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Attitudinal correlates associated with recent alcohol use and episodic heavy drinking among African American youth
The Social Science Journal 50 (2013) 530–539
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Attitudinal correlates associated with recent alcohol use and episodic heavy drinking among African American youth Rebecca A. Vidourek ∗ , Keith A. King 1 Health Promotion and Education, University of Cincinnati, PO Box 210068, ML 0068, 526TC, Cincinnati, OH 45221-0068, USA
a r t i c l e
i n f o
Article history: Received 17 May 2012 Received in revised form 5 August 2013 Accepted 6 August 2013 Available online 5 October 2013
Keywords: African-American Alcohol Risk factors
a b s t r a c t African–American students in 7th–12th grades completed the PRIDE survey examining attitudinal correlates associated with recent alcohol use and heavy episodic drinking. Of participants, 13.6% reported using alcohol in the past 30 days and 5.1% reported frequent heavy episodic drinking. Logistic regression analyses indicate that male, in high school and employed increased the odds of engaging in recent use and frequent heavy episodic drinking. Perceived harm and parent/peer disapproval of substance use was negatively associated with use. Results may assist professionals in developing prevention programs for African-American youth. © 2013 Western Social Science Association. Published by Elsevier Inc. All rights reserved.
1. Introduction General population studies on youth show alcohol use contributes to harmful consequences, such as unintentional injury, poor academic performance, depression, and suicide (United States Department of Health and Human Services, 1999), and alcohol consumption poses a significant health risk to African-American youth. Data from the most recent Youth Risk Behavior Survey (YRBS) finds that 69.1% of African-American youth report consuming alcohol in their lifetime (Centers for Disease Control and Prevention, 2008), whereas 34.5% report recent alcohol use in the past 30 days. Rates of recent use are similar for African-American male (34.1%) and female (34.9%) students; however, males report higher rates of heavy episodic drinking (14.5%) than females (10.7%). Although African-American youth consume less alcohol than Hispanic and white students, African-Americans
∗ Corresponding author. Tel.: +1 513 556 3857; fax: +1 513 556 3898. E-mail addresses: [email protected] (R.A. Vidourek), [email protected] (K.A. King). 1 Tel.: +1 513 556 3859.
are disproportionately and negatively affected by alcohol use (Caetano & Kaskutas, 1996; Wallace, 1999). In addition, African-Americans are at greater risk than other racial groups for negative health outcomes related to alcohol use, including heart disease and cancer (USDHHS, 1998). At the school level, African-American youth are at elevated risk for school expulsion and school suspension due to substance use (USDHHS, 1998). Despite the negative consequences regarding youth alcohol use, research examining AfricanAmerican youth and the factors associated with recent use and heavy episodic drinking is lacking. In the literature, research establishes risk and protective use factors. Vidourek and King (2010) find prosocial behaviors, such as making good grades and involvement in school clubs and sports, is associated with reduced alcohol consumption. Having parents and teachers who talk about the dangers of alcohol and other drug use and set firm rules against use also is associated with lower consumption levels among African-American youth. Conversely, involvement in risky behaviors, such as skipping school and getting in trouble with police, is associated with higher rates of use among this population. A paucity of research currently exists on the relationships between African-American students’ perceived harm
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R.A. Vidourek, K.A. King / The Social Science Journal 50 (2013) 530–539
of substance use and actual use. Among all races, most youth do not perceive alcohol use as harmful (Johnson, O’Malley, Bachman, & Schulenberg, 2008). The 2007 Monitoring the future finds perceived harm from alcohol decreases as student grade level increases with 14.8% of 8th graders, 11.6% of 10th graders, and 8.3% of 12th graders perceiving drinking as harmful. Stephens et al. (2009) find youth who perceive alcohol use as harmful report less intention to consume alcohol than their peers, and students’ who perceive alcohol as harmful to their future report low levels of consumption (Henry, Slater, & Oetting, 2005; Slater, 2003). However, national studies often include small sample sizes of African-American youth, and therefore, inadequately address African-American’s perceptions regarding harm of substance use. Alcohol availability and access are associated with recent alcohol use (Lipperman-Kreda, Paschall, & Grube, 2009). Access to alcohol through formal channels such as direct purchase at a convenient store and informal channels increases the frequency and quantity of alcohol use (Foley, Altman, Duran, & Wolfson, 2004; Treno, Grube, & Martin, 2003; Treno, Lee, Freishler, Remer, & Gruenwald, 2005; Treno, Gruenewald, Lee, & Remer, 2007). In addition, although access to alcohol is negatively associated with being African-American, access is positively correlated with age, male, disposable income, an older peer group, and having a parent who uses alcohol (Treno, Ponicki, Remer, & Gruenewald, 2008). This study seeks to determine if alcohol access is a correlate to recent use and heavy episodic drinking among African-American youth. Family factors such as parental involvement, perceived family connectedness, supportive parent–child relationships, and clear expectations and consequences regarding youth alcohol use decrease overall use (National Institute on Drug Abuse, 2005; Resnick et al., 1997; Search Institute, 2004). Conversely, parental approval of youth alcohol use and parental drinking increase use (Barnes, Reifman, Farrell, & Dintcheff, 2000; Beck, Boyle, & Boekeloo, 2003.) Despite such findings, little research currently is published on parental disapproval of substance use and recent alcohol use and heavy episodic drinking among African-American youth. Protective factors include peer disapproval of youth alcohol use and having positive peer relationships (Center for Substance Abuse Prevention, 2001; Scales & Leffert, 1999; Search Institute, 2004). In addition, friends’ alcohol use and friends’ beliefs concerning use are correlated to youth alcohol use (Duncan, Tildesley, Duncan, & Hops, 1995; Ennett & Bauman, 1994; Marcoux & Shope, 1997). Perceiving friends as alcohol users and having friends who drink is associated with actual consumption of alcohol among youth (Jackson, 1997). Similar to parent disapproval, research on peer disapproval of alcohol use and African-American youth is lacking. The present study addresses current gaps in the literature by examining attitudinal correlates and potential relationships to African-American recent alcohol use and heavy episodic drinking. In so doing, specific and effective prevention and educational initiatives for African-American youth can be developed and implemented. The purpose of the present study is to investigate
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the relationships between perceived harm of use, ease of access, parent and peer disapproval of substance use, and recent alcohol use and heavy episodic drinking among a sample of Midwestern African-American youth. The following objectives are considered. First, to determine the percent of African-American youth who perceive alcohol use to be harmful, easy to access, and disapproved of by parents and peers. Second, to determine the relationships among harm, access, and parent and peer disapproval of substance use with recent alcohol use and heavy episodic drinking. The following hypotheses are tested: (1) Recent involvement in alcohol use in the previous 30 days differs significantly based on perceived harm of alcohol use, perceived ease in accessing alcohol, and perceived parent and peer disapproval of substance use. (2) Frequent involvement in heavy episodic drinking differs based on perceived harm of alcohol use, perceived ease of accessing alcohol, and parent and peer disapproval of substance use.
2. Methods 2.1. Participants Participants in this study are 7488 African-American youth in grades 7 through 12 in public and private schools (N = 133 total schools) in 8 counties within the Greater Cincinnati area. All participation was voluntary and no incentives to students were provided. Students were excluded from the survey if parents requested that their child did not participate in the survey. All responses were kept anonymous and confidential.
2.2. Instrument The PRIDE Questionnaire for Grades 6–12 is used to survey participants in this study. This survey is a national instrument distributed to youth every two years to assess involvement in substance use and overall student perceptions regarding substances. The following survey sections were used in this study: (1) personal and family information for demographic information, (2) perceived harm of substance use, (3) perceived ease of access, (4) perceived parent/peer disapproval of substance use, and (5) frequency of alcohol use. Specific to alcohol use, students were requested to report whether or not they drank beer, drank, coolers, breezers, hard lemonade, etc., and drank liquor, such as whisky, vodka, or rum. In addition, students were requested to report whether they drank 5 or more glasses of beer, coolers, breezers, or liquor within a few hours. Stability reliability was established by distributing the survey to a sample of 631 students on two separate occasions, yielding correlation coefficient ranges of .814–.851 (Metze, 2000). Adams (1994) tests the validity of the survey by comparing PRIDE results to those from the National Institutes of Drug Abuse (NIDA) Monitoring the Future study. Results indicated that alcohol use rates were similar with the PRIDE findings being more conservative estimates than NIDA. Additional research on the psychometric properties of PRIDE (Craig & Emshoff, 1987) demonstrates the
<.001 68.098 (.308, .490) 1.0 .388 134 (9.0) 179 (3.7) 1349 (91.0) 4642 (96.3) <.001 99.607 (.408, .550)
<.001 69.421 (2.448, 4.419) 1.0 3.289 55 (2.1) 259 (6.6) 2577 (97.9) 3690 (93.4) <.001 145.504 202 (7.3) 732 (17.4)
337 (21.2) 573 (11.3)
2566 (92.7) 3481 (82.6)
1255 (78.8) 4504 (88.7)
1.0 .474
(1.084, 1.446) 404 (12.1) 449 (14.7)
1.0 1.252
(2.267, 3.147)
21.368 (1.373, 2.208) 1.0 1.741 .002 9.338
p 2 (95% CI) OR Used in past month n (%)
Notes: Odds ratios for recent alcohol use (past month) and frequent heavy episodic drinking (often/a lot VS never/seldom) based on sex grade, and job status.
Three-fourths (73.8%) of students felt it was harmful/very harmful to their health to drink any type of alcohol. Concerning specific alcoholic beverages, approximately
2927 (87.9) 2598 (85.3)
3.1. Perceived harm of alcohol use and perceived ease of access
Did not use in past month n (%)
The present study has 7488 African-American students (77% response rate). Most participants were female (51.7%) and unemployed (76.2%) in grades 7 through 12. Most report having mothers and fathers with a college education or less. One in three (34.8%) used alcohol annually, 13.6% used monthly, 7.1% used alcohol weekly, and 2.7% used alcohol daily. Higher grade level was associated with increased alcohol use. One in 20 (5.1%) report frequent (often/a lot) heavy episodic drinking. Logistic regression analyses demonstrates that students at highest risk for recent alcohol use and heavy episodic drinking were male, in high school, and employed (Table 1).
Item
3. Results
Table 1 Odds ratios for recent use and heavy episodic drinking based on sex, grade, and job status.
All data analysis was performed using the SPSS statistical software package. Frequency distributions, means, standards deviations, and ranges were used to described students’ background characteristics and overall perceptions regarding alcohol use. Recent alcohol use was defined as having used alcohol in the past 30 days. Heavy episodic drinking was dichotomized into two categories: frequent (often/a lot) and infrequent (rarely/never). Logistic regression analyses were performed to determine whether recent involvement in alcohol use and frequent heavy episodic drinking differ significantly based on sex, grade, job status, perceived harm, ease of access, and parental/peer disapproval of substance use. To control for potential confounding variables, analyses were conducted for males only, females only, junior high school students only, and high school students only. The alpha level of significance was set at .05.
Infrequent heavy episodic drinking n (%)
2.4. Data analysis
1.0 2.671
Frequent heavy episodic drinking n (%)
OR
(95% CI)
After approval by the Institutional Review Board, surveys were distributed to schools and completed by students in their homerooms. Schools were provided with data collection instructions to assist with the survey distribution procedures. Teachers read an information sheet to students, which included the study purpose and the voluntary and confidential nature of the survey. At the completion of the survey, all students placed their completed questionnaires in a designated envelope, which was taken to the office and sent out for data entry and analysis. Each student in attendance on the day of survey distribution was provided with a survey to complete. No surveys were collected outside of the school setting.
118 (3.7) 181 (6.3)
2
2.3. Procedures
3046 (96.3) 2684 (93.7)
p
survey to be valid and reliable with percent agreements greater than 80%.
<.001
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Sex Female Male Grade 7th–8th 9th–12th Job status Employed Unemployed
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R.A. Vidourek, K.A. King / The Social Science Journal 50 (2013) 530–539
two-thirds felt it was harmful/very harmful to drink liquor (67.7%) or beer (62.3%) whereas half (49.7%) felt it was harmful/very harmful to drink wine coolers, breezers, hard lemonade, etc. Those who felt alcohol was most harmful were female (p < .001) and not employed (p = .018). For grade level, one significant difference is that 7th through 8th graders were significantly more likely than 9th through 12th graders to perceive wine coolers as harmful/very harmful. One-third (36.3%) of students felt it was fairly easy/very easy to access alcohol. Males and females did not differ significantly in ease of access. However, those in high school (p < .001) and those employed (p < .001) were significantly more likely than their counterparts to perceive alcohol to be fairly easy/very easy to access. 3.2. Perceived parent/peer disapproval of substance use The majority of students report that their parents felt it was wrong/very wrong for them to use alcohol (82.2%), tobacco, (87.0%), marijuana (86.4%), or illicit drugs (90.3%). Logistic regression analyses demonstrate that students most likely to feel their parents and peers disapprove of substance use were: female, in 7th through 8th grade, and students who did not work. Regarding peer disapproval, more than half report that their friends felt it was wrong/very wrong to use alcohol (54.1%), tobacco (63.7%), marijuana (59.0%), or illicit drugs (76.8%). Students who were female (p < .001), in 7th through 8th grade (p < .001), and who did not work (p < .001) were most likely to feel that their peers disapproved of substance use. 3.3. Recent alcohol use and heavy episodic drinking based on students’ perceived harm, ease of access and parent/peer disapproval of substance use Logistic regression analyses were conducted to examine whether recent alcohol use and frequent heavy episodic drinking differed based on students’ perceived harm of substance use, ease of access, and parent/peer disapproval of use. Results indicated that students at lowest risk for recent alcohol use and heavy episodic drinking were those who felt substance use was harmful/very harmful, difficult/very difficult to access or who had parents and peers who felt it was wrong/very wrong for youth to use substances. These findings hold for males and females, as well as junior high and high school students (Tables 2–5). 4. Discussion The present study finds high rates of recent alcohol use and frequent heavy episodic drinking among AfricanAmerican youth, with males at higher risk than females. Such findings are lower than those from the YRBS (CDC, 2008), which may be due to the inclusion of middle school students in the present study. Alcohol use rates are less in lower grade levels than in high school (Johnston et al., 2008). Additional studies which focus on alcohol use among African-American middle school students are warranted.
533
Recent alcohol use and frequent heavy episodic drinking increase with grade level; a finding consistent with previous research among youth of other races (Johnston et al., 2008). Prevention efforts should, therefore, continue to provide youth with consistent messages regarding the potentially harmful consequences of alcohol use. Additional research is needed to investigate factors contributing to increased alcohol use and heavy episodic drinking among African-American students in higher grade levels. The present study finds African-American youth employed full or part time are at increased odds for recent alcohol use and heavy episodic drinking. General studies indicate that youth engagement in risky behaviors is associated with employment status (National Research Council, 1998). Youth who work may have more disposable income than those unemployed, which may help to provide them with increased opportunities for purchasing alcohol. As a result, while employment is associated with numerous positive outcomes, it also is correlated with elevated risk for some negative behaviors. These results indicate that perceived harm of alcohol is associated with decreases in recent alcohol use and heavy episodic drinking. Similarly, other research finds perceived harm is inversely related to alcohol use (Johnston et al., 2008). However, few studies explore perceived harm of substance use among African-American youth. The present study highlights the potential link between perceived harm on African-American alcohol use. Prevention programs targeting African-American students should focus on perceived harm as a method of reducing recent alcohol use and binge drinking. Research indicates that prevention strategies are based on the negative correlation between perceived harm and substance use (Bachman, Johnston, & O’Malley, 1998; Hemmelstein, 1995; Henry, Slater, & Oetting, 2005). Paralleling findings from general population studies, African-American youth in this study who report easy access to alcohol and drugs engage in higher levels of alcohol use (Kuntsche, Kuendig, & Gmel, 2008). Ease of access is positively associated with grade level and employment status, thus lending support to studies of general populations (Johnston et al., 2008). Parents and peers who disapprove of substance use act as protective factors against alcohol use among AfricanAmerican youth. In this study, students are less likely to engage in recent alcohol use and binge drinking if parents and peers disapproved of substance use. Previous research indicates that youth consume less alcohol when parents/peers express disapproval of alcohol use and prohibit drinking altogether (D’Amico & McCarthy, 2006; Hawkins et al., 1997; Kosterman, Hawkins, Guo, Catalano, & Abbott, 2000; Wood, Read, Mitchell, & Brand, 2004; Yu, 2003). Additional research on African-American parenting techniques finds parents tend to establish strict rules regarding substance use and monitor their children more closely than parents of other races and ethnicities (Sampson & Laub, 1994). Incorporating parents into prevention programs is an important method of reducing youth alcohol use among African-Americans. Practicing parent-child communication and discussing parent beliefs
534
Table 2 Odds ratios for recent alcohol use among males and females based on perceived harm, ease of access, and perceived parent/peer disapproval of use.
Did not use in past month n (%)
Harmful/very harmful 1850 (74.2) Any alcohol Any tobacco 2059 (82.0) 1684 (67.5) Any marijuana 2042 (82.3) Any other illicit drug Fairly easy/easy 728 (30.5) Alcohol 712 (29.7) Tobacco Marijuana 777 (32.6) Other illicit drug 463 (19.5) Parent disapproval of use wrong/very wrong Any tobacco use 2071 (86.4) 1971 (82.4) Any alcohol use 2068 (86.4) Any marijuana use 2122 (89.5) Any illicit drug use Peer disapproval of use wrong/very wrong 1435 (63.5) Any tobacco use Any alcohol use 1316 (58.4) 1361 (60.6) Any marijuana use 1671 (74.6) Any illicit drug use *
p < .001.
Females Used in past month n (%) 216 (49.4) 294 (66.7%) 162 (37.0) 265 (60.9)
OR
.340* .438* .282* .336*
(95% CI)
Did not use in past month n (%)
Used in past month n (%)
OR
(.276, .419) (.351, .547) (.228, .348) (.270, .418)
2262 (79.0) 2537 (88.1) 2114 (74.0) 2504 (87.8)
231 (60.0) 317 (80.7) 171 (44.1) 315 (80.4)
.399* .566* .277* .569*
782 (28.2) 832 (30.0) 836 (30.2) 439 (15.9)
223 (59.6) 268 (72.4) 260 (70.1) 102 (27.4)
3.762* 6.130* 5.422* 2.003*
(95% CI)
(.319, .499) (.430, .744) (.223, .345) (.433, .747)
312 (75.9) 265 (64.8) 303 (74.3) 190 (46.9)
7.190* 4.353* 5.968* 3.657*
242 (60.2) 208 (51.9) 235 (58.2) 282 (71.8)
.237* .230* .219* .297*
(.188, .299) (.184, .288) (.174, .275) (.230, .384)
2572 (92.4) 2447 (88.2) 2535 (91.4) 2624 (95.1)
315 (84.5) 258 (69.7) 302 (81.0) 328 (89.4)
.446* .309* .401* .433*
(.326, .609) (.240, .396) (.300, .536) (.298, .629)
138 (36.3) 78 (20.4) 103 (27.0) 207 (55.5)
.328* .183* .241* .425*
(.262, .411) (.141, .238) (.189, .307) (.339, .532)
1917 (71.0) 1634 (60.7) 1792 (66.6) 2233 (83.1)
156 (43.8) 74 (20.8) 107 (30.2) 243 (69.2)
.319* .170* .217* .457
(.254, .399) (.130, .222) (.171, .276) (.357, .586)
(5.643, 9.162) (3.489, 5.429) (4.705, 7.571) (2.935, 4.557)
(3.011, 4.699) (4.812, 7.808) (4.279, 6.869) (1.561, 2.571)
R.A. Vidourek, K.A. King / The Social Science Journal 50 (2013) 530–539
Males Item
Table 3 Odds ratios for heavy episodic drinking among males and females perceived harm, ease of access, and perceived parent/peer disapproval of use. Males Infrequent heavy episodic drinking n (%) Harmful/very harmful Any alcohol 1863 (73.2) Any tobacco 2095 (81.7) 1684 (66.0) Any marijuana Any other illicit drug 2069 (81.6) Fairly easy/easy 798 (32.9) Alcohol 766 (31.4) Tobacco Marijuana 856 (35.3) 498 (20.6) Other illicit drug Parent disapproval of use wrong/very wrong 2086 (85.5) Any tobacco use 1973 (81.1) Any alcohol use 2091 (85.9) Any marijuana use 2159 (89.5) Any illicit drug use Peer disapproval of use wrong/very wrong 1439 (62.4) Any tobacco use 1288 (55.8) Any alcohol use 1343 (58.4) Any marijuana use 1698 (74.1) Any illicit drug use *
Females Frequent heavy episodic drinking n (%)
OR
(95% CI)
Infrequent heavy episodic drinking n (%)
Frequent heavy episodic drinking n (%)
OR
(.174, .327) (.160, .300) (.091, .195) (.128, .240)
2306 (78.1) 2614 (87.8) 2137 (72.4) 2579 (87.7)
59 (51.3) 85 (73.3) 39 (34.2) 81 (69.8)
.295* .380* .198* .325
928 (32.4) 852 (29.7) 938 (32.8) 462 (16.1)
90 (84.1) 81 (75.0) 83 (76.9) 41 (38.3)
11.062 7.106* 6.817* 3.228*
(95% CI)
69 (39.4) 86 (49.4) 35 (20.6) 76 (43.7)
.239* .219* .133* .175*
137 (81.1) 126 (74.6) 135 (80.4) 105 (62.9)
8.745* 6.388* 7.508* 6.543*
73 (45.1) 64 (40.0) 65 (39.9) 88 (55.3)
.139* .155* .109* .145*
(.100, .193) (.112, .217) (.078, .152) (.104, .204)
2652 (92.4) 2497 (87.3) 2611 (91.4) 2712 (95.3)
77 (73.3) 66 (63.5) 70 (66.0) 82 (78.8)
.225* .253* .182* .183*
(.143, .354) (.167, .383) (.120, .278) (.111, .302)
38 (25.0) 27 (17.6) 32 (21.1) 56 (37.3)
.201* .170* .190* .209*
(.138, .293) (.111, .259) (.127, .283) (.148, .294)
1941 (69.9) 1614 (58.2) 1787 (64.5) 2300 (83.2)
32 (31.4) 19 (18.6) 27 (27.0) 54 (54.5)
.197* .164* .204* .243*
(.129, .301) (.099, .272) (.130, .319) (.161, .365)
(5.897, 12.968) (4.472, 9.125) (5.085, 11.085) (4.708, 9.092)
(.202, .429) (.248, .581) (.133, .294) (.215, .490) (6.549, 18.684) (4.563, 11.064) (4.330, 10.733) (2.159, 4.827)
R.A. Vidourek, K.A. King / The Social Science Journal 50 (2013) 530–539
Item
p < .001.
535
536
Table 4 Odds ratios for recent alcohol use among junior high and high school students based on perceived harm, ease of access, and perceived parent/peer disapproval of use. Junior high Did not use in past month n (%) Harmful/very harmful 1871 (76.1) Any alcohol Any tobacco 2069 (83.4) 1839 (74.8) Any marijuana 2034 (83.2) Any other illicit drug Fairly easy/easy 471 (19.9) Alcohol 455 (19.3) Tobacco Marijuana 447 (18.9) Other illicit drug 268 (11.4) Parent disapproval of use wrong/very wrong Any tobacco use 2159 (89.9) 2079 (86.8) Any alcohol use 2156 (90.0) Any marijuana use 2178 (91.9) Any illicit drug use Peer disapproval of use wrong/very wrong 1677 (74.3) Any tobacco use Any alcohol use 1586 (70.6) 1672 (74.5) Any marijuana use 1827 (81.7) Any illicit drug use *
p < .001.
High school Used in past month n (%)
OR
(95% CI)
Did not use in past month n (%)
Used in past month n (%)
OR
(.240, .438) (.275, .516) (.209, .380) (.326, .627)
2625 (77.5) 2974 (87.0) 2332 (68.6) 2952 (87.0)
406 (56.9) 552 (76.9) 282 (39.7) 513 (72.4)
.384* .498* .301* .391*
(3.845, 7.148) (2.521, 4. 680) (3.837, 7.128) (1.362, 2.930)
1211 (36.9) 1264 (38.6) 1355 (41.5) 745 (22.8)
446 (66.3) 525 (78.1) 507 (75.9) 280 (41.8)
3.367* 5.679* 4.446* 2.430*
(95% CI)
96 (50.8) 127 (65.5) 87 (45.5) 130 (69.1)
.324* .377* .282* .452*
103 (56.6) 82 (45.1) 100 (54.9) 37 (20.4)
5.243* 3.435* 5.230* 1.998*
140 (79.1) 120 (67.8) 138 (77.5) 149 (87.1)
.424* .320* .382* .600*
(.288, .624) (.228, .448) (.262, .557) (.375, .961)
2919 (89.6) 2759 (84.8) 2888 (88.8) 3020 (93.3)
468 (70.2) 391 (59.0) 449 (67.2) 525 (79.8)
.273* .257* .260* .282*
(.224, .334) (.214,. 308) (.214, .316) (.223, .357)
74 (45.1) 51 (31.9) 68 (42.0) 95 (61.3)
.285* .195* .247* .355*
(.206, .393) (.138, .276) (.179, .343) (.253, .499)
1996 (63.2) 1631 (51.6) 1767 (56.1) 2439 (77.6)
239 (37.3) 104 (16.1) 158 (24.7) 395 (62.2)
.347* .180* .257* .476*
(.291, .414) (.144, .224) (.212, .311) (.398, .571)
(.325, .455) (.407, .608 (.255, .356) (.323, .474) (2.827, 4.010) (4.669, 6.909) (3.675, 5.379) (2.042, 2.892)
R.A. Vidourek, K.A. King / The Social Science Journal 50 (2013) 530–539
Item
Table 5 Odds ratios for heavy episodic drinking among junior high and high school based on perceived harm, ease of access, and perceived parent/peer disapproval of use. Junior high Infrequent heavy episodic drinking n (%) Harmful/very harmful Any alcohol 1830 (75.0) Any tobacco 2043 (82.7) 1798 (73.5) Any marijuana Any other illicit drug 2015 (83.1) Fairly easy/easy 514 (21.8) Alcohol 489 (20.7) Tobacco Marijuana 485 (20.6) 278 (11.8) Other illicit drug Parent disapproval of use wrong/very wrong 2140 (89.9) Any tobacco use 2045 (86.1) Any alcohol use 2140 (90.1) Any marijuana use 2164 (92.0) Any illicit drug use Peer disapproval of use wrong/very wrong 1651 (73.5) Any tobacco use 1544 (69.2) Any alcohol use 1635 (73.3) Any marijuana use 1806 (81.3) Any illicit drug use *
High school Frequent heavy episodic drinking n (%)
OR
(95% CI)
Infrequent heavy episodic drinking n (%)
Frequent heavy episodic drinking n (%)
OR
(.180, .533) (.175, .527) (.120, .380) (.132, .395)
2745 (76.8) 3126 (87.1) 2395 (67.1) 3082 (86.6)
112 (44.6) 156 (61.9) 66 (26.7) 141 (56.6)
.243* .240* .179* .202*
(2.805, 8.770) (2.008, 6.199) (3.018, 9.444) (1.091, 4.274)
1404 (41.1) 1314 (38.3) 1514 (44.3) 799 (23.4)
204 (84.6) 189 (78.1) 192 (80.3) 135 (56.3)
7.909* 5.745* 5.135* 4.210*
(95% CI)
26 (48.1) 32 (59.3) 19 (37.3) 28 (52.8)
.310* .303* .214* .228*
29 (58.0) 24 (48.0) 29 (58.0) 11 (22.4)
4.960* 3.528* 5.339* 2.160*
27 (57.4) 26 (55.3) 28 (59.6) 32 (71.1)
.151* .199* .163* .215*
(.084, .274) (.111, .358) (.089, .295) (.111, .417)
3039 (89.0) 2852 (83.7) 3005 (88.3) 3165 (93.)
132 (55.9) 112 (48.3) 120 (50.6) 156 (66.7)
.157* .182* .137* .142*
(.119, .208) (.139, .240) (.104, .180) (.105, .193)
14 (31.1) 12 (26.7) 18 (40.9) 22 (51.2)
.162* .162* .252* .241*
(.086, .308) (.083, .316) (.137, .463) (.131, .442)
2042 (61.7) 1605 (48.4) 1771 (53.5) 2555 (77.4)
59 (26.1) 35 (15.4) 47 (20.9) 97 (43.9)
.219* .194* .229* .228*
(.161, .297) (.134, .279) (.165, .319) (.173, .301)
(.187, .315) (.183, .315) (.134, .239) (.154, .264) (5.536, 11.300) (4.204, 7.851) (3.706, 7.114) (3.223, 5.498)
R.A. Vidourek, K.A. King / The Social Science Journal 50 (2013) 530–539
Item
p <.001.
537
538
R.A. Vidourek, K.A. King / The Social Science Journal 50 (2013) 530–539
toward drugs and alcohol are essential aspects of prevention programs. Interestingly, African-American females and junior high school students are significantly more likely than their counterparts to report their parents feel it is wrong/very wrong to use alcohol. However, since parent disapproval of use decreases the risk of alcohol use (Sawyer & Stevenson, 2008), prevention specialists should incorporate parents into programming efforts. Employment status is also associated with parent disapproval of alcohol use. Students who do not work are more likely than employed students to report their parents feel it is wrong/very wrong to use alcohol. Previous research indicates that employed youth spend less time with positive adult role models, such as parents and teachers (Osgood, 1999; Osgood & Lee, 1993; Osgood, Wilson, Bachman, O’Malley, & Johnston, 1996). Employment may, in fact, compromise emotional connectedness to positive adults, decrease academic commitments, and reduce personal future aspirations and goals, thereby, increasing the risk of substance use (Paternoster, Bushway, Brame, & Apel, 2003). Programs addressing these risk factors and focusing on maintaining connectedness to positive adult role models is an important protective factor against adolescent alcohol use (Resnick et al., 1997). Peer disapproval of substance use is correlated with being female and being in a lower grade level. AfricanAmerican females are significantly more likely than African-American males to report their friends feel it is wrong/very wrong to use alcohol. This finding is in contrast to previous research by Simons-Morton (2004), which indicated that peer influence and peer use of substances are associated with alcohol use, regardless of sex, race, or ethnicity. In this study, 7th and 8th grade students are more likely than 9th through 12th grade students to report their friends feel it is wrong/very wrong to use alcohol. Perceived peer disapproval of alcohol decreases as grade level increases (Johnston et al., 2008). This study provides additional evidence regarding decreases in perceived peer disapproval of alcohol consumption as grade level increases. Previous research indicates employed youth may spend more time away from home, more time socializing with peers, and less time in the presence of authority figures than unemployed youth (Osgood, 1999). This dynamic may increase the risk of substance use among employed youth by exposing youth to peers who may be accepting of alcohol and other drug use. Practicing peer resistance skills may be essential to reducing alcohol use. In addition, strengthening ties to positive adult role models through mentoring programs may contribute to reduced use among employed African-American youth. 4.1. Limitations The following limitations to this study should be stated. First, the study sample is comprised of 7th through 12th grade African-American youth in one greater metropolitan area. Therefore, caution must be exercised in generalizing these study findings to African-American youth in other geographical locations. Second, the self-reported nature
of the survey may have resulted in socially desirable responses from some students. Lastly, the data is crosssectional in nature; therefore, causal relationships cannot be determined. 5. Conclusions and implications The present study helps to fill current gaps in the research by identifying protective factors associated with alcohol use among African-American youth. This study addresses attitudinal correlates to recent alcohol use and heavy episodic drinking in a large sample of African-American youth. Future in-depth examinations of correlates to substance use among minority youth are encouraged. In addition, program planners and intervention specialists may benefit from study findings as this information may enhance alcohol prevention programs tailored to African-Americans. Factors reducing alcohol use and heavy episodic drinking among African-American youth include perceived harm from substance use, access to alcohol, and parent and peer disapproval of substance use. Prevention specialists should remain mindful of prospective factors that may enhance existing programs and potentially reduce African-American youth engagement in recent alcohol use and heavy episodic drinking. References Adams, R. D. (1994). The PRIDE questionnaire for grades 6-12. 2nd developmental study. Retrieved from http://www.pridesurveys.com/ supportfiles/tr99612.pdf. Bachman, J. G., Johnston, L. D., & O’Malley, P. M. (1998). Explaining recent increases in students’ marijuana use: impacts of perceived risk and disapproval, 1976 through 1996. American Journal of Public Health, 88(6), 887–892. Barnes, G. M., Reifman, A. S., Farrell, M. P., & Dintcheff, B. A. (2000). The effects of parenting on the development of adolescent alcohol misuse: A six-wave latent growth model. Journal of Marriage and the Family, 62, 175–186. Beck, K. H., Boyle, J. R., & Boekeloo, B. O. (2003). Parental monitoring and adolescent alcohol risk in a clinic population. American Journal of Health Behavior, 27, 108–115. Caetano, R., & Kaskutas, L. A. (1996). Changes in drinking problems among white, blacks, and Hispanics: 1984–1992. Substance Use & Misuse, 31(11/12), 1547–1571. Centers for Disease Control Prevention. (2008). Youth Risk Behavior Surveillance – United States, 2007. Morbidity and Mortality Weekly Report, 57(SS-4), 1–136. Center for Substance Abuse Prevention. (2001). Underage drinking prevention: Action guide and planner. Rockville, MD: National Clearinghouse for Alcohol and Drug Information. Craig, J. R., & Emshoff, J. (1987). The PRIDE questionnaire grades 6-12. Developmental study. Retrieved from for http://www.pridesurveys.com/supportfiles/tr99612.pdf. D’Amico, E. J., & McCarthy, D. M. (2006). Escalation and initiation of younger adolescent’s substance use: The impact of perceived peer use. Journal of Adolescent Health, 39, 481–487. Duncan, T. E., Tildesley, E., Duncan, S. C., & Hops, H. (1995). The consistency of family and peer influences on the development of substance use in adolescence. Addiction, 90, 1647–1660. Ennett, S. T., & Bauman, K. E. (1994). The contribution of influence and selection to adolescent peer group homogeneity: The case of adolescent cigarette smoking. Journal of Personality and Social Psychology, 67, 653–663. Foley, K. L., Altman, D., Durant, R. H., & Wolfson, M. (2004). Adults’ approval and adolescents’ alcohol use. Journal of Adolescent Health, 35(4), 345.e17-345.e26. Hawkins, J. D., Graham, J. W., Maruin, E., Abbott, R., Hill, K. G., & Catalano, R. E. (1997). Exploring the effects of age of alcohol use initiation and psychological risk factors on subsequent alcohol misuse. Journal of Studies on Alcohol, 58, 280–290.
R.A. Vidourek, K.A. King / The Social Science Journal 50 (2013) 530–539 Hemmelstein, N. (1995). Adolescent marijuana use and perception of risk. Journal of Alcohol and Drug Education, 41(1), 1–14. Henry, K. L., Slater, M. D., & Oetting, E. R. (2005). Alcohol use in early adolescence: The effect of changes in risk taking, perceived harm, and friends’ alcohol use. Journal of Studies on Alcohol, 66, 275–283. Jackson, C. (1997). Initial and experimental stages of tobacco and alcohol use during late childhood: Relation to peer, parental and personal risk factors. Addictive Behaviors, 22, 685–698. Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2008). Monitoring the Future national results on adolescent drug use: Overview of key findings 2007 (NIH Publication No. 08-6418). Bethesda, MD: National Institute on Drug Abuse. Kuntsche, E., Kuendig, H., & Gmel, G. (2008). Alcohol outlet density, perceived availability and adolescent alcohol use: A multilevel structural equation model. Journal of Epidemiology and Community Health, 62, 811–816. Kosterman, R., Hawkins, J. D., Guo, J., Catalano, R. E., & Abbott, R. D. (2000). The dynamics of alcohol and marijuana initiation: Patterns and predictors of first use in adolescence. American Journal of Public Health, 90, 360–366. Lipperman-Kreda, S., Paschall, M. J., & Grube, J. W. (2009). Perceived local enforcement, personal beliefs, and underage drinking: An assessment of moderating and main effects. Journal of Studies on Alcohol and Drugs, 70(1), 64–69. Marcoux, B. C., & Shope, J. T. (1997). Application of the theory of planned behavior to adolescent use and misuse of alcohol. Health Education Research, 12, 323–331. Metze, L. (2000). The PRIDE questionnaire for grades 6-12. Validity and reliability study. Retrieved from http://www.pridesurveys.com/ supportfiles/tr99612.pdf. National Institute on Drug, & Abuse. (2005). Preventing drug use among children and adolescents, in brief (2nd ed.). Retrieved from http://www.nida.nih.gov/Prevention/risk.html. National Research, & Council. (1998). Protecting youth at work: Health, safety and development of working children and adolescents in the United States. National Academy Press. Osgood, D. W. (1999). Having the time of their lives: All work and no play? In A. Booth, A. C. Crouter, & M. J. Shanahan (Eds.), Transitions to adulthood in a changing economy (pp. 176–186). Westport, CT: Prager. Osgood, D. W., & Lee, H. (1993). Leisure activities, age, and adult roles across the lifespan. Society & Leisure, 16, 181–208. Osgood, D. W., Wilson, J. K., Bachman, J. G., O’Malley, P. M., & Johnston, L. D. (1996). Routine activities and individual deviant behavior. American Sociological Review, 61, 635–655. Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., et al. (1997). Protecting adolescents from harm: Findings from the national longitudinal study on adolescent health. Journal of the American Medical Association, 278(10), 823–832. Paternoster, R., Bushway, S., Brame, R., & Apel, R. (2003). The effect of teenage employment on delinquency and problem behaviors. Social Forces, 82(1), 297–335. Sampson, R. J., & Laub, J. H. (1994). Urban poverty and the family context of delinquency: A new look at structure and process in a classic study. Child Development, 65(2), 523–540. Sawyer, T. M., & Stevenson, J. F. (2008). Perceived parental and peer disapproval toward substances: Influences on adolescent decision-making. Journal of Primary Prevention, 29, 465–477. Scales, P. C., & Leffert, N. (1999). Developmental assets. A synthesis of the scientific research on adolescent development. Minneapolis, MN: Search Institute.
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Search Institute. (2004). Tapping the power of community: Building assets to strengthen substance abuse prevention. Insights and Evidence, 2(1), 1–14. Simons-Morton, B. (2004). Prospective association of peer influence, school engagement, drinking expectancies, and parent expectations with drinking initiation among sixth graders. Addictive Behaviors, 29, 299–309. Slater, M. D. (2003). Sensation-seeking as a moderator of the effects of peer influences, consistency with personal aspirations and perceived harm on marijuana and cigarette use among younger adolescents. Substance Use and Misuse, 38, 865–880. Stephens, P. C., Sloboda, Z., Stephens, R. C., Teasdale, B., Grey, S. F., Hawthorne, R. D., et al. (2009). Universal school-based substance abuse prevention programs: Modeling targeted mediators and outcomes for adolescent cigarette, alcohol, and marijuana use. Drug and Alcohol Dependence, 102, 19–29. Treno, A. J., Grube, J. W., & Martin, S. E. (2003). Alcohol availability as a predictor of youth drinking and driving: A hierarchical analysis of survey and archival data. Alcoholism: Clinical & Experimental Research, 27, 835–840. Treno, A. J., Lee, J. P., Freisthler, B., Remer, L. G., & Gruenewald, P. J. (2005). Association of evidence-based approaches to community interventions. In T. Stockwell, P. J. Gruenewald, J. W. Toumbourou, & W. Loxley (Eds.), Preventing harmful substance use: The evidence base for policy and practice (pp. 177–189). Chichester, West Sussex, England: John Wiley & Sons, Ltd. Treno, A. J., Gruenewald, P. J., Lee, J. P., & Remer, L. G. (2007). The Sacramento neighborhood alcohol prevention project: Outcomes from a community prevention trial. Journal of Studies on Alcohol and Drugs, 68, 197–207. Treno, A. J., Ponicki, W. R., Remer, L. G., & Gruenewald, P. J. (2008). Alcohol outlets, youth drinking, and self-reported ease of access to alcohol: A constraints and opportunities approach. Alcoholism: Clinical and Experimental Research, 32(8), 1372–1379. United States Department of Health, & Human Services. (1999). Mental health: A report of the surgeon general. Chapter 3, Child & mental health. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health. United States Department of Health and Human Services. (1998). Tobacco use among U.S. racial/ethnic minority groups – African-Americans, American Indians and Alaskan Natives, Asian Americans and Pacific Islanders, and Hispanics: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Vidourek, R. A., & King, K. A. (2010). Risk and protective factors for recent alcohol use among African-American youth. Journal of Drug Education, 40(4), 411–425. Wallace, J. M. (1999). Explaining race differences in adolescent and young adult drug use: The role of racialized social systems. Drugs and Society, 14, 21–36. Wood, M. D., Read, J. P., Mitchell, R. E., & Brand, N. H. (2004). Do parents still matter? Parent and peer influences on alcohol involvement among recent high school graduates. Psychology of Addictive Behaviors, 18, 19–30. Yu, J. (2003). The association between parent alcohol-related behaviors and children’s drinking. Drug and Alcohol Dependence, 69, 253–262.
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The Social Science Journal journal homepage: www.elsevier.com/locate/soscij
Attitudinal correlates associated with recent alcohol use and episodic heavy drinking among African American youth Rebecca A. Vidourek ∗ , Keith A. King 1 Health Promotion and Education, University of Cincinnati, PO Box 210068, ML 0068, 526TC, Cincinnati, OH 45221-0068, USA
a r t i c l e
i n f o
Article history: Received 17 May 2012 Received in revised form 5 August 2013 Accepted 6 August 2013 Available online 5 October 2013
Keywords: African-American Alcohol Risk factors
a b s t r a c t African–American students in 7th–12th grades completed the PRIDE survey examining attitudinal correlates associated with recent alcohol use and heavy episodic drinking. Of participants, 13.6% reported using alcohol in the past 30 days and 5.1% reported frequent heavy episodic drinking. Logistic regression analyses indicate that male, in high school and employed increased the odds of engaging in recent use and frequent heavy episodic drinking. Perceived harm and parent/peer disapproval of substance use was negatively associated with use. Results may assist professionals in developing prevention programs for African-American youth. © 2013 Western Social Science Association. Published by Elsevier Inc. All rights reserved.
1. Introduction General population studies on youth show alcohol use contributes to harmful consequences, such as unintentional injury, poor academic performance, depression, and suicide (United States Department of Health and Human Services, 1999), and alcohol consumption poses a significant health risk to African-American youth. Data from the most recent Youth Risk Behavior Survey (YRBS) finds that 69.1% of African-American youth report consuming alcohol in their lifetime (Centers for Disease Control and Prevention, 2008), whereas 34.5% report recent alcohol use in the past 30 days. Rates of recent use are similar for African-American male (34.1%) and female (34.9%) students; however, males report higher rates of heavy episodic drinking (14.5%) than females (10.7%). Although African-American youth consume less alcohol than Hispanic and white students, African-Americans
∗ Corresponding author. Tel.: +1 513 556 3857; fax: +1 513 556 3898. E-mail addresses: [email protected] (R.A. Vidourek), [email protected] (K.A. King). 1 Tel.: +1 513 556 3859.
are disproportionately and negatively affected by alcohol use (Caetano & Kaskutas, 1996; Wallace, 1999). In addition, African-Americans are at greater risk than other racial groups for negative health outcomes related to alcohol use, including heart disease and cancer (USDHHS, 1998). At the school level, African-American youth are at elevated risk for school expulsion and school suspension due to substance use (USDHHS, 1998). Despite the negative consequences regarding youth alcohol use, research examining AfricanAmerican youth and the factors associated with recent use and heavy episodic drinking is lacking. In the literature, research establishes risk and protective use factors. Vidourek and King (2010) find prosocial behaviors, such as making good grades and involvement in school clubs and sports, is associated with reduced alcohol consumption. Having parents and teachers who talk about the dangers of alcohol and other drug use and set firm rules against use also is associated with lower consumption levels among African-American youth. Conversely, involvement in risky behaviors, such as skipping school and getting in trouble with police, is associated with higher rates of use among this population. A paucity of research currently exists on the relationships between African-American students’ perceived harm
0362-3319/$ – see front matter © 2013 Western Social Science Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.soscij.2013.08.003
R.A. Vidourek, K.A. King / The Social Science Journal 50 (2013) 530–539
of substance use and actual use. Among all races, most youth do not perceive alcohol use as harmful (Johnson, O’Malley, Bachman, & Schulenberg, 2008). The 2007 Monitoring the future finds perceived harm from alcohol decreases as student grade level increases with 14.8% of 8th graders, 11.6% of 10th graders, and 8.3% of 12th graders perceiving drinking as harmful. Stephens et al. (2009) find youth who perceive alcohol use as harmful report less intention to consume alcohol than their peers, and students’ who perceive alcohol as harmful to their future report low levels of consumption (Henry, Slater, & Oetting, 2005; Slater, 2003). However, national studies often include small sample sizes of African-American youth, and therefore, inadequately address African-American’s perceptions regarding harm of substance use. Alcohol availability and access are associated with recent alcohol use (Lipperman-Kreda, Paschall, & Grube, 2009). Access to alcohol through formal channels such as direct purchase at a convenient store and informal channels increases the frequency and quantity of alcohol use (Foley, Altman, Duran, & Wolfson, 2004; Treno, Grube, & Martin, 2003; Treno, Lee, Freishler, Remer, & Gruenwald, 2005; Treno, Gruenewald, Lee, & Remer, 2007). In addition, although access to alcohol is negatively associated with being African-American, access is positively correlated with age, male, disposable income, an older peer group, and having a parent who uses alcohol (Treno, Ponicki, Remer, & Gruenewald, 2008). This study seeks to determine if alcohol access is a correlate to recent use and heavy episodic drinking among African-American youth. Family factors such as parental involvement, perceived family connectedness, supportive parent–child relationships, and clear expectations and consequences regarding youth alcohol use decrease overall use (National Institute on Drug Abuse, 2005; Resnick et al., 1997; Search Institute, 2004). Conversely, parental approval of youth alcohol use and parental drinking increase use (Barnes, Reifman, Farrell, & Dintcheff, 2000; Beck, Boyle, & Boekeloo, 2003.) Despite such findings, little research currently is published on parental disapproval of substance use and recent alcohol use and heavy episodic drinking among African-American youth. Protective factors include peer disapproval of youth alcohol use and having positive peer relationships (Center for Substance Abuse Prevention, 2001; Scales & Leffert, 1999; Search Institute, 2004). In addition, friends’ alcohol use and friends’ beliefs concerning use are correlated to youth alcohol use (Duncan, Tildesley, Duncan, & Hops, 1995; Ennett & Bauman, 1994; Marcoux & Shope, 1997). Perceiving friends as alcohol users and having friends who drink is associated with actual consumption of alcohol among youth (Jackson, 1997). Similar to parent disapproval, research on peer disapproval of alcohol use and African-American youth is lacking. The present study addresses current gaps in the literature by examining attitudinal correlates and potential relationships to African-American recent alcohol use and heavy episodic drinking. In so doing, specific and effective prevention and educational initiatives for African-American youth can be developed and implemented. The purpose of the present study is to investigate
531
the relationships between perceived harm of use, ease of access, parent and peer disapproval of substance use, and recent alcohol use and heavy episodic drinking among a sample of Midwestern African-American youth. The following objectives are considered. First, to determine the percent of African-American youth who perceive alcohol use to be harmful, easy to access, and disapproved of by parents and peers. Second, to determine the relationships among harm, access, and parent and peer disapproval of substance use with recent alcohol use and heavy episodic drinking. The following hypotheses are tested: (1) Recent involvement in alcohol use in the previous 30 days differs significantly based on perceived harm of alcohol use, perceived ease in accessing alcohol, and perceived parent and peer disapproval of substance use. (2) Frequent involvement in heavy episodic drinking differs based on perceived harm of alcohol use, perceived ease of accessing alcohol, and parent and peer disapproval of substance use.
2. Methods 2.1. Participants Participants in this study are 7488 African-American youth in grades 7 through 12 in public and private schools (N = 133 total schools) in 8 counties within the Greater Cincinnati area. All participation was voluntary and no incentives to students were provided. Students were excluded from the survey if parents requested that their child did not participate in the survey. All responses were kept anonymous and confidential.
2.2. Instrument The PRIDE Questionnaire for Grades 6–12 is used to survey participants in this study. This survey is a national instrument distributed to youth every two years to assess involvement in substance use and overall student perceptions regarding substances. The following survey sections were used in this study: (1) personal and family information for demographic information, (2) perceived harm of substance use, (3) perceived ease of access, (4) perceived parent/peer disapproval of substance use, and (5) frequency of alcohol use. Specific to alcohol use, students were requested to report whether or not they drank beer, drank, coolers, breezers, hard lemonade, etc., and drank liquor, such as whisky, vodka, or rum. In addition, students were requested to report whether they drank 5 or more glasses of beer, coolers, breezers, or liquor within a few hours. Stability reliability was established by distributing the survey to a sample of 631 students on two separate occasions, yielding correlation coefficient ranges of .814–.851 (Metze, 2000). Adams (1994) tests the validity of the survey by comparing PRIDE results to those from the National Institutes of Drug Abuse (NIDA) Monitoring the Future study. Results indicated that alcohol use rates were similar with the PRIDE findings being more conservative estimates than NIDA. Additional research on the psychometric properties of PRIDE (Craig & Emshoff, 1987) demonstrates the
<.001 68.098 (.308, .490) 1.0 .388 134 (9.0) 179 (3.7) 1349 (91.0) 4642 (96.3) <.001 99.607 (.408, .550)
<.001 69.421 (2.448, 4.419) 1.0 3.289 55 (2.1) 259 (6.6) 2577 (97.9) 3690 (93.4) <.001 145.504 202 (7.3) 732 (17.4)
337 (21.2) 573 (11.3)
2566 (92.7) 3481 (82.6)
1255 (78.8) 4504 (88.7)
1.0 .474
(1.084, 1.446) 404 (12.1) 449 (14.7)
1.0 1.252
(2.267, 3.147)
21.368 (1.373, 2.208) 1.0 1.741 .002 9.338
p 2 (95% CI) OR Used in past month n (%)
Notes: Odds ratios for recent alcohol use (past month) and frequent heavy episodic drinking (often/a lot VS never/seldom) based on sex grade, and job status.
Three-fourths (73.8%) of students felt it was harmful/very harmful to their health to drink any type of alcohol. Concerning specific alcoholic beverages, approximately
2927 (87.9) 2598 (85.3)
3.1. Perceived harm of alcohol use and perceived ease of access
Did not use in past month n (%)
The present study has 7488 African-American students (77% response rate). Most participants were female (51.7%) and unemployed (76.2%) in grades 7 through 12. Most report having mothers and fathers with a college education or less. One in three (34.8%) used alcohol annually, 13.6% used monthly, 7.1% used alcohol weekly, and 2.7% used alcohol daily. Higher grade level was associated with increased alcohol use. One in 20 (5.1%) report frequent (often/a lot) heavy episodic drinking. Logistic regression analyses demonstrates that students at highest risk for recent alcohol use and heavy episodic drinking were male, in high school, and employed (Table 1).
Item
3. Results
Table 1 Odds ratios for recent use and heavy episodic drinking based on sex, grade, and job status.
All data analysis was performed using the SPSS statistical software package. Frequency distributions, means, standards deviations, and ranges were used to described students’ background characteristics and overall perceptions regarding alcohol use. Recent alcohol use was defined as having used alcohol in the past 30 days. Heavy episodic drinking was dichotomized into two categories: frequent (often/a lot) and infrequent (rarely/never). Logistic regression analyses were performed to determine whether recent involvement in alcohol use and frequent heavy episodic drinking differ significantly based on sex, grade, job status, perceived harm, ease of access, and parental/peer disapproval of substance use. To control for potential confounding variables, analyses were conducted for males only, females only, junior high school students only, and high school students only. The alpha level of significance was set at .05.
Infrequent heavy episodic drinking n (%)
2.4. Data analysis
1.0 2.671
Frequent heavy episodic drinking n (%)
OR
(95% CI)
After approval by the Institutional Review Board, surveys were distributed to schools and completed by students in their homerooms. Schools were provided with data collection instructions to assist with the survey distribution procedures. Teachers read an information sheet to students, which included the study purpose and the voluntary and confidential nature of the survey. At the completion of the survey, all students placed their completed questionnaires in a designated envelope, which was taken to the office and sent out for data entry and analysis. Each student in attendance on the day of survey distribution was provided with a survey to complete. No surveys were collected outside of the school setting.
118 (3.7) 181 (6.3)
2
2.3. Procedures
3046 (96.3) 2684 (93.7)
p
survey to be valid and reliable with percent agreements greater than 80%.
<.001
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Sex Female Male Grade 7th–8th 9th–12th Job status Employed Unemployed
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two-thirds felt it was harmful/very harmful to drink liquor (67.7%) or beer (62.3%) whereas half (49.7%) felt it was harmful/very harmful to drink wine coolers, breezers, hard lemonade, etc. Those who felt alcohol was most harmful were female (p < .001) and not employed (p = .018). For grade level, one significant difference is that 7th through 8th graders were significantly more likely than 9th through 12th graders to perceive wine coolers as harmful/very harmful. One-third (36.3%) of students felt it was fairly easy/very easy to access alcohol. Males and females did not differ significantly in ease of access. However, those in high school (p < .001) and those employed (p < .001) were significantly more likely than their counterparts to perceive alcohol to be fairly easy/very easy to access. 3.2. Perceived parent/peer disapproval of substance use The majority of students report that their parents felt it was wrong/very wrong for them to use alcohol (82.2%), tobacco, (87.0%), marijuana (86.4%), or illicit drugs (90.3%). Logistic regression analyses demonstrate that students most likely to feel their parents and peers disapprove of substance use were: female, in 7th through 8th grade, and students who did not work. Regarding peer disapproval, more than half report that their friends felt it was wrong/very wrong to use alcohol (54.1%), tobacco (63.7%), marijuana (59.0%), or illicit drugs (76.8%). Students who were female (p < .001), in 7th through 8th grade (p < .001), and who did not work (p < .001) were most likely to feel that their peers disapproved of substance use. 3.3. Recent alcohol use and heavy episodic drinking based on students’ perceived harm, ease of access and parent/peer disapproval of substance use Logistic regression analyses were conducted to examine whether recent alcohol use and frequent heavy episodic drinking differed based on students’ perceived harm of substance use, ease of access, and parent/peer disapproval of use. Results indicated that students at lowest risk for recent alcohol use and heavy episodic drinking were those who felt substance use was harmful/very harmful, difficult/very difficult to access or who had parents and peers who felt it was wrong/very wrong for youth to use substances. These findings hold for males and females, as well as junior high and high school students (Tables 2–5). 4. Discussion The present study finds high rates of recent alcohol use and frequent heavy episodic drinking among AfricanAmerican youth, with males at higher risk than females. Such findings are lower than those from the YRBS (CDC, 2008), which may be due to the inclusion of middle school students in the present study. Alcohol use rates are less in lower grade levels than in high school (Johnston et al., 2008). Additional studies which focus on alcohol use among African-American middle school students are warranted.
533
Recent alcohol use and frequent heavy episodic drinking increase with grade level; a finding consistent with previous research among youth of other races (Johnston et al., 2008). Prevention efforts should, therefore, continue to provide youth with consistent messages regarding the potentially harmful consequences of alcohol use. Additional research is needed to investigate factors contributing to increased alcohol use and heavy episodic drinking among African-American students in higher grade levels. The present study finds African-American youth employed full or part time are at increased odds for recent alcohol use and heavy episodic drinking. General studies indicate that youth engagement in risky behaviors is associated with employment status (National Research Council, 1998). Youth who work may have more disposable income than those unemployed, which may help to provide them with increased opportunities for purchasing alcohol. As a result, while employment is associated with numerous positive outcomes, it also is correlated with elevated risk for some negative behaviors. These results indicate that perceived harm of alcohol is associated with decreases in recent alcohol use and heavy episodic drinking. Similarly, other research finds perceived harm is inversely related to alcohol use (Johnston et al., 2008). However, few studies explore perceived harm of substance use among African-American youth. The present study highlights the potential link between perceived harm on African-American alcohol use. Prevention programs targeting African-American students should focus on perceived harm as a method of reducing recent alcohol use and binge drinking. Research indicates that prevention strategies are based on the negative correlation between perceived harm and substance use (Bachman, Johnston, & O’Malley, 1998; Hemmelstein, 1995; Henry, Slater, & Oetting, 2005). Paralleling findings from general population studies, African-American youth in this study who report easy access to alcohol and drugs engage in higher levels of alcohol use (Kuntsche, Kuendig, & Gmel, 2008). Ease of access is positively associated with grade level and employment status, thus lending support to studies of general populations (Johnston et al., 2008). Parents and peers who disapprove of substance use act as protective factors against alcohol use among AfricanAmerican youth. In this study, students are less likely to engage in recent alcohol use and binge drinking if parents and peers disapproved of substance use. Previous research indicates that youth consume less alcohol when parents/peers express disapproval of alcohol use and prohibit drinking altogether (D’Amico & McCarthy, 2006; Hawkins et al., 1997; Kosterman, Hawkins, Guo, Catalano, & Abbott, 2000; Wood, Read, Mitchell, & Brand, 2004; Yu, 2003). Additional research on African-American parenting techniques finds parents tend to establish strict rules regarding substance use and monitor their children more closely than parents of other races and ethnicities (Sampson & Laub, 1994). Incorporating parents into prevention programs is an important method of reducing youth alcohol use among African-Americans. Practicing parent-child communication and discussing parent beliefs
534
Table 2 Odds ratios for recent alcohol use among males and females based on perceived harm, ease of access, and perceived parent/peer disapproval of use.
Did not use in past month n (%)
Harmful/very harmful 1850 (74.2) Any alcohol Any tobacco 2059 (82.0) 1684 (67.5) Any marijuana 2042 (82.3) Any other illicit drug Fairly easy/easy 728 (30.5) Alcohol 712 (29.7) Tobacco Marijuana 777 (32.6) Other illicit drug 463 (19.5) Parent disapproval of use wrong/very wrong Any tobacco use 2071 (86.4) 1971 (82.4) Any alcohol use 2068 (86.4) Any marijuana use 2122 (89.5) Any illicit drug use Peer disapproval of use wrong/very wrong 1435 (63.5) Any tobacco use Any alcohol use 1316 (58.4) 1361 (60.6) Any marijuana use 1671 (74.6) Any illicit drug use *
p < .001.
Females Used in past month n (%) 216 (49.4) 294 (66.7%) 162 (37.0) 265 (60.9)
OR
.340* .438* .282* .336*
(95% CI)
Did not use in past month n (%)
Used in past month n (%)
OR
(.276, .419) (.351, .547) (.228, .348) (.270, .418)
2262 (79.0) 2537 (88.1) 2114 (74.0) 2504 (87.8)
231 (60.0) 317 (80.7) 171 (44.1) 315 (80.4)
.399* .566* .277* .569*
782 (28.2) 832 (30.0) 836 (30.2) 439 (15.9)
223 (59.6) 268 (72.4) 260 (70.1) 102 (27.4)
3.762* 6.130* 5.422* 2.003*
(95% CI)
(.319, .499) (.430, .744) (.223, .345) (.433, .747)
312 (75.9) 265 (64.8) 303 (74.3) 190 (46.9)
7.190* 4.353* 5.968* 3.657*
242 (60.2) 208 (51.9) 235 (58.2) 282 (71.8)
.237* .230* .219* .297*
(.188, .299) (.184, .288) (.174, .275) (.230, .384)
2572 (92.4) 2447 (88.2) 2535 (91.4) 2624 (95.1)
315 (84.5) 258 (69.7) 302 (81.0) 328 (89.4)
.446* .309* .401* .433*
(.326, .609) (.240, .396) (.300, .536) (.298, .629)
138 (36.3) 78 (20.4) 103 (27.0) 207 (55.5)
.328* .183* .241* .425*
(.262, .411) (.141, .238) (.189, .307) (.339, .532)
1917 (71.0) 1634 (60.7) 1792 (66.6) 2233 (83.1)
156 (43.8) 74 (20.8) 107 (30.2) 243 (69.2)
.319* .170* .217* .457
(.254, .399) (.130, .222) (.171, .276) (.357, .586)
(5.643, 9.162) (3.489, 5.429) (4.705, 7.571) (2.935, 4.557)
(3.011, 4.699) (4.812, 7.808) (4.279, 6.869) (1.561, 2.571)
R.A. Vidourek, K.A. King / The Social Science Journal 50 (2013) 530–539
Males Item
Table 3 Odds ratios for heavy episodic drinking among males and females perceived harm, ease of access, and perceived parent/peer disapproval of use. Males Infrequent heavy episodic drinking n (%) Harmful/very harmful Any alcohol 1863 (73.2) Any tobacco 2095 (81.7) 1684 (66.0) Any marijuana Any other illicit drug 2069 (81.6) Fairly easy/easy 798 (32.9) Alcohol 766 (31.4) Tobacco Marijuana 856 (35.3) 498 (20.6) Other illicit drug Parent disapproval of use wrong/very wrong 2086 (85.5) Any tobacco use 1973 (81.1) Any alcohol use 2091 (85.9) Any marijuana use 2159 (89.5) Any illicit drug use Peer disapproval of use wrong/very wrong 1439 (62.4) Any tobacco use 1288 (55.8) Any alcohol use 1343 (58.4) Any marijuana use 1698 (74.1) Any illicit drug use *
Females Frequent heavy episodic drinking n (%)
OR
(95% CI)
Infrequent heavy episodic drinking n (%)
Frequent heavy episodic drinking n (%)
OR
(.174, .327) (.160, .300) (.091, .195) (.128, .240)
2306 (78.1) 2614 (87.8) 2137 (72.4) 2579 (87.7)
59 (51.3) 85 (73.3) 39 (34.2) 81 (69.8)
.295* .380* .198* .325
928 (32.4) 852 (29.7) 938 (32.8) 462 (16.1)
90 (84.1) 81 (75.0) 83 (76.9) 41 (38.3)
11.062 7.106* 6.817* 3.228*
(95% CI)
69 (39.4) 86 (49.4) 35 (20.6) 76 (43.7)
.239* .219* .133* .175*
137 (81.1) 126 (74.6) 135 (80.4) 105 (62.9)
8.745* 6.388* 7.508* 6.543*
73 (45.1) 64 (40.0) 65 (39.9) 88 (55.3)
.139* .155* .109* .145*
(.100, .193) (.112, .217) (.078, .152) (.104, .204)
2652 (92.4) 2497 (87.3) 2611 (91.4) 2712 (95.3)
77 (73.3) 66 (63.5) 70 (66.0) 82 (78.8)
.225* .253* .182* .183*
(.143, .354) (.167, .383) (.120, .278) (.111, .302)
38 (25.0) 27 (17.6) 32 (21.1) 56 (37.3)
.201* .170* .190* .209*
(.138, .293) (.111, .259) (.127, .283) (.148, .294)
1941 (69.9) 1614 (58.2) 1787 (64.5) 2300 (83.2)
32 (31.4) 19 (18.6) 27 (27.0) 54 (54.5)
.197* .164* .204* .243*
(.129, .301) (.099, .272) (.130, .319) (.161, .365)
(5.897, 12.968) (4.472, 9.125) (5.085, 11.085) (4.708, 9.092)
(.202, .429) (.248, .581) (.133, .294) (.215, .490) (6.549, 18.684) (4.563, 11.064) (4.330, 10.733) (2.159, 4.827)
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Item
p < .001.
535
536
Table 4 Odds ratios for recent alcohol use among junior high and high school students based on perceived harm, ease of access, and perceived parent/peer disapproval of use. Junior high Did not use in past month n (%) Harmful/very harmful 1871 (76.1) Any alcohol Any tobacco 2069 (83.4) 1839 (74.8) Any marijuana 2034 (83.2) Any other illicit drug Fairly easy/easy 471 (19.9) Alcohol 455 (19.3) Tobacco Marijuana 447 (18.9) Other illicit drug 268 (11.4) Parent disapproval of use wrong/very wrong Any tobacco use 2159 (89.9) 2079 (86.8) Any alcohol use 2156 (90.0) Any marijuana use 2178 (91.9) Any illicit drug use Peer disapproval of use wrong/very wrong 1677 (74.3) Any tobacco use Any alcohol use 1586 (70.6) 1672 (74.5) Any marijuana use 1827 (81.7) Any illicit drug use *
p < .001.
High school Used in past month n (%)
OR
(95% CI)
Did not use in past month n (%)
Used in past month n (%)
OR
(.240, .438) (.275, .516) (.209, .380) (.326, .627)
2625 (77.5) 2974 (87.0) 2332 (68.6) 2952 (87.0)
406 (56.9) 552 (76.9) 282 (39.7) 513 (72.4)
.384* .498* .301* .391*
(3.845, 7.148) (2.521, 4. 680) (3.837, 7.128) (1.362, 2.930)
1211 (36.9) 1264 (38.6) 1355 (41.5) 745 (22.8)
446 (66.3) 525 (78.1) 507 (75.9) 280 (41.8)
3.367* 5.679* 4.446* 2.430*
(95% CI)
96 (50.8) 127 (65.5) 87 (45.5) 130 (69.1)
.324* .377* .282* .452*
103 (56.6) 82 (45.1) 100 (54.9) 37 (20.4)
5.243* 3.435* 5.230* 1.998*
140 (79.1) 120 (67.8) 138 (77.5) 149 (87.1)
.424* .320* .382* .600*
(.288, .624) (.228, .448) (.262, .557) (.375, .961)
2919 (89.6) 2759 (84.8) 2888 (88.8) 3020 (93.3)
468 (70.2) 391 (59.0) 449 (67.2) 525 (79.8)
.273* .257* .260* .282*
(.224, .334) (.214,. 308) (.214, .316) (.223, .357)
74 (45.1) 51 (31.9) 68 (42.0) 95 (61.3)
.285* .195* .247* .355*
(.206, .393) (.138, .276) (.179, .343) (.253, .499)
1996 (63.2) 1631 (51.6) 1767 (56.1) 2439 (77.6)
239 (37.3) 104 (16.1) 158 (24.7) 395 (62.2)
.347* .180* .257* .476*
(.291, .414) (.144, .224) (.212, .311) (.398, .571)
(.325, .455) (.407, .608 (.255, .356) (.323, .474) (2.827, 4.010) (4.669, 6.909) (3.675, 5.379) (2.042, 2.892)
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Item
Table 5 Odds ratios for heavy episodic drinking among junior high and high school based on perceived harm, ease of access, and perceived parent/peer disapproval of use. Junior high Infrequent heavy episodic drinking n (%) Harmful/very harmful Any alcohol 1830 (75.0) Any tobacco 2043 (82.7) 1798 (73.5) Any marijuana Any other illicit drug 2015 (83.1) Fairly easy/easy 514 (21.8) Alcohol 489 (20.7) Tobacco Marijuana 485 (20.6) 278 (11.8) Other illicit drug Parent disapproval of use wrong/very wrong 2140 (89.9) Any tobacco use 2045 (86.1) Any alcohol use 2140 (90.1) Any marijuana use 2164 (92.0) Any illicit drug use Peer disapproval of use wrong/very wrong 1651 (73.5) Any tobacco use 1544 (69.2) Any alcohol use 1635 (73.3) Any marijuana use 1806 (81.3) Any illicit drug use *
High school Frequent heavy episodic drinking n (%)
OR
(95% CI)
Infrequent heavy episodic drinking n (%)
Frequent heavy episodic drinking n (%)
OR
(.180, .533) (.175, .527) (.120, .380) (.132, .395)
2745 (76.8) 3126 (87.1) 2395 (67.1) 3082 (86.6)
112 (44.6) 156 (61.9) 66 (26.7) 141 (56.6)
.243* .240* .179* .202*
(2.805, 8.770) (2.008, 6.199) (3.018, 9.444) (1.091, 4.274)
1404 (41.1) 1314 (38.3) 1514 (44.3) 799 (23.4)
204 (84.6) 189 (78.1) 192 (80.3) 135 (56.3)
7.909* 5.745* 5.135* 4.210*
(95% CI)
26 (48.1) 32 (59.3) 19 (37.3) 28 (52.8)
.310* .303* .214* .228*
29 (58.0) 24 (48.0) 29 (58.0) 11 (22.4)
4.960* 3.528* 5.339* 2.160*
27 (57.4) 26 (55.3) 28 (59.6) 32 (71.1)
.151* .199* .163* .215*
(.084, .274) (.111, .358) (.089, .295) (.111, .417)
3039 (89.0) 2852 (83.7) 3005 (88.3) 3165 (93.)
132 (55.9) 112 (48.3) 120 (50.6) 156 (66.7)
.157* .182* .137* .142*
(.119, .208) (.139, .240) (.104, .180) (.105, .193)
14 (31.1) 12 (26.7) 18 (40.9) 22 (51.2)
.162* .162* .252* .241*
(.086, .308) (.083, .316) (.137, .463) (.131, .442)
2042 (61.7) 1605 (48.4) 1771 (53.5) 2555 (77.4)
59 (26.1) 35 (15.4) 47 (20.9) 97 (43.9)
.219* .194* .229* .228*
(.161, .297) (.134, .279) (.165, .319) (.173, .301)
(.187, .315) (.183, .315) (.134, .239) (.154, .264) (5.536, 11.300) (4.204, 7.851) (3.706, 7.114) (3.223, 5.498)
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Item
p <.001.
537
538
R.A. Vidourek, K.A. King / The Social Science Journal 50 (2013) 530–539
toward drugs and alcohol are essential aspects of prevention programs. Interestingly, African-American females and junior high school students are significantly more likely than their counterparts to report their parents feel it is wrong/very wrong to use alcohol. However, since parent disapproval of use decreases the risk of alcohol use (Sawyer & Stevenson, 2008), prevention specialists should incorporate parents into programming efforts. Employment status is also associated with parent disapproval of alcohol use. Students who do not work are more likely than employed students to report their parents feel it is wrong/very wrong to use alcohol. Previous research indicates that employed youth spend less time with positive adult role models, such as parents and teachers (Osgood, 1999; Osgood & Lee, 1993; Osgood, Wilson, Bachman, O’Malley, & Johnston, 1996). Employment may, in fact, compromise emotional connectedness to positive adults, decrease academic commitments, and reduce personal future aspirations and goals, thereby, increasing the risk of substance use (Paternoster, Bushway, Brame, & Apel, 2003). Programs addressing these risk factors and focusing on maintaining connectedness to positive adult role models is an important protective factor against adolescent alcohol use (Resnick et al., 1997). Peer disapproval of substance use is correlated with being female and being in a lower grade level. AfricanAmerican females are significantly more likely than African-American males to report their friends feel it is wrong/very wrong to use alcohol. This finding is in contrast to previous research by Simons-Morton (2004), which indicated that peer influence and peer use of substances are associated with alcohol use, regardless of sex, race, or ethnicity. In this study, 7th and 8th grade students are more likely than 9th through 12th grade students to report their friends feel it is wrong/very wrong to use alcohol. Perceived peer disapproval of alcohol decreases as grade level increases (Johnston et al., 2008). This study provides additional evidence regarding decreases in perceived peer disapproval of alcohol consumption as grade level increases. Previous research indicates employed youth may spend more time away from home, more time socializing with peers, and less time in the presence of authority figures than unemployed youth (Osgood, 1999). This dynamic may increase the risk of substance use among employed youth by exposing youth to peers who may be accepting of alcohol and other drug use. Practicing peer resistance skills may be essential to reducing alcohol use. In addition, strengthening ties to positive adult role models through mentoring programs may contribute to reduced use among employed African-American youth. 4.1. Limitations The following limitations to this study should be stated. First, the study sample is comprised of 7th through 12th grade African-American youth in one greater metropolitan area. Therefore, caution must be exercised in generalizing these study findings to African-American youth in other geographical locations. Second, the self-reported nature
of the survey may have resulted in socially desirable responses from some students. Lastly, the data is crosssectional in nature; therefore, causal relationships cannot be determined. 5. Conclusions and implications The present study helps to fill current gaps in the research by identifying protective factors associated with alcohol use among African-American youth. This study addresses attitudinal correlates to recent alcohol use and heavy episodic drinking in a large sample of African-American youth. Future in-depth examinations of correlates to substance use among minority youth are encouraged. In addition, program planners and intervention specialists may benefit from study findings as this information may enhance alcohol prevention programs tailored to African-Americans. Factors reducing alcohol use and heavy episodic drinking among African-American youth include perceived harm from substance use, access to alcohol, and parent and peer disapproval of substance use. Prevention specialists should remain mindful of prospective factors that may enhance existing programs and potentially reduce African-American youth engagement in recent alcohol use and heavy episodic drinking. References Adams, R. D. (1994). The PRIDE questionnaire for grades 6-12. 2nd developmental study. Retrieved from http://www.pridesurveys.com/ supportfiles/tr99612.pdf. Bachman, J. G., Johnston, L. D., & O’Malley, P. M. (1998). Explaining recent increases in students’ marijuana use: impacts of perceived risk and disapproval, 1976 through 1996. American Journal of Public Health, 88(6), 887–892. Barnes, G. M., Reifman, A. S., Farrell, M. P., & Dintcheff, B. A. (2000). The effects of parenting on the development of adolescent alcohol misuse: A six-wave latent growth model. Journal of Marriage and the Family, 62, 175–186. Beck, K. H., Boyle, J. R., & Boekeloo, B. O. (2003). Parental monitoring and adolescent alcohol risk in a clinic population. American Journal of Health Behavior, 27, 108–115. Caetano, R., & Kaskutas, L. A. (1996). Changes in drinking problems among white, blacks, and Hispanics: 1984–1992. Substance Use & Misuse, 31(11/12), 1547–1571. Centers for Disease Control Prevention. (2008). Youth Risk Behavior Surveillance – United States, 2007. Morbidity and Mortality Weekly Report, 57(SS-4), 1–136. Center for Substance Abuse Prevention. (2001). Underage drinking prevention: Action guide and planner. Rockville, MD: National Clearinghouse for Alcohol and Drug Information. Craig, J. R., & Emshoff, J. (1987). The PRIDE questionnaire grades 6-12. Developmental study. Retrieved from for http://www.pridesurveys.com/supportfiles/tr99612.pdf. D’Amico, E. J., & McCarthy, D. M. (2006). Escalation and initiation of younger adolescent’s substance use: The impact of perceived peer use. Journal of Adolescent Health, 39, 481–487. Duncan, T. E., Tildesley, E., Duncan, S. C., & Hops, H. (1995). The consistency of family and peer influences on the development of substance use in adolescence. Addiction, 90, 1647–1660. Ennett, S. T., & Bauman, K. E. (1994). The contribution of influence and selection to adolescent peer group homogeneity: The case of adolescent cigarette smoking. Journal of Personality and Social Psychology, 67, 653–663. Foley, K. L., Altman, D., Durant, R. H., & Wolfson, M. (2004). Adults’ approval and adolescents’ alcohol use. Journal of Adolescent Health, 35(4), 345.e17-345.e26. Hawkins, J. D., Graham, J. W., Maruin, E., Abbott, R., Hill, K. G., & Catalano, R. E. (1997). Exploring the effects of age of alcohol use initiation and psychological risk factors on subsequent alcohol misuse. Journal of Studies on Alcohol, 58, 280–290.
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