Longitudinal risk and protective factors for adolescent substance use

1
Longitudinal risk and protective factors for
adolescent substance use

• Diana Smart
• Australian Institute of Family Studies
• Ann Sanson
• Australian Institute of Family Studies
• John Toumbourou
• Centre for Adolescent Health, Royal Childrens
  Hospital, Melbourne
• Presented at the Life-Course Perspectives on
  Health and Wellbeing Conference, Brisbane, 12-20
  November, 2001.

Australian Institute of Family Studies
2

• Teenage substance use is one type of
  health-compromising behaviour
• Both licit and illicit drug use carry personal
  and social costs
• Much of the relevant research is from other
  countries, or covers restricted time spans, or
  uses non-representative samples
• There is limited knowledge of the early
  precursors of teenage substance use

3

• Risk factors for teenage substance use -
• Individual attributes e.g. temperament or
  personality style, childhood externalising
  behaviour problems, poor school involvement
• Family environment factors e.g. parental
  substance use, less effective parenting styles,
  alienation from parents
• Social and community factors e.g. cultural norms,
  legislative control and availability of drugs

4
Questions addressed in this study

• What are the proximal and distal individual,
  peer, and family environment factors for
  substance use among this representative cohort of
  Australian adolescents?
• Are there sex differences in the risk and
  protective factors related to teenage substance
  use?
• We focus on multi-substance use - the moderate
  to high use of several drugs

5
The Australian Temperament Project

• A longitudinal study of childrens development
  from infancy onwards
• Representative sample of over 2400 children and
  families from urban and rural areas of Victoria
• 12 waves of data since 1983, at 1-2 yearly
  intervals and by mail surveys
• Domains assessed temperament, behaviour
  problems, school adjustment, health, social
  competence, family functioning, peer
  relationships, parenting style and family
  environment

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Substance Use Indicators at 15-16 years
(collected in 1998), rates for ATP study members,
and comparison to other Australian data

• Cigarette use 3 days in the past month
• 19.6 of sample 59 girls,
  chi 2 (1) 6.93, plt.008
• 1998 Household Study 14-19 years olds 23 had
  smoked in previous month
• Alcohol use 3 days in the past month
• 29.2 of sample, 52 boys
• 1998 Household Study14-19 year olds 43

7

• Intoxication 1 times in the past month
• 41.7 of sample 51.5 girls
• Marijuana use 1 times in the past month
• 24.3 of sample 51 girls
• 1998 Household Study 14-19 years olds 34 in
  last year

8

• Substance sniffing in lifetime
• 6.8 67.5 girls, chi 2 (1) 9.81, plt.002
• Heroin, morphine, cocaine, speed, hallucinogen or
  designer drug use in lifetime
• 2.0 65 girls, chi 2 (1) 2.26, p ns
• 1998 Household Study 14-19 years olds
  5 hallucinogens all other
  illicits 1

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• These indicators were summed to form a
  multi-substance use index
• Cutoff of 4 multi-substance use
• 123 adolescents were multi-substance users, 56
  of whom were girls
• Separate logistic regression analyses were
  conducted for each survey wave and for each
  source of report. Variables significant at plt.001
  are bolded, with odds ratios provided. Variables
  acting as risk factors are shown as R, while
  those which were protective are shown as P.
  Source of report is shown alongside the variable
  description (Par parent, Te teacher, Ch
  child).

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Significant Risk (R) or Protective (P) Factors
identified by logistic regression Child
Temperament

• Girls Boys
• Par Approach 5-6 yrs shy P --
• Par Approach 7-8 yrs shy P --
• Par Shy 9-10 yrs shy P --
• Par Sociable 9-10 yrs sociable R --
• Par Approach 13-14 yrs shy P --

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Child Temperament (cont)

• Girls Boys
• Par Activity 9-10 yrs active R --
• Par Activity 11-12 yrs -- active R
• Par Activity 12-13 yrs -- active R
• Par Activity 13-14 yrs active R active R

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Child Temperament (cont)

• Girls Boys
• Par Inflexibility 5-6 yrs -- inflex R
• Par Inflexibility 7-8 yrs -- inflex R
• Par Neg reactive 12-13 -- react
  R
• Par Neg reactive 12-13 -- react
  R

13
Child Temperament (cont)

• Girls Boys
• Te - Task orientation 5-6 yrs -- low
  R
• Ch breadth interests 13-14 R (2.24) R
• Ch depth interests 13-14 -- P

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Significant Risk (R) or Protective (P) Factors
identified by logistic regression Child
Behaviour Problems

• Girls Boys
• Par Total behr probs 1-2 P --
• Par aggression 5-6 yrs R R
• Te aggression 5-6 yrs -- R (3.8)
• Par aggression 7-8 yrs -- R
• Te aggression 7-8 yrs -- R
• Par aggression 11-12 yrs -- R
• Te aggression 11-12 yrs R R (3.03)

15
Child Behaviour Problems (cont)

• Girls Boys
• Par aggress 12-13 -- R
• Ch - aggress 12-13 R --
• Par - conduct dis 13-14 R R (1.08)
• Par soc aggress 13-14 R (1.23) R (1.27)
• Ch opposit 13-14 R (6.10) R (5.41)
• Ch delinquency 13-14 R (27.34) R (10.41)

16
Child Behaviour Problems (cont)

• Girls Boys
• Te hyperactive 5-6 -- R
• Te hyperactive 11-12 R --
• Ch hyperactive 12-13 R --
• Ch hyperactive 13-14 R (4.62) R

17
Child Behaviour Problems (cont)

• Girls Boys
• Par - Anxiety 3-4 P --
• Te - depression 11-12 R --
• Ch depression 12-13 R --
• Ch depression 13-14 R --

18
Significant Risk (R) or Protective (P) Factors
identified by logistic regression Child Social
Skills

• Girls Boys
• Ch - Cooperation 11-12 low R (.82) --
• Ch - Cooperation 12-13 low R (.82) low R
• Ch - Cooperation 13-14 low R (.79) low R
• Te - self control 11-12 -- low R
• Ch self control 11-12 low R --
• Ch self control 12-13 low R --
• Par - self control 13-14 low R low R
• Ch - self control 13-14 low R (.79) low R

19
Child Social Skills (cont)

• Girls Boys
• Ch assertive 11-12 low R --
• Par - assertive 13-14 hi R hi R
• Ch - assertive 13-14 hi R hi R (1.23)
• Par responsible 13-14 -- low R

20
Significant Risk (R) or Protective (P) Factors
identified by logistic regression Child Peer
Relationships

• Girls Boys
• Par deviant peer 11-12 R --
• Par deviant peer 13-14 R, 4.84 R, 7.87
• Ch deviant peer 13-14 R, 9.56 R, 19.68
• Par peer involve 13-14 hi R, 4.66 hi R
• Ch high quality -- hi R friendship at 13-14
• Par organised group hi P, .45 --
  participation 13-14

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Significant Risk (R) or Protective (P) Factors
identified by logistic regression Child School
Functioning

• Girls Boys
• Par - school probs 12-13 -- R
• Par - school probs 13-14 -- R
• Ch - school probs 13-14 R (4.18) R (3.68)

22

• Significant Risk (R) or Protective (P) Factors
  identified by logistic regression previous
  substance use and eating attitudes and behaviour
• Girls Boys
• Ch - Substance use 13-14 R,11.34 R
• Ch - Body dissatisf 12-13 R --
• Ch drive for thinness 12-13 R --
• Ch bulimia 12-13 R R

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Implications

• Range of individual, peer and family environment
  factors found to be important
• Proximal risks more powerful than distal risks
• Proximal risks were - delinquency, attraction to
  risk taking, gregariousness, school problems,
  earlier substance use, association with
  antisocial or substance using peers, parental
  substance use, and family environment
• Distal risks were - a sociable temperament style,
  high inflexibility/reactivity, aggression

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Sex Differences

• Precursors across both sexes - poor social
  skills, the temperament activity dimension,
  delinquency, peer involvement, association with
  deviant peers, previous substance use, attraction
  to risk taking, school problems
• Risk factors specific to boys - childhood
  aggression, inflexible/reactive temperament
  style, parental substance use
• Factors specific to girls - shy temperament and
  participation in organised peer group activities
  were protective, risk factors were depression,
  body image concerns and parent-child relationship
  difficulties