Problem Behavior Syndrome Research Articles

A Prospective Examination of the Path from Child Abuse and Neglect to Illicit Drug Use in Middle Adulthood: The Potential Mediating Role of Four Risk Factors

This study examines prostitution, homelessness, delinquency and crime, and school problems as potential mediators of the relationship between childhood abuse and neglect (CAN) and illicit drug use in middle adulthood. Children with documented cases of physical and sexual abuse and neglect (ages 0-11) during 1967-1971 were matched with non-maltreated children and followed into middle adulthood (approximate age 39). Mediators were assessed in young adulthood (approximate age 29) through in-person interviews between 1989 and 1995 and official arrest records through 1994 (N = 1,196). Drug use was assessed via self-reports of past year use of marijuana, psychedelics, cocaine, and/or heroin during 2000-2002 (N = 896). Latent variable structural equation modeling (SEM) was used to test: (1) a four-factor model with separate pathways from CAN to illicit drug use through each of the mediating risk factors and (2) a second-order model with a single mediating risk factor comprised of prostitution, homelessness, delinquency and crime, and poor school performance. Analyses were performed separately for women and men, controlling for race/ethnicity and early drug use. In the four-factor model for both men and women, CAN was significantly related to each of the mediators, but no paths from the mediators to drug use were significant. For women, the second-order risk factor mediated the relationship between CAN and illicit drug use in middle adulthood. For men, neither child abuse and neglect nor the second-order risk factor predicted drug use in middle adulthood. These results suggest that for women, the path from CAN to middle adulthood drug use is part of a general "problem behavior syndrome" evident earlier in life.

Energy Drinks, Race, and Problem Behaviors Among College Students

Purpose This study examined relationships between energy drink consumption and problem behaviors among adolescents and emerging adults. It was hypothesized that frequent consumption of energy drinks would be positively associated with substance abuse and other risky behaviors, and that these relationships would be moderated by race. Methods Cross-sectional, self-report survey data were collected from 602 Western New York undergraduate students in the spring of 2006. Differences in problem behaviors by frequency of energy drink consumption were assessed with multivariate linear and logistic regressions, controlling for gender, race, age, parental education, and college grade point average. Follow-up regressions were conducted to test for a moderating effect of race. Results Frequency of energy drink consumption was positively associated with marijuana use, sexual risk-taking, fighting, seatbelt omission, and taking risks on a dare for the sample as a whole, and associated with smoking, drinking, alcohol problems, and illicit prescription drug use for white students but not for black students. Conclusions These findings suggest that energy drink consumption is closely associated with a problem behavior syndrome, particularly among whites. Frequent consumption of energy drinks may serve as a useful screening indicator to identify students at risk for substance use and/or other health-compromising behavior.

Gambling and Health Risk Behaviors Among U.S. College Student-Athletes: Findings from a National Study

Purpose To examine prevalence and associations of gambling problems and health risk behaviors among college athletes from the first national survey of gambling among U.S. college student-athletes. Methods Conducted by the National Collegiate Athletic Association (NCAA), this self-administered and anonymous survey collected information from a nationally representative sample of 20,739 student-athletes. Results Males consistently had higher past-year prevalence of gambling than females (e.g., 62.4% of males reported some type of gambling vs. 42.8% of females). Based on DSM-IV Gambling Screen, this study identified 4.3% of males and 0.4% of females as problem/pathological gamblers. A general upward trend existed that as the level of gambling problems increased, so did the prevalence of substance use, gorging/vomiting, and unprotected sex. Cross-group comparisons by gambler type were all significant. Problem and pathological gamblers also experienced significantly more drug/alcohol-related problems than non-gamblers and social gamblers. Conclusions Direct associations found between gambling and multiple risk behaviors in college student-athletes support the persistence of the youth problem-behavior syndrome and suggest the need for multi-faceted initiatives to tackle these risk behaviors simultaneously.

Recent-onset ecstasy use: Association with deviant behaviors and psychiatric comorbidity.

Despite increases in ecstasy (MDMA) use in the United States, little is known about characteristics linked with recent-onset ecstasy use, especially psychiatric symptoms and deviant behaviors. To test whether individuals with high levels of other drug use are more likely to be recent-onset ecstasy users; to test whether psychiatric symptoms in adults are associated with recent-onset ecstasy use; to explore the association between recent-onset ecstasy use and concomitant deviant behaviors in adolescents and adults. Data from the 2001 National Survey on Drug Use and Health. Recent-onset ecstasy use was significantly more likely to occur among adolescents and adults (18-34 years old) who engaged in deviant behaviors during the past year as compared with those who did not engage in deviant behaviors during the past year. Higher levels of deviancy indicated a higher likelihood of being a recent-onset ecstasy user, and associations were strongest with nonviolent deviant behaviors such as selling illegal drugs and stealing. Associations between deviant behaviors and recent-onset ecstasy use were similar in strength to associations between deviant behaviors and recent-onset cocaine and marijuana use, respectively. Adults who had past-year psychiatric symptoms (both depressive and panic symptoms) were twice as likely to be recent-onset ecstasy users as compared with those without past-year psychiatric symptoms. Greater levels of drug involvement increased the odds of being a recent-onset ecstasy user. Recent-onset ecstasy use seems to be associated with a range of other behavioral problems and may reflect one aspect of a larger problem behavior syndrome.

Adolescent substance use and suicidal behavior: a review with implications for treatment research.

Adolescent substance use (alcohol and other drugs) and suicidal behavior, independently, pose serious public health problems. Youths who report co-occurring substance use and suicidality are a particularly high-risk group. In this review, we explore four areas that are pertinent to research with substance-abusing and suicidal adolescent populations. First, we review epidemiological research that is relevant to the association between substance use and suicidal behavior. Results suggest that substance use heightens statistical risk for suicidal behavior in adolescent clinical and community populations. Alcohol intoxication may serve as a proximal risk factor for suicidal behavior among distressed youths through its psychopharmacological effects on the brain. Substance use may also serve as a distal risk factor for suicidal behavior by increasing stress and exacerbating co-occurring psychopathology. Second, we propose different theoretical models that might explain the high rates of co-occurring substance use and suicidal behavior among adolescents. Substance use may stem from an underlying syndrome of problem behavior among impulsive suicide attempters with predominant externalizing symptoms. In contrast, nonimpulsive suicide attempters with predominant internalizing symptoms may use substances to cope with negative affective states. Third, we explore the status of treatment research with substance abusing and suicidal adolescent populations. Studies of substance abuse treatment and suicidal behavior have neither adequately assessed nor incorporated treatment of the other co-occurring problem. Finally, we conclude with proposed directions for future research, including the development of integrated interventions tailored to adolescents with these co-occurring problems.

Anabolic-Androgenic Steroid Use and other Adolescent Problem Behaviors: Rethinking the Male Athlete Assumption

Based on a national sample of over 16,000 public and private high school students (the 1997 Youth Risk Behavior Survey), we used logistic regression analysis to examine relationships among anabolicandrogenic steroid use and other problem behaviors for female and male athletes and nonathletes. After controlling for age, race/ethnicity, parental educational attainment, urbanicity, and recent exercise, users had significantly greater odds of engaging in other illicit drug, alcohol, and tobacco use, fighting, suicide attempts, sexual risk taking, vehicular risk taking, and pathogenic weight loss behavior, suggesting that steroid use is part of Jessor's problem behavior syndrome for adolescents. Despite the stereotypical images of the male athlete user, both nonathlete and female users also faced elevated risks of multiple drug use and other health-compromising behavior. Thus this study rejects the view of steroid use as merely a logical extension of the male athletic cultural imperative.

A prospective study of youth gambling behaviors.

Little is known about the course and outcomes of adolescent gambling. This prospective study describes findings from a 3-wave (Time 1 [T1], Time 2 [T2], and Time 3 [T3]) assessment of gambling behaviors among youth (N 305). Stable rates of any gambling and regular gambling (weekly or daily) were observed across T1, T2, and T3. The rate of at-risk gambling significantly increased at T3 (young adulthood), whereas the rate of problem gambling remained stable over time. Several adolescent risk factors were associated with either T3 at-risk or problem gambling, many of which are risk factors for adolescent substance abuse. Findings suggest that important to the origins of young adult gambling problems are risk factors associated with the problem behavior syndrome of adolescence. The rapid expansion and societal acceptance of legalized and high-stakes gambling have raised concerns among public health officials and researchers that underage gambling represents an elevated risk for the eventual development of problem gambling (Jacobs, 1989; National Research Council, 1999). These concerns have been advanced along three lines of evidence: epidemiological data on the prevalence of gambling involvement, epidemiological estimates of problem or pathological gambling, and cross-sectional studies on the psychosocial correlates of youth gambling. The epidemiological data suggest that youth gambling, like many behaviors during adolescence, occurs on a frequency continuum, ranging from no involvement to experimentation, occasional gambling, regular gambling, and preoccupation with serious adverse consequences (Stinchfield & Winters, 1998). Most youth have gambled at some time and typically at an early age, oftentimes in grade school (Ladouceur, Dube, & Bujold, 1994). Participation in legalized games is not uncommon (Winters, Stinchfield, & Fulkerson, 1993a), boys are more involved in gambling than girls, and older youth tend to gamble more often than younger teen-agers (e.g., Acuri, Lester, & Smith, 1985). Some studies have found racial– ethnic differences in youth gambling (Wallisch, 1993; Zitzow, 1996), including a recent study of Minnesota youth in which White and Asian high school students reported lower rates of gambling than the other ethnic groups (Stinchfield, Cassuto, Winters, & Latimer, 1997).

A prospective study of youth gambling behaviors.

Little is known about the course and outcomes of adolescent gambling. This prospective study describes findings from a 3-wave (Time 1 [T1], Time 2 [T2], and Time 3 [T3]) assessment of gambling behaviors among youth (N = 305). Stable rates of any gambling and regular gambling (weekly or daily) were observed across T1, T2, and T3. The rate of at-risk gambling significantly increased at T3 (young adulthood), whereas the rate of problem gambling remained stable over time. Several adolescent risk factors were associated with either T3 at-risk or problem gambling, many of which are risk factors for adolescent substance abuse. Findings suggest that important to the origins of young adult gambling problems are risk factors associated with the problem behavior syndrome of adolescence.

An instrumented vehicle assessment of problem behavior and driving style:: Do younger males really take more risks?

An instrumented vehicle was used to obtain behavioral data from 61 drivers ranging in age from 18 to 82. Each driver completed a personality questionnaire and participated in a study described as an evaluation of cognitive mapping and way-finding abilities. An evaluation of relationships between age, personality and driving style revealed that driver age and type A personality characteristics were significant predictors of vehicle speed and following distance, P<0.05. However, contrary to the earlier research, which relies heavily on a self-reported driving criterion, no significant gender differences were obtained. A factor analysis of several at-risk driving behaviors identified a cluster of correlated driving behaviors that appeared to share a common characteristic identified as aggressive/impatient driving. It is suggested that the correlated cluster of driving behavior provide objective support for the assumptions of response generalization and problem behavior theory. Results are discussed with regard to implications for safe driving interventions and a problem behavior syndrome.

The relationship of early-onset regular smoking to alcohol use, depression, illicit drug use, and other risky behaviors during early adolescence: results from the youth supplement to the third national health and nutrition examination survey.

Recently we found that the early onset of regular tobacco use is as predictive of lifetime drug use and depressive disorders as it is of alcohol use disorders [Alcohol.: Clin. Exp. Res. 23 (1999) 513.]. This finding, which paralleled findings regarding early onset of alcohol use [J. Subst. Abuse 10 (1998) 59.], suggested that early regular use of any drug might simply be an indicator of risk for a constellation of problem behaviors. The purpose of the present study is to test this hypothesis as well as to study the strength and patterns of associations among these problem behaviors already present among youth. The results will permit description of more precise profiles to identify groups of children at risk. Using data for respondents aged 12-16 from the Third National Health and Nutrition Examination Survey (NHANES III), descriptive statistics were calculated and logistic regression models were estimated. Descriptive analyses indicated that in comparison with those who never smoked, or who simply experimented, early-onset regular smokers, both those who began at age 13 or younger and those who did so between 14 and 16, were those most likely to use alcohol and other drugs as well as have school problems and early sexual experiences culminating in pregnancy. Multivariate logistic regression analyses were conducted to assess the associations among these high-risk behaviors. These results support the hypothesis that early onset of smoking is but an indicator of a syndrome of problem behaviors already in place during childhood. They also suggest that the significance of an age onset variable may differ depending on the age of the sample used. As follow-up data are collected, we expect to learn much about the natural course of the distinct risk groups identified in the analyses by studying longitudinally this nationally representative group of early adolescents.

Gambling, delinquency, and drug use during adolescence: mutual influences and common risk factors.

The purpose of this study was threefold: (1) to assess the possible mutual influence between gambling, substance use, and delinquency over a two-year period during mid adolescence, (2) to test whether variables that are usually predictive of delinquency and substance use also predict gambling, and (3) to test whether the links between the three problem behaviors could be, at least partially, accounted for by common antecedent factors (impulsivity, parental supervision, and deviant friends) assessed during early adolescence. Seven hundred and seventeen boys participated in the study. Impulsivity, parental supervision, and friends' deviancy were collected when participants were 13 and 14 years of age. Gambling, substance use, and delinquency were collected through self-reports at ages 16 and 17 years. Results showed no influence or modest influence of problem behaviors on each other from age 16 to age 17 years, once current links and auto-correlations were accounted for. Conversely, the cross-sectional links between the three problem behaviors at each age were moderately high. Impulsivity, low parental supervision, and deviant friends were predictively related to each problem. Finally, a significant, although modest, portion of the covariance between the three problem behaviors was accounted for by these three predictors. The present findings contradict previous findings about the influence of gambling on other problem behaviors and support the notion of a "general problem behavior syndrome" fed by generic risk factors.

Aggressive behavior and opportunities to purchase drugs

Robins, Kellam, and others found robust evidence linking youthful aggression and deviance to later illicit drug use. Some investigators favor the interpretation that drug use is just one manifestation or complication of a more general problem behavior syndrome or conduct disorder. In this work, we test the complementary hypothesis that aggressive youth are more likely to be approached with offers to buy drugs, and found the most aggressive youths were about five times more likely to be offered drugs for purchase. However, this association was much attenuated when levels of delinquency were taken into account. In this respect, delinquent rather than aggressive behavior might be more salient. This study's evidence does not contradict previous problem behavior theories, but rather prompts new ideas about how aggression, delinquency, and drug use might be linked. One testable hypothesis is that youths with both aggression and delinquency are more likely to enter microenvironments where drug dealing is more prevalent. Or, their observable behaviors or physical appearance might function as signs of apparent willingness to try drugs. These results add to our understanding of links between aggression, delinquency, and drug use, and introduce a new line of epidemiological inquiry focused upon drug purchase opportunities.

Trends in Adolescent Alcohol and Other Substance Use: Relationships to Trends in Peer, Parent, and School Influences

The aim of this study is to improve understanding of trends in adolescent substance use by comparing them with trends in peer substance use, school problem behavior, parental disapproval of alcohol and drugs, and exposure to school prevention information. These trends were determined using data from three large comparable representative surveys of 7–12th grade students in New York State conducted in 1983, 1990, and 1994. Analysis of variance was used to test the significance of the trends and to identify meaningful differences in trends by demographic subgroups (gender, grace level, and ethnicity). Adolescent alcohol and substance use declined in the 1980s, then increased from 1990 to 1994. Trends in friend's substance use and school problem behavior paralleled the alcohol and other substance use trends, consistent with their being part of the same adolescent problem behavior syndrome. Parental disapproval also followed a trend consistent with the substance use trends, i.e., parental disapproval increased in the 1980s but then decreased in the 1990s. However, the trend in school prevention influences did not parallel these substance use trends: student exposure to school primary prevention programs continued to increase from 1990 to 1994. Use of alcohol, cigarettes, marijuana, and other illicit drugs from 1990 to 1994, increased fastest among the younger students, despite increased school prevention exposure. Other factors must be sought as possible explanations of the increasing alcohol and substance use among adolescents.

Substance abuse and associated psychosocial problems among Argentina adolescents: sex heterogeneity and familial transmission

Objective: The goal of this investigation was to clarify the effects of sex and familial transmission in the psychosocial concomitants of substance abuse problems among adolescents. Method: Male ( n=956) and female ( n=303) adolescents in school, and male adolescents in a drug treatment program ( n=51) in Buenos Aires Province, Argentina were administered a translated version of the Drug Use Screening Inventory. Use of substances, familial substance abuse and associations between psychosocial problem domains and substance abuse problems were examined. Results: Sex heterogeneity was broadly observed in terms of both substance abuse and psychosocial problems. Female adolescents in the school-based sample were found to generally report higher levels of psychosocial problems and greater use of minor tranquillizers than school boys or boys in treatment for substance abuse. Conduct deviancy was associated with substance abuse problems only in males, while health problems were associated only in females. However, among all youth, substance abuse problems were found to be associated with older age, greater social competency, problems in school performance, and involvement with deviant peers. Familial substance abuse was associated with substance abuse problems among all adolescents, however, the pattern of associations with other psychosocial problems differed between males and females. Conclusions: Sex heterogeneity was found in the associations between psychosocial problems, adolescent substance abuse, and familial substance abuse. Furthermore, the results are consistent with a syndrome of problem behaviors.

Problem and Conventional Behaviors Among American Indian Adolescents: Structure and Validity

Empirical work based on Problem-Behavior Theory has supported a syndrome of adolescent problem behaviors such as substance use, delinquent behaviors, and sexual intercourse. The previously reported latent structure of a 4-item problem-behavior syndrome was replicated within a sample of 2,250 American Indian adolescents. With the inclusion of multiple indicators of several of the problem behaviors, a single factor no longer provided a satisfactory fit. With the addition of multiple indicators of conventional behavior, a 2nd-order latent construct model consisting of 1 problem-behavior construct and 1 conventional behavior construct provided a satisfactory fit. Both constructs contributed important and unique information to the prediction of adaptive and maladaptive psychosocial variables. Implications for understanding problem and conventional behaviors across cultural subgroups, as well as within the broader context of adolescent development, are raised.

Covariations of eating behaviors with other health-related behaviors among adolescents

The study objectives are: (1) to examine and compare patterns of covariation of a wide range of health behaviors among adolescent boys and girls; (2) to determine whether eating behaviors are part of a larger construct of health-related behaviors and to identify the behaviors with which they share underlying similarities; and (3) to determine whether youth engaging in other health-compromising behaviors are at risk for unhealthy eating. Data were analyzed from the Minnesota Adolescent Health Survey, a classroom-administered questionnaire, completed by 36,284 adolescents, in grades 7-12 from 1986-87. Among boys, factor analysis revealed five factors: (1) risk-taking behaviors, (2) school-related behaviors, (3) "quietly" disturbed behaviors (e.g., frequent dieting, self-induced vomiting, suicide attempts), (4) health-promoting behaviors; and (5) exercise. Eating behaviors loaded on the construct of health-promoting behaviors with brushing teeth and seat belt use. Among girls, four similar factors emerged; however, exercise loaded on the construct of health-promoting behaviors. Therefore, eating behaviors loaded with brushing teeth, seat belt use, and exercise among girls. Logistic regression analyses, controlling for sociodemographic and personal variables, revealed that boys and girls engaging in health-promoting behaviors were less likely to have unhealthy eating behaviors, while those engaging in quietly disturbed behaviors, risk-taking behaviors, and problematic school behaviors were more likely to have unhealthy eating behaviors. Eating behaviors appear to be part of a health-promoting behavioral construct and should not be viewed in isolation from other behaviors. Although eating behaviors do not appear to be part of the "problem behavior syndrome," youth engaging in a wide range of health-compromising behaviors are at risk for unhealthy eating; emphasizing the need to target high-risk youth with health promotion programs.

The changing importance of romantic relationship involvement to competence from late childhood to late adolescence

AbstractAlthough developmental theorists such as Sullivan (1953) and Havighurst (1972) have suggested that the formation of romantic relationships in adolescence is an important developmental task, researchers of the adolescent “problem behavior syndrome” have documented that early sexual intercourse is related to problems with conduct, academics, and chemical use. In this study multiple measures of competence and romantic relationship involvement were obtained from a normative community sample of children and adolescents. These were used in path analyses to document the concurrent and longitudinal predictions of romantic involvement and competence to examine the concurrent and longitudinal linkages of romantic interest and involvement to four other domains of adaptive behavior. Results suggest that although success in romantic relationships has roots in general peer competence, there may be both deviant and prosocial pathways of initial romantic involvement. Early romantic involvement in late childhood and early to middle adolescence may have negative consequences for academic, job, and conduct domains of competence. Later in adolescence, romantic relationship involvement loses its negative significance, perhaps as it becomes a normative developmental task. Results highlight the need for developmental research on the origins and meaning of romantic relationships, one of the most neglected aspects of peer relationships.

Sequence of Sexual Behavior and Its Relationship to Other Problem Behaviors in African American and Puerto Rican Adolescents

This study examined the sequence of sexual behavior of 695 African American and 637 Puerto Rican adolescents and the relationship of this sequence to other problem behavior measures. Analyses indicated that adolescents proceed through four stages of sexual behavior: no involvement, then deep kissing, then petting, and, finally, sexual intercourse. The sequence was similar in both ethnic groups and seemed both unidimensional and cumulative. In addition, for both ethnic groups the degree of sexual involvement was significantly related to the level of drug use and to the frequency of delinquent behavior, thereby suggesting an underlying problem behavior syndrome. Directions for future research are suggested.

The development of problem behavior syndromes in at-risk adolescents

AbstractThis study examined multiple paths that can explain the co-occurrence of behaviors comprising a problem behavior syndrome in adolescence. Two hundred sixteen 15–18-year-olds in service programs for at-risk adolescents were assessed twice over a 6–12-month period to examine predictors of changes in levels of their delinquency, unprotected sexual intercourse, and use of soft and of hard drugs. This study considered (a) potential common predictors of multiple behaviors, (b) predictive links among behaviors over time, and (c) whether or not important unique aspects of individual behaviors remain in spite of their co-occurrence. Results were consistent with the hypothesis that the co-occurrence of problem behaviors results from multiple pathways of influence. The future occurrence of several problem behaviors was predicted by adolescents' initial negative expectations in social interactions. In addition, alcohol and marijuana use predicted increases in several other problem behaviors over time. Finally, individual problem behaviors retained important unique characteristics, suggesting the need for further research examining both their syndromal and unique aspects.

Substance Use and Other Factors Associated with Risky Sexual Behavior among Pregnant Adolescents

A study of the relationship between substance use and risky sexual behavior was conducted among 241 unmarried pregnant adolescents aged 17 and younger who lived in a metropolitan area in the Northwest. The respondents had comparable or higher lifetime use rates for all substances than did women in a national sample of high school seniors, even though the pregnant adolescents were younger. Ninety-four percent had used alcohol, 78% marijuana, 30% cocaine and 30% stimulants, compared with 92%, 48%, 14% and 23%, respectively, among women in the national sample. Among the pregnant adolescents, 84% had had more than one sexual partner, 39% had had a sexually transmitted disease and 60% had used contraceptives during less than half of their sexual encounters. At the bivariate level, use of cigarettes and alcohol in general and use of alcohol and drugs during sex were positively associated with risky sexual behavior. However, when other characteristics associated with risky sexual behavior--family bonding, parental monitoring, commitment to conventional values, peer associations, self-esteem and delinquent activities--were included in the multivariate analysis, the effect of substance use disappeared.