Substance Use Among Youth During the COVID-19 Pandemic: a Systematic Review.

PURPOSE OF REVIEW: To review the literature on the trends in substance use among youth during the coronavirus SARS-CoV-2 (COVID-19) pandemic. RECENT FINDINGS: The pandemic has given rise to concerns about the mental health and social well-being of youth, including its potential to increase or exacerbate substance use behaviors. This systematic review identified and included 49 studies of use across alcohol, cannabis, tobacco, e-cigarettes/vaping, and other drugs, and unspecified substances. The majority of studies across all categories of youth substance use reported reductions in prevalence, except in the case of other drugs and unspecified drug and substance use, which included three studies that reported an increase in use and three studies that reported decrease in use. Overall, the results of this review suggest that the prevalence of youth substance use has largely declined during the pandemic. Youth substance use in the post-pandemic years will require monitoring and continued surveillance.

Trends in substance use and primary prevention variables among adolescents in Lithuania, 2006-19.

BACKGROUND: Since the implementation of the Icelandic Model for Primary Prevention of Substance Use in Iceland (IPM), substance use has decreased steadily among 14-16-year-old adolescents and primary prevention factors have improved. Although the IPM is being implemented in several other regions around the world, information documenting its effectiveness in other country contexts is lacking. This study assessed trends in substance use and primary prevention variables in three cities in Lithuania following the implementation of the IPM. METHODS: Data collected from repeated, comparative cross-sectional self-report surveys conducted among a total of 30 572 10th graders in the cities of Kaunas, Klaipeda and Vilnius, Lithuania, from 2006 to 2019, were analyzed. Cochran-Armitage test for linear trend and analysis of variance for linear trend was used to assess time-trends in prevalence of substance use and mean levels of primary prevention variables over time. RESULTS: Following the implementation of IPM rates of cigarette smoking and the use of alcohol, cannabis and amphetamine has decreased among 10th graders in Lithuania's three largest cities and simultaneously preventive variables targeted have improved. Similar to Iceland, primary prevention variables were related to substance use in the expected direction, with the exception of organized sports participation, which was not associated with less likelihood of alcohol, cannabis and amphetamine use. CONCLUSION: Trends in substance use and primary prevention variables following the implementation of the IPM are similar in the three cities in Lithuania as in Iceland. Further research is needed to better understand the mechanisms underlying these trends.

A multi-level developmental approach towards understanding adolescent mental health and behaviour: rationale, design and methods of the LIFECOURSE study in Iceland.

PURPOSE: Identifying and understanding modifiable risk and protective factors that can inform early detection and intervention to prevent adolescent emotional problems and harmful behaviours is among the most pressing modern-day public health challenges. This paper describes the rationale, objectives, methods, and anticipated outcomes of the LIFECOURSE study, a multi-level, bio-psychosocial prospective study designed to advance our understanding of factors that shape adolescent mental health and behaviour. METHODS: Conducted by the Icelandic Centre for Social Research and Analysis at Reykjavik University, LIFECOURSE is a longitudinal population-based developmental study of Icelandic adolescents born in 2004. The study utilizes a comprehensive multi-informant assessment of individual, societal and biological factors measured across the lifespan. Data assembly and collection were conducted from 2016-2020 and utilize both retrospective and prospective data sources: (a) retrospective registry data assembled from seven national databases, (b) prospectively collected social surveys and (c) biomarker samples. RESULTS: Of the 3914 eligible adolescents, 60.8% (n = 2378) provided informed parental consent and student assent to participate in the study, with approximately half of the participants being female (n = 1175, 49.4%) and the majority being born in the capital area (n = 1455; 61.2%). The coverage of available data from the national databases and participation in the social surveys ranged from 81.7 to 100%. CONCLUSIONS: Major gaps remain in our knowledge of how individual, societal and biological factors across the lifespan-from early life to adolescence-interact and shape the risk for emotional problems and harmful behaviours during adolescence. The LIFECOURSE study was designed to address this knowledge gap.

Stress and adolescent well-being: the need for an interdisciplinary framework.

Stress and strain among adolescents have been investigated and discussed largely within three separate disciplines: mental health, where the focus has been on the negative effects of stress on emotional health; criminology, where the emphasis has been on the effects of strain on delinquency; and biology, where the focus has been to understand the effects of stress on physiology. Recently, scholars have called for increased multilevel developmental analyses of the bio-psychosocial nature of risk and protection for behaviors of individuals. This paper draws on several different but converging theoretical perspectives in an attempt to provide an overview of research relevant to stress in adolescence and puts forth a new framework that aims to provide both a common language and consilience by which future research can analyze the effects of multiple biological, social and environmental factors experienced during specific developmental periods, and cumulatively over time, on harmful behavior during adolescence. We present a framework to examine the effects of stress on diverse behavioral outcomes among adolescents, including substance use, suicidal behavior, self-inflicted harm, and delinquency.

Self-generated identification codes in longitudinal prevention research with adolescents: a pilot study of matched and unmatched subjects.

Self-generated identification codes (SGICs) are an increasingly utilized methodological feature of longitudinal prevention research among adolescents. This study sought to test the differences between the matched and unmatched groups at baseline on a number of background, health, and well-being and risk behavior measures in a prevention study among 13- to 16-year-old Icelandic adolescents where a SGIC was constructed and used to link individual-level respondent data over two data collection points one year apart. We use pilot data from two Reykjavik city secondary schools collected as part of the population study Youth in Iceland in February 2010 and 2011 (N = 366, SGIC matching rate 61%). Baseline results for the matched and unmatched participants are compared. Findings indicate that the unmatched subjects are both more likely to be substance users than their matched counterparts as well as being more likely to be boys and/or from disrupted families. Five out of the seven scaled measures for risk and protective factors and personality indicators reveal no difference between the matched and unmatched subjects and the significantly different measures reveal small effect sizes between the two groups. However, the effect sizes for substance use are significantly different between the matched and unmatched groups for all seven substance use measures with effect sizes from 0.52 to 1.32. These findings therefore indicate that the measurement validity of adolescent risk behaviors such as substance use may be put in jeopardy when using SGIC and that unmatched subjects may be more likely to distrust the SGIC process.

Electronic screen use and mental well-being of 10-12-year-old children.

BACKGROUND: Today's children spend a great deal of time viewing electronic screen material, but the consequences of such behaviors, if any, are unknown. This study sought to identify (i) the magnitude of total daily electronic screen time and (ii) the relations between electronic screen use and mental well-being indicators, in a sample of 10-12-year-old children. METHODS: We analysed cross-sectional, population-based data of 10-12-year-old children from the 2007 Youth in Iceland school survey (n = 10,829, response rate: 81.7%, boys: 50.5%). Logistic regression models with odds ratios and 95% confidence intervals were conducted to assess the odds of each selected mental well-being indicator, depending on the number of daily hours spent on each electronic screen-based activity. All analyses were conducted separately for boys and girls and adjusted for family structure. RESULTS: The prevalence of self-reported screen use of 4 hours per day or more ranges from 2.8% to 6.6% among boys and from 1.0% to 3.8% among girls. All five screen-based activities were significantly associated with all seven well-being indicators (P < 0.001) with symptoms being more common with increased time spent on screen use. CONCLUSIONS: This study is the first of its kind to demonstrate a dose-response relationship between electronic screen use and mental well-being in 10-12-year-old children. Further research is needed to assess the validity and potential implications of these findings.

Effect of the COVID-19 pandemic on adolescent mental health and substance use up to March, 2022, in Iceland: a repeated, cross-sectional, population-based study.

BACKGROUND: Poor mental health in the first year of the COVID-19 pandemic has been well documented in adolescents; however, less is known about the longer-term effect of the pandemic. We aimed to examine adolescent mental health and substance use as well as covariates associated with these outcomes 1 year or more into the pandemic. METHODS: A nationwide sample of adolescents aged 13-18 years enrolled in school in Iceland were invited to complete surveys administered during October-November or February-March, 2018, October-November, 2020, February-March or October-November, 2021, and February-March 2022. The survey was in Icelandic for all administrations and offered to adolescents aged 13-15 years in English in 2020 and 2022 and in Polish in 2022. Surveys assessed depressive symptoms (Symptom Checklist-90); mental wellbeing (Short Warwick Edinburgh Mental Wellbeing Scale); and the frequency of cigarette smoking, e-cigarette use, and alcohol intoxication. Covariates comprised age, gender, and migration status as determined by language spoken at home, level of social restrictions based on residency, parental social support, and sleep duration (≥8 h nightly). Weighted mixed-effect models were used to determine the effect of time and the covariates on mental health and substance use. The main outcomes were assessed in all participants with more than 80% of the necessary data, and multiple imputation was used to handle missing data. Bonferroni corrections were used to adjust for multiple testing and analyses were considered significant at a p value of <0·0017. FINDINGS: 64 071 responses were submitted and analysed between 2018 and 2022. Elevated depressive symptoms and worsened mental wellbeing across girls and boys aged 13-18 years were observed to have been maintained up to 2 years into the pandemic (p>0·0017). Alcohol intoxication initially decreased during the pandemic but increased again as social restrictions eased (p<0·0001). No changes were observed in cigarette smoking and e-cigarette use during the COVID-19 pandemic. Higher levels of parental social support and an average sleep duration of 8 h or more per night were associated with mental health better outcomes and less substance use (p<0·0001). Social restrictions and migration background were inconsistently associated with the outcomes. INTERPRETATION: Population-level prevention targeting adolescent depressive symptoms should be prioritised in health policy in the wake of COVID-19. FUNDING: Icelandic Research Fund.

Body weight dissatisfaction in the Icelandic adult population: a normative discontent?

BACKGROUND: Body weight dissatisfaction is a common problem in many modern societies and it appears to have grown over time. This study examined the prevalence and predictors of body weight dissatisfaction among 18- to 79-year-old Icelanders. The distribution of body weight dissatisfaction according to the WHO body mass index criteria for underweight, normal weight, overweight and obesity was also assessed. METHODS: The study was based on 5832 participants in the cross-sectional survey 'Health and Well-Being of Icelanders', administered by the Public Health Institute in Iceland in the fall of 2007. RESULTS: Around 43% of adult Icelanders are dissatisfied with their own body weight (50% of females; 35% of males) and 72% believe they need to lose weight (80% of females; 63% of males). Despite being in normal range according to the WHO-based BMI criteria, 64% of females in that category believe they need to lose weight. Multivariate results show that indicators of socio-economic status (SES) are not significantly associated with body weight dissatisfaction among females, while among males, those with university education are more often dissatisfied than those with secondary education (OR = 1.5, P < 0.05; for self-perceived need to lose weight, estimates are OR = 1.4, P < 0.05 for females, and OR = 2.5, P < 0.001 for males). CONCLUSION: The prevalence of body dissatisfaction is so prominent among Icelandic female adults that it can rightfully be labelled a normative discontent in this population.

Adolescent substance use, sleep, and academic achievement: evidence of harm due to caffeine.

Using academic achievement as the key outcome variable, 7377 Icelandic adolescents were surveyed for cigarette smoking, alcohol use, daytime sleepiness, caffeine use, and potential confounders. Structural equation modeling (SEM) was used to examine direct and indirect effects of measured and latent variables in two models: the first with caffeine excluded and the second with caffeine included. A substantial proportion of variance in academic achievement, which might otherwise have been attributed to the harmful effects of cigarette smoking and alcohol use, was found to be attributable to caffeine. Evidence was obtained that daytime sleepiness, which was found to be independently associated with usage of licit substances (nicotine and alcohol) and caffeine, may be an important mediator of the negative impact of those substances on academic achievement. Findings suggest the importance of including measurements of caffeine consumption in future studies of adolescent substance use.

Adolescent well-being amid the COVID-19 pandemic: Are girls struggling more than boys?

BACKGROUND: Differential effects of the coronavirus SARS-CoV-2 (COVID-19) pandemic and associated public restrictions on adolescent girls and boys are emerging but have not been elucidated. This study examined gender differences across broad indicators of adolescent well-being during the COVID-19 pandemic in Iceland, and explored potential explanations for these differences. METHODS: In total, 523 youth (56.5% girls) born in Iceland in 2004 completed measures on mental health problems (depressive symptoms, anger and suicide attempts) and measures designed for this study to assess broad indicators of adolescent well-being (e.g., day-to-day life, academic performance, family and peer relationships, and mental and physical health) and behavioral changes during the COVID-19 pandemic. Mental health problems during the pandemic were compared to expected scores based on nationwide ratings of same-aged peers in 2018. RESULTS: Although both boys and girls appeared affected, girls reported a greater negative impact across all the broad indicators of well-being and behavioral change during COVID-19 than boys, and their depressive symptoms were above and beyond the expected nationwide scores (t(1514) = 4.80, p < .001, Cohen's d = 0.315). Higher depressive symptoms were associated with increased passive social media use and decreased connecting with family members via telephone or social media among girls, and decreased sleeping and increased online gaming alone among boys. Concern about others contracting COVID-19, changes in daily and school routines, and not seeing friends in person were among the primary contributors to poor mental health identified by youth, particularly girls. CONCLUSIONS: Adolescents were broadly negatively affected by the COVID-19 pandemic and accompanying restrictions; however, this negative impact was more pronounced in girls. The findings suggest that a steady routine and remaining socially connected may help youth cope with the uncertainty and social restrictions associated with a pandemic. Moreover, healthcare providers, teachers, and other professionals should pay close attention to depressive symptoms among girls during a pandemic.

Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: a longitudinal, population-based study.

BACKGROUND: Adolescence represents a crucial developmental period in shaping mental health trajectories. In this study, we investigated the effect of the COVID-19 pandemic on mental health and substance use during this sensitive developmental stage. METHODS: In this longitudinal, population-based study, surveys were administered to a nationwide sample of 13-18-year-olds in Iceland in October or February in 2016 and 2018, and in October, 2020 (during the COVID-19 pandemic). The surveys assessed depressive symptoms with the Symptom Checklist-90, mental wellbeing with the Short Warwick Edinburgh Mental Wellbeing Scale, and the frequency of cigarette smoking, e-cigarette use, and alcohol intoxication. Demographic data were collected, which included language spoken at home although not ethnicity data. We used mixed effects models to study the effect of gender, age, and survey year on trends in mental health outcomes. FINDINGS: 59 701 survey responses were included; response rates ranged from 63% to 86%. An increase in depressive symptoms (ß 0·57, 95% CI 0·53 to 0·60) and worsened mental wellbeing (ß -0·46, 95% CI -0·49 to -0·42) were observed across all age groups during the pandemic compared with same-aged peers before COVID-19. These outcomes were significantly worse in adolescent girls compared with boys (ß 4·16, 95% CI 4·05 to 4·28, and ß -1·13, 95% CI -1·23 to -1·03, respectively). Cigarette smoking (OR 2·61, 95% CI 2·59 to 2·66), e-cigarette use (OR 2·61, 95% CI 2·59 to 2·64), and alcohol intoxication (OR 2·59, 95% CI 2·56 to 2·64) declined among 15-18-year-olds during COVID-19, with no similar gender differences. INTERPRETATION: Our results suggest that COVID-19 has significantly impaired adolescent mental health. However, the decrease observed in substance use during the pandemic might be an unintended benefit of isolation, and might serve as a protective factor against future substance use disorders and dependence. Population-level prevention efforts, especially for girls, are warranted. FUNDING: Icelandic Research Fund. TRANSLATION: For the Icelandic translation of the abstract see Supplementary Materials section.

Adolescent substance use, parental monitoring, and leisure-time activities: 12-year outcomes of primary prevention in Iceland.

OBJECTIVE: To examine 12-year changes in alcohol use and cigarette smoking in response to community-based prevention activities among Icelandic adolescents. METHODS: This study used a quasi-experimental, non-randomized control group design to compare outcomes in 4 Icelandic communities (n=3117) that participated in community-based substance use prevention activities designed to increase levels of parental monitoring and adolescent engagement in healthy leisure-time activities and a matched group of 7 comparison communities (n=1,907). Annual, nationwide, population-based cross-sectional surveys of the prevalence of adolescent substance use were conducted among cohorts of Icelandic adolescents, aged 14-15 years (N=5,024), in all communities from 1997 to 2009. RESULTS: Parental monitoring and adolescent participation in organized sports increased in communities that adopted the intervention program compared to communities that did not, whereas unmonitored idle hours and attendance at unsupervised parties decreased. Over time, alcohol use (OR=0.89, 95% CI 0.82, 0.98, p=0.012) and being intoxicated during the last 30 days (OR=0.86, 95% CI 0.78, 0.96, p=0.004) decreased more in the intervention than control communities. CONCLUSION: Community-based prevention designed to strengthen parental monitoring and participation in organized sports may confer some protection against adolescent substance use.

Parental divorce and adolescent cigarette smoking and alcohol use: assessing the importance of family conflict.

AIM: To investigate how family conflict contributes to the relationship between parental divorce and adolescent cigarette smoking and alcohol use. DESIGN: Population-based cross-sectional survey. SETTING: School classrooms in Iceland in which an anonymous questionnaire was administered to respondents by supervising teachers. Participants were 7430 (81.4%) of 9124 14- to 16-year-old adolescents. MAIN OUTCOME MEASURE: Cigarette smoking and alcohol use during the last 30 days were assessed by self-report. RESULTS: Parental divorce was related to adolescent cigarette smoking during the last 30 days (OR = 2.12, 95% CI 1.84-2.44) when controlling for gender only, but was insignificant (OR = 1.18 95%, CI 0.99-1.44) when controlling for relationship with parents, disruptive social changes and family conflict. There was a significant relationship between parental divorce and adolescent alcohol use during last 30 days (OR = 1.66, 95% CI 1.48-1.87), controlling only for gender; however, the relationship disappeared (OR = 1.04, 95% CI 0.91-1.20) when controlling for other variables. CONCLUSION: Family conflicts are important contributors to the relationship between parental divorce and adolescent cigarette smoking and alcohol use. Conflict between parents and adolescents, but not inter-parental conflict, appears to be the most important factor in the relationship between family conflict and adolescent substance use.

Substance use prevention for adolescents: the Icelandic Model.

Data from the European School Survey Project on Alcohol and other Drugs have shown that adolescent substance use is a growing problem in western and particularly Eastern European countries. This paper describes the development, implementation and results of the Icelandic Model of Adolescent Substance Use Prevention. The Icelandic Model is a theoretically grounded, evidence-based approach to community adolescent substance use prevention that has grown out of collaboration between policy makers, behavioural scientists, field-based practitioners and community residents in Iceland. The intervention focuses on reducing known risk factors for substance use, while strengthening a broad range of parental, school and community protective factors. Annual cross-sectional surveys demonstrate the impact of the intervention on substance use among the population of 14- to 16-year-old Icelandic adolescents. The annual data from two cohorts of over 7000 adolescents (>81% response rate) show that the proportions of those who reported being drunk during the last 30 days, smoking one cigarette or more per day and having tried hashish once all declined steadily from 1997 to 2007. The proportions of adolescents who reported spending time with their parents and that their parents knew with whom they were spending their time increased substantially. Other community protective factors also showed positive changes. Although these data suggest that this adolescent substance use prevention approach successfully strengthened a broad range of parental, school and community protective factors, the evidence of its impact on reducing substance use needs to be considered in light of the correlational data on which these observations are based.

Adolescent health behavior, contentment in school, and academic achievement.

OBJECTIVES: To examine the association between health behavior indicators, school contentment, and academic achievement. METHODS: Structural equation modeling with 5810 adolescents. RESULTS: Our model explained 36% of the variance in academic achievement and 24% in school contentment. BMI and sedentary lifestyle were negatively related to school contentment and academic achievement, but physical activity was positively related to school contentment and academic achievement (P < .01). School contentment was strongly related to academic achievement but only a weak mediator of the health behavior indicators. CONCLUSION: Findings may inform the efforts to improve academic achievement and the general health status of youth.

Adolescent substance use and peer use: a multilevel analysis of cross-sectional population data.

BACKGROUND: Limited evidence exists concerning the importance of social contexts in adolescent substance use prevention. In addition to the important role schools play in educating young people, they are important ecological platforms for adolescent health, development and behaviors. In this light, school community contexts represent an important, but largely neglected, area of research in adolescent substance use and prevention, particularly with regard to peer influences. This study sought to add to a growing body of literature into peer contexts by testing a model of peer substance use simultaneously on individual and school community levels while taking account of several well established individual level factors. METHOD: We analyzed population-based data from the 2009 Youth in Iceland school survey, with 7,084 participants (response rate of 83.5%) nested within 140 schools across Iceland. Multilevel logistic regression models were used to analyze the data. RESULTS: School-level peer smoking and drunkenness were positively related to adolescent daily smoking and lifetime drunkenness after taking account of individual level peer smoking and drunkenness. These relationships held true for all respondents, irrespective of socio-economic status and other background variables, time spent with parents, academic performance, self-assessed peer respect for smoking and alcohol use, or if they have substance-using friends or not. On the other hand, the same relationships were not found with regard to individual and peer cannabis use. CONCLUSIONS: The school-level findings in this study represent context effects that are over and above individual-level associations. This holds although we accounted for a large number of individual level variables that studies generally have not included. For the purpose of prevention, school communities should be targeted as a whole in substance use prevention programs in addition to reaching to individuals of particular concern.

Data collection procedures for school-based surveys among adolescents: the Youth in Europe Study.

BACKGROUND: Collection of valid and reliable surveillance data as a basis for school health promotion and education policy and practice for children and adolescence is of great importance. However, numerous methodological and practical problems arise in the planning and collection of such survey data that need to be resolved in order to ensure the validity of the data and to maximize the response rate without being prohibitively costly. METHOD: This article builds on a 15-yearlong experience of such annual data collections in Iceland and describes the preparation, process, and collection of data that provide a common methodologic framework for the school-based survey, Youth in Europe, a population-based survey of 14- to 16-year-old adolescents, being collected across 18 European cities now participating in the European Cities Against Drugs (ECAD) program. RESULTS: We identified 11 critical steps for developing and implementing the surveys in light of the recent literature on the preparation and implementation practices in school-based data collection among adolescents. CONCLUSION: Limiting the disruption of daily operations in schools while at the same time ensuring both quality and clarity of data collection procedures in school-based surveys are of paramount importance for researchers, school personnel, and students.

Intrafamilial conflict and emotional well-being: a population based study among Icelandic adolescents.

OBJECTIVES: During intrafamilial conflicts children are often innocent bystanders, caught in the crossfire. In such situations, they are at increased risk to become directly involved in abusive verbal behavior of the perpetrator, and exposed to being shouted or yelled at, threatened, rejected and even physically abused. The present study has two main objectives: (1) ascertain a national base rate of intrafamilial conflicts and physical violence at home among Icelandic adolescents; and (2) to investigate the association of witnessing and/or having been a part of intrafamilial conflict or physical violence at home with variables that relate to mental health and well-being. METHODS: The participants were 3,515 students, 14- and 15-year-old, in the national compulsory school system in Iceland. As a part of the 2003 ESPAD survey, each pupil was asked about experiences of severe verbal arguments and physical violence at home as well as their background, behaviors, and mental health assessed with the use of tested measurement scales such as the Symptom Distress Checklist 90 (SCL-90) and the Rosenberg Self-Esteem Scale. RESULTS: About 22% of the participants stated that they had witnessed a severe verbal argument between parents and 34% stated that they had been involved in a severe verbal argument with parents. This rate was slightly higher for girls compared to boys. All together 7% of adolescents had witnessed physical violence at home where an adult was involved and 6% of the participants stated that they had experiences of being involved in physical violence at home where an adult was involved. Witnessing or being involved in severe verbal arguments at home and/or witnessing or being involved in physical violence with an adult was significantly associated with greater levels of depression, anger, and anxiety, and negatively related with self-esteem (p<0.01). CONCLUSIONS: Many adolescents in Iceland witness severe parental verbal arguments or physical violence between adults in their homes and some are directly involved in such acts. It affects their long-term emotional and behavioral development and well-being. PRACTICE IMPLICATIONS: Preventive measures have to be implemented at an early age and should include, but not be limited to, information on disciplining and upbringing of children and the negative impact of intrafamilial conflicts on the long-term health of their children. Due attention should be given to the health and well-being of children where such violence is known to occur.

Health behavior and academic achievement among adolescents: the relative contribution of dietary habits, physical activity, body mass index, and self-esteem.

This study tested a structural equation model to estimate the relationship between health behaviors, body mass index (BMI), and self-esteem and the academic achievement of adolescents. The authors analyzed survey data from the 2000 study of Youth in Iceland , a population-based, cross-sectional sample of 6,346 adolescents in Iceland. The model demonstrated good fit with chi-square of 2685 (n = 5,810, df = 180), p < .001, Comparative Fit Index value of .94, and a root mean square error of approximation of .049. Lower BMI, physical activity, and good dietary habits were all associated with higher academic achievement; however, health behavior was positively and robustly associated with greater self-esteem. Self-esteem was positively influenced both through physical activity (beta = .16) and the consumption of fruits and vegetables (beta = .14). In contrast, poor dietary habits negatively influenced self-esteem and academic achievement, and self-esteem was negatively influenced by increasing levels of BMI (beta = -.05).

Perceived parental reactions and peer respect as predictors of adolescent cigarette smoking and alcohol use.

Cigarette smoking and alcohol use contribute substantially to the global burden of morbidity and premature mortality. Most use begins during adolescence, often with experimentation taking place between 11 and 15 years of age. This study examined the importance of perceived parental reactions to, and peer respect for, cigarette smoking and alcohol use. Particular attention was given to the relative importance of these variables compared with the more widely examined influences of perceived parental and peer support. Our final models explained 44% of the variance in cigarette smoking and 46% in alcohol use. Most of the explained variance in both cigarette smoking and alcohol use was accounted for by only three variables: peer use, perceived parental reaction to use, and perceived respect from peers if using. Our findings indicate that perceived parental reaction to use and peer respect for use may be important contributors to adolescent cigarette smoking and alcohol use.