Intervening early to reduce developmentally harmful substance use among youth populations

Early-onset or frequent substance use during adolescence increases the risk of developing mental health problems, as well as a range of other adverse outcomes (eg, alcohol or drug dependence, educational underachievement, health problems, social difficulties) during late adolescence and early adulthood.

Increases in rates of risky drinking among young people are particularly concerning, suggesting that an effective, evidence-based alcohol policy and preventive framework needs to be developed.

Restricting the supply of licit and illicit substances to adolescents, delaying the age that licit substances can be legally purchased, reducing positive media portrayals of substance use, and banning targeted promotions, should be universal, public prevention priorities.

Mass-media campaigns need to deliver coherent and credible evidence-based messages to young people, utilising a broad array of dissemination strategies.

Clear policy and guidelines for parents regarding appropriate alcohol use for adolescents also need to be developed.

Prevention programs should target children and adolescents in families with parents who use drugs, young people who have been suspended from school, or those with mental health problems.

Preventive screening and targeted brief interventions can be effectively delivered in a variety of settings by a range of health professionals.

Risk factors for violence and relational aggression in adolescence

Analyses examined risk factors for seventh- and ninth-grade youth  categorized as nonoffenders, physically violent, relationally aggressive, and both violent and relationally aggressive. Bivariate and multivariate results showed that relationally aggressive youth were elevated on most risks above levels for nonoffenders but lower than those for youth who were violent alone or violent in combination with relational aggression. Youth who were both relationally aggressive and violent did not differ from those who were violent alone on most risk factors examined. Peer, individual, and family risks were among the strongest predictors.

The evidence that exercise during growth or adulthood reduces the risk of fragility fractures is weak

There has never been, and will never be, a randomized double-blind placebo-controlled trial demonstrating that exercise in youth, adulthood or old age reduces fragility or osteoporosis-related fractures in old age. The next level of evidence, a randomized, controlled but unblinded study with fractures as an end-point is feasible but has never been done. The basis for the belief that exercise reduces fractures is derived from lower levels of ‘evidence’, namely, retrospective and prospective observation cohort studies and case–control studies. These studies are at best hypothesis generating, never hypothesis testing. They are all subject to many systematic biases and should be interpreted with extreme scepticism. Surrogate measures of anti-fracture efficacy are the next level of evidence, such as the demonstration of a reduction in risk factors for falls, a reduction in falls, a reduction in fractures due to falls, an increase in peak bone size and mass, prevention of bone loss in midlife and restoration of bone mass and structure in old age.

A cross-national comparison of risk and protective factors for adolescent substance use : the United States and Australia

Purpose
To compare risk and protective factors that influence youth substance use in Australia and the United States. The two countries have different policy orientations toward substance use: Australia has adopted harm-reduction policies, and the United States has adopted abstinence-focused polices.

Methods
Cross-sectional survey data were collected from independent samples of adolescents in the states of Maine (N = 16,861; 53% female, 7% Non-white) and Oregon (N = 15,542; 51% female, 24% Non-white) in the United States and Victoria in Australia (N = 8442; 54% Female, 11% Non-white) in 1998 (Maine and Oregon) and 1999 (Victoria). Chi-square tests, t-tests, effect size comparisons, and logistic regression analyses that accounted for age and gender were used to investigate cross-national similarities and differences in: (a) rates of cigarette, alcohol, and marijuana use; (b) levels of risk and protective factors; and (c) magnitudes of associations between risk and protective factors and substance use.

Results
More adolescents in Victoria reported using cigarettes and alcohol, whereas more of the U.S. adolescents reported using marijuana. Exposure to risk and protective factors was generally similar in the cross-national samples. However, adolescents in Maine and Oregon perceived handguns to be more readily available, reported more participation in religious activities, and were higher in sensation-seeking and social skills; and adolescents in Victoria had more favorable attitudes toward drug use and reported community norms and parental attitudes more favorable to drug use. Most of the risk and protective factors were strongly associated with substance use to a similar degree in Victoria, Maine, and Oregon. However, among adolescents in Maine and Oregon peer/individual risk and protective factors associated with social detachment were more strongly related to substance use, and among adolescents in Victoria, family protective factors were less strongly related to alcohol use.

Conclusions
Inter-country influences on youth substance use are generally similar despite different policy directions. Existing differences suggest that the abstinence policy context is associated with higher levels of illicit drug use and stronger relations between individual indicators of social detachment and substance use, whereas the harm reduction policy context is related to more cigarette and alcohol use, possibly from exposure to normative influences that are more tolerant of youth drug use.

Consequences of youth tobacco use: a review of prospective behavioural studies

Background Cigarette smoking represents a significant health problem and tobacco has been identified as causing more preventable diseases and premature deaths than any other drug. Although health consequences from smoking have been documented, there has been a surprising lack of research into behavioural consequences.

Aims To review what is known of the long-term relationship between patterns of tobacco use prior to age 18 years and behavioural consequences in adulthood.

Method A literature search of electronic abstraction services from 1980 to September 2005 was conducted. To be included in the review, studies had to have large, representative samples, be longitudinal studies with baseline age under 18 years and follow-up age 18 years or older and clarify effects due to attrition, leaving 16 articles that met the inclusion criteria. Two reviewers evaluated each paper.

Findings Adolescent tobacco use predicts a range of early adult social and health problems. Surprisingly few studies met the inclusion criteria. The limited evidence available suggests that adolescent tobacco smoking increases the likelihood of early adult tobacco use and the initiation of alcohol use or the development of alcohol-related problems. The link between adolescent tobacco use and subsequent cannabis use was not resolved convincingly from the studies summarized. The effects of tobacco use on later illicit drug use tended to fall away when adjusting for underlying risk factors. Existing studies of the effects of tobacco use on later mental health have many limitations. Nevertheless, a finding that youth tobacco use may predict subsequent mental health problems deserves further investigation. The possible effects of tobacco use on academic/social problems and sleep problems also warrant further investigation.

Conclusion This review highlights links between youth tobacco use and subsequent behavioural and mental health problems. It provides health care professionals with evidence of the possible harmful effects of youth tobacco smoking on later social, emotional, and behavioural well-being.

Risk and protection factors for different intensities of adolescent substance use: when does the prevention paradox apply?

The 'Prevention Paradox' applies when low-risk individuals in a population contribute the most cases of a condition or problem behaviour by virtue of their being in the majority, thereby recommending a universal or whole of population approach to prevention. The applicability of a universal as opposed to a targeted high-risk approach to the prevention of youth substance use was examined in two studies of children and adolescents conducted in Victoria, Australia. These studies were reanalysed by recombining developmental, social and individual measures to form cumulative risk indices for substance use. In Study 1, a cross-sectional survey of students, most regular tobacco, alcohol and cannabis use by 15/16-year-olds occurred in the moderate and low-risk groups, recommending a universal prevention strategy . However, the majority of illicit drug use occurred in the highest-risk group (top 15%). Furthermore, in younger age groups both legal and illegal drug use was concentrated mainly in the highest risk group. Study 2 used data from a major longitudinal study where risk factors at around age 11/12 years were used to predict substance use at age 17/18 years. Most students who admitted involvement in frequent smoking, heavy drinking and, although to a lesser degree, cannabis were classified as low or average risk. It is concluded that universal prevention strategies are needed for late adolescent alcohol, tobacco and cannabis use and more targeted strategies for addressing harm related to early age drug use, frequent cannabis use and illegal drug use. [Stockwell T, Toumbouru JW, Letcher P, Sanson A, Bond L. Risk and protection factors for different intensities of adolescent substance use: when does the prevention paradox apply?

Risky business: health education and the limits of risk discourse

The paper explores the ways in which risk operates as a powerful discourse that shapes what health education teachers said about and what they did in their classroom practices. The paper draws on a qualitative study that seeks to explore the dominant and contesting discourses within health education.

Combating homophobia : preliminary results of a school-based program to reduce discrimination against same-sex attracted youth

Two key determinants of mental health are (a) freedom from discrimination and (b) social connectedness. Same-sex attracted youth who are subjected to violence and discrimination, or who experience homophobia in their everyday lives are at greater risk of mental health problems, including suicidal thoughts and behaviours. As one of the most significant sites of homophobia is the school, a 6-week school-based program designed to help students explore their attitudes to gays and lesbians was developed, called “Pride & Prejudice”. In order to evaluate the usefulness of the program, students’ attitudes were measured before and after their participation. Variables assessed were: beliefs about gender roles, social desirability, attitudes to gay men and lesbians, social connectedness, self-esteem, and attitudes to race. Attitudes towards gay men held by students were significantly more positive after the program, and the level of attendance during the program significantly predicted > this change. A significant positive change also occurred in attitudes towards lesbians. Process evaluation showed that students generally viewed the program positively. From this preliminary data, it can be concluded that school-based programs delivered to individual classes in which students are given the opportunity to explore their attitudes towards lesbians and gay men are likely to lead to a significant reduction in homophobia. Health-promoting schools now have available to them an effective tool for promoting opportunities for students to reflect on their attitudes towards gay men and lesbians, and other aspects of “social diversity”. It is hoped that school-wide implementation of such a program will eventually lead to a reduction in the discrimination same-sex attracted youth often experience (either directly, or indirectly), and improve the social-connectedness of all students.

Are youth mentoring programs good value-for-money? An evaluation of the Big Brothers Big Sisters Melbourne program

Background : The Big Brothers Big Sisters (BBBS) program matches vulnerable young people with a trained, supervised adult volunteer as mentor. The young people are typically seriously disadvantaged, with multiple psychosocial problems.

Methods : Threshold analysis was undertaken to determine whether investment in the program was a worthwhile use of limited public funds. The potential cost savings were based on US estimates of life-time costs associated with high-risk youth who drop out-of-school and become adult criminals. The intervention was modelled for children aged 10–14 years residing in Melbourne in 2004.

Results : If the program serviced 2,208 of the most vulnerable young people, it would cost AUD 39.5 M. Assuming 50% were high-risk, the associated costs of their adult criminality would be AUD 3.3 billion. To break even, the program would need to avert high-risk behaviours in only 1.3% (14/1,104) of participants.

Conclusion : This indicative evaluation suggests that the BBBS program represents excellent 'value for money'.

Dose-response associations between screen time and overweight among youth

Objective. To examine dose-response associations between screen time and overweight, independent of physical activity and dietary intake.

Methods. Participants were 580 Dutch youth (13 years; 48% boys). Body mass index, waist circumference and skinfold thickness at four sites determined weight status. Questionnaires examined television viewing and computer use, participation in organized sport and high caloric snack and sugar-containing beverage consumption.

Results. There were no significant associations among boys. Compared with girls spending less than two hours/day in screen time, those who spent three to four hours/day were more likely to be classified as overweight by waist circumference (odds ratio [OR]=3.4; 95% confidence intervals [CI]=1.1-10.7; p=0.03), and this likelihood increased substantially among those spending more than four hours/day (OR=5.5; 95% CI=2.1-14.1; p≤0.0001).

Conclusions. Girls who spend three or more hours/day in screen time are at increased risk of being classified as overweight by waist circumference.

Modifiable determinants of youth violence in Australia and the United States : a longitudinal study

Youth violence is a global problem. Few studies have examined whrther the prevalence or predictors of youth violence are similar in comparable Western countries like Australia and the United States (US). In the current article, analyses are conducted using two waves of data collected as part of a longitudinal study of adolescent development in approximately 4,000 students aged 12 to 16 years in Victoria, Australia and Washington State, US. Students completed a self-report survey of problem behaviours including violent behaviour, as well as risk and protective factors across five domains (individual, family, peer, school, community). Compared to Washington State, rates of attacking or beating another over the past 12 months were lower in Victoria for females in the first survey and higher for Victorian males in the follow-up survey. Preliminary analyses did not show state-specific predictors of violent behaviour. In the final multivariate analyses of the combined Washington State and Victorian samples, protective factors were being female and student emotion control. Risk factors were prior violent behaviour, family conflict, association with violent peers, community disorganisation, community norms favourable to drug use, school suspensions and arrests. Given the similarity of influential factors in North America and Australia, application of US early intervention and prevention programs may be warranted, with some tailoring to the Australian context.

Influence of family factors and supervised alcohol use on adolescent alcohol use and harms : similarities between youth in different alcohol policy contexts

Objective: Harm-minimization policies suggest that alcohol use is a part of normal adolescent development and that parents should supervise their children's use to encourage responsible drinking. Zero-tolerance policies suggest that all underage alcohol use should be discouraged. This article compared hypotheses derived from harm-minimization and zero-tolerance policies regarding the influence of family context and supervised drinking on adolescent alcohol use and related harms among adolescents in Washington State, USA, and Victoria, Australia. two states that have respectively adopted zero-tolerance and harm-minimization policies.

Method: Representative samples of seventh-grade students (N = 1,945:989 females) were recruited from schools in each state. Students completed comprehensive questionnaires on alcohol use, related problem behaviors, and risk and protective factors annually from 2002 to 2004 when they were in ninth grade.

Results: Relationships between family context and alcohol use and harmful use were very similar in both states. Adult-supervised settings for alcohol use were associated with higher levels of harmful alcohol consequences. Adult-supervised alcohol use mediated the links between favorable parental attitudes to alcohol use and ninth-grade alcohol use for students in both states.

Conclusions: Despite policy differences in the two states, relationships between family context variables and alcohol use and harmful use are remarkably similar. Adult-supervised settings for alcohol use resulted in higher levels of harmful alcohol consequences, contrary to predictions derived from harm-minimization policy. Findings challenge the harm-minimization position that supervised alcohol use or early-age alcohol use will reduce the development of adolescent alcohol problems.

How does perceived risk mediate associations between perceived safety and parental restriction of adolescents' physical activity in their neighborhood?

Background
There is evidence that adolescence is a critical period of decline in physical activity. However, adolescents may have limited opportunities to be physically active outdoors if their parents are concerned about neighborhood safety and restrict their adolescent’s physical activity within their neighborhood. Pathways that lead to parental restriction of adolescents’ physical activity (constrained behavior) are under-researched. This study aimed to examine perceived risk as a potential mediator of associations between perceived safety/victimization and constrained behavior.
Methods
Cross-sectional study of adolescents (43% boys) aged 15–17 years (n = 270) in Melbourne, Australia. Parents reported perceived safety (road safety, incivilities and personal safety) and prior victimization in their neighborhood, perceived risk of their children being harmed and whether they constrained their adolescent’s physical activity. Constrained behavior was categorized as ‘avoidance’ or ‘defensive’ behavior depending on a whether physical activity was avoided or modified, respectively, due to perceived risk. MacKinnon’s product-of-coefficients test of mediation was used to assess potential mediating pathways between perceived safety/victimization and constrained behavior.
Results
For girls only, perceived risk was a significant mediator of associations between perceived road safety and avoidance/defensive behavior, and between perceived incivilities, perceived personal safety, victimization and defensive behavior.
Conclusions
Associations between perceived safety/victimization and constrained behavior are complex. Findings may guide the design of interventions that aim to improve actual and perceived levels of safety and reduce perceptions of risk. This is of particular importance for adolescent girls among whom low and declining levels of physical activity have been observed worldwide.

Youth physical activity and sedentary time and associations with cardiometabolic health

In recent years, there has been increasing interest in the effects of sedentary behaviour on children’s health, defined as sitting behaviours that require low levels of energy expenditure (≤1.5 METs).¹ There is some evidence that sedentary behaviours may be detrimental to children’s health, though the majority of associations observed are derived from cross-sectional studies examining television viewing and adiposity.² This study adds to the literature by examining cross-sectional and prospective associations between objectively measured moderate- to vigorous physical activity (MVPA) and sedentary time, and cardiometabolic risk factors in youth aged 4–18 years.

Sizing the association between lifestyle behaviours and fatness in a large, heterogeneous sample of youth of multiple ethnicities from 4 countries

Background: