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Drugs and adolescent girls

2002; Elsevier BV; Volume: 32; Issue: 1 Linguagem: Inglês

10.1016/s1054-139x(02)00586-4

1879-1972

I LITT,

Smoking Behavior and Cessation

This issue of JAH focuses on the problem that has not (and probably never will) disappear: drug abuse in adolescents. Although the problem is an old one, the information provided herein provides new insights into correlates, predictors, prevention, its relationship to employment, drug testing, body modification, and eating disorders, as well as some international perspectives.Throughout, we hear the familiar refrain that drug use is more common in boys than girls. More careful scrutiny of the data presented reminds us, once again, that there is a growing problem of substance abuse in female adolescents and that its determinants may be very different.The study on the relationship between substance abuse and employment [1Wu, L-T, Schlenger WE, Galvin DM. The relationship between employment and substance use among students aged 12 to 17. J Adolesc Health 2003;32:5–11Google Scholar] finds that it is females who work part-time (in contrast with males in whom full-time work is the risk factor) who have a higher rate of smoking. Moreover, whereas no association was found between alcohol use and work status in boys, those females who worked full-time, part-time, or who were unemployed had an increased odds of alcohol abuse. Part-timers had not only a special risk for binge drinking, but also an increased risk of abuse of illicit drugs. Internalizing emotional syndromes predicted increased rates of abuse of all substances for girls, not boys, suggesting the possibility of self-medication.The study of binge drinking [2Weitzman ER, Nelson TF, Wechsler H. Taking up binge drinking in college: The influences of person, social group and environment. J Adolesc Health 2003;32:26–35Google Scholar] reports an equal gender distribution but did not explicitly investigate gender differences in predictors. For males, being white and a member of a Greek letter organization were found to be risk factors for binge drinking. What about the females?In the study of alcohol use in relationship to eating disorders, the former was found in 25.6% of male adolescents and l8.6% of the females. Although the expected higher incidence of eating disorders was found in females, the only reported gender difference was a higher score on positive femininity in the girls whose scores revealed higher alcohol use [3Williams RJ, Ricciardelli LA. Negative perceptions about self-control and identification with gender-role stereotypes related to binge eating, problem drinking, and co-morbidity among adolescents. J Adolesc Health 2003;32:66–72Google Scholar].Body modification was more common in girls, but no gender difference in substance abuse among teens who had engaged in that behavior [4Brooks TL, Woods ER, Knight JR, Shrier LA. Body modification and substance use in adolescents: Is there a link? J Adolesc Health 2003;32:44–49Google Scholar].The Cape Town study reminds us of the importance of examining racial/ethnic, as well as gender issues, in trying to better understand this phenomenon. They report that substance abuse was lowest in black females and that no increase was noted throughout the 8th–11th grades, in sharp contrast with findings in other racial groups and boys [5Flisher AJ, Parry CDH, Evans J, et al. Substance use by adolescents in Cape Town: Prevalence and correlates. J Adolesc Health 2003;32:58–65Google Scholar].The publication of this issue is timely as the 2001 update from the ongoing “Monitoring the Future” study has just been released [6Johnston L.D. O’Malley P.M. Bachman J.G. Monitoring the Future national survey results on drug use, l975-2001. Vol. 1: Secondary school students (NIH Publication No. 02-5106). National Institute on Drug Abuse, Bethesda, MD2002Google Scholar]. A propos this discussion of gender differences, there are data showing that in 8th- and 10th-grade samples, the rate for the use of any illicit drug other than marijuana is slightly higher for girls, as is that for use of amphetamines and tranquilizers. The higher rates for substance abuse in boys emerges only in the 12th-grade. 2001 also saw smoking rates higher among college females than males. This study has also taught us the importance of not simply inquiring about “alcohol” use, but rather the importance of obtaining information about specific alcoholic beverages when it comes to gender differences. For example, general alcohol use is considerably higher in boys than girls (36% for senior males vs. l8% for senior females) but this gender difference is almost entirely owing to differences in beer consumption. For wine and wine-coolers, however, girls consume the same or slightly more than boys (more than 5%).Not only are there gender differences in patterns of use, but also in the reasons for use as well-described in the Commonwealth Fund’s Survey of the Health of Adolescent Girls [7Schoen C, Davis K, Scott Collins K, et al. Commonwealth Fund Survey of the Health of Adolescent Girls, l997. Available at: http://www.cmwf.org/programs/women/adoleshl.asp. Girls, l997. Accessed November 5, 2002Google Scholar]. For example, two-thirds of girls who smoked and 38% of those who drank said they did so to relieve stress. This was particularly common in those girls with depressive symptoms and those who were victims of abuse.We can no longer ignore or minimize the problem of substance abuse in teenaged girls just because it is more common in males. Nor can we extrapolate from the male experience and expect that we will be able to address it effectively. Flisher et al conclude their article concerning teens in Cape Town with the following:“…there are no studies involving drinking among adolescent girls …There is an urgent need to fill this gap” [5Flisher AJ, Parry CDH, Evans J, et al. Substance use by adolescents in Cape Town: Prevalence and correlates. J Adolesc Health 2003;32:58–65Google Scholar]. This exhortation should reverberate around the world! This issue of JAH focuses on the problem that has not (and probably never will) disappear: drug abuse in adolescents. Although the problem is an old one, the information provided herein provides new insights into correlates, predictors, prevention, its relationship to employment, drug testing, body modification, and eating disorders, as well as some international perspectives. Throughout, we hear the familiar refrain that drug use is more common in boys than girls. More careful scrutiny of the data presented reminds us, once again, that there is a growing problem of substance abuse in female adolescents and that its determinants may be very different. The study on the relationship between substance abuse and employment [1Wu, L-T, Schlenger WE, Galvin DM. The relationship between employment and substance use among students aged 12 to 17. J Adolesc Health 2003;32:5–11Google Scholar] finds that it is females who work part-time (in contrast with males in whom full-time work is the risk factor) who have a higher rate of smoking. Moreover, whereas no association was found between alcohol use and work status in boys, those females who worked full-time, part-time, or who were unemployed had an increased odds of alcohol abuse. Part-timers had not only a special risk for binge drinking, but also an increased risk of abuse of illicit drugs. Internalizing emotional syndromes predicted increased rates of abuse of all substances for girls, not boys, suggesting the possibility of self-medication. The study of binge drinking [2Weitzman ER, Nelson TF, Wechsler H. Taking up binge drinking in college: The influences of person, social group and environment. J Adolesc Health 2003;32:26–35Google Scholar] reports an equal gender distribution but did not explicitly investigate gender differences in predictors. For males, being white and a member of a Greek letter organization were found to be risk factors for binge drinking. What about the females? In the study of alcohol use in relationship to eating disorders, the former was found in 25.6% of male adolescents and l8.6% of the females. Although the expected higher incidence of eating disorders was found in females, the only reported gender difference was a higher score on positive femininity in the girls whose scores revealed higher alcohol use [3Williams RJ, Ricciardelli LA. Negative perceptions about self-control and identification with gender-role stereotypes related to binge eating, problem drinking, and co-morbidity among adolescents. J Adolesc Health 2003;32:66–72Google Scholar]. Body modification was more common in girls, but no gender difference in substance abuse among teens who had engaged in that behavior [4Brooks TL, Woods ER, Knight JR, Shrier LA. Body modification and substance use in adolescents: Is there a link? J Adolesc Health 2003;32:44–49Google Scholar]. The Cape Town study reminds us of the importance of examining racial/ethnic, as well as gender issues, in trying to better understand this phenomenon. They report that substance abuse was lowest in black females and that no increase was noted throughout the 8th–11th grades, in sharp contrast with findings in other racial groups and boys [5Flisher AJ, Parry CDH, Evans J, et al. Substance use by adolescents in Cape Town: Prevalence and correlates. J Adolesc Health 2003;32:58–65Google Scholar]. The publication of this issue is timely as the 2001 update from the ongoing “Monitoring the Future” study has just been released [6Johnston L.D. O’Malley P.M. Bachman J.G. Monitoring the Future national survey results on drug use, l975-2001. Vol. 1: Secondary school students (NIH Publication No. 02-5106). National Institute on Drug Abuse, Bethesda, MD2002Google Scholar]. A propos this discussion of gender differences, there are data showing that in 8th- and 10th-grade samples, the rate for the use of any illicit drug other than marijuana is slightly higher for girls, as is that for use of amphetamines and tranquilizers. The higher rates for substance abuse in boys emerges only in the 12th-grade. 2001 also saw smoking rates higher among college females than males. This study has also taught us the importance of not simply inquiring about “alcohol” use, but rather the importance of obtaining information about specific alcoholic beverages when it comes to gender differences. For example, general alcohol use is considerably higher in boys than girls (36% for senior males vs. l8% for senior females) but this gender difference is almost entirely owing to differences in beer consumption. For wine and wine-coolers, however, girls consume the same or slightly more than boys (more than 5%). Not only are there gender differences in patterns of use, but also in the reasons for use as well-described in the Commonwealth Fund’s Survey of the Health of Adolescent Girls [7Schoen C, Davis K, Scott Collins K, et al. Commonwealth Fund Survey of the Health of Adolescent Girls, l997. Available at: http://www.cmwf.org/programs/women/adoleshl.asp. Girls, l997. Accessed November 5, 2002Google Scholar]. For example, two-thirds of girls who smoked and 38% of those who drank said they did so to relieve stress. This was particularly common in those girls with depressive symptoms and those who were victims of abuse. We can no longer ignore or minimize the problem of substance abuse in teenaged girls just because it is more common in males. Nor can we extrapolate from the male experience and expect that we will be able to address it effectively. Flisher et al conclude their article concerning teens in Cape Town with the following:“…there are no studies involving drinking among adolescent girls …There is an urgent need to fill this gap” [5Flisher AJ, Parry CDH, Evans J, et al. Substance use by adolescents in Cape Town: Prevalence and correlates. J Adolesc Health 2003;32:58–65Google Scholar]. This exhortation should reverberate around the world!