David J. DeWit

Comorbidity of substance use disorders with mood and anxiety disorders: Results of the international consortium in psychiatric epidemiology

This article reports the results of a cross-national investigation of patterns of comorbidity between substance use and psychiatric disorders in six studies participating in the International Consortium in Psychiatric Epidemiology. In general, there was a strong association between mood and anxiety disorders as well as conduct and antisocial personality disorder with substance disorders at all sites. The results also suggest that there is a continuum in the magnitude of comorbidity as a function of the spectrum of substance use category (use, problems, dependence), as well as a direct relationship between the number of comorbid disorders and increasing levels of severity of substance use disorders (which was particularly pronounced for drugs). Finally, whereas there was no specific temporal pattern of onset for mood disorders in relation to substance disorders, the onset of anxiety disorders was more likely to precede that of substance disorders in all countries. These results illustrate the contribution of cross-national data to understanding the patterns and risk factors for psychopathology and substance use disorders.

Prevalence and age of onset for drug use in seven international sites: results from the international consortium of psychiatric epidemiology

This study compares lifetime prevalence and age of first use (onset) for alcohol, cannabis, and other drugs in six international sites. Data from seven epidemiologic field surveys that used compatible instruments and study designs were compiled for cross-site analyses by the International Consortium of Psychiatric Epidemiology (ICPE). The world health organizations composite international diagnostic instrument (WHO-CIDI) and additional items were used to ascertain drug use in each site. Lifetime use rates were estimated for alcohol, cannabis, and other illicit drugs. Survival analyses were used to estimate age of onset. Study settings and main results: use of alcohol twelve or more times ranged in descending order from the Netherlands (86.3%), United States (71.7%), Ontario, Canada (71.6%); São Paulo, Brazil (66.1%), Munich, Germany (64.9%), Fresno, California (USA) (51.9%), to Mexico City (43.2%). Use of cannabis five or more times in a lifetime ranged from 28.8 in the United States to 1.7% in Mexico City, and other drugs ranged from United States (19.4%) to Mexico City (1.7%). Age of first use was similar across study sites. This study demonstrates the fundamental uniformity of onset patterns by age as contrasted with wide variations in lifetime prevalences across sites. Study findings suggest that drug use patterns may change among emigrating populations from low consumption nations as a consequence of international resettlement in nations with higher rates. Methodological limitations of the study along with recommendations for future international comparative research are discussed.

High School‐Aged Youths' Attitudes Toward their Peers with Disabilities: the role of school and student interpersonal Factors

Negative peer attitudes are generally recognised as being a major barrier to full social inclusion at school for children and youth with disabilities. The present study examined the attitudes of 1,872 grade nine high school students in Ontario, Canada toward their peers with disabilities. A bioecological perspective and a structural equation modeling approach were adopted to investigate how various aspects of school culture and student interpersonal factors influenced attitudes. The majority of students (61%) held attitudes toward peers with disabilities that ranged from slightly above neutral to very positive. However, a substantial number (21%) held slightly below neutral to very negative attitudes. Positive student relationships at the school level and a school goal task structure that promoted learning and understanding for all students, rather than social comparison and competition among students, were two aspects of school culture that had both direct associations with positive attitudes and indirect associations through student interpersonal factors. Teacher and student relationships at the school level was an aspect of school culture that had an indirect association with positive attitudes via interpersonal support from teachers. Results support the development of ecologically based programs aimed at promoting aspects of school culture that contribute to positive attitudes of students toward their peers with disabilities.

Frequent childhood geographic relocation : Its impact on drug use initiation and the development of alcohol and other drug-related problems among adolescents and young adults

Early geographic relocation has been implicated as an important correlate of psychopathology, learning difficulties, and behavioural problems among child and adolescent populations, yet systematic studies of the potential influence of relocation on youthful drug use have not been conducted. This study explored the relationship between number of geographic moves before the age of 16 and the timing of onset of drug use and progression to drug-related problems. Data were obtained from 3,700 young adults aged 18 to 35 years participating in the 1990-1991 Ontario Mental Health Supplement, a large random probability survey of the residents of the Province of Ontario, Canada. Holding constant potential confounding factors, results showed highly significant positive relationships between moving and early initiation of illicit drugs including marijuana, hallucinogens, crack/cocaine, and illicit use of prescribed drugs. Among marijuana users, moving was also associated with a hastening of time to marijuana-related problems. Relationships between moving and measures of alcohol use/problems (onset of first drink, onset of any alcohol-related problem) were either weak or nonsignificant. Important sex differences were found, with statistically significant relationships between moving and early drug use initiation and progression occurring primarily among males. Future research is required to test for possible mediating mechanisms linking relocation with drug use as well as moderating influences. Efforts should also focus on finding out why drug use appears to be a more common response to relocation among boys.

Patterns of onset and cessation of drug use over the early part of the life course.

This study uses retrospective drug use histories to examine the timing of drug use behavior among young people participating in a large random probability survey of residents of the province of Ontario, Canada. Results reveal that the major risk period for initiation into alcohol, tobacco, and most illicit drugs begins around age 12 and is mostly over by age 22. For most drugs, peak periods of risk of initiation occur in the age range 15 to 19. For all categories of illicit drugs, results reveal high quit rates in the first few years of use followed by a sharp decline. Differences by gender reveal higher rates of onset for males for most drugs. Male drug users are significantly less likely than female users to quit using a drug. Results are discussed in terms of their implications for the development of primary prevention and early intervention programs for adolescents and young adults.

Predictors of Change Over Time in the Activity Participation of Children and Youth With Physical Disabilities

Little is known about predictors of change over time in the intensity of the leisure and recreational activity participation of children with physical disabilities. This study reports data from 402 children and youth with physical disabilities (216 boys and 186 girls), ages 6 to 15, collected on 3 occasions over a 3-year period. Latent growth curve modeling was used to determine the significant child, family, and community predictors of change in the intensity of their participation in 5 types of activities (recreational, active physical, social, skill-based, and self-improvement). Differences in predictors were examined for boys versus girls, and older versus younger children. Significant predictors of change were found only for recreational and active physical activities. The findings indicate that factors associated with change in participation intensity are dependent on the type of activity and vary as a function of childrens gender and age. Implications for research and service delivery are discussed, including the importance of a contextualized, holistic, and developmental approach to intervention.

Pathways to Children's Academic Performance and Prosocial Behaviour: Roles of Physical Health Status, Environmental, Family, and Child Factors.

The objective of this article is to examine the pathways by which children’s physical health status, environmental, family, and child factors affect children’s academic performance and prosocial behaviour, using a theoretically‐based and empirically‐based model of competence development. The model proposes that 3 types of relational processes, dealing with opportunity, support, and skill development through participation, lead to competence. Structural equation modelling was performed on cross‐sectional, parent‐report data for approximately 10,000 Canadian children aged 6–11 years from the 1994–95 National Longitudinal Survey of Children and Youth. The analyses controlled for family socioeconomic status and child’s age and sex, and included 3 groups of children (those with activity‐limiting conditions, non‐activity‐limiting conditions, or no health problems). There was little evidence that children with chronic conditions were at direct risk for poorer outcomes. Children with activity‐limiting conditions were at increased indirect risk for academic difficulties through the role played by cognitive functioning. Cognitive functioning and hyperactivity/inattention difficulties were the major predictors of academic performance. Recreational participation and behavioural functioning were the main predictors of prosocial behaviour. The pathways in the model also indicated the importance of family functioning, social support to parents, and neighbourhood cohesion. In conclusion, the findings indicate the utility of the model of competence development in understanding the pathways and processes by which various factors affect children’s academic and social outcomes.

The Effect of School Culture on Adolescent Behavioural Problems: SelfEsteem, Attachment to Learning, and Peer Approval of Deviance as Mediating Mechanisms

Adopting a social ecological perspective, this study examined the role of adolescent personality and social traits as mediating mechanisms linking school culture with adolescent behavioural problems. Data were obtained from the self-reports of 1,100 grade nine students attending four southern Ontario high schools. Structural equation model results revealed that student exposure to an unfavourable school culture (marked by perceptions of low teacher and classmate support, student conflict, unfair school rules and disciplinary practices, and low student autonomy in school decision-making and affairs) was positively associated with low attachment to learning and peer approval of deviance each of which were positively associated with disciplinary problems, conduct disorder, oppositional-defiant disorder, attention-deficit hyperactivity, and substance use. Low self-esteem emerged as a significant mediator in two models. Significant direct effects of school culture were found for most outcomes. Discussion focused on the significance of study findings for future program development and research.

Out-of-school time activity participation profiles of children with physical disabilities: a cluster analysis

OBJECTIVE To determine out-of-school activity participation profiles of school-aged children with physical disabilities. METHODS Activity participation profiles were determined by cluster analysing 427 childrens responses on multiple dimensions of participation (intensity, location, companionship, enjoyment, preference) in five activity types (recreational, active physical, social, skill-based, self-improvement). Socio-demographic, child, parent, family and environmental predictors of group membership were determined, along with child functioning, socio-demographic, self-concept and social support variables significantly associated with group membership. RESULTS The cluster analysis revealed four groups, labelled Social Participators (a highly social and neighbourhood-focused group), Broad Participators (a group of high participators who enjoy participation), Low Participators (a group with low enjoyment and weak preferences) and Recreational Participators (a group of younger children who participate in recreational activities with family members). The groups showed meaningful differences across a range of socio-demographic, child, parent, family and environmental variables. CONCLUSIONS The findings support an affective and contextual view of participation, indicating the importance of motivational theory and a person-environment approach in understanding the complexity of childrens out-of-school activity participation.

An Exploratory Study of the Nature of Family Resilience in Families Affected by Parental Alcohol Abuse

Resilient families are able to adapt to adversities, but the nature of family resilience is not well understood. This study examines patterns of family functioning that may protect families from the negative impact of alcohol abuse. Naturally occurring patterns of family functioning are identified and associations between these patterns and parenting, current parental alcohol use, recent family stressful events, supportive relationships outside the family, and demographic characteristics are assessed. Cross-sectional data are analyzed from racially diverse American and Canadian families (N = 674) who have at least one parent with an alcohol abuse problem and a child between ages 9 and 12 years. Cluster analyses derived from family functioning indicators are used to identify naturally occurring family patterns. Multivariate assessments evaluated relationships between family functioning clusters and potentially influencing factors. The study results reveal a continuum of family functioning associated with parenting, child’s perception of teacher caring, and race.