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1.  Current smoking among young adolescents: assessing school based contextual norms 
Tobacco Control  2004;13(3):301-307.
Objective: To extend research on the relation of school based contextual norms to current smoking among adolescents by using three analytic techniques to test for contextual effects. It was hypothesised that significant contextual effects would be found in all three models, but that the strength of these effects would vary by the statistical rigor of the model.
Design: Three separate analytic approaches were conducted on baseline self report student survey data from a larger study to test the relation between school level perceived peer tobacco use and individual current smoking status.
Participants: A representative sample of 5399 sixth through eighth grade students in 14 midwestern middle schools completed the survey. All enrolled sixth through eighth grade students were eligible to participate in the survey. The student participation rate was 91.4% for the entire sample, and did not differ significantly between the schools (range 82–100%).
Main outcome measure: Thirty day cigarette smoking prevalence.
Results: A level 2 only model based on aggregated individual responses indicated that students in schools with higher average reported peer tobacco use were more likely to be current smokers than students in schools with lower average peer tobacco use. Using a level 1 only model based on individual responses indicated that the effect of school level perceived peer tobacco use on current smoking was significant when individual perceived peer tobacco use was excluded from the model but was non-significant when individual perceived peer tobacco use was added to the model. A multilevel model also indicated that the effect of school level perceived peer tobacco use on current smoking was not significant when individual perceived peer tobacco use was added to the model.
Conclusion: The analytic approach used to examine contextual effects using individuals' reports of peer tobacco use norms that were aggregated to obtain a context measure of the school norms may produce statistical artefacts that distort the association of the school context in general, and peer tobacco use norms in particular, with increased risk for current smoking beyond the risk associated with individual factors.
PMCID: PMC1747892  PMID: 15333888
2.  Engaging Parents in the Family Check-Up in Middle School: Longitudinal Effects on Family Conflict and Problem Behavior Through the High School Transition 
The Journal of Adolescent Health  2012;50(6):627-633.
Adolescence is a time of significant developmental change. During this period, levels of problem behavior that had been relatively innocuous may escalate in the company of peers, with simultaneous reductions in parental monitoring and involvement. In this article we report the results of a randomized controlled trial of the Family Check-Up (FCU), a family-centered, school-based intervention designed to forestall the escalation of adolescent problem behavior by promoting and motivating skillful parenting through the transition to high school.
In this study, 593 ethnically diverse families were randomized to be offered the FCU when their youth was in seventh and eighth grades of middle school. We used complier average causal effect (CACE) analysis to examine change in family conflict, antisocial behavior, involvement with deviant peers, and alcohol use from sixth through ninth grades.
Analyses revealed that when compared with a matched control group, youths whose parents had engaged in the FCU demonstrated significantly lower rates of growth in family conflict (P = .052), antisocial behavior, involvement with deviant peers, and alcohol use.
Our results extend current research on the FCU and provide support for theory linking family conflict with a variety of youth problem behavior. These results, and the extant research on the FCU, suggest that traditional school-based service delivery models that focus on the individual child may benefit from a shift in perspective to engage parents and families.
PMCID: PMC3360879  PMID: 22626491
family conflict; peer group; adolescent behavior; alcohol consumption; prevention
3.  Adolescent Bullying Involvement and Perceived Family, Peer and School Relations: Commonalities and Differences Across Race/Ethnicity 
Although bullying is recognized as a serious problem in the U.S., little is known about racial/ethnic differences in bullying risk. This study examined associations between bullying and family, peer, and school relations for White, Black and Hispanic adolescents.
A nationally-representative sample (n=11,033) of adolescents in grades six to ten participated in the 2001 Health Behaviors in School-Aged Children survey, self-reporting bullying involvement and information on family, peer and school relations. Descriptive statistics and multinomial logistic regression analyses controlling for gender, age and affluence were stratified by race/ethnicity.
Nine percent of respondents were victims of bullying, 9% were bullies, and 3% were bully-victims. Black adolescents reported a significantly lower prevalence of victimization than White and Hispanic students. Multivariate results indicated modest racial/ethnic variation in associations between bullying and family, peer and school factors. Parental communication, social isolation, and classmate relationships were similarly related to bullying across racial/ethnic groups. Living with two biological parents was protective against bullying involvement for White students only. Further, although school satisfaction and performance were negatively associated with bullying involvement for White and Hispanic students, school factors were largely unrelated to bullying among Black students.
Although school attachment and performance were inconsistently related to bullying behavior across race/ethnicity, bullying behaviors are consistently related to peer relationships across Black, White and Hispanic adolescents. Negative associations between family communication and bullying behaviors for White, Black and Hispanic adolescents suggest the importance of addressing family interactions in future bullying prevention efforts.
PMCID: PMC1989108  PMID: 17707299
4.  Deviating From the Norm: Body Mass Index (BMI) Differences and Psychosocial Adjustment Among Early Adolescent Girls 
Journal of Pediatric Psychology  2012;38(4):376-386.
Objective To examine whether deviation from one’s ethnic group norm on body mass index (BMI) was related to psychosocial maladjustment among early adolescent girls, and whether specific ethnic groups were more vulnerable to maladjustment. Methods Hierarchical regression analyses were conducted on self- and peer-report measures from an ethnically diverse sample of sixth-grade girls (N = 2,636). Results African Americans and Latinas had a higher mean BMI than Asians and Whites. As deviation from their ethnic group BMI norm increased, girls reported greater social anxiety, depression, peer victimization, and lower self-worth, and had lower peer-reported social status. Associations were specific to girls deviating toward obesity status. Ethnic differences revealed that Asian girls deviating toward obesity status were particularly vulnerable to internalizing symptoms. Conclusions Emotional maladjustment may be more severe among overweight/obese girls whose ethnic group BMI norm is furthest away from overweight/obesity status. Implications for obesity work with ethnically diverse adolescents were discussed.
PMCID: PMC3633251  PMID: 23248348
early adolescence; ethnic differences; group norm; obesity; psychosocial adjustment; social status
5.  Adolescents’ Conformity to Their Peers’ Pro-Alcohol and Anti-Alcohol Norms: The Power of Popularity 
Research on adolescent development suggests that peer influence may play a key role in explaining adolescents’ willingness to drink, an important predictor of drinking initiation. However, experiments that thoroughly examine these peer influence effects are scarce. This study experimentally examined whether adolescents adapted their willingness to drink when confronted with the pro-alcohol and anti-alcohol norms of peers in a chat room session and whether these effects were moderated by the social status of peers.
We collected survey data on drinking behavior, social status, and willingness to drink among five hundred thirty-two 14- to 15-year-olds. Of this sample, 74 boys participated in a simulated Internet chat room session in which participants were confronted with preprogrammed pro-alcohol or anti-alcohol norms of “grade-mates” which were in fact preprogrammed e-confederates. Accordingly, we tested whether participants adapted their willingness to drink to the norms of these grade-mates. To test whether adaptations in participants’ willingness to drink would depend on grade-mates’ social status, we manipulated their level of popularity.
The results indicated that adolescents adapted their willingness to drink substantially to the pro-alcohol (i.e., more willing to drink) as well as anti-alcohol (i.e., less willing to drink) norms of these peers. Adolescents were more influenced by high-status than low-status peers. Interestingly, the anti-alcohol norms of the popular peers seemed most influential in that adolescents were less willing to drink when they were confronted with the anti-alcohol norms of popular peers. Additionally, the adolescents internalized these anti-alcohol norms.
This study gives more insight into peer influence processes that encourage or discourage alcohol use. These results could be fundamental for the development of prevention and intervention programs to reduce alcohol use among the adolescents.
PMCID: PMC3666104  PMID: 22509937
Peer Influence; Drinking Norms; Adolescents; Popularity
6.  Moderation of the Association between Media Exposure and Youth Smoking Onset: Race/Ethnicity, and Parent Smoking 
Prevention Science  2012;13(1):55-63.
This study of youth smoking onset aims to replicate previously published media moderation effects for race/ethnicity in a national longitudinal multiethnic sample of U.S. adolescents. Previous research has demonstrated that associations between media and smoking during adolescence are greater for Whites than Hispanics or Blacks, and for youth living in non-smoking families. In this study, changes in smoking status over 24 months were assessed among 4,511 baseline never-smokers. The incidence of smoking onset was 14.3% by 24 months with no differences by race/ethnicity. Blacks had higher exposure to movie smoking and overall television viewing compared with Whites and Hispanics. Whites responded to movie smoking regardless of parent smoking but more strongly if their parents were non-smokers. In contrast, Black adolescents showed little behavioral response to any media, regardless of parent smoking. Hispanic adolescents responded only to TV viewing and only when their parents did not smoke. In an analysis assessing the influence of the race of smoking characters on smoking behavior of White and Black adolescents, Whites responded to both White and Black movie character smoking, whereas Blacks responded only to smoking by Black movie characters. Taken as a whole, the findings replicate and extend previous findings, suggesting media factors are more influential among adolescents at low to moderate overall risk for smoking. We draw analogies between these low-moderate risk adolescents and “swing voters” in national elections, suggesting that media effects are more apt to influence an adolescent in the middle of the risk spectrum, compared with his peers at either end of it.
PMCID: PMC3284682  PMID: 21901429
Smoking initiation; Media exposure; Adolescent behavior; Racial differences
7.  Moderation of the Association between Media Exposure and Youth Smoking Onset: Race/Ethnicity, and Parent Smoking 
Prevention Science  2011;13(1):55-63.
This study of youth smoking onset aims to replicate previously published media moderation effects for race/ethnicity in a national longitudinal multiethnic sample of U.S. adolescents. Previous research has demonstrated that associations between media and smoking during adolescence are greater for Whites than Hispanics or Blacks, and for youth living in non-smoking families. In this study, changes in smoking status over 24 months were assessed among 4,511 baseline never-smokers. The incidence of smoking onset was 14.3% by 24 months with no differences by race/ethnicity. Blacks had higher exposure to movie smoking and overall television viewing compared with Whites and Hispanics. Whites responded to movie smoking regardless of parent smoking but more strongly if their parents were non-smokers. In contrast, Black adolescents showed little behavioral response to any media, regardless of parent smoking. Hispanic adolescents responded only to TV viewing and only when their parents did not smoke. In an analysis assessing the influence of the race of smoking characters on smoking behavior of White and Black adolescents, Whites responded to both White and Black movie character smoking, whereas Blacks responded only to smoking by Black movie characters. Taken as a whole, the findings replicate and extend previous findings, suggesting media factors are more influential among adolescents at low to moderate overall risk for smoking. We draw analogies between these low-moderate risk adolescents and “swing voters” in national elections, suggesting that media effects are more apt to influence an adolescent in the middle of the risk spectrum, compared with his peers at either end of it.
Electronic supplementary material
The online version of this article (doi:10.1007/s11121-011-0244-3) contains supplementary material, which is available to authorized users.
PMCID: PMC3284682  PMID: 21901429
Smoking initiation; Media exposure; Adolescent behavior; Racial differences
8.  Concurrent multiple health risk behaviors among adolescents in Luangnamtha province, Lao PDR 
BMC Public Health  2011;11:36.
Multiple health risk behaviors (HRBs) among adolescents pose a threat to their health, including HIV/AIDS. Health risk behaviors such as alcohol use, smoking, substance use, and sexual risk behaviors among youth have been shown to co-occur with each others. The objectives of this study was to estimate the prevalence of single and concurrent health risk behaviors and to explore how health risk behavior is associated with socio-demographic factors and peers' behaviors.
A cross sectional design was used to examine health risk behaviors of adolescents between the age 14 and 19 years living in the Luangnamtha province, Lao PDR. The study was conducted between June and August, 2008. An ordinal logistic regression model that simultaneously explored demographic factors and the influence of the behavior of peers on three categories of multiple HRBs (no risk, one risk, and two or more health risk behaviors) was performed.
A total of 1360 respondents, 669 (49.1%) boys with mean age 16.7 ± 1.6 and 699 (50.9%) girls aged 16.1 ± 1.5 were recruited into the study. The majority reported two or fewer risk behaviors. However, multiple risk behaviors increased with age for both sexes. About 46.8% (n = 637) reported no risk, 39.3 percent (n = 535) reported one risk, 8.1 percent (n = 110) reported two risks, and 5.8 percent reported more than two health risk behaviors.
The protective factors among boys were school attendance (OR = .53, CI = .33-.86), being Hmong and Yao ethnicity (OR = .48, CI-.26-.90), while being above the age of 15 (OR = 2.20, 95% CI = 1.33-3.60), Akha ethnicity (OR = 2.20, 95% CI = 1.04-4.61), peer's smoking (OR = 3.11, 95% CI = 2.1-4.6), and peer's drinking alcohol (OR = 1.88, 95% CI = 1.1-3.21) were significantly associated with the presence of multiple risk behaviors among boys.
Having some education (OR = 0.17, 95% CI = 0.06-0.45), and being of Hmong and Yao ethnicity (OR = 0.38, 95% CI = 0.18-0.80) were factors that protected girls from multiple risk behaviors; while peer's drinking alcohol (OR = 2.55, 95% CI = 1.59-4.09) and peer's being sexually active (OR = 2.82, 95% CI = 1.65-4.8) were significantly associated with the presence of multiple risk behaviors among girls.
There are sex, age and ethnic differences in the concurrent health risk behaviors. The influencing factors are adolescent's education and peer influence. Interventions should focus to encourage adolescents to complete the compulsory primary education as well as help them to establish friendships and follow peers with good behavior. Risk reduction messages need to take account of diverse multiple HRBs within the specific socio-cultural and gender specific context and target vulnerable adolescents such as ethnic minorities and less educated adolescents.
PMCID: PMC3031220  PMID: 21232108
9.  Growth in Alcohol Use in At-Risk Adolescent Boys: Two-Part Random Effects Prediction Models 
Drug and alcohol dependence  2009;105(1-2):109-117.
Alcohol use frequently onsets and shows rapid growth during the adolescent years, but few studies have examined growth in two indicators, namely in use and in volume given use, with prediction from key risk factors measured across the adolescent years.
Based on a dynamic developmental systems framework, we predicted that the general risk pathway associated with the development of antisocial behavior (namely poor parental practices and antisocial behavior/deviant peer association) would be associated with both indicators of use in Grade 6. Specific proximal social influences, namely alcohol use by parents and peers, were also hypothesized, with growth in peer use of alcohol expected to be predictive of growth. Predictors were assessed by youth, parent, and teacher reports, with alcohol use and volume assessed yearly by youth self-reports. Models were tested separately for the 3-year middle school period and the 4-year high school period. Hypotheses were tested for the Oregon Youth Study sample of approximately 200 at-risk boys.
Findings indicated that alcohol use by both parents and peers were associated with initial levels of alcohol use and volume, but increases in peer use predicted growth in these indicators. Parental monitoring showed a protective effect on growth in volume in high school.
Alcohol use by members of the adolescent’s social network is critical to initiation of use, and peer use is critical to growth. With these predictors specific to alcohol use in the model, none of the general risk factors for antisocial behavior were significant.
PMCID: PMC2752270  PMID: 19625141
alcohol growth; adolescence; monitoring; antisocial behavior; parent alcohol use; peer alcohol use
10.  Peer Standing and Substance Use in Early-Adolescent Grade-Level Networks: A Short-Term Longitudinal Study 
Two competing hypotheses were tested concerning the associations between current alcohol and cigarette use and measures of individual, group and network peer standing in an ethnically-diverse sample of 156 male and female adolescents sampled at two time points in the seventh grade. Findings lent greater support to the person hypothesis, with early regular substance users enjoying elevated standing amongst their peers and maintaining this standing regardless of their maintenance of or desistance from current use later in the school year. In the fall semester, users (n=20, 13%) had greater social impact, were described by their peers as more popular, and were more central to the peer network than abstainers (i.e., those who did not report current use).
Conversely, in the spring semester, there were no differences between users (n=22, 13%) and abstainers in peer ratings of popularity or social impact. Notably, the spring semester users group retained fewer than half of the users from the fall semester. Further, students who had reported current use in the fall, as a group, retained their positions of elevated peer standing in the spring, compared to all other students, and continued to be rated by their peers as more popular and as having greater social impact.
We discuss the findings in terms of the benefit of employing simultaneous systemic and individual measures of peer standing or group prominence, which in the case of peer-based prevention programs, can help clarify the truly influential from the “pretenders” in the case of diffusion of risk-related behaviors.
PMCID: PMC2789699  PMID: 17013672
Early adolescents; Substance use; Peer standing; Social networks
11.  Temporal Associations of Popularity and Alcohol Use Among Middle School Students 
The goal of this study is to better understand the longitudinal cross-lagged associations between popularity, assessed through self-rating and peer nominations, and alcohol use among middle school students.
The analytic sample is 1,835 6th–8th grade students who were initially recruited from three California middle schools and surveyed in the fall and spring semesters of two academic years. Students reported on their background characteristics, past month alcohol use, and perceived popularity. Additionally, students provided school-based friendship nominations, which were used to calculate peer-nominated popularity. A cross-lagged regression approach within a structural equation modeling framework was used to examine the longitudinal relationship between popularity (self-rated and peer-nominated) and alcohol use.
There was a statistically significant (p = 0.024) association between peer-nominated popularity and the probability of alcohol consumption at the subsequent survey, but not vice versa. Our results suggest that in a scenario where 8% of students are past month drinkers, each increase of 5 friendship nominations is associated with a 30% greater risk of being a current drinker at the next wave. We found no evidence of longitudinal associations between past month alcohol consumption and self-rated popularity.
Popularity is a risk factor for drinking during the middle school years, with peer-nominated popularity being more predictive of use than self-perceptions of popularity. To inform alcohol prevention efforts for middle school students, additional research is needed to better understand why adolescents with a larger number of school-based friendship ties are more inclined to drink.
PMCID: PMC3533252  PMID: 23260843
popularity; adolescent; longitudinal; alcohol; middle school; cross-lagged
12.  Alcohol-Related Sexual Assault Victimization Among Adolescents: Prevalence, Characteristics, and Correlates* 
The purpose of this study was to document the prevalence and describe the characteristics of alcohol-related sexual assault among middle and high school students.
A Web-based, self-administered survey was used to collect data on 7th- through 12th-grade students (n = 1,037) in a large metropolitan area in the Midwest. A modified version of the Sexual Experiences Survey was used to ask students about their sexual victimization experiences so as to examine the involvement of alcohol within specific assault events. The sample was equally distributed by biological gender and ethnicity (white vs black) and was, on average (SD), 14 (2) years of age.
Findings from the study indicate that alcohol was involved in approximately 12%–20% of the assault cases, depending on age and gender of the respondent. For females, the presence of alcohol during assault differed significantly based on the location at which the assault occurred, ranging from 6% (at the survivor’s home) to 29% (at parties or someone else’s home). Furthermore, alcohol-related assault among females was more likely to involve physical force than non-alcohol-related assault.
Results are discussed in light of the risk factors of alcohol-related assault among adolescents as well as the nature of social contexts that fosters alcohol-related sexual assault among both adolescents and college students.
PMCID: PMC2713994  PMID: 18080063
13.  Adult Consequences of Late Adolescent Alcohol Consumption: A Systematic Review of Cohort Studies 
PLoS Medicine  2011;8(2):e1000413.
In a systematic review of cohort studies of adolescent drinking and later outcomes, Jim McCambridge and colleagues show that although studies suggest links to worse adult physical and mental health and social consequences, existing evidence is of poor quality.
Although important to public policy, there have been no rigorous evidence syntheses of the long-term consequences of late adolescent drinking.
Methods and Findings
This systematic review summarises evidence from general population cohort studies of drinking between 15–19 years old and any subsequent outcomes aged 20 or greater, with at least 3 years of follow-up study. Fifty-four studies were included, of which 35 were assessed to be vulnerable to bias and/or confounding. The principal findings are: (1) There is consistent evidence that higher alcohol consumption in late adolescence continues into adulthood and is also associated with alcohol problems including dependence; (2) Although a number of studies suggest links to adult physical and mental health and social consequences, existing evidence is of insufficient quality to warrant causal inferences at this stage.
There is an urgent need for high quality long-term prospective cohort studies in order to better understand the public health burden that is consequent on late adolescent drinking, both in relation to adult drinking and more broadly. Reducing drinking during late adolescence is likely to be important for preventing long-term adverse consequences as well as protecting against more immediate harms.
Please see later in the article for the Editors' Summary
Editors' Summary
The effects of alcohol intoxication (drunkenness), dependence (habitual, compulsive, and long-term drinking), and the associated biochemical changes, have wide-ranging health and social consequences, some of which can be lethal. Worldwide, alcohol causes 2.5 million deaths (3.8% of total) and 69.4 million (4.5% of total) of disability-adjusted life years (DALYs). Unintentional injuries alone account for about one-third of the 2.5 million deaths, whereas neuro-psychiatric conditions account for almost 40%. There is also a causal relationship between alcohol consumption and more than 60 types of disease and injury; worldwide, alcohol is estimated to cause about 20%–30% cases of esophageal cancer, liver cancer, cirrhosis of the liver, homicide, epilepsy, and motor vehicle crashes. There is increasing evidence that, in addition to the volume of alcohol consumed, the pattern of drinking has an effect on health outcomes, with binge drinking found to be particularly harmful. As the majority of people who binge drink are teenagers, this group may be particularly vulnerable to the damaging health effects of alcohol, leading to global concern about the drinking trends and patterns among young people.
Why Was This Study Done?
Although there have been many published cohort studies reporting the longer term harms associated with adolescent drinking, the strength of this evidence remains unclear, which has implications for the objectives of interventions. For example, if adolescent drinking does not cause later difficulties, early intervention on, and management of, the acute consequences of alcohol consumption, such as antisocial behaviour and unintentional injuries, may be the most appropriate community safety and public health responses. However, if there is a causal relationship, there needs to be an additional approach that addresses the cumulative harmful effects of alcohol. The researchers conducted this systematic review of cohort studies, as this method provides the strongest observational study design to evaluate evidence of causality.
What Did the Researchers Do and Find?
The researchers conducted a comprehensive literature review to identify relevant studies that met their inclusion criteria, which were: (1) data collection from at least two points in time, at least 3 years apart, from the same cohort; (2) data collection regarding alcohol consumption between the ages of 15 and 19 years old; and (3) inclusion of a report of at least one quantitative measure of effect, such as an odds ratio, between alcohol involvement and any later outcome assessed at age 20 or greater. The majority of these studies were multiple reports from ten cohorts and approximately half were from the US. The researchers then evaluated the strength of causal inference possible in these studies by assessing whether all possible contributing factors(confounders) had been taken into account, identifying studies that had follow-up rates of 80% or greater, and which had sample sizes of 1,000 participants or more.
Using these methods, the researchers found that, overall, there is consistent evidence that higher alcohol consumption in late adolescence continues into adulthood and is also associated with alcohol problems, including dependence. For example, one population-based cohort showed that late adolescent drinking can cause early death among men, mainly through car crashes and suicides, and there was a large evidence base supporting the ongoing impacts of late adolescent drinking on adult drinking behaviours—although most of these studies could not strongly support causal inferences because of their weak designs. The researchers also concluded that although a number of studies suggested links with late adolescent drinking to adult physical and mental health and social consequences, this evidence is generally of poor quality and insufficient to infer causality.
What Do These Findings Mean?
The results of this study show that that the evidence-base on the long-term consequences of late adolescent drinking is not as extensive or compelling as it needs to be. The researchers stress that there is an urgent need for high quality long-term prospective cohort studies in order to better understand the public health burden associated with adolescent drinking in general and in relation to adult drinking. However, there is sufficient evidence to suggest that reducing drinking during late adolescence is likely to be important for preventing long-term adverse consequences as well as protecting against more immediate harmful consequences harms.
Additional Information
Please access these Web sites via the online version of this summary at
The World Health Organization has information about the global incidence of alcohol consumption
The US-based Marin Institute has information about alcohol and young people
The BBC also has a site on late adolescent drinking
PMCID: PMC3035611  PMID: 21346802
14.  Driving after Drinking among Young Adults of Different Race/Ethnicities in the United States: Unique Risk Factors in Early Adolescence? 
National guidelines for alcohol screening and brief interventions advise practitioners to consider age, drinking frequency, and context to identify at-risk youth. The purpose of this study was to identify the contextual risk and protective factors in high school-aged adolescents associated with future driving after drinking (DUI at age 21) by race/ethnicity.
Data included 10,271 adolescents (67% White, 12% Hispanic, 16% Black, 3.6% Asian; 49% Male) who participated in the National Longitudinal Study of Adolescent Health (Waves I, II, and III) from 1995 to 2001. A lagged panel design and survey logistic regression was used to examine the association between multiple contextual factors (e.g. demographics, parents, peers, social context) during adolescence and self-reported DUI in young adulthood.
As expected, the likelihood of DUI was higher among Whites followed by Hispanics, Asians, and Blacks in all models. Perception of easy home access to alcohol increased risk for future DUI for Whites (OR: 1.25 CI: 1.04–1.49), Hispanics (OR: 2.02 CI: 1.29–3.16), and Asians (OR: 1.90 CI: 1.13–3.22), but not for Black youth. Drinking frequency and prior DUI were not risk factors for Hispanics. Risk-taking attitudes, marijuana use, and religious affiliation were risk factors for Whites only.
Findings suggest that in addition to screening for drinking behaviors, brief interventions and prevention efforts should assess perceived home access to alcohol and other race-specific factors to reduce alcohol-related injuries and harm.
PMCID: PMC3634100  PMID: 23608720
Drunk driving; alcohol; race/ethnicity; home access
15.  Peer selection and influence effects on adolescent alcohol use: a stochastic actor-based model 
BMC Pediatrics  2012;12:115.
Early adolescent alcohol use is a major public health challenge. Without clear guidance on the causal pathways between peers and alcohol use, adolescent alcohol interventions may be incomplete. The objective of this study is to disentangle selection and influence effects associated with the dynamic interplay of adolescent friendships and alcohol use.
The study analyzes data from Add Health, a longitudinal survey of seventh through eleventh grade U.S. students enrolled between 1995 and 1996. A stochastic actor-based model is used to model the co-evolution of alcohol use and friendship connections.
Selection effects play a significant role in the creation of peer clusters with similar alcohol use. Friendship nominations between two students who shared the same alcohol use frequency were 3.60 (95% CI: 2.01-9.62) times more likely than between otherwise identical students with differing alcohol use frequency. The model controlled for alternative pathways to friendship nomination including reciprocity, transitivity, and similarities in age, gender, and race/ethnicity. The simulation model did not support a significant friends’ influence effect on alcohol behavior.
The findings suggest that peer selection plays a major role in alcohol use behavior among adolescent friends. Our simulation results would lend themselves to adolescent alcohol abuse interventions that leverage adolescent social network characteristics.
PMCID: PMC3469361  PMID: 22867027
16.  Emotion regulation and internalizing symptoms in a longitudinal study of sexual minority and heterosexual adolescents 
Sexual minority adolescents appear to be at increased risk for internalizing disorders relative to their heterosexual peers, but there is a paucity of research explaining this elevated risk. Emotion regulation deficits are increasingly understood as important predictors of internalizing psychopathology among general samples of adolescents. The present study sought to examine whether deficits in emotion regulation could account for disparities in internalizing symptoms between sexual minority and heterosexual adolescents.
The present study utilized longitudinal data from a racially/ethnically diverse (68% non-Hispanic Black and Hispanic/Latino) community sample of 1,071 middle school students (ages 11–14).
Adolescents who endorsed same-sex attraction evidenced higher rates of internalizing symptoms at both time points. Structural equation modeling indicated that sexual minority adolescents exhibited greater deficits in emotion regulation (rumination and poor emotional awareness) than their heterosexual peers. Emotion regulation deficits in turn mediated the relationship between sexual minority status and symptoms of depression and anxiety.
The results demonstrate the importance of considering normative psychological processes in the development of internalizing symptomatology among sexual minority adolescents, and suggest emotion regulation deficits as specific targets of prevention and intervention efforts with this population. Future studies are needed to determine whether stigma-related stressors are responsible for emotion regulation deficits among sexual minority youth.
PMCID: PMC2881586  PMID: 18564066
Depression; anxiety; emotion regulation; sexual minority youth
17.  Psychosocial factors associated with smoking and drinking among Japanese early adolescent boys and girls: Cross-sectional study 
Smoking and drinking alcohol among early adolescents are serious public health concerns, but few studies have been conducted in Japan to assess their prevalence and etiology. A regional survey was conducted in eight schools in two Japanese school districts to identify psychosocial factors associated with smoking and drinking behaviors for boys and girls.
Junior high school students from seventh to ninth grades (N = 2,923) completed a self-reported questionnaire between December 2002 and March 2003. Relationships between psychosocial variables (i.e., self-assertive efficacy to resist peer pressure, parental involvement, school adjustment, and deviant peer influence) and smoking and drinking were investigated using logistic regression analyses and path analyses.
Smoking in the last six months was significantly more prevalent in boys (7.9%) than girls (5.1%). The prevalence of drinking in the last six months was similar in boys (23.7%) and girls (21.8%). Self-efficacy to resist peer pressure was negatively associated with both smoking and drinking among both boys and girls and provided both direct and indirect effects through deviant peer influence. Parental involvement showed indirect effects through school adjustment and/or deviant peer influence to both smoking among both boys and girls and drinking among girls, although parental involvement showed direct effects on smoking only for boys. School adjustment was negatively associated with smoking among both boys and girls and drinking among girls.
These findings suggest that self-assertive efficacy to resist peer pressure, parental involvement, school adjustment and deviant peer influence are potentially important factors that could be addressed by programs to prevent smoking and/or drinking among early adolescent boys and girls in Japan.
PMCID: PMC1934913  PMID: 17610717
18.  Is relatively young age within a school year a risk factor for mental health problems and poor school performance? A population-based cross-sectional study of adolescents in Oslo, Norway 
BMC Public Health  2005;5:102.
Several studies have shown that children who are relatively young within a school year are at greater risk for poorer school performance compared with their older peers. One study also reported that relative age within a school year is an independent risk factor for emotional and behavioral problems. The objective of this study was to test the hypothesis that relatively younger adolescents in the multiethnic population of Oslo have poorer school performance and more mental health problems than their relatively older classmates within the same school year.
This population-based cross-sectional study included all 10th-grade pupils enrolled in 2000 and 2001 in the city of Oslo. The participation rate was 88%. Of the 6,752 pupils in the study sample, 25% had a non-Norwegian background. Mental health problems were quantified using the abbreviated versions of Symptom Check List-25 (SCL-10) and the Strength and Difficulties Questionnaire (SDQ). Information on school performances and mental health problems were self-reported. We controlled for confounding factors including parental educational level, social support, gender, and ethnicity.
The youngest one-third of pupils had significantly lower average school grades than the middle one-third and oldest one-third of their classmates (p < 0.001). Of the mental health problems identified in the questionnaires, the groups differed only on peer problems; the youngest one-third reported significantly more problems than the middle and oldest groups (p < 0.05). Age within a school year and gender showed significant interactions with total SDQ score, SDQ peer problems score, SDQ pro social score, and SCL-10 score. After stratifying for gender, the peer problem scores differed significantly between age groups only among boys. The SCL-10 score was significant, but only in girls and in the opposite direction to that expected, with the oldest pupils having significantly higher scores than the other two groups (p < 0.05).
In adolescents from a multicultural city in Norway, relative age within a school year significantly influenced academic performance. In contrast to data from Great Britain, relative age within a school year was not an important risk factor for mental health problems in adolescents in Oslo.
PMCID: PMC1260023  PMID: 16207379
19.  Physical Activity and Sedentary Behavior in an Ethnically Diverse Group of South African School Children 
Few studies have examined physical activity and inactivity levels in an urban South African setting across 12 years of formal schooling. This information is important for implementing strategies to curb increasing trends of physical inactivity and related negative consequences, especially in low to middle income countries facing multiple challenges on overburdened health care systems. We examined levels of physical activity and sedentary behaviour cross-sectionally over 12 school years from childhood to adolescence in Black, White and Indian boys and girls. The aim of our study was to describe gender and race related patterns of physical and sedentary activity levels in a sample of South African children and to determine whether there were associations between these variables and body mass status. Physical activity questionnaires, previously validated in a South African setting, were used to gather information about activity and sedentary behaviours among 767 Black, White and Indian children (5-18 years of age) across the 12 grades of formal schooling. Body mass and height were also measured. Time spent in moderate-vigorous physical activity declined over the school years for all race groups and was consistently lower for girls than boys (p = 0.03), while time spent in sedentary activity increased with increasing grade (p < 0.001) for boys and girls and across all race groups. Associations between physical activity and body mass were observed for White children (r = -0.22, p < 0.001), but not for Black and Indian children (p > 0.05) whereas time spent in sedentary activities was significantly and positively correlated with body mass across all race groups: Indian (r = 0.25, p < 0.001), White (r = 0.22, p < 0.001) and Black (r = 0.37, p = 0.001). The strength of the associations was similar for boys and girls. Black and Indian children were less physically active than their white peers (p < 0.05), and Black children also spent more time in sedentary activity (p < 0.05). Additionally, Black children had the highest proportion of overweight participants (30%), and Indian children the most number of underweight children (13%). Regardless of ethnicity, children who spent more than 4 hours per day in front of a screen were approximately twice as likely to be overweight (OR, 1.96 [95%CI: 1.06-3.64, p = 0.03]). Regardless of race, inactivity levels are related to body mass. Ethnic and gender disparities exist in physical activity and sedentary activity levels and this may echo a mix of biological and cultural reasons.
Key pointsRegardless of race, inactivity levels are related to body mass.In an ethnically diverse urban group of South African school children, there exists an age related decline in physical activity and increase in time spent in front of a screen.Ethnic and gender disparities exist in physical activity and sedentary activity levels and this may echo a mix of biological and cultural reasons.
PMCID: PMC3990892  PMID: 24790492
South African children; ethnicity; screen time; physical activity
20.  Effects of Parenting and Deviant Peers on Early to Mid-Adolescent Conduct Problems 
Journal of abnormal child psychology  2012;40(8):1249-1264.
We investigated the influence of effective parenting behaviors (father and mother reports) and deviant peer association (adolescent reports) on subsequent young adolescent conduct problems (teacher reports) during grades 7–9, using structural equation modeling. Data were from a sample of 226 rural adolescents (n=112 boys; n=107 girls; n=7 gender unknown), their parents, and teachers. Both effective parenting and association with deviant peers influenced later conduct problems; however, the pattern of influence varied across time and between fathers and mothers, with complex patterns of interactions between effective parenting and peer deviance. From seventh to eighth grade, effective parenting by both mothers and fathers buffered the effect of higher levels of peer deviance on conduct problems across adolescent gender. From eighth to ninth grade (i.e., transition into high school), fathers’ effective parenting buffered the effects of deviant peer association on their daughters’ conduct problems, whereas both fathers’ and mothers’ influence was stronger for sons when deviant peer associations were lower. Analyses also evaluated bi-directional longitudinal effects among adolescents, parents, and peers. Although varying by parent and adolescent gender or adolescent age, results generally supported the protective effects of parenting on their children’s conduct problems during early to mid adolescence.
PMCID: PMC3740509  PMID: 22648200
Effective parenting; peer deviance; adolescent conduct problems; buffering effects; bi-directional effects
21.  Exploring the Effects of Age of Alcohol Use Initiation and Psychosocial Risk Factors on Subsequent Alcohol Misuse* 
Journal of studies on alcohol  1997;58(3):280-290.
This study examines whether the age of initiation of alcohol use mediates the effects of other variables that predict alcohol misuse among adolescents and also whether the age of initiation of alcohol use accounts for known gender differences in the severity of alcohol misuse.
Data were taken from an ethnically diverse sample of 808 (412 male) students who were recruited in grade 5 at age 10–11 and followed prospectively on an annual basis for the next 7 years to age 17–18. State-of-the-art missing data methodology was used to address nonresponse due to noninitiation of alcohol use. Structural equation modeling was used to examine hypotheses for the prediction of alcohol misuse.
A younger age of alcohol initiation was strongly related to a higher level of alcohol misuse at age 17–18 and fully mediated the effects of parent drinking, proactive parenting, school bonding, peer alcohol initiation and ethnicity, all measured at age 10–11, and perceived harmfulness of alcohol use, measured at age 10–11 and age 11–12. However, age of alcohol initiation did not fully account for gender differences in the level of alcohol misuse at age 17–18. To further examine the role of gender, interactions between gender and school bonding, and gender and friend's alcohol initiation, were evaluated. However, neither of the interaction terms had direct effects on either age of initiation or level of alcohol-related problems.
Most measured risk factors for alcohol misuse were mediated through age of alcohol initiation. Only gender differences in alcohol misuse at age 17–18 were not mediated by age of alcohol initiation. Variables associated with these differences require further study. The results of this study indicate the importance of prevention strategies to delay the age of initiation of alcohol use.
PMCID: PMC1894758  PMID: 9130220
22.  Racism, ethnic density and psychological well-being through adolescence: evidence from the Determinants of Adolescent Social well-being and Health longitudinal study 
Ethnicity & Health  2012;17(1-2):71-87.
Objective. To investigate the effect of racism, own-group ethnic density, diversity and deprivation on adolescent trajectories in psychological well-being.
Design. Multilevel models were used in longitudinal analysis of psychological well-being (total difficulties score (TDS) from Goodman's Strengths and Difficulties Questionnaire, higher scores correspond to greater difficulties) for 4782 adolescents aged 11–16 years in 51 London (UK) schools. Individual level variables included ethnicity, racism, gender, age, migrant generation, socioeconomic circumstances, family type and indicators of family interactions (shared activities, perceived parenting). Contextual variables were per cent eligible for free school-meals, neighbourhood deprivation, per cent own-group ethnic density, and ethnic diversity.
Results. Ethnic minorities were more likely to report racism than Whites. Ethnic minority boys (except Indian boys) and Indian girls reported better psychological well-being throughout adolescence compared to their White peers. Notably, lowest mean TDS scores were observed for Nigerian/Ghanaian boys, among whom the reporting of racism increased with age. Adjusted for individual characteristics, psychological well-being improved with age across all ethnic groups. Racism was associated with poorer psychological well-being trajectories for all ethnic groups (p <0.001), reducing with age. For example, mean difference in TDS (95% confidence interval) between boys who experienced racism and those who did not at age 12 years = 1.88 (+1.75 to + 2.01); at 16 years = +1.19 (+1.07 to +1.31). Less racism was generally reported in schools and neighbourhoods with high than low own-group density. Own ethnic density and diversity were not consistently associated with TDS for any ethnic group. Living in more deprived neighbourhoods was associated with poorer psychological well-being for Whites and Black Caribbeans (p <0.05).
Conclusion. Racism, but not ethnic density and deprivation in schools or neighbourhoods, was an important influence on psychological well-being. However, exposure to racism did not explain the advantage in psychological well-being of ethnic minority groups over Whites.
PMCID: PMC3379740  PMID: 22332834
psychological well-being; adolescence; racism; deprivation; ethnic density/diversity; neighbourhoods; schools
23.  Staying Cool Across the First Year of Middle School 
Journal of Youth and Adolescence  2010;40(7):776-785.
As students transition into middle school they must successfully negotiate a new, larger peer context to attain or maintain high social standing. The goal of this study was to examine the extent to which the maintenance, attainment, and loss of a cool status over the course of the sixth grade is associated with student and classroom levels of physical, verbal, and relational aggression. To address this goal, we studied a sample of 1985 (55% girls) ethnically diverse adolescents from 99 sixth grade classrooms in the United States. Attaining a cool status at any point across the school year was associated with stronger aggressive reputations. Additionally, classroom norms for aggressive behavior moderated the association between changes in aggression over the school year and the stability of coolness such that students who maintained their coolness across the school year showed greater increases in their verbally aggressive reputations from fall to spring when they were in classrooms with higher levels of aggression. The findings illustrate the importance of fitting in with social norms for maintaining a high social status among a new set of peers in middle school.
PMCID: PMC3111727  PMID: 20842415
Coolness; Popularity; Aggression; Middle school
24.  The face of appearance-related social pressure: gender, age and body mass variations in peer and parental pressure during adolescence 
Appearance-related social pressure plays an important role in the development of a negative body image and self-esteem as well as severe mental disorders during adolescence (e.g. eating disorders, depression). Identifying who is particularly affected by social pressure can improve targeted prevention and intervention, but findings have either been lacking or controversial. Thus the aim of this study is to provide a detailed picture of gender, weight, and age-related variations in the perception of appearance-related social pressure by peers and parents.
1112 German students between grades 7 and 9 (mean age: M = 13.38, SD = .81) filled in the Appearance-Related Social Pressure Questionnaire (German: FASD), which considers different sources (peers, parents) as well as various kinds of social pressure (e.g. teasing, modeling, encouragement).
Girls were more affected by peer pressure, while gender differences in parental pressure seemed negligible. Main effects of grade-level suggested a particular increase in indirect peer pressure (e.g. appearance-related school and class norms) from early to middle adolescence. Boys and girls with higher BMI were particularly affected by peer teasing and exclusion as well as by parental encouragement to control weight and shape.
The results suggest that preventive efforts targeting body concerns and disordered eating should bring up the topic of appearance pressure in a school-based context and should strengthen those adolescents who are particularly at risk - in our study, girls and adolescents with higher weight status. Early adolescence and school transition appear to be crucial periods for these efforts. Moreover, the comprehensive assessment of appearance-related social pressure appears to be a fruitful way to further explore social risk-factors in the development of a negative body image.
PMCID: PMC3662600  PMID: 23680225
Peer pressure; Parental pressure; Adolescence; Gender; Age; BMI
25.  Peer Selection and Socialization in Adolescent Depression: The Role of School Transitions 
Journal of Youth and Adolescence  2011;41(3):320-332.
Previous studies have indicated homophily in internalizing distress among adolescent friends, resulting from both peer selection and socialization processes. However, developmental differences and the role of school transitions in these processes have not been elucidated. A sample of 367 adolescents was followed from 6th to 11th grade to investigate prospective relationships between adolescents' and their friends' depressive symptoms in middle school, during transition to high school, and in high school. Results revealed that students selected friends with similar levels of depressive symptoms after each school transition. Additionally, friends appeared to socialize adolescents to become more similar in depressive affect in late middle school years. These findings suggest normative selection effects following school transitions, followed by socialization effects in middle school, but not high school.
PMCID: PMC3277679  PMID: 22009309
Depression; friendship; peers; internalizing; school transitions

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