban Settings

We tested the relationships and predictive power of family factors on rural, suburban, and urban adolescent substance use. A representative statewide survey of 11th grade students for gender, place of residence, and ethnicity was conducted. No significant differences were found between rural, suburban, and urban adolescents for substance use. For family sanction variables across all locations, adolescent substance involvement was significantly lower the more they perceived their families would stop them or care if they got drunk, smoked cigarettes, or used marijuana. Rural and suburban youth who reported that their parents talked to them about the dangers of smoking and getting drunk were less involved in substance use. While controlling for location, gender, and ethnicity, regression analyses showed that family sanctions against smoking cigarettes and marijuana explained a modest proportion of the variance in substance use. Finally, family talking about the dangers of cigarettes, family involvement in schools and belief that their families cared about them predicted lower substance use regardless of location, although minimal variance was explained. The findings have implications for social service providers regarding location settings, prevention, education, and intervention programming.     

Prospective Associations of Internalizing and Externalizing Problems and Their Co-Occurrence with Early Adolescent Substance Use

The literature is equivocal regarding the role of internalizing problems in the etiology of adolescent substance use. In this study, we examined the association of internalizing and externalizing behavior problems and their co-occurrence with early adolescent substance use to help clarify whether internalizing problems operate as a risk or protective factor. A large community sample (N?=?387; mean age at the first assessment 12 years old; 83 % White/non-Hispanic) was assessed annually for 3 years. Externalizing problem behavior in the absence of internalizing problems showed the strongest prospective association with alcohol, cigarette, and marijuana use. A weaker, albeit statistically significant prospective positive association was found between co-occurring internalizing and externalizing behavior problems and substance use. Internalizing problems in the absence of externalizing problems protected adolescents against cigarette and marijuana use. Clarifying the role of internalizing problems in the etiology of adolescent substance use can inform the development of early intervention and prevention efforts. Our results highlight the importance of further considering the co-occurrence of internalizing and externalizing behavior problems in developmental pathways to substance use.     

Parental Knowledge and Substance Use Among African American Adolescents: Influence of Gender and Grade Level

Parental knowledge is defined as parental awareness and information about a child’s activities, whereabouts, and associations that is obtained through parental monitoring, parental solicitation, or self-disclosure. Increased parental knowledge is generally associated with lower adolescent substance use; however, the influence of various contextual factors, such as adolescent gender and grade level is not well understood, particularly for different racial or ethnic groups. In the present study, we used Hierarchical Generalized Linear Modeling analyses to examine the longitudinal relationship of parental knowledge to adolescent substance use in the context of adolescent gender and grade level among 207 urban African American adolescents in grades 6–11. Results indicated that increased parental knowledge is associated with a concurrent lower likelihood of substance use across all types of substances examined (alcohol, tobacco, marijuana, other drug use, and any drug use), but it did not predict changes in substance use 1 year later for the entire sample. However, analyses by gender and grade level showed that for boys and middle school youth, parental knowledge was a protective factor for increases in substance use across 1 year. Findings are discussed in terms of their implications for prevention and health promotion interventions for adolescent substance use among African American youth.     

Implementing a Comprehensive Program for the Prevention of Conduct Problems in Rural Communities: The Fast Track Experience

Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program.     

Adolescent socialization and use of licit and illicit substances: Impact on adult health

Abstract

This study examined the impact of adolescent substance use on young adult health. Longitudinal data from 825 participants were assessed when the participants were junior high school and high school students (1969-1973) and again in 1981. Latent variable models were used to determine what effect adolescent drug use had on later health. General substance use, which included tobacco, alcohol, stimulants, sedatives, and other hard drugs, had a small effect on adult health problems associated with substance use, and also predicted accidents related to substance use. In addition, the specific use of tobacco and cannabis in adolescence predicted later respiratory problems, while cigarette smoking during adolescence also predicted decreased physical hardiness. Lower adolescent socialization predicted post high school accidents (automobile and other) serious enough to require medical attention, and predicted increased psychosomatic and seizure symptoms, as well as general psychiatric distress. Implications of these results for the successful prevention or intervention of drug use are discussed. In addition to these results, gender differences are also examined.     

Childhood proactive and reactive aggression: Differential risk for substance use?

The link between child/adolescent aggression and substance use is an important area of study, as child aggression is a strong risk factor for substance use — a major public health concern for which few successful interventions are available. A better understanding of the link between aggression and substance use could help to refine and develop more effective and perhaps more targeted prevention and intervention strategies. One way to further understand the link between aggression and substance use may be to distinguish between proactive and reactive functions of aggression. Indeed, there is growing evidence to suggest that proactively aggressive behavior is more strongly linked to substance use, particularly problem drinking, than reactive aggression. However, further investigation is needed to fully understand these associations. This paper presents a thorough review of the available research, outlines gaps in the literature, and offers suggestions for future research.     

Family factors and adolescent substance use: models and mechanisms

This article considers the relation of family factors to adolescent substance use, with a focus on the specific pathways by which family factors have their effects. We review findings on four types of variables (family substance use, parental support and monitoring, parent-child conflict, and family life events) and discuss theoretical models of how family risk and protective factors are related to adolescents' outcomes. The evidence favors a transactional model in which family factors have largely mediated effects on adolescent substance use through relations to adolescents' self-control, life events, and peer affiliations; interactions between variables are also prominent. We discuss the implications of mediated effects for theoretical models of human development and consider how the transactional approach opens avenues for preventive intervention.     

The community substance use environment: The development and predictive ability of a multi‐method and multiple‐reporter measure

This study tested the feasibility and utility of developing a multiple‐method and multiple‐reporter measure that describes the community substance use environment. Data on community‐level norms and availability of substances were reported by 5261 students and 181 prevention‐focused community leaders (CL) involved in the 28 promoting school–university–community partnerships to enhance resilience (PROSPER) Project communities between 2002 and 2005. Additionally, locations of alcohol and tobacco outlets were geocoded. Initially, these four subscales were aggregated to measure the community substance use environment. Analyses demonstrated this measure was associated with community rates of adolescent reported cigarette use, but it was not associated with community rates of adolescent reported alcohol use. Further analyses tested the relative strength of the four different subscales in predicting rates of student use. Implications of these results for the field of community‐based prevention are discussed, as well as limitations and future directions. Copyright © 2009 John Wiley & Sons, Ltd.     

Substance use and violent behavior in adolescence

The relation between substance use and violent behavior in adolescence is reviewed, and each of five competing models of this relation is examined. I begin by presenting background material on adolescent substance use and adolescent violence. I then describe five different models that have been proposed to explain the association between substance use and violent behavior. Next, I review the adolescent literature concerning substance use and violence, noting methodological weaknesses that have plagued this research. I conclude with an evaluation of the five models and suggestions for future research.     

Family Intervention to Prevent Depression and Substance Use Among Adolescents of Depressed Parents

Parental depression places offspring at elevated risk for multiple, co-occurring problems. The purpose of this study was to develop and preliminarily evaluate Project Hope, a family intervention for the prevention of both depression and substance use among adolescent-aged children (M?=?13.9?years) of depressed parents. The program was created by blending two empirically supported interventions: one for depression and another for substance use. Thirty families were randomly assigned to either Project Hope (n?=?16) or a wait-list control condition (n?=?14). Pretests, posttests (n?=?29), and 5-month follow-ups (n?=?28) were conducted separately with parents and youth via phone interviews. Questions asked about the family depression experience, family interactions, family management, coping, adolescent substance use beliefs and refusal skills, adolescent depression, and adolescent substance use. Project Hope was fully developed, manualized, and implemented with a small sample of targeted families. Engagement in the program was relatively high. Preliminary outcome analyses were conducted using 2 (Group) ×3 (Time) analyses of covariance. Results provided some evidence for significant improvements among intervention compared to control participants in indicators of the family depression experience, family management, and coping, and a statistically significant decrease from pretest to posttest in alcohol quantity for intervention compared to control youth. Next steps for this program of research are discussed.     

The impact of continuing care adherence on environmental risks, substance use, and substance-related problems following adolescent residential treatment.

The effectiveness of adolescent treatment to reduce substance use has been demonstrated by a number of different literature reviews, yet longer term outcome studies have suggested that continued alcohol and other drug use is common. Participation in continuing care services and reductions in environmental risk factors (e.g., peer substance use or alcohol or drug use in the home) have both been found to be associated with improved posttreatment substance use. The authors conducted Path analysis to examine the experimental direct effect of the Assertive Continuing Care Protocol (S. H. Godley, M. D. Godley, & M. L. Dennis, 2001) on general continuing care adherence following residential treatment and the protocol's indirect effect (via general continuing care adherence) on social and environmental risk factors, as well as subsequent substance use and substance-related problems. Supporting previous findings, the final model indicates that greater adherence to continuing care is associated with reductions in environmental risk, which in turn is associated with reduced adolescent substance use and substance-related problems 9 months after discharge from residential treatment.     

Social Cohesion,Neighborhood Collective Efficacy,and Adolescent Subjective Well‐being in Urban and Rural Taiwan

This study investigates the association between neighborhood social cohesion, collective efficacy, and adolescent subjective well‐being in a nationally representative sample of Taiwanese youth. The study represents a first to adapt and test a developmental ecological model within a Chinese cultural context. Data came from the Taiwan Youth Project, which assessed representative samples of seventh graders (n = 2,690) and ninth graders (n = 2,851) from both urban and rural counties. The analytic sample included 4,988 adolescents (M age = 14.4, SD = 1.14; 50% female) in Taiwan. A path analysis estimated the direct and indirect effects of social cohesion on adolescent well‐being. The results suggest that neighbors can affect young people's well‐being by reinforcing their perception of safety and enhancing their self‐esteem. Comparisons between youth from urban and rural areas demonstrate a general similarity in the developmental processes, though the perception of safety is less of a concern in rural areas. Findings emphasize universal aspects of neighborhood collective efficacy and developmental–ecological models, as well as allude to culturally specific dimensions in a Chinese‐based context.     

Interpersonal Goals and Susceptibility to Peer Influence: Risk Factors for Intentions to Initiate Substance Use during Early Adolescence

Though peer socialization theories are prominent in the adolescent substance use literature, variability in the degree to which adolescents are vulnerable to peer influence is likely, and few studies have examined this issue. This study examines the association between perceived peer substance use/approval of substance use and adolescent intentions to initiate alcohol and cigarette use, and how social goals moderate this relationship. Results support the moderating role of social goals, and suggest important differences across alcohol and cigarette use. Peer use and approval of cigarette use was associated with future intentions to smoke for adolescents with strong agentic goals, and peer use and approval of alcohol use was associated with intentions to drink for adolescents with strong communal goals. These findings suggest that adolescent substance use theories and prevention programs focusing on peer socialization should consider individual differences in social goals and potential differences in peer influence across drugs.