Significance of Self-Reported Drug or Alcohol Use Among Inner-City Teenagers

Youths who grow up in disadvantaged communities in our nation's cities are exposed to a range of stressful life conditions, such as exposure to violence, crime, and drugs. In turn, these factors can increase their likelihood of developing emotional, behavioral, and substance use problems. According to the 2002 statistical abstract of the U.S. Census Bureau, the number of juvenile arrests for drug abuse has increased almost twofold since 1980 (1). Youths who are involved with drugs and alcohol have high rates of comorbid mental illness, and adolescents with dual diagnoses are among the more difficult patients to treat (2). In many cases it is unclear whether mental illness causes teenagers to use drugs and alcohol, or whether substance use lowers the threshold for mental illness.

Adolescents are at greater risk of exposure to violence than adults (1). This exposure occurs in many forms—verbal, physical, sexual, witnessed, and televised—and locations—home, school, and the community. Data from the U.S. Census Bureau show that in 2000 youths aged from 16 to 19 years had the highest rate of victimization from violent crimes compared with all other age groups (1). Many have argued that an adolescent's threshold for psychopathology is lowered with repeated exposure to violence, which in turn can lead to emotional and behavioral problems. Often, it is this change in behavior and development of psychological symptoms that compel teachers and parents to seek the aid of mental health services.

Previous research has demonstrated the relationship between exposure to violence and substance abuse among adolescents (3). Other research has documented that both exposures are significant risk factors for the development of a range of internalizing and externalizing behavioral problems. The National Adolescent and Child Treatment Study found that conduct disorder and depression were associated with increased rates of substance use disorders (2). Another study used self-reports from 223 children and younger teenagers and determined that exposure to violence was associated with increased rates of depression (4). Additional studies have documented that peer antisocial behavior increased the likelihood of adolescent substance abuse (5). Recent research has also documented the importance of adolescents' positive family and peer relations to protect against substance involvement and exposure to violence (6).

Our literature review identified a limited body of research that explored psychosocial risk and protective factors for substance use among youths from the inner city. We hypothesized that adolescents from the inner city who used any drugs or alcohol in the past would report higher levels of exposure to violence, problems resulting from their drug or alcohol involvement, peer involvement with drugs and alcohol, and emotional and behavioral problems as well as lower levels of protective factors, compared with youths who reported no involvement with drugs or alcohol.

Methods

The study, with the approval of the University of Maryland at Baltimore's institutional review board, was conducted in May 2001. Participants were from an inner-city high school in a northeastern city, where 98 percent of the students were African American. The high school was part of a school-based mental health program, and the principal expressed interest in participating in this pilot study. School counselors identified students from six English or social studies classes who were in grades nine through 12 and who were representative of the school's population. Letters and self-addressed stamped postcards were mailed to the parents and guardians of all the students in these selected classes (N=217), affording them the opportunity to decline participation of their child in the study. Along with the letters and postcards, all prospective participants and their families were given general reading materials about avoiding violence and substance abuse and strategies for achieving and maintaining physical and mental health. Researchers provided a monetary incentive of $5 to each student who participated in the study. A total of 106 youths from grades nine through 12 provided parental consent and student assent to be in the study. Of these, 101 youths completed all the project measures and were included in the planned analyses.

All the youths in our study were African American, their mean±SD age was 16.05±1.13 years, and 59 (58 percent) were female. Participants completed questionnaires anonymously in a group format that consisted of students in their normally scheduled class. Youths who reported any past use of drugs or alcohol (47 participants, or 47 percent) were compared with those who reported no past use of drugs or alcohol (54 participants, or 53 percent) on study measures. All measures that were used had adequate psychometric properties.

The exposure to Violence Screening Measure is a nine-item scale that assesses exposure to violence among youths aged from 10 to 20 years. Youths report whether they have witnessed, experienced, or know of victims in reference to specified forms of violence, such as stabbings, shootings, robbery, and assault (7).

We used an abbreviated version of the Drug Use Screening Inventory that focused on three domains that were of most interest to our study: substance use, problems that resulted from involvement with drugs or alcohol, and peer involvement with drugs or alcohol (8).

The Youth Self-Report is a 112-item instrument that assesses emotional (internalizing) behavior problems, such as depression and anxiety, and behavioral (externalizing) behavior problems, such as aggression and delinquency, among youths and adolescents (9).

The My Life Questionnaire is a 23-item questionnaire that measures protective factors that are relevant for inner-city youths, with three domains that involve avoiding negative peer influences, focusing on the future, and having a sense of meaning and spiritual involvement (10).

Results

A two-way (past use of drugs or alcohol by gender) multivariate analysis of variance was conducted on dependent variables: problems that resulted from involvement with drugs or alcohol, exposure to violence, protective factors, peer involvement with drugs or alcohol, and internalizing and externalizing problems. A significant main effect was found for any past use of drugs or alcohol (Wilks' lambda=.609, F=8.36, df=7, 91, p<.001) but not for gender or for the interaction between gender and any past use of drugs or alcohol. Univariate analyses for youths who reported any past drug or alcohol use (N=47), compared with those who reported no past drug or alcohol use (N=54), revealed significant effects for problems that resulted from involvement with drugs or alcohol (p<.01), exposure to violence (p<.01), protective factors (p<.01), peer involvement with drugs or alcohol (p<.01), internalizing problems (p<.05), and externalizing problems (p<.01). Table 1 presents descriptive statistics and significant findings for study variables by gender and past drug or alcohol use.

Discussion and conclusions

Findings from this study are consistent with previous research that has documented the relationship between exposure to violence, substance abuse, and emotional and behavioral problems among adolescents (2,4). In addition, our study underscores the importance of protective factors that can help inner-city youths avoid substance abuse, such as avoiding peer conflict, focusing on the future, and having a sense of meaning and spiritual involvement. Although our descriptive research design does not allow for definitive causal statements, the simple reporting of any past drug or alcohol use by participants in our study was associated with elevated levels of exposure to violence, peer involvement with drugs or alcohol, and emotional and behavioral problems among youths as well as lower levels of protective factors. This finding supports the importance of asking questions about substance use history in mental health screening and assessment efforts among inner-city youths.

Although these findings are important, we need to acknowledge limitations of our study, which include its cross-sectional design, its homogeneity of ethnicity, its small sample, and the exclusive use of self-report questionnaires—necessitated by limited permission to work with youths in their classrooms. The public health and clinical implications of the complex interplay of these factors in the lives of adolescents are obvious and of pressing significance. Further research that explores the implications of past drug or alcohol use, exposure to violence, and psychosocial adjustment among inner-city teenagers is warranted. In particular, there is a need for research that assesses the generalizability of these research findings to youths from other racial and ethnic backgrounds.

Acknowledgments

Financial support was provided by the Janssen Scholars in Research on Severe Mental Illness program of the American Psychiatric Institute for Research and Education. The authors acknowledge Ellie Turner, M.S.W., for her assistance in finding participants for this study. Dr. Weist's work on this study was supported by cooperative agreement U93-MC-00174 from the Office of Adolescent Health, Maternal and Child Health Bureau, Health Resources and Services Administration, with cofunding by the Center for Mental Health Services.

The authors are affiliated with the department of psychiatry at the University of Maryland School of Medicine in Baltimore. Send correspondence to Dr. Weist, Center for School Mental Health Assistance, 680 West Lexington Street, 10th Floor, Department of Psychiatry, University of Maryland, Baltimore, Maryland 21201 (e-mail, [email protected]).

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