Health problems in adolescents with alcohol use disorders: self-report, liver injury, and physical examination findings and correlates.

BACKGROUND: Although adolescent alcohol consumption has been found to be positively correlated with self-reported health problems, few studies have examined other health indicators. This study compared adolescents with alcohol use disorders (AUDs) and a community reference group on self-reported health problems, serum liver enzymes, and physical examination findings. The relevance of negative emotionality to understanding these health problems was also investigated. METHODS: The subjects were adolescents with AUDs recruited from clinical programs and classified as having DSM-IV alcohol dependence (n = 71) or alcohol abuse (n = 57) and reference adolescents without AUDs recruited from community sources (n = 131). The assessment of health status included self-reported health problems in 15 areas; serum liver enzyme assays, including gamma-glutamyl transpeptidase, alanine aminotransferase, and aspartate aminotransferase; and physical examination findings. Negative emotionality was determined by systematically combining scores from the Hamilton Anxiety Rating Scale, the Beck Depression Inventory, the Child Behavior Checklist, and the Multidimensional Personality Questionnaire. RESULTS: Adolescent AUDs were associated with more self-reported health problems, higher gamma-glutamyl transpeptidase and alanine aminotransferase levels, and more physical examination abnormalities. Negative emotionality was highly correlated with self-reported health problems, mediated the relationship between AUDs and self-reported health problems, and was not correlated with serum liver enzyme levels or physical examination abnormalities. CONCLUSIONS: These results indicated that AUDs during adolescence were associated with health problems, including modest but demonstrable liver injury. Self-reported health problems were probably best understood, in this context, as a negative emotionality manifestation.

Alcohol use disorders and risk factor interactions for adolescent suicidal ideation and attempts.

Four hundred eighty-two adolescents who were diagnosed with at least one mental disorder were studied to determine the predictors of suicidal ideation and suicide attempts. Major depression was predictive of suicidal ideation and suicide attempts for both genders. Chronic stress was found predictive of male suicidal ideation, while low self-esteem and high family dysfunction were found to be predictive of suicidal ideation in females. Statistical trends suggest that females with comorbid alcohol use/conduct disorder were approximately three times more likely to have attempted suicide than those with only one of these conditions. Clinicians working with adolescents should be aware that, while depression remains the number one clinical risk forsuicidal behavior, risk factors for suicidal ideation may be different than those for attempted suicide and may vary by gender.

Constructive thinking in adolescents with substance use disorders.

This study examined the concurrent validity and clinical correlates of the Constructive Thinking Inventory (CTI), a measure of experiential coping, in 551 adolescents aged 14-18 years with and without Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) substance use disorders (SUDs). The CTI was correlated with depression, anxiety, and conduct problems. After controlling for demographics and comorbid lifetime psychiatric disorders, the CTI scales of Behavioral Coping and Categorical Thinking distinguished adolescents with and without SUDs. Implications of these findings for assessment and treatment are discussed.

Confirmatory factor analyses of the alcohol use disorders identification test (AUDIT) among adolescents treated in emergency departments.

OBJECTIVE: The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item instrument designed by the World Health Organization to assess problematic drinking. The objective of this study was to conduct confirmatory factor analysis of the AUDIT in a sample of adolescents and young adults who were treated in emergency departments. METHOD: Adolescents and young adults (N= 103, 55 males), ranging in age from 12 to 20.9 years (mean [SD] age = 17.5 [2.1]), completed the AUDIT. Confirmatory factor analyses were conducted using LISREL 8.20 software to test the one-factor, two-factor and three-factor solutions for the AUDIT reported in the literature. RESULTS: Goodness-of-fit indices indicated that a correlated two-factor solution, consisting of a consumption factor and an alcohol-related-problems factor, provides the best fit to the data. The three-factor solution fits the data equally well, but Factor 2 (dependency) and Factor 3 (problems) correlate 1.00. The one-factor solution did not provide a good fit to the data. CONCLUSIONS: Our findings support those of others who have reported that the AUDIT assesses a consumption factor and an alcohol-related problems factor among primary care patients at risk for problematic drinking behavior.

Adolescent problem drinking: stability of psychosocial and behavioral correlates across a generation.

OBJECTIVE: Research conducted in the 1970s demonstrated that Problem Behavior Theory could account for approximately 40% of the variance in problem drinking in both local and national sample studies. The present analyses sought to determine whether the personality, perceived environment, and behavior variables of the framework continue to contribute to the explanation of problem drinking among contemporary American youth. METHOD: Correlational and multiple regression analyses were performed on six separate databases collected at different times between 1972 and 1992. Due to sociodemographic differences among the samples, separate analyses were performed for male and female adolescents, and age, ethnicity and socioeconomic status were statistically controlled. RESULTS: There was considerable consistency across the samples in both the partial correlations and the partial multiple correlations, and this result held for both genders. Not only did the framework account for the same percentage of the variance (40%) in problem drinking in the 1992 data as it did in the 1972 data, but the results for the intervening years were consistent as well. CONCLUSIONS: The consistency of results over a 20-year period confirms that the social-psychological meaning of adolescent involvement in problem drinking has remained stable despite changes in the larger sociohistorical context.

A National, Randomized Survey of HIV/AIDS Knowledge and Attitudes Among Psychiatrists in Training.

Given the broad spectrum of medical and psychiatric complications associated with HIV (human immunodeficiency virus) disease, HIV-related education is an important curriculum topic for all physicians. This study examined the HIV-related knowledge and attitudes among psychiatrists in training to evaluate their training needs. A survey instrument was developed containing 15 knowledge items, 15 attitude items, demographic items, and questions concerning how HIV/AIDS (acquired immunodeficiency syndrome) affected residency choice and self-perception of training needs. The questionnaire was mailed to 2,252 psychiatrists in training randomly selected and stratified by American Psychiatric Association district and postgraduate training year. The sample consisted of 825 respondents representing 37% of the initial pool. Knowledge was most lacking in areas dealing with HIV-related neuropsychiatric complications and issues concerning HIV/AIDS and special populations. In general, the respondents expressed positive attitudes about HIV-related issues; however, three items correctly endorsed by fewer than 75% of the sample dealt specifically with the management of neuropsychiatric complications, working with dying patients, and the range of normal sexuality. Targeted HIV-related education is needed for psychiatrists in training and particularly should encompass neuropsychiatric syndromes and issues of special populations.

Gender and comorbid psychopathology in adolescents with alcohol dependence.

OBJECTIVE: Although several mental disorders have been shown to be common in adolescents with substance use disorders, prior studies have not specifically focused on alcohol dependence and have not had sufficient sample sizes to examine gender effects. This study contrasts mental disorder diagnoses and symptoms between a sample of adolescents with alcohol dependence and a community control sample of adolescents and incorporates gender analyses. METHOD: Adolescents (aged 14 years 0 months to 18 years 0 months) with alcohol dependence (females: n = 55; males: n = 78) and community-dwelling control adolescents without substance use disorders (females: n = 44; males: n = 42) were assessed by means of a semistructured interview for DSM-III-R. RESULTS: While cannabis and hallucinogen use disorders were common in the alcohol dependence group, females and males had similar rates. Conduct disorder (CD), oppositional defiant disorder, attention-deficit hyperactivity disorder, major depression (MD), and posttraumatic stress disorder (PTSD) had significantly higher rates in the alcohol dependence than in the community control group. Depression and PTSD symptoms were more strongly associated with alcohol dependence in females than in males. A configural frequency analysis showed that CD and MD tended to occur together in both female and male adolescents with alcohol dependence. CONCLUSIONS: While alcohol-dependent females and males similarly exhibited more comorbid disorders than control adolescents, gender affects the relationship of alcohol dependence to MD and PTSD. Rather than reflecting distinct types, the comorbid disorders of CD and MD jointly characterize many adolescents with alcohol dependence.

Contraceptive behavior and adolescent lifestyles: a structural modeling approach.

PIP: Findings are presented from a study assessing the relationship of contraceptive use to adolescent problem behavior and health-protective behavior. Study data were collected in spring 1992 from 793 sexually active, unmarried high school students in a large, metropolitan school district. Respondents are 51% male and approximately 34% White, 22% Black, 40% Hispanic, 2% Asian, and 2% Native American. A latent variable measure of regular contraceptive use was shown to be negatively correlated with latent constructs of alcohol use, drug use, aggression, and delinquency, and positively correlated with latent variables of diet, exercise, seatbelt use, and dental hygiene. These findings point to the need to conceptualize contraceptive behavior within broader domains of behavior.^ieng

Psychosocial conventionality, health orientation, and contraceptive use in adolescence.

PURPOSE: The purpose of this paper is to determine psychosocial and behavioral factors that are associated with variation in contraceptive use among adolescents. Because regular use of contraception may be seen both as a conventional behavior and as a health-protective behavior, analyses assess the association between psychosocial conventionality and health orientation, on the one hand, and variation in contraceptive use, on the other. METHODS: Analyses are based on an urban sample of 971 white, African-American, and Hispanic male and female sexually active high school students. Study participants filled out a 38-page questionnaire that included a wide range of measures derived from Problem-Behavior Theory. RESULTS: Correlational analysis and hierarchical regression analysis indicate that more regular contraceptive use is associated with greater psychosocial conventionality and also with greater orientation toward health for both male and female adolescents. These relationships hold when the sociodemographic characteristics of race/ethnicity, socioeconomic status, grade in school, family composition, and pregnancy experience are controlled. The linkages of psychosocial conventionality and health orientation to contraceptive behavior are stronger for African-American than for white and Hispanic adolescents. CONCLUSIONS: The present findings establish a more comprehensive and more distal set of influences on regularity of contraceptive use. In its negative relationship to problem behavior and its positive linkage with health behavior, contraceptive behavior may be seen as part of a larger, organized system of behavior in this stage of development (i.e., a more conventional adolescent lifestyle).

PIP: This study examines the influence of psychosocial conventionality and health value orientation on regularity of condom use among adolescents in the US. Data were obtained from 971 ethnically and racially mixed students from a large urban school district in the Rocky Mountain Region who were followed up in the final wave of a 4-wave longitudinal study of adolescent health and development in 1992. The sample included only non-virgins and unmarried, sexually active persons, who had scores ranging from 151-217 on a regularity of contraceptive use measure. The most commonly used contraceptive method was the condom. Explanatory factors included a three-item scale of contraceptive use, three indexes of conventionality (the Independence-Achievement Value Discrepancy index and the Parent-Friends Compatibility and the Deviant Behavior scales), and 11 health measures on personality characteristics, perceived environmental factors, and behavior (Value on Health, Maternal Model for Health Behavior, and Exercise scales). Findings are given for a bivariate analysis, multivariate analyses, and a comparative analysis of bivariate and multivariate results. The general finding is that greater psychosocial and behavioral conventionality and greater health orientation were associated with more regular contraceptive use among sexually active male and female adolescents. Patterns were comparable for males and females. The relationships remained stable, after controls were introduced for sociodemographic characteristics. Conventionality was expressed as a higher value being placed on academic achievement and greater involvement in school achievement than on independence and having fewer friends with problem behaviors, such as drinking and smoking marijuana. More regular contraceptive use was related to greater health orientation, such as exercise, healthy diets, and seat belt use. The relationship between health orientation and conventionality and contraceptive use was stronger for African-Americans.

Identifying anxiety disorders in adolescents hospitalized for alcohol abuse or dependence.

In structured clinical interviews of 43 adolescents hospitalized for alcohol abuse or dependence, 17 subjects met criteria for an anxiety disorder, with social phobia (N = 9) and posttraumatic stress disorder (N = 7) most common. Of these 17 subjects, only four were identified in hospital records as having an anxiety disorder. In a comparison of 30 hospitalized adolescents with a matched control group of 30 adolescents from the community, the hospitalized adolescents had a higher rate of anxiety disorders, psychoactive substance use disorders, disruptive behavior disorders, and mood disorders.

Reliability and validity of the Hamilton Anxiety Rating Scale in an adolescent sample.

OBJECTIVE: Although generalized anxiety is an important clinical problem among adolescents, there are no interview procedures to provide a global anxiety rating that have demonstrated reliability and validity for this population. The Hamilton Anxiety Rating Scale (HARS) is a general measure of anxiety that was developed for adults. The purpose of this study was to determine the reliability and validity of the HARS when used with adolescents. METHOD: The sample consisted of 257 adolescents aged 12 to 18 years from both clinical and community sources. The HARS interviews and ratings were conducted as part of an extensive psychiatric and medical assessment. Psychiatric diagnoses were determined by structured interview. Other questionnaire measures of anxiety were also obtained. RESULTS: The interrater reliability and internal consistency of the HARS were acceptable in this adolescent sample and were comparable to results reported for adults. The HARS exhibited good construct validity, showing statistically significant relationships with independent self-report measures of generalized anxiety and other anxiety variables. The factor structure of the HARS also was found to be similar to that found earlier with adults. CONCLUSIONS: These results demonstrate that the HARS is a reliable and valid measure for the assessment of global anxiety in the adolescent population.

Structure of health-enhancing behavior in adolescence: a latent-variable approach.

The structure of the interrelations among a variety of health-enhancing behaviors was examined using structural equation modeling analyses of questionnaire data from 1,280 middle school students and 2,219 high school students. The health-enhancing behaviors included seat belt use, adequate hours of sleep, attention to healthy diet, adequate exercise, low sedentary behavior, and regular toothbrushing. In the middle school sample, all of the health-enhancing behaviors correlated significantly but modestly with each other, except for sleep with toothbrushing. In the high school sample, all but three of the 15 correlations among the behaviors were significant. The results further show that a single underlying factor can account for the modest correlations among these health-enhancing behaviors in both samples. The generality of the single-factor model was also established for male, female, White, Hispanic, and Black students at each school level. These findings provide some support for the existence of health-related lifestyles in adolescence.

Young adult drinking-driving: behavioral and psychosocial correlates.

Behavioral and psychosocial correlates of drinking and driving were examined in two independent samples of licensed drivers aged 18 to 25 selected from the Colorado Division of Motor Vehicles database. Mail questionnaires were returned by 2,300 young adults (1,196 in Sample 1; 1,104 in Sample 2). Structural equation modeling was used to examine the relation of a latent-variable measure of drinking-driving to latent-variable measures of other driving behaviors, problem behaviors and psychosocial variables. Drinking-driving, drug-driving and risky driving were found to comprise a more general, second-order factor of problem driving behavior. Drinking-driving was also found to constitute one aspect of a larger second-order latent variable that included problem drinking, marijuana use, other illicit drug use and delinquent-type behavior. In combination, the variables of problem driving, other problem behaviors, psychosocial unconventionality, risk-taking and hostility/aggression accounted for 57% of the variance in young adult drinking-driving. All of these Sample 1 findings were buttressed by confirmatory analyses in the independent Sample 2 data. The conclusion can be drawn that drinking-driving is part of a more general lifestyle involving behavior and psychosocial unconventionality.

Adolescent health behavior and conventionality-unconventionality: an extension of problem-behavior theory.

Examined the relation of psychosocial and behavioral conventionality-unconventionality to health-related behavior in cross-sectional data from 1,588 male and female 7th to 12th graders. Conventionality-unconventionality was represented by personality, perceived social environment, and behavior variables selected from the social-psychological framework of problem-behavior theory (R. Jessor & S. L. Jessor, 1977). Greater psychosocial conventionality correlates with more regular involvement in health-related behavior (regular physical activity, adequate sleep, safety belt use, attention to healthy diet). Greater behavioral conventionality (less involvement in problem behaviors such as marijuana use, problem drinking, delinquent-type behavior, and greater involvement in conventional behaviors such as church attendance) was also associated with greater involvement in health-maintaining behavior. The overall findings provide support for the extension of problem-behavior theory to the domain of adolescent health behavior and for the relevance of the dimension of conventionality-unconventionality.

Diabetic retinopathy and insulin therapy in a rural diabetic population.

The prevalence of diabetic retinopathy was lower in a rural diabetic population when compared to the prevalence of diabetic retinopathy in medical center clinic populations. Adult-onset (Type II) diabetics were at greater risk for developing diabetic retinopathy shortly after diagnosis than newly diagnosed cases of juvenile diabetes (Type I). The use of insulin positively correlated with the prevalence of diabetic retinopathy in this rural population.

Problem drinking and the dimension of involvement with drugs: a Guttman scalogram analysis of adolescent drug use.

Analyses of data from two nationwide surveys of high school students, one carried out in 1974 and the other in 1978, suggest that problem drinking may be seen as yet another step along an underlying dimension of involvement with both licit and illicit drugs. The dimension of involvement with drugs consists of the following levels: nonuse of alcohol or illicit drugs; nonproblem use of alcohol; marijuana use; problem drinking; use of pills (amphetamines, barbiturates, hallucinogenic drugs); and the use of "hard drugs" such as cocaine or heroin. The dimension possesses excellent Guttman-scale properties in both national samples as well as in subsamples differing in gender and ethnic background. The ordering of the levels of involvement was confirmed by the ordering of the alcohol-drug involvement groups based on their mean scores on measures of psychosocial proneness for involvement in problem behavior. The excessive use of a licit drug, i.e., problem drinking, appears to indicate greater involvement in drug use than does the use of an illicit drug, marijuana. This finding points to the importance of distinguishing between use and problem use of drugs in efforts to understand adolescent drug involvement.

Problem drinking in adolescence and young adulthood. A follow-up study.

Men and women classified as problem drinkers while adolescents or college students (1972-1973) tended to be nonproblem drinkers as young adults (1979), although young men tend to be at greater risk than young women to maintain problem drinking. Those whose earlier personality, perceived-environment and behavior scores indicated greater theoretical proneness for problem behavior were significantly more likely as young adults to be involved in problem drinking.

Psychosocial correlates of marijuana use and problem drinking in a national sample of adolescents.

Personality, environmental, and behavioral variables representing psychosocial risk factors for adolescent problem behavior were assessed in a 1974 national sample study of over 10,000 junior and senior high school students. Significant correlations were found with marijuana use, and the relationships held across differences in age, sex, and ethnic group membership. Greater involvement in marijuana use was associated with greater value on independence than on academic achievement, lower expectations for academic achievement, lesser religiosity, greater tolerance of deviance, less compatibility between friends and parents, greater influence of friends relative to parents, greater models and support for problem behavior, greater actual involvement in other problem behaviors such as drunkenness, and less involvement in conventional behavior such as attending church. Multiple regression analyses show that this pattern of psychosocial correlates accounts for over 50 per cent of the variation in marijuana use. The pattern is nearly identical to the pattern that accounts for problem drinking in these same adolescents. The similarity of the patterns of psychosocial risk, and the substantial correlations of marijuana use with problem drinking and with other problem behaviors, suggest that marijuana use is best seen as part of a syndrome of adolescent problem behavior. (Am J Public Health 70:604- 613,1980.)