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ABSTRACT
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2003, Baywood Publishing Co., Inc.
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often this bonding is seen as an individual (internal) attribute, the young persons
belief that this external connection is meaningful to him or her. Developing a sense
of connectedness [21] to meaningful segments of the environment that provide
and support positive opportunities is an important aspect of the internal protective orientation of young people in high-risk environments. Protective factors
therefore represent the influences, orientations, and behaviors in youths lives
that contribute to positive development and help prevent negative behaviors and
outcomes such as substance use.
AN INTEGRATED MODEL OF ADOLESCENT
SUBSTANCE USE
The analyses in the present study incorporate much of the thinking presented
above regarding the important relationship between substance use norms, external
and internal risk and protective factors, and adolescent substance use. Our model
asserts that external and internal risk and protective factors all influence substance
use behaviors, and that it is the interrelationship between the internal and external
factors, particularly connectedness of youth to their families and school, that are
most critical.
This theory-driven model draws heavily from the work of Hawkins and Weis
[12] and Kumpfer and Turner [22]. Hawkins and Weis=s social development
model was created in the context of juvenile delinquency, and asserted that
the most important units of socialization, family, schools, peers, and community, influence behavior sequentially [12, p. 73]. Juvenile delinquency could
be reduced not by focusing upon single influences, but by examining the ways in
which factors emerge and interact during the different stages in youngsters
lives [12, p. 74]. More specifically, they posit that opportunities for involvement
and interaction must exist in order for youth to become attached and committed
to conventional social values. This attachment and commitment leads to positive
associations with peers, which leads to nondelinquent behaviors. Kumpfer and
Turners social development model supports this research using a sample of
mainly Caucasian youth living in the State of Utah (n = 1800) [22]. This model
recognized the role of family, school, and peers in determining substance use
behaviors among adolescents, and expands the model to include academic
efficacy, or a measure of the degree to which youth felt effective in school. The
present analysis is a further expansion of this research, using a large sample of
high-risk youth.
METHOD
The study uses data from the Center for Substance Abuse Prevention (CSAP)
National Cross-Site Evaluation of High Risk Youth Programs. Forty-eight highrisk youth demonstration programs, funded by CSAP in 1994 and 1995, across the
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The most frequently reported substances used were alcohol (18 percent),
cigarettes (18.5 percent), and marijuana (14 percent). Relatively few youth
reported recent use of drugs such as cocaine or crack, speed, tranquilizers, PCP,
and heroin.
The use rates of youth in the cross-site sample were higher than those of the
general population of youth. Table 1 compares use rates of 12- to 17-year olds in
the study sample with those of youth who participated in the 1998 National
Household Survey on Drug Abuse (NHSDA), a randomly sampled general population survey of persons 12-years-old and older [23]. Use rates for the NHSDA
population are considerably lower than those of the cross-site sample, indicating
the high-risk nature of the cross-site sample. Although the circumstances of the
NHSDA and the National Cross-Site Evaluation data collection are not identical,
this comparison suggests that the cross-site programs served youth who were at
higher risk for initiating use when young.
To profile the sample, a composite measure of 30-day substance use was
constructed. This composite measure includes the use of any one of three
substancestobacco, alcohol, or marijuanawithin the past 30 days. Figure 2
displays the percentage of youth who reported substance use by age and gender
using this composite measure of 30-day use.
Use rates for younger children remain low until around age 13 and then rise
rapidly until age 16 for females and age 17 for males. Use rates across the age
groups are consistently higher among males than females. Substance use among
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NHSDA
Cross-site
NHSDA
Cross-site
NHSDA
Cross-site
12-13
8.0%
9.6%
4.9%
11.3%
1.7%
5.8%
14-15
18.2%
32.8%
20.9%
31.2%
8.8%
27.0%
16-17
29.3%
51.4%
32.0%
46.4%
14.7%
46.7%
Age
Note: National Household Survey on Drug Abuse (NHSDA) sample size for 12- to
17-year-olds (n = 6,778); Cross-Site sample size for 12- to 17-year-olds (n = 7,245).
females levels off at age 16 and remains somewhat constant through age 18. Males
in the 16- and 17-year-old age groups are mainly from very high-risk sites serving
incarcerated males, which accounts for the high use pattern in the age group at
program entry. The lower 30-day use rates for 18-year-olds suggests that the older
youth who participated in the study programs were individuals who were not as
involved in recent drug use as the younger high-school aged youth.
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Measures
The CSAP National Youth Survey designed for the Cross-Site Evaluation
included items in four domains: substance use norms, external risk and protection,
internal risk and protection, and individual substance use. Substance use norms
measures included: 1) perceived parental attitudes toward their child substance
use; 2) perceived peer attitudes toward substance use; and 3) peer substance use.
External risk and protective factor measures included: 1) family supervision;
2) family communication; 3) school prevention environment, or the degree to
which schools convey prevention messages about substance use and positive
personal development; 4) community protection environment, or the degree to
which the respondent participates in organized opportunities in the community;
and 5) neighborhood risk, or the perceptions of neighborhood substance use,
crimes against persons and property. Internal risk and protective factors include
measures of: 1) family bonding; 2) school bonding; 3) self-efficacy; and
4) self-control.
Pathways of Influence among Risk and
Protective Factors and Substance Use
These interrelationships between substance use, substance use norms, external
risk and protive factors, and internal risk and protective factors, were explored
with structural equation modeling using LISREL [24]. Specifically, the pathways
of influence among the risk and protective factors and substance use that were
supported in earlier research were examined using this large sample of high-risk
youth. The model presented in Figure 3 is based on data from the full (both
participant and comparison youth) study sample at baseline.1
The model includes the array of risk and protection factors and substance use
norms described in the previous section.2 The model fits the data well (CFI =
0.90),3 meeting the high standard for good model fit in these kinds of analyses.
Modeling Decisions
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The model in Figure 3 supports the relationship between risk and protection
factors and substance use, particularly the roles of family and school. Family
connectedness is a key to the substantial path of influence on substance use shown
in the model. When family connectedness is high, family supervision and parental
attitudes exert strong influences on peer associations and substance use. When
family connectedness is high and parental supervision is high, parental attitudes
carry particular weight. The substantial direct negative effect (coefficient = 0.40)
on substance use indicates that parental attitudes matter in the connected
familyeven when those attitudes are at odds with peer attitudes and behaviors.
School connectedness is also a crucial link in the internal risk and protection path.
Family connectedness and self-control contribute to school connectedness, which
relates to school performance, peer substance use, and ultimately personal
substance use. The measure of school performance (self-reported grades and
attendance) provides an important link in this path. Youth doing well in school
tend to associate with non-using peers and use less. In the community domain,
neighborhood risk is associated with peer substance use as an influence on
personal use, reflecting the importance of social environment in shaping youth
behaviors. Youth living in more dysfunctional neighborhoods are more likely to
associate with substance using peers and use themselves. The model clearly
supports the interactive nature of protective influencesinternal, external, and
normativeagainst substance use.
Pathways of Influence among Males and Females
All item and factor variances were estimated freely between the group, with equality constraints
placed on the factor loadings and factor correlations.
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than for males (0.13), suggesting that for females than for males, bonding to school
influences their academic performance. Parental attitudes toward substance use
are slightly more strongly related to personal use for females (0.42) than for
males (0.37). This suggests that females are less likely than males to use if
their parents clearly disapprove of their use. Both paths from neighborhood
risk to peer substance use to the subject=s own substance use are slightly stronger
for males (0.31 and 0.56) than females (0.14 and 0.48). Males are more
influenced by peer and community factors than females. However, these differences are minor within the overall similarity of the paths to substance use for
both genders.
Pathways of Influence among Younger and Older Youth
The models were also analyzed according to the age of youth in the study.
The sample was divided in two groups: 9 to 11 year olds and 12 to 18 year olds.
The unconstrained model fit the data well (CFI = 0.92). (Coefficients in parentheses are for the older youth.) The model is strong for both younger and older
youth.
Several major age-related differences emerge in the model. The first is the
importance of family factors for older youth. Family supervision and parental
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attitudes are stronger predictors of substance use behavior in youth 12 years and
older than they are for preteens. Some of this difference may be attributed to
reduced variation in the younger group, where positive orientation toward family
is higher in general. Nevertheless, the data indicate that the family continues to
play a critical protective role as youth develop through adolescencedespite the
fact that teens report a decline in family supervision and family connectedness as
they grow older (see Figures 3 and 4).
Second, peers influence older youth more than younger youth. Peer attitudes
and perceptions of peer use are stronger predictors of substance use among older
youth than they are for those younger than 12. This reflects the developing
sensitivity to social perceptions that begins in early adolescence and continues
into adulthood. Third, the path from school connectedness to school performance
is stronger for younger youth than for the older group. This suggests that school
plays a critical role in influencing positive behaviors that may lead to prevention of or reductions in substance use among younger youth. Fourth, school
performance is a stronger predictor of substance use behavior in older youth
than in younger youth. For students 12 and older, the model suggests that poor
grades are associated with substance-using peers and personal substance use.
In sum, school performance, parental supervision, parental attitudes, and peer
attitudes influence youths decisions regarding personal use, especially among
older youth.
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Model Summary
In summary, the model of risk and protection factors for substance use among
high-risk youth is robust. It is based on a large sample of at-risk youth, and it
applies to females and males, and younger and older youth. The model emphasizes
the critical importance of family, peers, and individual protective factors for
buffering youth from substance use. More importantly, it suggests the interdependence of these domains. The key to prevention is not to make youth
insensitive to their social environment, but to ensure that they are strongly
connected to positive, healthy environments. Given the stability of the model
across these important population subgroups, practitioners can use it to address
important questions about which risk and protective factors prevention programs
should be targeting. By reducing to a manageable number the important predictors of substance use, the model should help practitioners focus their resources
efficiently to improve program outcomes.
DISCUSSION
The CSAP National Cross-Site Evaluation of High-Risk Youth Programs has
created an excellent opportunity to expand knowledge about risk and protective
factors and substance use among youth at high risk. The models presented here
bring additional coherence and focus to the ways in which risk, protective, and
normative factors influence substance use among youth. Expanding on prior
research, these models show the indirect and direct relationships among individual, family, peer, school, and community factors using a large sample of
high-risk youth. The model is relatively stable across age and gender. There is
some evidence that family and school influences are more important for females
than males and that peer and neighborhood risk influences are stronger for males.
The models also show the important role that family plays in adolescent substance
use, especially for older youth.
By specifying plausible pathways within and between external, internal, and
normative risk factors and substance use, the model adds detail to understanding why adolescents use. In terms of internal risk and protection, the
analyses have important research implications. The previous literature on
internal risk and protection has proposed numerous attitudes, orientations, and
personal competencies as critical factors in youths use of substances. The
result has been confusion. This analysis suggests a much simpler structure of
important issues. Factors that build connectedness with the external environment (family and school connectedness) are critical deterrents to adolescent
substance use.
The analyses also point to the importance of school as a forum for changing
substance use patterns. Both school connectedness and school performance
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show strong associations with individual substance use. Furthermore, this study
shows the strong association between peers and individual substance use. The
relationship between peer and individual substance use is the strongest among
the factors in the model. This finding is supported among males and females, as
well as older and younger youth. Peer effects also serve as a powerful mediator
between individual, family, school, and community factors and individual substance use. Finally, by highlighting the importance of the family and the school,
the model suggests that youth develop important personal competencies (such
as cooperativeness, a positive view of the future, a belief in self, and a feeling of
personal efficacy) through positive orientations to, and interactions with, central
social settings.
These analyses have direct implications for prevention policy and practice.
They confirm the importance of comprehensive prevention that addresses the
range of environmental factors as well as the individual orientations and behaviors
of the youth themselves. The central implication for prevention is the need to build
connections to positive and meaningful social environments for youth. Though
important, just changing the environment, or just changing individual orientations,
is not enough. Protection and positive development requires connection between
the two. Building and supporting these connections is a central challenge to
prevention and a positive promise to youth.
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