Substance use among late adolescent urban youths: Mental health and gender influences
Introduction
Alcohol and drug use among America's youth are associated with unintentional injuries, violent behavior, school failure, adulthood substance use disorders, chronic disease, unemployment, and incarceration (Bachman et al., 2008, Grant et al., 2004, Hingson et al., 2003, U.S. Department of justice, 2006). The progression through adolescence into young adulthood is marked by increased substance use. By 12th grade, 44% of students report past-month alcohol consumption, a nearly threefold increase from 8th grade (Johnston, O'Malley, Bachman, & Schulenberg, 2008a). Monthly cigarette use increases from 7% to 21% during high school; nearly one in five 12th-graders reports monthly marijuana use (Johnston et al., 2008a). Ethnic-racial differences are apparent in substance use rates (Simantov, Schoen, & Klein, 2000), with Black youths reporting lower rates of alcohol, cigarette, and illicit drug use than White and Latino youths (Johnston, O'Malley, Bachman, & Schulenberg, 2008b).
Trends in gender differences in alcohol and substance use are mixed. In early and mid-adolescence, female substance use matches and in some instances exceeds substance use by males. By 12th grade, however, several gender differences emerge. Males outpace their female counterparts with respect to annual prevalence rates of certain illicit drug use (e.g., heroin, steroids, and hallucinogens), daily marijuana and alcohol use, and frequency of binge drinking (Johnston et al., 2008b; Johnston, O'Malley, Bachman, & Schulenberg, 2008c). Past-month alcohol use and annual rates of amphetamine use and illicit drugs other than marijuana are comparable between 12th grade males and females (Johnston et al., 2008b). Despite similar rates of substance use among males and females, the risk factors for using likely differ by gender (Fisher et al., 2007, Silberg et al., 2003). Mental health disorders comprise one such constellation of risk factors that may differentially affect substance use among boys and girls (Simantov et al., 2000). Accordingly, the influences of mental health and gender on adolescent substance use warrant additional consideration.
The association between mental health problems and substance use is well established (Harris and Edlund, 2005, Kessler et al., 1996). Adolescence, in particular, is a high risk period for the onset of mental health and substance use disorders (Rao, Daley, & Hammen, 2000). Consequently, teenage alcohol and drug use in these years are associated with depression (Brook, Brook, Zhang, Cohen, & Whiteman, 2002). Anxiety disorders, such as post-traumatic stress disorder, are also associated with increased use of marijuana and other illicit drugs among adolescents (Rey, Sawyer, Raphael, Patton, & Lynskey, 2001). Similarly, behavioral problems during adolescence, such as conduct disorder, are a leading risk factor for alcohol use and are predictive of drug use (Armstrong and Costello, 2002, Moss and Lynch, 2001).
Though evidence exists to support the association between mental health problems and substance use among adolescents, some research has failed to find such an association. For example several studies found no evidence to support the comorbidity of depression and marijuana use (Degenhardt et al., 2003, Green and Ritter, 2000). Additional studies failed to find a relationship between increased internalizing symptoms (e.g., depression and anxiety) and increased drug (Curran, White, & Hansell, 2000) or alcohol use (Hussong, Curran, & Chassin, 1998). Measelle, Stice, and Springer (2006) contend that the relatively small relationship between substance use and such disorders as depression and anxiety is rendered non-significant when examined within the context of other risk factors.
Gender differences in psychiatric symptoms and diagnoses among adolescents are well documented (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003). By age 14 years, females experience depression at two and three times the rate of males (Brooks et al., 2002, Wade et al., 2002). One study found that nearly two-thirds of adolescents with an anxiety disorder were female (Lewinsohn, Gotlib, Lewinsohn, Seeley, & Allen, 1998). During late adolescence and young adulthood, the gender gap in such externalizing behaviors as conduct disorder, delinquency, and aggression widens, with a male-to-female ratio greater than two to one (Moffitt, Caspi, Rutter, & Silva, 2001).
The few studies that have examined whether gender moderates the relationship between mental health and substance use among adolescents show mixed results. Supporting the role of gender as a moderator are data linking depression and anxiety disorders to heavy smoking among adolescent girls, but not among adolescent boys (Acierno et al., 2000). Similarly, frequent marijuana use is associated with depression among adolescent girls but not among adolescent boys (Patton et al., 2002). In other data, elevated depression was related to increased marijuana use for adolescent boys and girls, though depressed girls were additionally at risk for increased alcohol and cigarette consumption (Poulin, Hand, Boudreau, & Santor, 2005).
But, disruptive disorders have been linked to equivalent increases in substance use for both genders (Shrier, Harris, Kurland, & Knight, 2003). Other data with adolescents found no differences in the association between depression and cigarette smoking among adolescent boys and girls (Galambos, Leadbeater, & Barker, 2004). These data echo a longitudinal study finding no gender effect on the relationship between mental health and adolescent alcohol, marijuana, cigarette, or other illicit drug use (Brook, Cohen, & Brook, 1998). Finnish study data found that whereas girls experience more depression than boys, the strength of the association between depression and substance use did not differ by gender (Torikka, Kaltiala-Heino, Rimpelä, Rimpelä, & Rantanen, 2001). Finally, recent data indicated that anxiety, hostility, and depressive symptoms were similarly associated with increased smoking for boys and girls (Weiss, Palmer, Chuo, Mouttapa, & Johnson, 2008). With some exceptions, most studies on mental health, gender, and substance use focus principally on majority-culture early adolescents. In light of lower rates of alcohol and drug use by Black youths (Johnston et al., 2008b) and the inconcinnity of racial disparities for mental health indicators (Williams & Earl, 2007), study findings from majority-culture samples may be limited in their generalizability.
Consequently, the present study engaged a sample of late adolescent minority youths to examine the relationship between mental health and substance use. Gender differences in mental health and substance use were examined, as were the potential moderating effects of gender on the mental health and substance use relationship. We hypothesized that substance use would not differ by gender, but that mental health would differ by gender. Further, in our urban minority sample we predicted that mental health and substance use would be related and that mental health would function as a correlate of substance use differentially for males and females.
Section snippets
Participants
The sample consisted of 400 youths involved in an ongoing clinical trial of an alcohol abuse prevention program (Schinke et al., 2006, Schinke et al., 2004, Schinke et al., 2005). Youths were recruited from 43 community-based agencies serving economically disadvantaged youth in greater New York City, Delaware, and New Jersey. These urban agencies were principally Police Athletic Leagues, Boys and Girls Clubs, and centers affiliated with and on the premises of public housing supported by the New
Demographics
The participant sample of 400 urban youths included 216 females (54%) and 184 males (Table 1). The average age was 17.3 years (SD = 1.11) with a range of 15 to 20 years. Most youths were Black (52%), 28% were Latino, 9% were White, and 11% were from other ethnic-racial groups. Most youths (69%) were enrolled in high school, 18% were in college, and 13% were out of school. The majority of participants lived at home with their parents; approximately 20% of the sample lived alone, with a roommate,
Discussion
Among our sample of late adolescent urban youths, and as hypothesized, rates of alcohol, cigarette, marijuana, and other illicit drug use did not differ by gender. This finding is consistent with recent data suggesting that gender differences in use are disappearing (Johnston et al., 2008b). Gender differences, however, were evident in two of the three measured mental health variables in our data. Compared to males, females reported higher levels of depression and anxiety. Surprisingly, and
References (47)
- et al.
Longitudinal study of co-occurring psychiatric disorders and substance use
Journal of the American Academy of Child and Adolescent Psychiatry
(1998) - et al.
Association of adolescent risk behaviors with mental health symptoms in high school students
Journal of Adolescent Health
(2002) - et al.
The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002
Drug and Alcohol Dependence
(2004) - et al.
Comorbid disruptive behavior disorder symptoms and their relationship to adolescent alcohol use disorders
Drug and Alcohol Dependence
(2001) - et al.
Relationship between depression and substance use disorders in adolescent women during transition to adulthood
Journal of the American Academy of Child & Adolescent Psychiatry
(2000) - et al.
Emergence of gender differences in depression during adolescence: National panel results from three countries
Journal of the American Academy of Child and Adolescent Psychiatry
(2002) - et al.
Assault, PTSD, family substance use, and depression as risk factors for cigarette use in youth: Findings from the National Survey of Adolescents
Journal of Traumatic Stress
(2000) - et al.
Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity
Journal of Consulting and Clinical Psychology
(2002) - Bachman, J.G., O'Malley, P.M., Schulenberg, J.E., Johnston, L.D., Freedman-Doan, P., & Messersmith, E.E. (2008). The...
- et al.
Drug use and the risk of major depressive disorder, alcohol dependence, and substance use disorders
Archives of General Psychiatry
(2002)
Methodology of the Youth Risk Behavior Surveillance System
Morbidity and Mortality Weekly Report
YRBSS: Youth Risk Behavior Surveillance System
Prevalence and development of psychiatric disorders in childhood and adolescence
Archives of General Psychiatry
Personality, environment, and problem drug use
Journal of Drug Issues
Exploring the association between cannabis use and depression
Addiction
Brief Symptom Inventory: Administration, scoring, and procedures manual—II
The Brief Symptom Inventory: An introductory report
Psychological Medicine
Brief Symptom Inventory: Administration, scoring, and procedures manual—I
Predictors of initiation of alcohol use among US adolescents
Archives of Pediatrics and Adolescent Medicine
Gender differences in and risk factors for depression in adolescence: A 4-year longitudinal study
International Journal of Behavioral Development
Marijuana use and depression
Journal of Health and Social Behavior
Self-medication of mental health problems: New evidence from a national survey
Health Services Research
Age of first intoxication, heavy drinking, driving after drinking and risk of unintentional injury among U.S. college students
Journal of Studies on Alcohol
Cited by (41)
Substance Use Screening, Brief Intervention, and Referral to Treatment in Multiple Settings: Evaluation of a National Initiative
2022, Journal of Adolescent HealthBorderline personality disorder among cannabis users and its association with demographic variables
2022, Psiquiatria BiologicaPeer victimization and substance use: Understanding the indirect effect of depressive symptomatology across gender
2018, Addictive BehaviorsCitation Excerpt :However, the effect for each substance disappeared after accounting for concurrent use of other substances. The absence of a gender effect has also been observed in other studies with both community and nationally-representative samples (Brook, Cohen, & Brook, 1998; Schwinn, Schinke, & Trent, 2010). To date, only one published study has examined gender differences in the indirect effect of negative affect on peer victimization and substance use.
Predictors of positive drinking outcomes among youth receiving an alcohol brief intervention in the emergency department
2018, Drug and Alcohol DependenceCitation Excerpt :Second, as an exploratory aim, and consistent with a social-ecological perspective (Connell et al., 2010; Nargiso et al., 2015; Yap et al., 2017), we tested hypotheses that BI responders would report more baseline community involvement (i.e., community engagement, has a mentor), positive peer influences, and parental support, and would report less baseline negative peer influences, parental approval of substance use, and parental substance use compared to non-responders. Moreover, given that depression and anxiety symptoms are individual-level factors associated with substance use among adolescents (Schwinn et al., 2010), we hypothesized BI responders would report fewer anxiety and depression symptoms at baseline compared to non-responders. The current study presents secondary data analyses of those receiving a BI as part of a randomized controlled trial of an alcohol BI delivered to 14–20 year olds in an academic level 1 ED (Project U-Connect: Cunningham et al., 2015; Walton et al., 2015; Walton et al., 2017).
Association between schizotypal and borderline personality disorder traits, and cannabis use in young adults
2016, Addictive BehaviorsCitation Excerpt :Depressive symptoms have been found to be associated to cannabis use, borderline and schizotypal traits (e.g., Chabrol et al., 2005, 2015; Schwinn, Schinke, & Trent, 2010). Some studies reported gender differences in the relationships between mental health and cannabis use, and more specifically between depressive and borderline traits, and cannabis use or problematic use (e.g., Chabrol et al., 2005) but other studies did not find evidence of the influence of gender (e.g., Schwinn et al., 2010). No study explored the influence of gender on the association between schizotypal traits and cannabis use.
Directions of the relationship between substance use and depressive symptoms from adolescence to young adulthood
2016, Addictive BehaviorsCitation Excerpt :Studies examining sex differences show conflicting results. For example, symptoms of depression were positively associated with alcohol, tobacco, and drug use in a clinical sample of 400 youths but relationships were not moderated by sex (Schwinn, Schinke, & Trent, 2012). In contrast, in a sample of ninth and 10th grade students, overall negative mood predicted rapid smoking escalation in boys, but only those with affect-related motives for smoking; for girls, negative mood variability predicted smoking escalations indicating moderation by sex (Weinstein & Mermelstein, 2013).