Risk Behaviors

DRUG USE AMONG TEENS
Christopher L. Ringwalt

HIV/AIDS AND ITS IMPACT ON ADOLESCENTS
Denise Dion Hallfors
Carolyn Tucker Halpern
Bonita Iritani

SEXUAL ACTIVITY AMONG TEENS AND TEEN PREGNANCY TRENDS
Sheila Peters

TABLE 1

SEXUALLY TRANSMITTED DISEASES
Angela Huang

SMOKING AND ITS EFFECT ON CHILDREN'S HEALTH
Christopher S. Greeley

SUICIDE
Peter L. Sheras

TEEN PREGNANCY
Douglas B. Kirby

DRUG USE AMONG TEENS

Substance abuse is an international problem of epidemic proportions that has particularly devastating effects on youth because the early initiation of alcohol, tobacco, or other drug (ATOD) use within this population is linked to abuse and related problem behaviors among adults. The cost of alcohol abuse to society is estimated to be $250 billion per year in health care, public safety, and social welfare expenditures. Key trends in substance use by twelfth graders are displayed in Table 1.

Causes

A number of models and theories address the causes of adolescent ATOD use. The most salient of these is the "Risk and Protective Factor" framework, which has identified a variety of psychosocial factors associated with ATOD use. In the individual domain, substance use has been linked to values and beliefs about and attitudes toward substances, genetic susceptibility, early ATOD use, sensation seeking, and various psychological disorders including anti-social, aggressive, and other problem behaviors. In the family domain, ATOD use has been associated with familial substance use, poor parenting practices including harsh or inconsistent discipline, poor intrafamilial communication, and inadequate supervision and monitoring of children's behaviors and peer associations. In the peer domain, substance use has been linked to social isolation and association with ATOD-using and otherwise deviant peer networks. In the school domain, ATOD use has been linked to poor academic performance and truancy, as well as a disorderly and unsafe school climate and lax school policies concerning substance use. In the community and environmental domains, ready social and physical access to ATODs has been associated with use, as has lack of recreational resources (especially during the after-school hours).

Protective Factors

Protective factors, or factors that promote resiliency, have also been identified in these various domains. Among those most frequently cited are religiosity or spirituality, commitment to academic achievement, strong life skills, social competencies, and belief in self-efficacy. Protective factors in the family and school domains include strong intrafamilial bonds, positive family dynamics, and positive attachment to school. In the community and environmental domains, strongly held adult values antithetical to substance use constitute protective factors, as do clearly communicated and consistently enforced regulations concerning use.

Prevention Strategies

A variety of strategies have demonstrated effectiveness in preventing or reducing ATOD use. Project Alert, described by Phyllis Ellickson and colleagues in a 1993 article, and Life Skills Training Program, described by Gill Botvin and colleagues in 1995, are the two most-prevalent effective classroom-based-curricula. The "Reconnecting Youth" Program, described by Leona Eggert and colleagues in 1994, is designed for high school students who manifest poor academic achievement or who are at high risk for dropping out and other problem behaviors. In the family domain, the Iowa Strengthening Families Program, described by Richard Spoth and colleagues in 1999, has received considerable attention. In the community and environmental domains, strategies have been developed to increase the enforcement of public policies and ordinances that inhibit adolescent substance use. These include efforts targeting tobacco and alcohol outlets, including restrictions on their location and density and on alcohol and tobacco advertising. Also effective is the vigorous enforcement of laws governing sales to minors, including using underage youth to buy alcohol and tobacco products in "sting" operations. Increasing excise taxes on alcohol and tobacco products has also been associated with reductions in use, as has linking apprehension for infractions of laws related to purchasing and consuming ATODs to suspension or revocation of driver's licenses. Other preventive measures that target youth drivers include "zero tolerance" laws linking evidence of alcohol on the breath with suspension or revocation of driving privileges.

The results of two decades of evaluative research have yielded considerable information suggesting that a number of approaches to adolescent ATOD use prevention do not work. Scare tactics, designed to frighten adolescents into avoiding drugs, are often recognized as such by their target audiences and can even be counterproductive. Efforts to raise self-esteem as a drug prevention strategy have long been discredited given the lack of association between self-esteem and ATOD use. Strategies designed to increase knowledge and convey information about the risks and dangers of drug use are generally recognized to be failures, in part because of the lack of association between knowledge and use. Indeed, all largely didactic approaches to prevention education, such as Project "Drug Abuse Resistance Education" (Project DARE), are widely understood to be ineffective, especially if they concentrate on long-term risks. Mass media campaigns are of dubious value, especially if they are brief, aired in contexts that are unlikely to reach their target audience, and uncoordinated with a comprehensive, community-wide strategy.

Unfortunately, relatively little is also known about prevention on college campuses. Many college campuses have cultures that are at least covertly supportive of alcohol consumption, and many administrators treat the issue with benign neglect. While most drinking on college campuses occurs in neighborhood bars and residential contexts such as fraternities, relatively little has been done to develop and implement demonstration programs that increase enforcement of, and penalties for, selling or otherwise supplying liquor to underage students.

It is known that even the most effective and comprehensive school-based strategies, and even those that reinforce their messages across multiple grade levels, are only slightly more effective than school-based programs that are generally discredited in the early twenty-first century. There has evolved a consensus among both practitioners and researchers that school-based programs, by themselves, are insufficient. Such efforts should be part of a broad and comprehensive array of prevention approaches that integrate both supply and demand reduction strategies in the family and community, as well as the individual, domains.