An mHealth Approach to Extend a Brief Intervention for Adolescent Alcohol Use and Suicidal Behavior: Qualitative Analyses of Adolescent and Parent Feedback

Abstract

Mobile health (mHealth) tools that supplement inpatient psychiatric care can maintain and enhance intervention effects following hospitalization. Adolescents hospitalized following a suicidal event represent a vulnerable population who could greatly benefit from such an mHealth intervention. In specific, suicidal adolescents who drink alcohol are in need of robust interventions that address the bidirectional relationship between alcohol use and suicidal thoughts and behaviors, because it puts them at especially high risk for suicide upon discharge. The purpose of this study was to conduct qualitative interviews to gather feedback to improve a brief alcohol intervention provided to suicidal adolescents during psychiatric hospitalization, and to develop a mHealth tool to extend care after discharge. Participants, eight adolescents and their parents, identified the need for a smartphone application to deliver intervention content to adolescents and parents during the posthospitalization period. Adolescents sought support in meeting alcohol- and mood-related goals, while parents desired general resources as well as tips for conversations with their adolescent about mood and alcohol use.     

Family Communication and Adolescent Alcohol Use in Nicaragua,Central America: A Test of Primary Socialization Theory

ABSTRACT

Applying primary socialization theory to a sample of early adolescents from Nicaragua, this study examines direct and indirect associations between family bonding and adolescent alcohol use via substance specific prevention communication (SSPC) and adolescent efficacy. Early adolescents in 7th and 8th grades completed a self-report, cross-sectional survey. Structural equation modeling revealed that family expressiveness was significantly indirectly related to adolescent lifetime alcohol use through SSPC. Results are discussed in relation to primary socialization theory, family communication, and international substance use prevention efforts. This study provides supportive evidence for the important role of positive family communication as a protective factor for early adolescents in Nicaragua.     

Using the NIAAA brief alcohol screener in social work practice for selected prevention targeting youth

ABSTRACT

This article discusses the use of brief screeners in social work practice to identity adolescents in need of selected interventions for alcohol and other drug use problems. Brief screeners can increase access to alcohol or other drug intervention services and promote the diffusion of evidence-based interventions to underserved communities when integrated in Screening, Brief Intervention, and Referral to Treatment (SBIRT) initiatives. The two-item NIAAA Brief Alcohol Use Screener is discussed as a developmentally tailored assessment tool that can be integrated into SBIRT in social work practice to improve detection of early-stage alcohol problems among adolescents who lack routine access to preventative health care. The use of brief, empirically supported alcohol screeners in trainings for social work students and new professionals can enhance their preparation and competence to offer child and adolescent clients appropriate selected intervention options to reduce harms associated with underage alcohol use.     

Sense of Belonging in School as a Protective Factor Against Drug Abuse Among Native American Urban Adolescents

ABSTRACT

This article presents the results of a study conducted with 243 Native American students who were part of a multi-ethnic sample of adolescents attending middle school in a large urban center in the Southwest region of the United States. Native adolescents who felt a stronger sense of belonging in their school were found to report a lower lifetime use of alcohol and cigarettes, lower cigarette and marijuana use in the previous month, lower frequency of current use of these substances, fewer substances ever used, and a later age of initiation into drug use than other Native students. Research implications are discussed in relationship to school environment, culturally-grounded prevention curricula, and school social work practice.     

A Longitudinal Analysis of Adolescent Substance Use and School Motivation Among African American Youth

Cross‐sectional research has shown a link between adolescent substance use and educational motivation. The purpose of the current study was to examine this link in a longitudinal sample of African American youth. The study examined the interrelationships between alcohol and both marijuana use and school motivation over the high school years and their effect on graduation in 681 African American adolescents (50.8% female). School motivation was shown to relate to subsequent alcohol use throughout high school and marijuana use early in high school. School motivation did not affect graduation status, but alcohol and marijuana use were related to a lower likelihood of graduating from high school. Some gender differences and differences among those who had tried alcohol or marijuana at the first wave as opposed to those who had not tried each substance were found. The findings support a systems model where school experiences can affect substance use, which, in turn, can affect the completion of high school.     

Gender differences in the association of smartphone use with the vitality and mental health of adolescent students

ABSTRACT

Objective: The present study examined variations in the degree of smartphone use behavior among male and female adolescents as well as the association between various degrees of smartphone use behavior and the vitality and mental health of each gender.

Participants: A total of 218 adolescents were recruited from a junior college in September 2014.

Methods: All the participants were asked to answer questionnaires on smartphone use.

Results: The findings showed that adolescent females as compared with adolescent males exhibited significantly higher degrees of smartphone dependence and smartphone influence. Positive correlations were observed between the duration of smartphone use on weekends and the vitality/mental health of the male adolescents; negative correlations were found between smartphone dependence and the vitality/mental health of males.

Conclusion: The findings demonstrate that adolescent females are deeply affected by their smartphone use. Smartphone dependence may decrease the vitality and mental health of male adolescents.     

How Academic Achievement,Attitudes, and Behaviors Relate to the Course of Substance Use During Adolescence: A 6‐Year,Multiwave National Longitudinal Study

Self‐report data regarding alcohol, cigarette, and marijuana use were collected biennially from ages 14 to 20 in a nationally representative panel sample of adolescents (N=1,897) from the Monitoring the Future study. Growth curve analyses were performed using hierarchical linear modeling to consider psychosocial background, motivation and school attitudes, and parental and peer influences at age 14 as predictors of concurrent substance use and change in substance use. Results indicated that school misbehavior and peer encouragement of misbehavior were positively associated with substance use at age 14 and with increased use over time; school bonding, school interest, school effort, academic achievement, and parental help with school were negatively associated. The protective effects of positive school attitudes and perceptions of high status connected to academics were stronger for low‐achieving compared with high‐achieving youth. Implications for a developmental perspective on substance use etiology and prevention are discussed.     

Alcohol and employment in the transition to adulthood

We elaborate the relationship between work hours and alcohol use during the transition from adolescence to adulthood. Both hours of employment and drinking may be products of weak bonds to school and family. Alternatively, work may exert an independent effect on alcohol use by exposing adolescents to opportunities and associates that facilitate drinking. Using longitudinal data from the Youth Development Study (YDS), we present static score regression models showing that long work hours increase levels of drinking during high school. These effects are mediated in large part by work-derived independence from parents, suggesting that a precocious transition to adult roles may be the mechanism connecting work hours and alcohol use. Work effects on drinking are short-lived, however, as adolescent hours of employment do not significantly influence alcohol use after high school.     

Behavioral health correlates of exposure to community violence among African-American adolescents in Chicago

AimsThough public health researchers are more aware of behavioral health concerns among African American youth, few studies have explored how exposure to community violence may be related to adverse youth concerns. This study examines the relationship between exposure to community violence and mental health problems, substance use, school engagement, juvenile justice involvement, and STI risk behaviors.MethodsA total of 638 African American adolescents living in predominantly low-income, urban communities participated in the study by completing self-report measures on exposure to community violence, mental health, school engagement proxies, substance use, delinquency markers and sexual risk behaviors.ResultsAdolescents who reported higher rates of exposure to community violence were significantly more likely to report poorer mental health, delinquent behaviors, a history of juvenile justice involvement, lower school bonding and student-teacher connectedness. These youth were also significantly more likely to use alcohol, cigarettes, and illicit substances, and engage in sexual risk behaviors.ConclusionsFindings suggest that there is a critical need for culturally relevant prevention and intervention efforts for African American adolescents who are frequently exposed to community violence.     

Concurrent alcohol and cigarette use among school-going adolescents in Korea

BackgroundConrurrent alcohol and tobacco use may increase the risk for substance abuse in adolescents. The aim of this study was to investigate concurrent alcohol and cigarette use and the co-occurrence risks of each substance in school-going adolescents in Korea.MethodsIn a cross-sectional nationally representative survey in 2016, 65,528 students (Mean age = 15.1 years, SE = 0.02) responded to a questionnaire that included measures of substance use and substance use exposure.ResultsIn all, 13.3% of the students were concurrent lifetime smokers and drinkers (19.3% among boys and 6.7% among girls), 25.5% lifetime alcohol users only (24.2% among boys and 26.9% among girls), 3.0% lifetime smokers only (4.7% among boys and 1.1% among girls) and 58.3% never smoked and never used alcohol (52.2% among boys and 47.8% among girls). All measures of more intensive smoking pattern and smoking exposure and more intensive drinking pattern and drinking exposures, respectively, were associated with consistently increased risk of lifetime alcohol use and lifetime smoking, respectively, compared to lifetime never smokers and abstainers. In multinomial logistic regression, compared to students who neither had used alcohol nor tobacco, concurrent lifetime smokers and drinkers were more likely to be male, mixed or boys school, higher school grade, lower paternal and maternal educational level, perceived lower socio-economic status, ever drug user, perceived stress above average, depressive mood, experience of violence victimization, and living in a rural area or medium sized city.ConclusionPrevention and treatment strategies should better incorporate the comorbidity of cigarette smoking and alcohol use in their intervention programmes.     

Clinical Uses of an Adolescent Intake Questionnaire

Summary

Open dialogue concerning behavioral and environmental risks is key to effective, holistic intervention with urban adolescents. Topics for discussion must include substance use, sexual behaviors and abuse, health concerns, exposure to violence and racism, school performance, and relationships with family and peers. Clinical engagement of adolescents requires focusing the therapeutic relationship on issues of their own choice, at their own pace. This article describes the clinical uses and practice impacts of a comprehensive adolescent self-assessment questionnaire (Adquest). By normalizing sensitive topics and allowing clients to exercise control over the therapeutic agenda and pace, Adquest serves as a “bridge to engagement,” a device for keeping the clinical dialogue open and a mode of induction to the client role. For staff, it represents a way of standardizing and broadening clinical assessment, identifying treatment objectives, and framing psycho-educational interventions.     

Adolescent American Sex

SUMMARY

Though there has been a decline in the percentage of sexually active high school students in the past decade in the United States, the rate of adolescents engaging in sexual behavior leading to orgasm has actually increased. Such orgasms are achieved without penetration and penetration is how most American adolescents define sex. Most adolescent sex also occurs within intimate relationships with partners at or near their own age but definitions of what constitutes intimacy is different than in the past. Sexuality is very important in the life of adolescents in the United States, and sexual activity broadly defined begins fairly early among teenagers although actual sexual intercourse usually takes place much later.     

Negotiating Family

Abstract

This study sought to determine how several child-rearing behaviors within the Chinese parent-adolescent relationship were predictive of youthful self-esteem through either collectivistic or individualistic socialization approaches. Theoretically based relationships were tested with structural equation modeling to examine whether dimensions of parental behavior (i.e., support, reasoning, monitoring, and punitiveness) influenced the self-esteem of Chinese adolescents through the mediating influences of either conformity (i.e., collectivism) or autonomy (i.e., individualism) in reference to parents. The sample for this study consisted of 497 adolescents from Beijing, China, ranging in age from 12-19 years of age. Data were acquired with self-report questionnaires administered in school classrooms. Results provided support for parental behaviors as predictors of self-esteem development through individualistic patterns of socialization. Although collectivistic parent-adolescent patterns did not predict the self-esteem of Chinese adolescents, several results supported a collectivistic conception of socialization through significant relationships involving parental behaviors as predictors of adolescent conformity to parents. Some results of this study highlight the significance of parental support and dimensions of moderate parental control (e.g., reasoning and monitoring) within the Chinese parent-adolescent relationship, while identifying only a minimal role for punitive behavior.     

Examining Racial Differences in the Effects of Substance Abuse on High School Students' Academic Achievement

Abstract

Many studies document racial disparities in the American educational system, finding that white students generally outperform black students. Researchers justifiably focus on structural explanations for such disparities, but generally pay less attention to more proximate influences on academic achievement. However, studies have found that substance use negatively impacts adolescent academic achievement; other findings on race and substance use suggest that this relationship could be more damaging for black students. This paper uses National Education Longitudinal Study data to determine if substance use negatively impacts the academic achievement of high school students, and if black students are more negatively affected than whites. The analysis finds that substance use has a negative impact on academic achievement, even while controlling for a range of known influences on academic achievement. However, this relationship is not found to be more damaging to black students, probably due to white students' higher level of substance use.     

Substance Use Among Rural African American Adolescents: Identifying Risk and Protective Factors

Substance use continues to be a significant problem among youth in our society, particularly in rural communities. The purpose of the current study was to identify the possible risk and protective factors that may be affecting the rates of alcohol and illegal drug use among a population of African American adolescents living in a rural, southern community. The following were identified as possible risk factors: (1) Being an older adolescent (15 years of age or older); (2) Spending afternoons after school with friends; (3) Having friends or family members who use alcohol or illegal drugs; (4) Being raised by non-family members; and (5) Having plans to enter military after high school. The following characteristics were associated with less alcohol and illegal drug use, and were identified as possible protective factors: (1) Being raised by parent(s) or other family members; (2) Spending afternoons after school with parents; (3) Having parents who talk to youth about dangers of drug and alcohol use; (4) Having parents who disapprove of their child using drugs or alcohol; (5) Being involved in extra-curricular church-related activities; and (6) Having plans to work, or attend college or technical school after high school. Characteristics that have been associated with drug and alcohol in previous research that were not associated with use in the current study include: (1) Being male; (2) Peer pressure to use alcohol or illegal drugs; (3) Grades in school; and (4) Involvement in extra-curricular activities. Implications for developing effective community programs aimed at reducing substance use among our youth are discussed.     

Adolescents' Need to Talk About School and Work in Mental Health Treatment

Summary

School-aged adolescents spend much of their time in school. As a result, it is important for mental health practitioners who work with adolescents to address their clients' educational concerns and risks. Based on data “mined” from an adolescent intake questionnaire (Adquest), this study explores how adolescents view their educational life and their need to address educational risks clinically. Likewise, the world of work, also important to adolescents, is discussed. Overall, adolescents are concerned about their educational risk factors, want to be employed, and want to talk about both with clinicians in a mental health context.     

When Do First-Year College Students Drink Most During the Academic Year? An Internet-Based Study of Daily and Weekly Drinking

Abstract

Objective: The authors investigated the alcohol consumption trajectories among first-year university students. Participants: A sample of 415 students attending a large university in Southwestern Ontario, Canada, was recruited. Methods: Students completed a baseline questionnaire and 26 weekly brief Internet surveys assessing alcohol consumption from September 2006 to April 2007. Results: Findings indicated that alcohol consumption varies considerably as a function of time of the academic year. Overall trends indicate that students drink more heavily at the beginning of each semester and less during exam periods. Daily patterns indicate that most drinking occurs on weekends. The highest drinking days in the first academic year included Halloween, New Year's Eve, and St. Patrick's Day. Conclusions: The present study provides evidence that periods of high and low alcohol consumption are contingent upon specific events and the time of the year.     

School Connectedness Buffers the Effects of Negative Family Relations and Poor Effortful Control on Early Adolescent Conduct Problems

This study examined the unique and interactive contributions of school connectedness, negative family relations, and effortful control to subsequent early adolescent conduct problems. Data were collected from 476 adolescents when they were initially in the 6th and 7th grades and again 1 year later. Results from hierarchical regression analyses showed that even after controlling for negative family relations, effortful control, baseline levels of conduct problems, and gender, school connectedness contributed to decreasing subsequent conduct problems. Examination of 2- and 3-way interactions indicated that high levels of school connectedness offset the adverse effects of negative family relations for boys and girls and the adverse effects of low levels of effortful control for girls. Findings underscore the role of school connectedness as a protective factor for early adolescent conduct problems.     

The Impact of Parental Attachment on Adolescent Perception of the School Environment and School Connectedness

The extent to which students feel accepted, valued, respected and included in the school has recently surfaced as one of the most important predictors of adolescent mental health (particularly depressive symptoms). The school environment is an established predictor of school connectedness, but we set out to examine whether parental attachment predicts both adolescents' perception of the school environment and school connectedness. A study of 171 high school students from years 8 to 12 showed that parent attachment strongly predicted both. We also confirmed that the relationship between parent attachment and school connectedness is not a direct one but that parent attachment influences individual differences in the way adolescents perceive the school environment, which in turn influences school connectedness. This finding shows how multiple systems might be interlinked in influencing wellbeing in adolescents, and confirms the importance of intervening at the double level of both the family and the school system.