Monica H. Swahn

Measuring Sex Differences in Violence Victimization and Perpetration Within Date and Same-Sex Peer Relationships

This study examines sex differences in the patterns of repeated perpetration and victimization of physical violence and psychological aggression within dating relationships and same-sex peer relationships. Data were obtained from the Youth Violence Survey: Linkages among Different Forms of Violence, conducted in 2004, and administered to all public school students enrolled in grades 7, 9, 11 and 12 (N = 4,131) in a high-risk school district. Analyses of adolescents who dated in the past year (n = 2,888) show that girls are significantly more likely than boys to report physical violence and psychological aggression perpetration within dating relationships. However, boys are significantly more likely than girls to report physically injuring a date. Boys are also significantly more likely than girls to report physical violence victimization and perpetration within same-sex peer relationships. Implications and directions for future research are discussed.

Tobacco Smoke Exposure and Levels of Urinary Metals in the U.S. Youth and Adult Population: The National Health and Nutrition Examination Survey (NHANES) 1999–2004

We assessed 12 urine metals in tobacco smoke-exposed and not exposed National Health and Nutrition Examination Survey participants. Our analysis included age, race/ethnicity, and poverty status. Gender and racial/ethnic differences in cadmium and lead and creatinine-adjusted and unadjusted data for group comparisons are presented. Smokers’ had higher cadmium, lead, antimony, and barium levels than nonsmokers. Highest lead levels were in the youngest subjects. Lead levels among adults with high second-hand smoke exposure equaled smokers. Older smokers had cadmium levels signaling the potential for cadmium-related toxicity. Given the potential toxicity of metals, our findings complement existing research on exposure to chemicals in tobacco smoke.

Psychosocial predictors and outcomes of loneliness trajectories from childhood to early adolescence.

Using latent class growth analysis, we were interested in investigating how experiences of loneliness emerge in distinct developmental patterns over the course of middle childhood and adolescence (NICHD Study of Early Child Care, N = 832). Second, we examined the role of demographic, mental health, and behavioral variables in association with these discrete patterns of loneliness. Loneliness was measured at 3 time points: age 9, age 11, and age 15. Results indicated five discrete trajectories of loneliness from middle childhood to adolescence. Most children exhibited a stable and low level of loneliness over time. The remaining children were split among moderate increasing, high increasing, decreasing, and chronic loneliness groups. Ethnicity, income, age 7 social skills, age 7 depression, and age 7 aggression were associated with trajectory membership. In addition, the loneliness trajectories predicted self-reports of social skills deficits, depression, aggression, and suicidal ideation at age 15.

Changes in Loneliness during Middle Childhood Predict Risk for Adolescent Suicidality Indirectly through Mental Health Problems

We investigated whether changes in loneliness during middle childhood as well as from middle childhood into adolescence were associated with adolescent self-harm behaviors and suicidal thoughts using a community sample of 889 participants. Multivariate logistic regressions indicate that the relationship between changes in loneliness and suicidality is no longer statistically significant once depression and externalizing behavior problems are included as controls. Follow-up analyses indicate that increases in loneliness indirectly affect self-harm behaviors and suicidal thoughts through depression and externalizing behavior problems. These findings are consistent with other studies on peer relationships and adolescent suicidality, suggesting that experiences with peers indirectly affect risk for suicidality through mental health problems. These findings highlight the importance of considering how experiences in middle childhood peer relationships affect risk for suicide in consecutive developmental periods, particularly adolescence.

Alcohol and Drug Use Among Gang Members: Experiences of Adolescents Who Attend School

BACKGROUND Problems related to gangs have been noted in large cities and in many schools across the United States. This study examined the patterns of alcohol, drug use, and related exposures among male and female high school students who were gang members. METHODS Analyses were based on the Youth Violence Survey, conducted in 2004, and administered to over 80% of eligible public school students in grades 7, 9, 11, and 12 (N = 4131) in a high-risk, urban school district. The self-administered survey, completed during a class period, included measures of alcohol and drug use and related exposures. Tests of associations were determined using chi-square tests and logistic regression analyses. RESULTS In this study, 8.8% of students reported gang membership. Students who initiated alcohol use prior to age 13 (OR = 4.90; 95% CI: 3.65-6.58), who drank alcohol 3 or more times per week (OR = 9.57; 95% CI: 6.09-15.03) and who used drugs 3 or more times per week (OR = 6.51; 95% CI: 4.59-9.25) were more likely to report gang membership than students who did not report alcohol or drug use. Boys were more likely than girls to report alcohol-related fighting and drug selling. DISCUSSION Gang members were significantly more likely than non-gang members to have initiated alcohol early, to have reported a high prevalence of alcohol use, to have engaged in alcohol-related physical fighting, peer drinking, drug use, drug selling, peer drug selling, and having seen drug deals in their neighborhood. Schools may serve as a critically important source for intervention and prevention efforts for gang members, especially those in 7th grade, who still attend school.

Pre-teen alcohol use initiation and suicide attempts among middle and high school students: Findings from the 2006 Georgia Student Health Survey

Early alcohol use initiation has been linked to suicide attempts among youth. However, very little is known about the potential impact of alcohol-related norms and beliefs and how these may impact the association between alcohol use and suicide attempt. This study examines the associations between early alcohol use and suicide attempts while controlling for demographic characteristics, and alcohol-related beliefs and norms (e.g., believing alcohol causes harm to health or that adults or friends disapprove of alcohol use) and potential confounders. Analyses were based on the 2006 Georgia Student Health Survey (N=175,311) of students in grades 6, 8, 10 and 12. The current analyses were limited to students in grades 8, 10 and 12, who either began drinking prior to age 13 or who were non drinkers (n=87,349). Pre-teen alcohol use initiation was associated with suicide attempts (Adj.OR=1.51; 95%CI:1.38-1.66) relative to not drinking with similar associations for boys (Adj.OR=1.72; 95%CI:1.52-1.94) and girls (Adj.OR=1.26; 95%CI:1.08-1.45). Students who believed that alcohol was harmful to their health, or that friends or adults disapproved of their alcohol use, or who had been taught about substance use in school were less likely to make a suicide attempt, although findings differed for boys and girls. Pre-teen alcohol use initiation is an important risk factor for suicide attempts among boys and girls in Georgia. Increased efforts to delay and reduce early alcohol use through clinical interventions, education, and policies that impact norms and knowledge related to alcohol use are needed and may in turn reduce suicide attempts.

Perceived Overweight, BMI, and Risk for Suicide Attempts: Findings from the 2007 Youth Risk Behavior Survey

Among U.S. youth (N = 14,041), perceived (odds ratio [OR]adj. = 1.45, 95% confidence interval [CI]: 1.18-1.72) and actual overweight (ORadj. = 1.31, 95% CI: 1.07-1.60) were associated with suicide attempts in analyses controlling for demographic characteristics and potential confounders. There is a need to better understand associations between perceived and actual overweight and risk for suicide attempts and to develop appropriate strategies for prevention.

Alcohol Marketing, Drunkenness, and Problem Drinking among Zambian Youth: Findings from the 2004 Global School-Based Student Health Survey

This study examines the associations between alcohol marketing strategies, alcohol education including knowledge about dangers of alcohol and refusal of alcohol, and drinking prevalence, problem drinking, and drunkenness. Analyses are based on the Global School-Based Student Health Survey (GSHS) conducted in Zambia (2004) of students primarily 11 to 16 years of age (N = 2257). Four statistical models were computed to test the associations between alcohol marketing and education and alcohol use, while controlling for possible confounding factors. Alcohol marketing, specifically through providing free alcohol through a company representative, was associated with drunkenness (AOR = 1.49; 95% CI: 1.09–2.02) and problem drinking (AOR = 1.41; 95% CI: 1.06–1.87) among youth after controlling for demographic characteristics, risky behaviors, and alcohol education. However, alcohol education was not associated with drunkenness or problem drinking. These findings underscore the importance of restricting alcohol marketing practices as an important policy strategy for reducing alcohol use and its dire consequences among vulnerable youth.

The associations between early alcohol use and suicide attempts among adolescents with a history of major depression.

OBJECTIVE Previous studies have identified significant associations between alcohol initiation before the age of 13 years and risk for suicide attempts. However, these associations have not been extensively tested using data obtained from populations with clinically significant psychopathology. The current study seeks to extend knowledge of the associations between early alcohol initiation and risk for suicide by identifying the associations between age of first alcohol use and suicide attempts among a sample of youth age 13 to 15 years with a history of major depression. METHODOLOGY Data were obtained from the National Study of Drug Use and Health (NSDUH), a household-based survey of U.S. adolescents and adults age 12 years and older. RESULTS Results from these analyses confirm previous reports of significant associations between age of first alcohol use and suicide attempts and extend previous understanding of risk by using data obtained from a household-based survey and from adolescents with clinically relevant psychopathology. CONCLUSIONS These findings provide further support for the implementation, enforcement, and continued support of both targeted and universal prevention strategies designed to reduce underage drinking.

Assessing and quantifying high risk: Comparing risky behaviors by youth in an urban, disadvantaged community with nationally representative youth

Objective. This study examined whether youth who live in an urban, disadvantaged community are significantly more likely than youth representing the nation to engage in a range of health-compromising behaviors. Methods. Analyses were based on the Youth Violence Survey conducted in 2004 and administered to students (n=4,131) in a high-risk school district. Students in ninth grade (n=1,114) were compared with ninth-grade students in the 2003 national Youth Risk Behavior Survey (n=3,674) and the National Longitudinal Study of Adolescent Health conducted in 1995/1996 (n=3,523). Analyses assessed the differences in prevalence of risk and protective factors among ninth-grade students from the three studies using Chi-square tests. Results. The results showed that youth in this urban, disadvantaged community were significantly more likely than their peers across the country to report vandalism, theft, violence, and selling drugs. Youth in this community also reported significantly less support from their homes and schools, and less monitoring by their parents. Moreover, youth in this community were significantly less likely to binge drink or initiate alcohol use prior to age 13 than youth across the U.S. Conclusions. Youth who live in this urban, disadvantaged community reported significantly higher prevalence of some, but not all, risky behaviors than nationally representative U.S. youth. These findings highlight that some caution is justified when defining what might constitute high risk and that demographic and other characteristics need to be carefully considered when targeting certain high-risk behaviors.