1 Drug and Alcohol Dependence 52 (1998) Substance abuse and associated psychosocial problems among Argentina adolescents: sex heterogeneity and familial transmission Howard B. Moss a, *, Silvia Bonicatto b, Levent Kirisci a, Ana Maria Girardelli b, Lenn Murrelle c a Department of Psychiatry, Uni ersity of Pittsburgh Medical Center, 3811 O Hara Street, Pittsburgh, PA 15213, USA b Fundacion Fundonar, La Plata, Argentina c Virginia Institute for Psychiatric and Beha ioral Genetics, Medical College of Virginia, Richmond, VA, USA Received 7 January 1998; received in revised form 10 May 1998; accepted 10 May 1998 Abstract Objecti e: The goal of this investigation was to clarify the effects of sex and familial transmission in the psychosocial concomitants of substance abuse problems among adolescents. Method: Male (n=956) and female (n=303) adolescents in school, and male adolescents in a drug treatment program (n=51) in Buenos Aires Province, Argentina were administered a translated version of the Drug Use Screening Inventory. Use of substances, familial substance abuse and associations between psychosocial problem domains and substance abuse problems were examined. Results: Sex heterogeneity was broadly observed in terms of both substance abuse and psychosocial problems. Female adolescents in the school-based sample were found to generally report higher levels of psychosocial problems and greater use of minor tranquillizers than school boys or boys in treatment for substance abuse. Conduct deviancy was associated with substance abuse problems only in males, while health problems were associated only in females. However, among all youth, substance abuse problems were found to be associated with older age, greater social competency, problems in school performance, and involvement with deviant peers. Familial substance abuse was associated with substance abuse problems among all adolescents, however, the pattern of associations with other psychosocial problems differed between males and females. Conclusions: Sex heterogeneity was found in the associations between psychosocial problems, adolescent substance abuse, and familial substance abuse. Furthermore, the results are consistent with a syndrome of problem behaviors Elsevier Science Ireland Ltd. All rights reserved. Keywords: Adolescents; Substance abuse; Psychosocial problems; Sex heterogeneity; Cross-cultural 1. Introduction * Corresponding author. Tel.: ; fax: ; mosshb msx.upm.edu Adolescence is a critical developmental period characterized by transitions. Not only are marked changes occurring in physical development, but concurrent emotional, cognitive, environmental and social alterations also transpire. During adolescence, youth acquire the culturally appropriate educational, social and occupational skills necessary to become productive adult members of society. However, strain is not uncommon during this critical time. In context, familial relations may become stressed (Offer and Offer, 1975; Montemayor, 1982), aggressive, and delinquent behaviors may become more evident (Robins and Ratcliff, 1979; Olweus, 1979; Rolf and Wirt, 1984; Patterson et al., 1989), health compromising recklessness increases (Jessor and Jessor, 1977; Arnett, 1992), adult psychiatric disorders may emerge (Lewinsohn et al., 1986; Burke et al., 1990; Ferdinand and Verhulst, 1995), and the initia /98/$ Elsevier Science Ireland Ltd. All rights reserved. PII S (98)
2 222 H.B. Moss et al. / Drug and Alcohol Dependence 52 (1998) tion into the use and misuse of alcohol and drugs can occur (Loeber and Dishion, 1983; Kandel, 1975; White and Labouvie, 1989). Importantly, US investigators have found significant covariation between several of these diverse adolescent problem behaviors such as delinquency, problematic school behavior and performance, risky sexual behavior (including AIDS risk), and drug and alcohol use/misuse are (Donovan and Jessor, 1985; Jessor, 1987; Allen et al., 1990). However, little date are available concerning the patterns and manifestations of problematic adolescent behavior in South America. Recent increases in the prevalence of illicit and licit substance use among youth in some Latin American countries (Climent and de Aragón, 1986; Jutkowitz and Eu, 1994) have aroused significant societal concerns resulting in the initiation of several major regional adolescent prevention and early intervention initiatives based primarily on US models. However, the culturespecific, empirical identification of the most adversely affected aspects of an adolescent s life has yet to be accomplished. These adolescent life problem domains represent the critical content areas that primary and secondary prevention interventions should address in order to maximize both their efficacy and their efficiency. In the present study, we examined and contrasted the behavioral problem profiles of male and female adolescents from a school-based convenience sample accrued from two sites in Buenos Aires Province of Argentina, comparing these with data from male adolescents in a drug treatment program. Known correlates of substance abuse problems were examined within and across school and treatment settings such that both consistencies and disparities could be revealed. The results have implications for understanding how cultural factors may influence the behavioral and social concomitants of substance abuse among adolescents within the context of sex heterogeneity and familial transmission of substance abuse problems. 2. Methods 2.1. Study groups The sample was comprised of year old adolescents (males: n=670; females: n=234) ascertained through three mixed-sex public schools in La Plata, Argentina with nearly inhabitants, the second largest city in Buenos Aires Province. Generally, these students are lower middle to middle class. This urban sample was augmented by data accrued from lower middle to middle class students attending one public and one private school in a rural town called 9 de Julio in the interior of Buenos Aires Province (males: n= 286; females: n=69). These two sites made up the school-based sample (males: n=956; females: n=303). In addition, a smaller group of male adolescents attending one of the publicly-funded outpatient substance abuse treatment program for adolescents in the city of La Plata was obtained (n=51). While females are admitted to this treatment program, at the time of ascertainment, only male adolescents were enrolled. Typically, adolescent patients are either family-referred, self-referred or court mandated for this program. For the school-based samples, the mean age of males was 15.3 years (S.D. =1.6), and females was 15.6 years (S.D. =1.4). For the males in the substance abuse treatment program, the mean age was 15.7 years (S.D. =1.4). Demographic may be found in Table 1. The confidentiality of the information solicited was emphasized in each setting, and no personal identifying information was collected. Cooperation with the study was strictly volitional in all settings, and there were no refusals. Parental consent was not required. The survey questionnaires were completed in the classroom setting Instrumentation Drug use screening in entory The drug use screening inventory (Tarter, 1990) is a multidimensional, pencil and paper, self-report questionnaire consisting of a brief drug involvement section and 149 dichotomous (yes/no) items. The drug involvement section inquires about the typical number of times each month a given psychoactive substance has been using during the past year. Drugs surveyed broadly range from alcohol to anabolic steroids. The monthly use choices range from no use to more than 20 times a month. In this analysis, we contrasted responses indicating any regular monthly substance use during the past 12 months with responses indicative of no monthly use during the past 12 months. The remaining 149 DUSI items correspond to ten psychosocial domains known to be associated with substance involvement and behavioral problems in adolescents. The domains include (1) substance use (SU), (2) health status (HS), (3) behavior problems (BP), (4) school adjustment (SA), (5) peer relations (PR), (6) psychiatric problems (PP), (7) social (in)competency (SC), (8) family system (FS), (9) leisure and recreation (LR), and (10) work adjustment (WA). All items in the DUSI version used in this study refer to the past 12 months. Whether self-administered or applied via direct interview, the DUSI required approximately 20 min to complete in all study groups. DUSI-derived problem severity indices are used in this analysis. Specifically, a problem density score (PDS) was obtained by calculating the proportion of problems endorsed in each domain (i.e. number of positive responses/total number of items answered 100). The psychometric properties of the English lan-
3 H.B. Moss et al. / Drug and Alcohol Dependence 52 (1998) Table 1 Characteristics of adolescent sample School sample Treatment program: boys (TB) (n=51) Significant comparisons Boys (SB) (n=956) Girls (SG) (n=303) Mean age (S.D.) Residence Urban (1.66) 673 (70.4%) (1.40) 234 (77.2%) (1.39) 51 (100%) SG urban than SB and TB* Rural 283 (29.6%) 69 (22.8%) 0 (0%) Parental divorce rates Familial substance abuse problems None 142 (14.8%) 857 (89.6%) 64 (21.1%) 263 (86.8%) 0 (0%) 23 (45.1%) SG parental divorce than SB and TB* TB familial substance abuse than SB and SG* Either alcohol or drugs 78 (8.2%) 30 (9.9%) 12 (23.5%) Both alcohol and drugs Drugs used during the past 12 months Tobacco only 21(2.2%) 46 (4.8%) 10 (3.3%) 13 (4.3%) 16 (31.4%) 1 (2%) TB tobacco use than SB and SG* Alcohol only 247 (25.8%) 78 (25.7%) 1 (2%) TB alcohol than SB and SG* Alcohol and tobacco only 153 (16.0%) 50 (16.5%) 3 (5.9%) TB combined alcohol and tobacco than SB and SG* Tranquilizers (e.g. diazepam) 43 (4.5%) 34 (11.2%) 3 (5 9%) SG tranquilizer use than SB and TB* Illegal drugs (e.g. marijuana, 91 (9.5%) 19 (6.3%) 41 (80.4%) TB illegal drug use than SB and SG* cocaine) only Inhalants 24 (2.5%) 3 (1.0%) 0 (0%) SB inhalants than SG and TB* No psychoactive drug use 353 (36.8%) 105 (34.7%) 0 (0%) SB and SG no use than TB* Users of tranquilizers, illegal drugs and inhalants may or may not have been users of alcohol and/or tobacco. * P guage version of the DUSI have been published elsewhere (Kirisci et al., 1994), and have shown the instrument to be acceptable psychometrically Spanish-language translation of the DUSI A Spanish-language translation of the DUSI that is specific for the dialect spoken in the region of Buenos Aires Province, Argentina was used. The translation was performed by bilingual healthcare professionals from that area. Although no formal back-translation was performed, each item was reviewed by two of the investigators (HBM and SB) to insure conceptual fidelity with its corresponding item from the English version of the DUSI Indicator of familial substance abuse An indicator of familial substance abuse was also obtained from the DUSI employing two items from the Family System domain (DUSI item c84 Has a member of your family (mother, father, brother or sister) used marijuana or cocaine? ; DUSI item c85 Has a member of your family used alcohol to the point of causing problems at home, at work, or with friends? ) that specifically asked about family members using cocaine, marijuana or problematic alcohol use behavior. The responses according to group are displayed in Table 1. In the multiple regression analysis, responses were added linearly such that scores on this construct ranged from 0 to Statistical analyses Reliability of the translated DUSI The reliability of the translated DUSI scales was estimated separately in males and females through the computation of Cronbach s coefficient alpha (Cronbach, 1951) Between-group differences in demographic characteristics and DUSI problem density scale scores In order to evaluate between-group differences in nominal descriptive data (e.g. parental marital status, residence and drug use), Pearson chi-square tests were performed. For each DUSI domain problem density score and age, one-way analyses of variance were performed to test for between-group differences. Resultant probabilities were a Bonferroni-corrected in order to adjust for alpha-inflation due to multiple comparisons.
4 224 H.B. Moss et al. / Drug and Alcohol Dependence 52 (1998) Association of psychosocial problems with substance abuse problems In order to determine which psychosocial problems were associated with the severity of substance abuse problems in the school-based samples, linear regression analyses were performed. Separate regression analyses were conducted in males and females. Hypothesized putative predictor variables included age and an indicator of familial substance abuse problems, as well as the other DUSI problem domains. Then, the similarity of the two regression lines was tested in order to determine any between-group differences in the prediction of substance abuse problems. A significant F-ratio indicated that the slopes and intercepts differed beyond chance between the sexes. This analysis was conducted using the linear regression by groups program implemented in BMDP (University of California Press, Berkeley, CA). A similar linear regression by group analysis was performed contrasting the predictors of substance abuse problems in the school boys with those of the boys in the treatment program for substance abusing adolescents Associations between familial substance abuse and adolescent psychosocial problems The variability present in the two school-based samples provided an opportunity to examine the associations between adolescent psychosocial problems and familial substance abuse. Polyserial correlations were computed using the familial substance abuse indicator score and all DUSI domains, with the exception of the family systems scale. This scale was excluded from the analysis since the indicators for the family systems scale were derived from questions from that DUSI scale score. Separate analyses were conducted for boys and girls. 3. Results 3.1. Demographics As displayed in Table 1, several significant demographic differences were found between boys and girls in the school-based sample, as well as differences between the boys in treatment and the school-based adolescents. The ages of females in school were found not to differ significantly from the ages of boys in the school sample nor the boys in treatment (F 2,1304 =4.61; P=n.s.). Unlike the school-based sample, all adolescents in treatment resided in urban areas. However within the school-based sample, the proportion of boys and girls residing in urban and rural settings differed significantly (chi-square=5.8, df=1, P 0.05.). A larger proportion of girls resided in urban rather than rural settings. A greater proportion of girls in school had divorced parents than either male adolescents in school or those in treatment (chi-square=17.13, df=2, P 0.001) Familial substance abuse As displayed in Table 1, a substantially higher proportion of boys in treatment came from families where there was problematic involvement with alcohol, use of illicit drugs, or both in comparison to boys and girls in the school-based sample (chi-square=138.71, df=4, P 0.001). There were no differences in familial substance abuse between boys and girls within the schoolbased sample (chi-square=2.16, df=2, P=n.s.) Patterns of drug use As noted in Table 1, significant differences were found in the patterns of drug use between males and females in the school-based sample, and those males in treatment (chi-square=280.82, df=14, P 0.001). Specifically, boys in treatment had greater illicit drug use, but less alcohol and tobacco use only either independently or in combination together than did adolescents in the school-based sample. Interestingly, adolescent girls in the school-based sample had higher tranquillizer use than did boys in treatment or boys in school. Other significant differences were observed between male and female adolescents within the schoolbased sample. Adolescent boys in school tended to report higher illegal drug and inhalant use (chisquare=23.44, df=7; P 0.001), but did not differ from girls in terms of tobacco or alcohol use Estimated reliability of the translated DUSI The Cronbach s alpha reliability coefficients for each domain of the translated DUSI were computed separately for male and female adolescents as displayed in Table 2. The least reliable scale was for Health Status (males: =0.65; females: =0.62) while the most reliable was Substance Use (males: =0.89; females = 0.89). The average reliability of the translated DUSI across scales was 0.78 (S.D.=0.07) for males and 0.75 (S.D. =0.08) for females. In general, these data suggest that the internal consistency of the translated DUSI items within each domain was acceptable DUSI problem density scores in adolescent school students and adolescent boys in substance abuse treatment Fig. 1 displays the problem density scores for the school-based adolescent males and females, and the adolescent males in treatment. Within the school-based sample, female adolescents scored significantly higher
5 H.B. Moss et al. / Drug and Alcohol Dependence 52 (1998) Table 2 Reliability of translated drug use screening inventory scales Cronbach s alpha Male Female Substance use Behavioral patterns Health status Psychiatric disorder Social (in)competence Family system School performance Work adjustment Peer relationships Leisure/recreation Average 0.78 (S.D.=0.07) 0.75 (S.D.=0.08) than their male counterparts on problem density scores for Behavior Problems (F 1,1260 =15.59, P 0.001), Health Status (F 1,1260 =17.73, P 0.001), Psychiatric Disorders (F 1,1260 =45.55, P 0.001), Social (In)Competency (F 1,1260 =53.98, P 0.001), Family Systems (F 1,1260 =55.99, P 0.001), Peer Relations (F 1,1260 =18.96, P 0.001) and Leisure and Recreation (F 1,1260 =49.19, P 0.001). Sex differences were absent for the Substance Use, School Adjustment, and Work Adjustment problem domains. Not surprisingly, male adolescents in substance abuse treatment differed significantly from male adolescents in the broad school-based sample on all DUSI problem domains. Boys in treatment scores had higher problem density scores for Substance Use (F 1,1008 =158.10, P 0.001), Behavior Problems (F 1,1008 =59.74, P 0.001), Health Status (F 1,1008 =104.67, P 0.001), Psychiatric Problems (F 1,1008 =112.58, P 0.001), Social (In)Competency (F 1,1008 =70.68, P 0.001), Family Systems (F 1,1008 =92.08, P 0.001), School Adjustment (F 1,1008 =98.91, P 0.001), Work Adjustment (F 1,1008 =237.37, P 0.001), Peer Relations (F 1,1008 = 71.66, P 0.001), and Leisure and Recreation (F 1,1008 =51.75, P 0.001) Association of psychosocial problems with substance abuse problems Table 3 displays the results of the multiple regression analysis used to determine the comparative psychosocial correlates of substance abuse problems among adolescents in each study group. For school boys, substance abuse problems were associated with older age, severity of behavior problems, less social incompetency, severe school performance problems, and problematic peer relations. Curiously, a reduced severity of family systems problems (as indicated by a negative Fig. 1. Adolescent psychosocial problem profiles from boys in school, girls in school and males adolescents in a substance abuse treatment program. In the school-based samples, boys had significantly lower scores than girls for problem behaviors (P 0.001), health status problems (P 0.001), psychiatric problems (P 0.001), problems in social competency (P 0.001), peer relation problems (P 0.001), and leisure/recreation problems (P 0.001). Boys in substance abuse treatment scores significantly higher than school boys and girls on all adolescent psychosocial problem domains (Note: for each scale P 0.001).
6 226 H.B. Moss et al. / Drug and Alcohol Dependence 52 (1998) Table 3 Prediction of substance abuse problems in adolescents (regression by groups) Group Problem domains Standardized regression coefficients T-value Probability School boys Age Behavior problems Health status Psychiatric disorders Social (in)competency Family systems School performance Work adjustment Peer relations Leisure/recreation Familial substance abuse Model multiple r 2 =0.41; F 11,946 =59.82, P * School girls Age Behavior problems Health status Psychiatric disorders Social (in)competency Family systems School performance Work adjustment Peer relations Leisure/recreation Familial substance abuse Model multiple r 2 =0.41; F 11,291 =18.55, P * Analysis of variance of regression coefficients between school boys and girls: F 12,1237 =1.79; P 0.05* Boys in treatment Age Behavior problems Health status Psychiatric disorders Social (in)competency Family systems School performance Work adjustment Peer relations Leisure/recreation Familial substance abuse Model multiple r 2 =0.52; F 11,39 =3.89, P 0.001* Analysis of variance of regression coefficients between school boys and treatment boys: F 12,985 =4.35, P * regression coefficient) was also a significant correlate of substance abuse problems among males. Familial substance abuse was not a significant correlate. The overall regression model explained about 41% of the variance in drug involvement/problems (r 2 =0.41) and was highly statistically significant (F 11,946 =59.82; P ). For girls in school, a slightly different pattern emerged. Substance abuse problems were related to the girls age, severity of health status, social incompetency, problematic school performance, and severity of problematic peer relations. Familial substance abuse was not a significant correlate in girls. Here, the regression model also accounted for 41% of the variance (r 2 =0.41), and again was highly statistically significant (F 11,946 =18.55; P ). When an analysis of variance of regression coefficients was computed between boys and girls in school, the results indicated that the two regression lines were statistically different (F 12,1237 =1.79; P 0.05). This demonstrates a differing pattern for the associations with substance abuse problems between adolescent school boys and school girls. For the adolescent boys in the substance abuse treatment program, a similar linear regression analysis was performed. For these youth, significant asso-
7 H.B. Moss et al. / Drug and Alcohol Dependence 52 (1998) ciations with substance abuse problems included older age, behavior problems, school performance problems, and involvement in problematic peer relations. Familial substance abuse was not a significant correlate. The regression model explained 52% of the variance (r 2 =0.52), and was statistically significant (F 11,39 =3.89; P 0.001). Since the pattern of association with substance abuse problems differed between boys and girls, an analysis of variance of regression coefficients was conducted only between school boys and their male counterparts in substance abuse treatment. The results indicated that the two regression lines were statistically different (F 12,985 =3.89; P 0.001). This demonstrates a differing pattern for the relationship of substance abuse problems between adolescent boys in school and the male youth that have been identified as having a clinically relevant substance abuse problem necessitating treatment Associations between familial substance abuse and adolescent psychosocial problems Among boys in school, the extent of familial substance abuse correlated significantly with adolescent problems with Substance Use (r=0.32, chi-square= 86.62, df=3, P 0.001), Behavior Problems (r= 0.44, chi-square=17.53, df=3, P 0.001), Health Status (r=0.44, chi-square=21.49, df=3, P 0.001), Psychiatric Problems (r=0.51, chi-square= 12.81, df=3, P 0.005), Social (In)Competency (r=0.40, chi-square=19.45, df=3, P 0.001), School Adjustment (r=0.52, chi-square=25.54, df= 3, P 0.001), Work Adjustment (r=0.42, chisquare=39.17, df=3, P 0.001), Peer Relations (r=0.38, chi-square=10.87, df=3, P 0.05), but not Leisure and Recreation (r=0.38, chi-square= 5.16, df=3, P=n.s.). For the girls in school, a different pattern of association emerged. The severity of familial substance abuse correlated significantly with adolescent problems with Substance Use (r=0.35, chi-square= 26.60, df=3, P 0.001), Psychiatric Problems (r=0.39, chi-square=10.86, df=3, P 0.05), School Adjustment (r=0.41, chi-square=16.45, df=3, P 0.001), and Work Adjustment (r=0.35, chi-square= , df=3, P 0.001). No significant associations were found between familial substance abuse and problems with Social (In)Competency (r=0.27, chisquare=6.28, df=3, P=n.s.), Behavior Problems (r=0.43, chi-square=3.73, df=3, P=n.s.), Health Status (r=0.27, chi-square=1.77, df=3, P=n.s.), Peer Relations (r=0.32, chi-square=2.97, df=3, P=n.s.), nor Leisure and Recreation (r=0.28, chisquare=5.02, df=3, P=n.s.). 4. Discussion This investigation of psychosocial problems among Argentine youth provides a practical opportunity to examine the culturally-determined aspects of problem behaviors among adolescents in the US. Differences in adolescent problem profiles may reflect the complexities of cultural influence on human psychosocial development. Similarities permit the cross-cultural confirmation of psychosocial phenomena that were first described among North American adolescents in another industrialized culture in this hemisphere. The instrumentation used in this research, the DUSI, is an assessment tool first developed in the US and then specifically translated for application in this culture. The DUSI was translated into the Spanish idiom spoken in the region of Buenos Aires Province of Argentina. This version appears to have reasonably good psychometric properties. Its reliability was actually superior to the American English version of the instrument (Kirisci et al., 1994). Thus, it appeared to be a useful instrument to study substance abuse and other psychosocial problems of adolescents in that region. The results of this study demonstrate several interesting sex differences in psychosocial problems and substance use behavior among Argentine adolescents in school. These female adolescents in school scored significantly higher than their male counterparts on problem density scores for Behavior Problems, Health Status, Psychiatric Disorders, Social (In)Competency, Family Systems, Peer Relations, and Leisure and Recreation scales. This pattern suggests a heightened vulnerability to a broad spectrum of psychosocial problems among the females in this sample. The observation that females had higher rates of tranquillizer use than either boys in school or boys in substance abuse treatment may be consistent with female adolescents experiencing heightened psychosocial problems and possibly using tranquillizers to self medicate their distress. Interestingly, this pattern of sex differences in psychosocial problems is not apparent in US investigations of adolescents using the DUSI. Here, problem density scores for females are reported as being equal to or less than those of male adolescents (Kirisci et al., 1994). Other US studies have failed to demonstrate sex differences in psychosocial risk factors for substance abuse (Newcomb et al., 1986, 1987). Cultural variations or sampling biases may account for the discrepancy between the Argentine and US data. These results also provide evidence for sex differences and similarities in the psychosocial correlates of substance abuse problems among these communitydwelling Argentine adolescents in school. For both sexes, being older was associated with increased substance abuse problems. Similar findings have been observed in prospective research in the US (Allen et al.,
8 228 H.B. Moss et al. / Drug and Alcohol Dependence 52 (1998) ), and it has been theorized that substance use behaviors become more stable and less transitory in later adolescence. Conduct deviancy, as reflected by the Behavior Problems scale score, was significantly associated with substance abuse problems in males, but not in female adolescents. While this observation in boys is consistent with significant intercorrelations between different types of problem behaviors noted by many others (e.g. Donovan and Jessor, 1985; Farrell et al., 1992), it is noteworthy that this relationship is not apparent among the girls in this sample and may represent a cultural variation. Conversely, health problems were associated with substance abuse problems in girls only. Family problems were associated with substance abuse problems in boys, but not girls suggesting that the impact of family discord is greater on male adolescents than females perhaps due to culturally-bound role differences. While family stressors have been associated with delinquency (Farrington, 1987), little extant data reveal sex differences similar to those reported herein. In both sexes, substance abuse problems were found to be associated with better social competency (a negative regression coefficient for the Social (In)Competency problems scale score), problems in school performance, and problematic affiliation with deviant peers (as reflected by the Peer Relations scale score). At the community level, school-based Argentine substance abuse prevention interventions might use these criteria to identify high-risk youth (Hawkins et al., 1992). The association in both sexes between better social competency and substance abuse problems is initially counterintuitive and required methodological verification. Dodge et al. (1986) have shown that socially inept children may interpret ambiguous social stimuli as hostile and consequently behave in a less competent and more problematic fashion. However, we have concurrently demonstrated an association between involvement with deviant peers (as indicated by the Peer Relations scale score) and substance abuse problems. The affiliation with deviant peers and the disposition to behavioral deviancy is a well-characterized relationship (e.g. Jensen, 1972; Jessor and Jessor, 1977; Elliot et al., 1985; Kaplan et al., 1987). Thus, heightened social competency may augment the process of social affiliation with deviant peers, thereby further facilitate deviant patterns of behavior. The relationship between school problems and substance abuse problems is in no way surprising. A linkage between undersocialized behavioral problems and scholastic difficulties are well-established, though a clear causal relationship remains obscure (Rutter, 1974; Hinshaw, 1992; Moss et al., 1995). Interestingly, a slightly different pattern of psychosocial predictors of substance abuse problems emerged for those boys who are in treatment for a substance abuse disorder. Scale scores were significantly elevated for all psychosocial problem domains in those adolescent males in substance abuse treatment, thus providing cross-cultural support for a syndrome of problem behaviors (Donovan and Jessor, 1985; Dembo et al., 1992; Allen et al., 1994). Significant associations between age, behavior problems, school performance problems and deviant peer relations and substance abuse problems were found. However, these predictions were statistically different between boys in school and boys in substance abuse treatment, with these factors accounting for a greater proportion of the variance in substance abuse problems. The types of drugs used were also quite different. While the adolescents in school used primarily tobacco and alcohol, the majority of the youth in treatment were users of illicit drugs. Thus, the more elevated the severity of psychosocial problems, the more antisocial the pattern of drug use behavior and vice versa. Again, this is consistent with a syndrome of problem behaviors. One of the goals of this study was to examine the influence of an indicator of familial risk (i.e. the influence of the rearing environment, the genes shared in common by parents and child, or a complex interaction of genes with family environmental influences) of problematic substance use behavior on substance abuse problems in each of the adolescent groups. The likelihood of substance abuse problems in family members among the community-dwelling and substance abuse treatment samples was therefore compared. Not surprisingly, there was significantly lower risk of familial substance abuse problems among the communitydwelling school-based samples, much higher rates of familial substance abuse problems were found among the male adolescents in treatment. Thus, familial transmission appears to be influential for those boys identified as having a clinically salient substance abuse disorder necessitating treatment. However, an independent association between familial substance abuse and the severity of adolescent substance abuse problems was not demonstrated. Thus, the effect of familial transmission may be confirmed to increase the liability for a clinically relevant, supra-threshold disorder (Falconer, 1965). While we initially hoped to examine the associations between familial substance abuse problems and psychosocial problems among all three groups of adolescents, the sample of boys in treatment had such elevated DUSI scores and high rates of familial substance abuse problems, there was insufficient variability to examine this relationship in a meaningful quantitative manner. Thus, we have confined our analysis to the schoolbased samples of adolescents. The regression analyses did not find that familial substance abuse accounted for a significant amount of variance in predicting substance abuse problems when simultaneously analyzed with the adolescent psychosocial problem domains. However,
9 H.B. Moss et al. / Drug and Alcohol Dependence 52 (1998) the subsequent associational analysis examined the correlations between familial substance abuse and these psychosocial problem domains. For boys, familial substance abuse significantly correlated with adolescent substance abuse problems and all other problem areas, except for the leisure and recreation domain. For girls, a different pattern was noted. Here, familial substance abuse correlated significantly with only adolescent substance abuse problems, psychiatric problems, problematic school and work adjustment. Problem behaviors, social competency, health problems, peer relations, and leisure activities were not influenced by familial substance abuse. Thus, the data suggest that there are sex differences in the manifestations of familial transmission of substance abuse liability among adolescents. These results are consistent with behavior genetic investigations demonstrating sex heterogeneity in the influences of genes and environment on the risk for substance abuse (e.g. Pickens et al., 1991). There are several caveats that must be understood in the reporting of these data. First, the research was not conducted on a probability sample of Argentine youth. Consequently, we cannot make honest assertions about the representativeness or generalizability of the results within Argentina, nor can we interpret these data within the context of population estimates. The selection of Argentine schools for this research was based purely on matters of convenience. Second, the sample size of the drug abuse treatment sample is rather low, and therefore the stability of the linear regression coefficients for this group may be sub-optimal. Third, the data are cross-sectional and correlative, consequently causal relationships cannot be determined. Furthermore, these data are not informative from a developmental perspective. The stability over time of the relationships noted herein cannot be determined. Lastly, the School Performance and Work Adjustment DUSI problem behavior domains contain each three individual items that reflect potential consequences of substance use, thus they are not totally independent of the Substance Use scale. While the Work Adjustment scale has not turned out to be a significant correlate of the Substance Use problems scale in these analyses, the School Performance scale has been found herein to be modestly associated with Substance Use problems. Elimination of the problematic items and re-scaling the domains could resolve any such potential tautology, however we have elected not to follow that procedure in order to permit a more direct comparison of the extant published data on the DUSI in the US in its original format (e.g. Tarter, 1990; Kirisci et al., 1994). There are several cross-cultural issues in the demographic characteristics of these subjects that are worthy of comment and may bear upon the results. There were nearly three times as many male adolescents in the urban school sample compared to female adolescents, while there were four-times as many males adolescents in the rural school sample than females adolescents. These observations are not attributable to variations in response rates. They do, however, reflect cultural attitudes towards the lessor importance of secondary education for girls in some segments of Argentine society. Consequently, the sex differences observed may be due to the selectivity of the female adolescent sample. In addition, a higher divorce rate was noted among the parents of the girls in school (21.1%), compared to the parents of the boys in school (14.6%). While the interpretation of these results are open to conjecture, it may be that divorced Argentine mothers place a greater value on educational attainment and its associated independence and therefore encourage school attendance among their daughters. In summary, this study conducted in Buenos Aires Province, Argentina, reveals significant sex differences in the severity of psychosocial problems among adolescents that may be culturally specific. In general, female adolescents had a heightened severity of a spectrum of psychosocial problems compared to males. Consistent with the US scientific literature, substance abuse problems were found to be associated with older age, greater social competency, problems in school performance, and involvement with deviant peers. In the schoolbased sample, substance abuse problems among the adolescents were significantly associated with familial substance abuse. Thus, prevention and early identification efforts may use these characteristics to identify their target populations. However, significant sex differences were also observed which are not described in the US literature. For example, conduct deviancy was associated with substance abuse problems only among male adolescents, while health problems were associated with substance abuse problems only among the girls. These sex differences may be ascribed to cultural factors and may not be a culture-free feature of substance abuse problems among adolescents. However, in the aggregate this study provides a cross-cultural confirmation for a syndrome of problem behaviors, as well as being consistent with the broad extant literature on adolescent behavioral deviancy and substance abuse. Acknowledgements This work was supported in part by the Center for Education and Drug Abuse Research (a consortium of the University of Pittsburgh and St. Francis Medical Center) funded by the National Institute on Drug Abuse (P50-DA 05605) and by a National Institute on Drug Abuse Senior Scientist grant awarded to Dr Moss (KO-5 DA-00308). We would also like to acknowledge the efforts of Dr Minotti Alberto in the collection of research data in the town of 9 de Julio, Buenos Aires
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