Elsevier

Addictive Behaviors

Volume 35, Issue 1, January 2010, Pages 30-34
Addictive Behaviors

Substance use among late adolescent urban youths: Mental health and gender influences

https://doi.org/10.1016/j.addbeh.2009.08.005Get rights and content

Abstract

This paper explores gender and mental health influences on alcohol, tobacco, and illicit drug use among late adolescent urban youths. Specifically, we examine whether rates of substance use differ by gender, whether mental health indices differ by gender and are predictive of substance use, and whether gender moderates the relationship between mental health and substance use. Data from our non-clinical sample of 400 youths were collected primarily online. Analysis of cross-sectional data revealed no differences in substance use by gender. Indices of mental health differed by gender, with girls reporting greater symptoms of depression and anxiety. Ratings of hostility were similar for boys and girls. Alcohol, tobacco, and drug use were associated with greater symptoms of depression, anxiety, and hostility; this relationship, however, was not moderated by gender. Study findings provide evidence that among late adolescent youths living in urban areas, poorer mental health status is associated with increased substance use. Evidence of a moderating effect of gender on the relationship between mental health and substance use was not significant.

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

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