Traci Brooks

Association of adolescent risk behaviors with mental health symptoms in high school students

PURPOSE To examine the hypothesis that self-reported symptoms of depression and stress may be associated with other risk behaviors. METHODS A secondary data analysis of the 1992 Massachusetts Adolescent Health Survey involving a representative sample of 2,224 ninth and twelfth grade students was performed. The dichotomous dependent variable was positive if the adolescent reported feeling depressed or stressed for 10 or more days in the past month. Potential independent variables examined were age, gender, race/ethnicity, and 14 risk or protective behaviors: each scored on a seven point scale representing increasing frequency of a behavior in the past month. A four-level sexual risk variable was constructed as well. Associations were assessed using Chi-square, and phi/contingency coefficients, and logistic regression analyses to predict the odds of reporting depression/stress. RESULTS The mean age of the sample was 16.2 +/- 1.6 years; 52% males; 78% were white, 9% black, 6% Latino, 2% Asian, and 4% other racial/ethnic heritage; 35% reported feeling depressed/stressed > or = 10 days in the past month. A logistic regression model found that feelings of depression/stress were associated with increasing age (OR = 1.09 with each additional year [95% CI, 1.02-1.18]), female gender (3.28 [2.62-4.12]); increasing levels of tobacco use (1.07 [1.01-1.12]), physical fights (1.19 [1.11-1.28]); and non-use of birth control compared with never having been sexually active (1.81 [1.31-2.49]). Independent variables of reporting depression/stress for males included increasing age (1.15 [1.03-1.28]), and physical fights (1.20 [1.10-1.30]), and non-use of birth control compared with never sexually active (1.91 [1.28-2.92]). Independent risk and protective factors for females included tobacco use (1.10 [1.02-1.19]), healthy diet (0.89 [0.83- 0.96]), and always (1.49 [1.03-2.28]) or sometimes used birth control (1.56 [1.03-1.28]) compared with never sexually active. CONCLUSIONS Female gender had greater than threefold increased odds of reporting depression/stress. Other associations, with some gender differences, include older age, physical fights, non-use of birth control, lack of a healthy diet, and use of tobacco.

Body modification and substance use in adolescents: is there a link?

PURPOSE To describe the characteristics of body modification among adolescents and to determine whether adolescents who engage in body modification are more likely to screen positive for alcohol and other drug problems than those who do not. METHODS Adolescents aged 14 to 18 years presenting to an urban adolescent clinic for routine health care completed a questionnaire about body modification and a substance use assessment battery that included the 17-item Problem Oriented Screening Instrument for Teenagers Alcohol/Drug Use and Abuse Scale (POSIT-ADS). Body modification was defined as piercings (other than one pair of bilateral earlobe piercings in females), tattoos, scarification, and branding. Problem substance use was defined as a POSIT-ADS score > or =1. Data were analyzed using logistic regression to determine whether the presence of body modification was an independent predictor of problem substance use. RESULTS The 210 participants had a mean (+/- SD) age of 16.0 (+/- 1.4) years and 63% were female. One hundred adolescents (48%) reported at least one body modification; girls were more likely than boys to have body modification (59% vs. 28%, p < or = .0005). Ninety (42%) reported piercings, 22 (10%) tattoos, 9 (4%) scarification, and 1 (< 1%) branding; 21 (10%) had more than one type of body modification. These were in a variety of locations, most commonly the ear and the nose (piercings) or the extremities (tattoos). One-third of the sample (33%) screened positive for problem substance use on the POSIT-ADS questionnaire. Controlling for age, adolescents with body modification had 3.1 times greater odds of problem substance use than those without body modification (95% CI 1.7, 5.8). CONCLUSIONS Body modification was associated with self-reported problem alcohol and other drug use among middle adolescents presenting for primary care. More research is needed to determine the clinical and sociocultural significance of body modification and its relationship to substance use in this population.

Computer-Facilitated Substance Use Screening and Brief Advice for Teens in Primary Care: An International Trial

OBJECTIVE: Primary care providers need effective strategies for substance use screening and brief counseling of adolescents. We examined the effects of a new computer-facilitated screening and provider brief advice (cSBA) system. METHODS: We used a quasi-experimental, asynchronous study design in which each site served as its own control. From 2005 to 2008, 12- to 18-year-olds arriving for routine care at 9 medical offices in New England (n = 2096, 58% females) and 10 in Prague, Czech Republic (n = 589, 47% females) were recruited. Patients completed measurements only during the initial treatment-as-usual study phase. We then conducted 1-hour provider training, and initiated the cSBA phase. Before seeing the provider, all cSBA participants completed a computerized screen, and then viewed screening results, scientific information, and true-life stories illustrating substance use harms. Providers received screening results and “talking points” designed to prompt 2 to 3 minutes of brief advice. We examined alcohol and cannabis use, initiation, and cessation rates over the past 90 days at 3-month follow-up, and over the past 12 months at 12-month follow-up. RESULTS: Compared with treatment as usual, cSBA patients reported less alcohol use at follow-up in New England (3-month rates 15.5% vs 22.9%, adjusted relative risk ratio [aRRR] = 0.54, 95% confidence interval 0.38–0.77; 12-month rates 29.3% vs 37.5%, aRRR = 0.73, 0.57–0.92), and less cannabis use in Prague (3-month rates 5.5% vs 9.8%, aRRR = 0.37, 0.17–0.77; 12-month rates 17.0% vs 28.7%, aRRR = 0.47, 0.32–0.71). CONCLUSIONS: Computer-facilitated screening and provider brief advice appears promising for reducing substance use among adolescent primary care patients.