A STUDY ON DRUG ABUSE AMONG YOUTHS AND FAMILY RELATIONSHIP

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1 A STUDY ON DRUG ABUSE AMONG YOUTHS AND FAMILY RELATIONSHIP << 青 年 濫 藥 與 家 庭 關 係 的 研 究 >> THE FINAL REPORT (FINAL version) February

2 PREFACE The project on the study on DRUG ABUSE AMONG YOUTHS AND FAMILY RELATIONSHIP ( the Study ) is being undertaken by the Centre for Suicide Research and Prevention and the Department of Social Work and Social Administration at the University of Hong Kong ( the Consultant ). The research team comprises the principal investigator (PI), Professor Paul YIP, Director of the Centre for Suicide Research and Prevention and Professor of the Department of Social Work and Social Administration at the University of Hong Kong, and eight co-investigators (Co-Is), Dr. CHEUNG Siu Lan Karen (Demographer), Dr. Sandra Tsang (Social and Family Worker), Dr. Samson Tse (Focus group expert on mental health and drug abuse), Dr. Wong Oi Ling (Family therapist, Family Institute), Prof. Karen Laidler (Sociologist, expertise on assessing drug abuse problem), Dr. Paul Wong (Clinical psychologist), Ms. Frances Law (Social Worker), and Dr. Lilian Wong (Associate Consultant, Department of Pediatrics and Adolescent Medicine, Tseung Kwan O Hospital, Hospital Authority). We would like to thank Mr. Gary Ip, the research assistant of the Department of Social Work and Social Administration, Ms. Garlum Lau, the senior research officer 2

3 of the Department of Sociology, the participants and NGOs for focus groups and case studies for their kind and valuable support on this project without which the completion of this study would not have been possible. 3

4 TABLE OF CONTENTS PREFACE... 2 TABLE OF CONTENTS... 4 EXECUTIVE SUMMARY... 6 報 告 摘 要 LIST OF FIGURES LIST OF TABLES LIST OF APPENDICS CHAPTER 1: INTRODUCTION CHAPTER 2: LITERATURE ON DRUG ABUSE Drug-use situation among youth in Hong Kong Theoretical framework Countries Analysis Key Issues and the way forward CHAPTER 3: SECONDARY DATA ANALYSIS Overview & Data Descriptive analysis Statistical methods Framework of the study: Proposed pathways between family quality and drug use Research questions Hypothesis Statistical methods Mediation analysis Conclusion CHAPTER 4: QUALITATIVE STUDY - FOCUS GROUPS Background Methodology Results Discussion and recommendation Conclusion and recommendation CHAPTER 5: IN DEPTH CASE STUDIES OF YOUTHS WHO DO NOT MATCH A DIAGNOSIS OF SUBSTANCE RELATED DISORDER Background Methodology Analysis

5 5.4 Results Discussion Recommendation CHAPTER 6: CONCLUSIONS AND POLICY RECOMMENDATIONS REFERENCES

6 EXECUTIVE SUMMARY (1) Based on the extensive literature review on family role in helping teen drug abusers with a family perspective and the comparisons with the results and evidence of the local and overseas studies and Eastern and Western practices dealing with teen drug addictions, this final report makes policy recommendations with regard to the key findings from the secondary data analysis, the focus groups and the case studies. (2) Some previous studies show that the overall trend of lifetime drug-taking secondary students rose from 3.3% in 2004/05 to 4.3% in 2008/09. The age of students starting to take drugs has become younger: for those aged 12 or below, there was a close to double increase in drug prevalence of 2.4% in 2004/05 to 4.6% in 2008/09. Among this group of students, 7.7% did not live with either of the parents, compared to 2.5% for their non-drug-using counterparts. From the experiences of front-line social workers and research studies, Hong Kong experiences the process of normalization of drug use, especially among marginal youth. The major problem is that they do not consider themselves as having problems or in need of help. (3) Chapter 2 summarizes overseas experiences, including Western countries such as Australia, Canada, the U.K., and the U.S. and Asian countries such as Taiwan, Mainland China and Singapore. In those Western countries, there are several initiatives to deal with drug taking and prevention: (i) identifying and reducing the risk factors related to youth substance use; (ii) enhancing protective factors and strengthening the family functioning and attached bonding, maintaining effective communications and harmonized relationships with adults through 6

7 family-based intervention like parental or family training, provision of nationwide meaningful youth engagement; (iii) addressing the needs of not only the adolescent themselves, but also the young adults, their families and the broader community; (iv) acknowledging the importance of supporting parents and the families to build healthy families at an early stage so that children and youth can benefit from growing up in a positive environment, thereby naturally building resistance against delinquent behaviors; (v) collaborating with different stakeholders (e.g. NGOs and government) to assist at-risk families, so as to minimize drug and other social problems being spread inter-generationally (especially in the U.K. and Australia); (vi) mobilizing different sectors of the community to address the drug issue (especially in the U.S.); and (vii) emphasizing youth-focused community prevention initiatives involving different partners (especially in Canada). However, in Asian countries, such as Taiwan, Mainland China and Singapore: more emphasis on information dissemination, school drug education and law enforcement are placed. Little is to do with risk and protective factors or the ecological framework of drug use. (4) Chapter 3 shows that use of psychotropic substance has become more prevalent among boys in older adolescents (Form 3-7) than for younger adolescents (Form 1-2), and exceed the prevalence of using inhalant. There is about 5% prevalence of drug abuse among our youth of aged The drug prevalence for working young adults soars up to 14% for males and 9% for females. The drug abusers have similar risk profiles with other deviant behaviors, e.g. deliberate self-harm, smoking and drinking. From the study of odds ratios of logistic regression models, there is a significant association between family structure and drug abuse among boys. The adjusted odds ratios showed that, compared to those who have 7

8 married parents, boys whose either or both parents has passed away were more likely to be drug users (OR=4.633, CI=2.294, 9.355), whereas girls whose parents were divorced or separated were more likely to be drug users (OR=2.367, CI=1.178, 4.759). Parents divorce, separation or passing away has a high influence on substance abuse among adolescents. Feeling happy about family life, good relationship with parents and acceptance to parenting are significant protective factors to substance abuse. (5) In Chapter 4, the results of focus groups show that there are four themes. First, young people s initial drug use must be understood in the context and primacy of their peers. Second, both young people and their children recognize the lack of communication in the family as one of the risk factors, and want to develop the ability to have meaningful interactions. Third, youth and their family relationships are heavily shaped by parents work and other commitments in a culture which is perceived to place heavy emphasis on materialism. This can add further pressure on parents and their children. Fourth, at the community and education levels, young people tend to thrive in an environment of creativity. (6) Based on the four in-depth case studies as presented in Chapter 5, a number of risk and protective factors around five themes have been identified: including 1) family crisis; 2) attachment to family members; 3) factors attributable to drug use; 4) factors conducive to drug withdrawal; and 5) issues in tacking drug use. Youths seem to share a very similar pattern of taking drug and other deviant behaviors. These youths started to experiment with drugs after the occurrence of a family crisis (i.e., presence of parent s physical illness, parents relationship problems) which strongly weakens the parental monitoring and family system. The results reveal a common pathway of marginal youths taking drug when they possessed 8

9 less family and school social capital, suffered from more educational disadvantages and failures, and had involvement with drug-taking peers. However, with the help of the attached parent(s) or significant others and efforts from professionals, the four cases demonstrated that they were able to stop using drugs. More importantly, the non-psychiatric medical services have helped the drug-taking youths have a better understanding of the physical harmfulness of drug use on them. They have also provided a platform for multi-disciplinary effort in dealing with recreational drug-taking youths who have yet to develop substance-use disorders that require psychiatric service. (7) In short, a common trajectory of the youths taking drug is ascertained in this study. Drug use like other adolescent behavioral issues involves a number of factors, some of which interact or operate jointly. Firstly, most of them are heavily affected by dysfunction families due to unstable family condition (e.g. poor marital relationship, family crisis, divorce, single-parent family), low income and long working hours of family members (e.g. limited family time, little attention to young people, poor attachment with parents/significant others), poor/ineffective communication between youth and his/her family (e.g. inadequate/poor parenting and bad relationship with parents). Secondly, easy access to drugs within immediate neighborhood (e.g. convenient supply and relatively cheap cost) increases the exposure of risk to drug. Thirdly, failure of school achievement, feeling boredom and affected by undesirable peer influence and intergenerational addiction are also the major risk factors. (8) Given the evidence and findings from this study, a public health approach with a multi-layered intervention is therefore recommended to empower family. Efforts on preventions and interventions should be made to enhance protective factors 9

10 through family-based intervention like parental or family training, provision of community-wide meaningful youth engagement, and reduce risk factors, instead of focusing on the drug issue per se and individual. The target would not only cover among the school youths, but also drop-out, unemployed or working youngsters. FOUR themes should be included youth-centered (for, with, and by the youth); family-focused (equal-finality proposition); neighborhood and community-sensitive (ecological, public health, social development, broken window (early intervention); cultural/contextual); and government-led (topdown directives especially for cross-departmental collaborations) approach focusing on transitional periods and developmental stages. Specific recommendations should be included: (i) to identify and support high risk families: single-parent, inter-generational addictions (drug/gambling/drinking), poorer social economic status (e.g. receiving CSSA), having frequent family crises involving school-age children, out of school youths and working youths through the cooperation of different sectors of the community (i.e. outreach social workers, non-clinical & clinical professionals, teachers and schools, police, etc.) and link with referral of family services (e.g. in-home family support); (ii) to nurture positive family relationship: a family-friendly working environment should be promoted and reinforced in Hong Kong; (iii) to enhance community involvement: especially for poorer household income and at-risk districts.; (iv) to curb drug sources covering a wider range: such as random drug tests at the border between Mainland and Hong Kong to handle cross-border drug and liaison with the Mainland authority in making it more difficult for young people to get hold of the drug rather than just imposing drug tests at school; (v) to extend more professional trainings: which include to develop a manual to work 10

11 with children and parents in dysfunctional families, provide more trainings, seminars and workshops for identifying at-risk families and suggesting measures to strengthen family protective factors that can be held at the district level and school-based with the support of the parent association in the school; family and school social workers as trusted professionals in the neighborhood and in the workplace to provide family parenting education and early identification and to help family recover the resiliency of family function; (vi) to provide more efficient anti-drug programs: it is necessary to examine how different existing programs modify the youth s drug-related attitude and behavior in the long run; (vii) to reform the mindset in the educational system: such as making school curriculum more attractive and developing interactive joint parental activities and to reinforce the importance of family values which can help the youths become a full competent, self-regulated and caring person. Incentives such as scholarships can be awarded to the students who might not perform well in academic, but in other domains such as sports and arts; (viii) to disseminate credible anti-drug and family-harmonized environment messages/slogans: youth-respite and drugfree and family-harmonized ambassadors should be appointed through public events to establish a positive idol to the youngsters and enhance parental relationship. 11

12 報 告 摘 要 (1) 這 份 報 告 書 的 政 策 建 議 是 根 據 廣 泛 的 文 獻 回 顧 數 據 分 析 焦 點 小 組 和 個 案 研 究 的 結 果 所 提 出 並 從 家 庭 觀 點 上, 綜 合 中 西 方 在 實 踐 處 理 青 少 年 濫 用 毒 品 成 癮 的 結 果 和 證 據 中 找 出 家 庭 角 色 如 何 能 幫 助 濫 用 毒 品 的 青 少 年 (2) 從 過 往 的 研 究 顯 示, 中 學 生 曾 經 濫 用 毒 品 的 趨 勢 由 2004/05 年 度 的 3.3% 上 升 至 2008/09 年 度 的 4.3% 濫 用 毒 品 的 年 齡 更 有 年 輕 化 的 跡 象 ; 對 於 12 歲 或 以 下 的 學 童, 比 率 由 同 時 期 的 2.4% 大 幅 增 加 至 4.6%, 上 升 接 近 一 倍 這 群 濫 用 毒 品 的 學 生 當 中 有 7.7% 並 非 與 父 母 同 住, 相 比 沒 有 濫 用 毒 品 的 學 生 祇 有 2.5% 為 高 根 據 前 線 社 工 的 經 驗 和 調 查 結 果, 香 港 正 經 歷 濫 用 毒 品 正 常 化 的 問 題, 特 別 是 對 於 邊 緣 青 年, 關 鍵 是 他 們 不 認 為 自 己 有 問 題 或 需 要 幫 助 (3) 第 二 節 綜 合 外 國 的 經 驗, 包 括 西 方 國 家 如 澳 大 利 亞 加 拿 大 英 國 美 國, 及 亞 洲 國 家 如 台 灣 中 國 大 陸 和 新 加 坡 在 這 些 西 方 國 家 中, 已 有 數 項 措 施 以 應 付 及 預 防 濫 用 毒 品 :( 一 ) 先 找 出 和 減 少 有 關 青 年 使 用 毒 品 的 風 險 因 素 ;( 二 ) 加 強 保 護 因 素 和 強 化 家 庭 關 係 及 保 持 家 庭 成 員 之 間 有 效 的 溝 通 與 和 諧 的 關 係, 並 通 過 以 家 庭 為 基 礎 的 干 預, 如 父 母 或 家 庭 培 訓 及 提 供 更 全 面 性 和 有 意 義 的 活 動 供 青 少 年 參 與 ;( 三 ) 在 處 理 這 些 濫 用 毒 品 的 問 題 時, 不 僅 針 對 青 少 年 本 身 的 需 要, 還 有 他 們 的 家 庭 及 整 個 社 會 ;( 四 ) 確 立 支 援 家 長 及 家 庭 的 重 要 性, 協 助 建 立 一 個 健 康 家 庭, 讓 兒 童 和 青 年 在 早 期 階 段 中 能 夠 在 一 個 積 極 的 環 境 中 成 長, 從 而 自 然 地 抵 抗 偏 離 的 行 為 ;( 五 ) 與 不 同 的 服 務 機 構 平 台 ( 如 非 牟 利 機 構 和 政 府 ) 合 12

13 作, 協 助 有 問 題 的 家 庭, 使 濫 用 毒 品 和 其 他 社 會 問 題 跨 代 傳 播 的 風 險 降 至 最 低 ( 參 考 如 在 英 國 和 澳 大 利 亞 );( 六 ) 動 員 社 會 各 界 人 士 來 解 決 毒 品 問 題 ( 參 考 如 在 美 國 ) 和 ( 七 ) 以 青 年 為 重 點, 與 不 同 的 夥 伴 合 作 的 制 定 社 區 預 防 措 施 ( 參 考 如 在 加 拿 大 ) 但 是, 在 亞 洲 國 家, 如 台 灣 中 國 大 陸 及 新 加 坡 : 則 强 調 資 料 信 息 的 傳 播, 特 別 集 中 加 强 在 學 校 禁 毒 教 育 和 執 法 上 的 位 置 對 於 利 用 風 險 和 保 護 因 素 或 是 從 社 會 生 態 學 角 度 上 所 做 的 工 作 仍 然 很 少 (4) 第 三 節 顯 示 年 紀 較 大 並 就 讀 中 三 至 中 七 的 男 學 生 比 就 讀 中 一 至 中 二 的 更 為 普 遍 使 用 精 神 科 藥 物, 這 情 況 比 使 用 吸 入 式 的 更 為 嚴 重 在 歲 的 青 年 中, 濫 用 毒 品 的 比 率 約 為 5% 在 職 青 年 的 的 比 率 更 飆 升 至 男 性 為 14% 及 女 性 為 9% 濫 用 毒 品 與 其 他 偏 差 行 為 ( 如 蓄 意 自 我 傷 害 吸 煙 和 酗 酒 ) 都 擁 有 類 似 的 風 險 特 徵 從 羅 吉 斯 的 迴 歸 勝 算 比 法 中, 家 庭 結 構 與 濫 用 毒 品 在 男 性 中 有 顯 著 的 關 係 調 整 後 的 數 值 顯 示, 假 若 男 孩 的 其 中 一 名 或 雙 親 已 過 世, 他 更 有 可 能 使 用 毒 品 (OR = 4.633,CI 為 2.294, 9.355); 另 一 方 面, 假 若 女 孩 的 父 母 已 離 婚 或 分 居, 她 使 用 毒 品 的 風 險 亦 相 對 增 加 (OR = 2.367,CI 為 1.178,4.759) 父 母 離 婚 分 居 或 離 世 均 明 顯 地 影 響 青 少 年 濫 用 毒 品 對 家 庭 生 活 感 到 快 樂 與 父 母 有 良 好 的 關 係 及 接 受 父 母 的 教 導 都 是 防 止 濫 用 毒 品 的 保 護 因 素 (5) 在 第 四 節 中, 聚 焦 小 組 結 果 顯 示 四 個 主 題 首 先, 要 了 解 年 青 人 初 次 吸 毒 必 須 從 其 背 景 和 朋 輩 著 手 第 二, 無 論 是 兒 童 或 年 青 人 都 認 為 缺 乏 家 庭 溝 通 是 其 中 一 種 風 險 因 素, 他 們 亦 希 望 能 在 家 庭 中 發 展 有 意 義 的 互 動 交 流 第 三, 青 年 與 家 庭 的 關 係 大 部 分 受 父 母 的 工 作 和 社 會 文 化 中 唯 物 主 義 所 塑 造, 這 樣 會 加 重 父 母 與 子 女 間 相 處 的 壓 力 第 四, 在 社 區 和 教 育 層 面 上, 年 青 人 較 希 望 能 在 富 創 造 力 的 環 境 中 成 長 13

14 (6) 在 第 五 節 中, 根 據 四 個 深 入 的 個 案 研 究, 分 別 找 出 一 些 風 險 和 保 護 因 素 並 圍 繞 著 五 個 主 題 : 包 括, 一 ) 家 庭 危 機 ; 二 ) 與 家 庭 成 員 之 間 的 情 感 ; 三 ) 導 致 使 用 毒 品 的 因 素 ; 四 ) 停 止 使 用 毒 品 的 因 素 ; 及 五 ) 打 撃 使 用 毒 品 的 問 題 在 使 用 毒 品 及 其 他 偏 離 的 行 為, 青 年 似 乎 有 著 非 常 類 似 的 模 式 這 些 青 少 年 在 經 歷 家 庭 危 機 後 便 開 始 嘗 試 毒 品 ( 如 父 母 患 病 或 父 母 之 間 出 現 問 題 ), 這 些 情 況 強 烈 地 削 弱 了 父 母 的 管 教 和 家 庭 制 度 研 究 結 果 顯 示, 邊 緣 青 少 年 吸 毒 都 擁 有 一 個 共 同 模 式, 就 是 當 他 們 在 家 庭 及 學 校 獲 得 較 少 的 資 源 並 在 學 業 上 觸 礁 和 失 敗 以 及 受 周 圍 朋 輩 吸 毒 所 影 響 可 是, 隨 著 父 母 或 其 他 重 要 人 物 和 專 業 人 士 的 努 力 和 幫 助, 他 們 亦 能 夠 停 止 使 用 毒 品 最 重 要 是, 非 精 神 科 的 醫 療 服 務 能 幫 助 吸 毒 青 年 更 了 解 毒 品 對 他 們 身 體 上 的 損 害 這 些 服 務 還 提 供 了 一 個 平 台 作 多 方 面 的 接 觸, 處 理 一 些 吸 毒 情 況 未 致 於 需 要 精 神 科 服 務 及 視 毒 品 為 娛 樂 性 質 的 青 年 (7) 總 括 而 言, 這 項 研 究 確 定 了 青 少 年 濫 用 毒 品 擁 有 一 個 共 同 軌 跡 他 們 使 用 毒 品 就 如 其 他 偏 離 行 為 問 題 一 樣 涉 及 多 種 因 素, 而 這 些 因 素 亦 彼 此 互 動 及 相 連 的 首 先, 大 多 數 的 因 素 是 由 於 不 穩 定 的 家 庭 狀 況 影 響, 以 致 喪 失 家 庭 功 能 ( 如 父 母 關 係 變 差 家 庭 危 機 離 婚 及 單 親 家 庭 ), 家 庭 成 員 工 作 時 間 長 或 低 收 入 ( 如 缺 乏 家 人 相 聚 的 時 間 較 少 時 間 注 意 青 少 年 與 父 母 或 重 要 人 物 有 惡 劣 的 關 係 ), 青 年 與 他 / 她 的 家 庭 之 間 缺 乏 有 效 的 溝 通 ( 如 管 教 不 足 及 不 善 或 與 父 母 有 惡 劣 的 關 係 ) 其 次, 一 個 容 易 獲 得 毒 品 的 鄰 舍 ( 如 方 便 供 應 和 相 對 低 廉 的 成 本 ) 亦 增 加 使 用 毒 品 的 風 險 第 三, 在 學 習 上 的 失 敗, 感 到 厭 倦 和 受 不 良 朋 輩 影 響 及 隔 代 毒 癮 也 是 主 要 風 險 因 素 14

15 (8) 根 據 這 項 研 究 的 證 據 和 調 查 結 果, 我 們 建 議 應 該 以 家 庭 為 基 礎, 並 使 用 公 共 健 康 的 模 式 與 多 層 次 的 干 預 在 防 治 和 干 預 上 應 加 強 保 護 因 素 和 降 低 危 險 因 素, 如 提 供 父 母 或 家 庭 培 訓, 增 加 全 體 性 及 有 意 義 的 青 年 參 與 行 動 ; 而 不 是 只 集 中 在 個 人 或 濫 毒 者 身 上 我 們 的 目 標 不 僅 包 括 在 學 的 青 少 年 ; 還 有 輟 學 失 業 或 在 職 的 青 年 四 個 主 題 包 括 以 青 年 為 核 心 ( 給 他 們 與 他 們 並 由 他 們 的 角 度 出 發 ), 以 家 庭 為 重 點 ( 如 平 等 及 阻 截 性 的 建 議 ) 針 對 鄰 舍 及 社 區 ( 如 生 態 上 公 共 衛 生 社 會 發 展 破 窗 理 論 ( 及 早 干 預 ) 文 化 及 背 景 ) 和 政 府 主 導 ( 由 上 而 下 的 指 示, 並 進 行 跨 部 門 的 合 作 ) 的 方 式, 並 將 焦 點 集 中 在 過 渡 時 期 和 成 長 階 段 具 體 建 議 應 包 括 :( 一 ) 透 過 社 會 各 界 人 士 的 合 作 ( 如 外 展 社 工 非 臨 床 及 臨 床 專 業 人 員 教 師 和 學 校 警 察 等 ) 和 轉 介 家 庭 服 務 ( 例 如 家 庭 探 訪 支 援 ) 找 出 和 支 援 一 些 高 風 險 家 庭 : 如 單 親, 隔 代 成 癮 ( 毒 品 / 賭 博 / 酗 酒 ), 經 濟 能 力 較 差 ( 如 領 取 綜 援 人 士 ), 頻 密 發 生 家 庭 危 機 的 學 齡 兒 童 輟 學 及 在 職 青 年 ;( 二 ) 培 養 正 面 的 家 庭 關 係 : 應 促 進 和 加 強 一 個 友 善 家 庭 的 工 作 環 境 ;( 三 ) 加 強 社 區 參 與 : 特 別 是 針 對 幫 助 貧 困 和 低 收 入 的 家 庭 及 高 危 的 地 區 ;( 四 ) 擴 大 毒 品 來 源 的 涵 蓋 範 圍 : 如 在 內 地 與 香 港 邊 境 之 間 作 隨 機 驗 毒, 並 聯 繫 內 地 當 局 及 有 關 部 門 以 處 理 跨 境 毒 品, 令 青 少 年 更 難 得 到 毒 品 ; 而 不 是 僅 僅 在 學 校 實 施 驗 毒 計 劃 ;( 五 ) 延 長 更 專 業 的 培 訓 : 當 中 包 括 制 定 一 本 家 庭 手 冊, 或 為 高 風 險 的 家 庭 提 供 更 多 的 培 訓 研 討 會 和 講 習 班, 用 以 加 強 家 庭 保 護 因 素 ; 並 以 地 區 層 面 和 學 校 為 基 礎, 透 過 家 長 會 的 支 持, 家 人 和 駐 校 社 工 分 別 擔 當 在 鄰 舍 和 工 作 單 位 中 可 信 任 的 專 業 人 士, 目 的 是 提 供 家 庭 教 導 孩 子 的 教 育 識 別 濫 用 毒 品 的 知 識 及 幫 助 家 庭 重 新 恢 復 家 庭 功 能 ;( 六 ) 提 供 更 有 效 的 禁 毒 計 劃 : 必 須 評 估 現 階 段 不 同 研 究 計 劃 中 青 少 年 對 毒 品 的 態 度 和 行 為 上 的 長 遠 影 響 ;( 七 ) 改 革 教 育 思 維 : 如 使 學 校 的 課 程 更 具 吸 引 力 及 發 展 和 父 母 共 同 15

16 參 與 互 動 的 活 動, 以 致 力 加 強 對 家 庭 價 值 觀 的 重 要 性, 從 而 幫 助 青 少 年 成 為 一 個 完 整, 自 我 調 節 和 關 懷 他 人 的 人 並 可 設 置 獎 學 金 獎 勵 一 些 雖 在 學 業 上 不 太 理 想, 但 在 其 他 領 域, 如 體 育 和 藝 術 表 現 出 色 的 學 生 ; 及 ( 八 ) 傳 播 有 公 信 力 的 反 濫 用 毒 品 及 強 化 和 諧 家 庭 的 信 息 或 標 語 : 甚 至 推 舉 以 青 少 年 為 主 的 無 毒 大 使 及 和 諧 家 庭 大 使, 從 而 透 過 一 些 公 眾 活 動 對 青 少 年 建 立 一 個 正 面 的 形 象 及 強 化 青 年 與 父 母 之 間 的 關 係 16

17 LIST OF FIGURES Figure 1 Number of reported substance abusers under aged 21 from st Quarter Figure 2 Percentage of youth drug use in U.K., U.S., Canada, and Hong 32 Kong (note variation in age groupings across countries) Figure 3 Bronfenbrenner s ecological systems theory 52 Figure 4 The Public Health Model 58 Figure 5 Building Protection: The Social Development Theory 66 Figure 6 The Building Blocks of Family Pathfinders 106 Figure 7 SAMHSA s Strategic Prevention Framework 120 Figure 8 Procedures for mediation analysis 200 Figure 9 Path diagram (A) 208 Figure 10 Path diagram (B) 208 Figure 11 Path diagram (C)(for boys only) 208 Figure 12 Character categorization of 4 case studies

18 LIST OF TABLES Table 1 Overview of the frequency, type of drugs used, and location of 31 drug use by group in 2008/09. Table 2 Risk factors of adolescent problem behavior 64 Table 3 Prevalence of psychotropic substance and inhalant use among 178 in-school respondents Table 4 Cross tabulation of family antecedents and substances use 179 among Form 3 to 7 respondents (both sexes) Table 4.1 Mean score for scales for both sexes 180 Table 5 Cross tabulation of family antecedents and substances use 182 among Form 3 to 7 boys Table 5.1 Mean score for scales for boys 183 Table 6 Cross tabulation of family antecedents and substances use 185 among Form 3 to 7 girls Table 6.1 Mean score for scales for girls 186 Table 7 Prevalence of psychotropic substance and inhalant use among 187 young adult respondents Table 8 Cross tabulation of family antecedents and substances use 188 among out-school respondents (both sexes) Table 9 Cross tabulation of family antecedents and substances use 189 among out-school male respondents Table 10 Cross tabulation of family antecedents and substances use 190 among out-school female respondents Table 11 Univariate odds ratios of regular drinking, regular smoking and 202 ever drug use from multiple logistic regressions Table 12 Interaction effect between variables in Female. 203 Table 13 Mediation models 1. Results from the mediation analysis 206 through multiple logistic regressions (All respondents) Table 14 Mediation models 3. Results from the mediation analysis 207 through multiple logistic regressions (All respondents were boys) Table 15 Univariate odds ratios of regular drinking, regular smoking and 211 ever drug use from multiple logistic regressions Table 16 Focus group: Summary of focus group participants 216 Table 17 Research rigor in phase II study 218 Table 18 Changes in Satisfaction score on family relationship before and 243 after receiving treatment service, Regular Teen Users Table 19 Socio-demographic Background

19 LIST OF APPENDICS Appendix A Major anti-drug websites 322 Appendix B Anti-drug initiatives in major countries 324 Appendix C The distribution of drinking and smoking habits behaviors 328 in group 1 participants in focus group Appendix D The distribution of drinking and smoking habits behaviors 332 in group 2 participants in focus group Appendix E General guidelines: Key topics for discussion 335 Appendix F Details of the pilot project 337 Appendix G Youth and/or family interview questions 339 Appendix H Involved clinicians/professionals interview questions

20 CHAPTER 1: INTRODUCTION Introduction This project on the study of drug abuse among youths and family relationship ( the Study ) is being undertaken by a multidisciplinary team consisting of public health researchers, medical doctors, psychologist, and social worker, starting from 7 May The Principal Investigator, Professor Paul S F Yip is in the Centre for Suicide Research and Prevention at the University of Hong Kong. The ethical approval has been sought on 11 May 2010 and approved by the Human Research Ethics Committee for Non-Clinical Faculties (Reference No. EA380410). Research Aims This study aims to examine the underlying causes of the youth drug abusers and how they are related in his/her family and to identify problems and needs that young drug abusers are facing. The emphasis would be in understanding how to empower the family s role for prevention of drug abuse in the community. Specific and evidence-based policy recommendations are expected. 20

21 Themes and Research Questions This study focuses on a community based sample of youngsters aged (involving different age developmental stages). FOUR MAJOR THEMES AND RESEACH QUESTIONS are investigated in the project: 1. Family antecedent of youth drug abusers the forerunning family background of youth drug abusers will be juxtaposed. Research questions are developed in terms of family composition and structure e.g. whether the teen drug abusers have a broken family with a single-parent or not and whether only living with grandparents and relatives are more likely to hazard to take drugs. A combination of different family composition is taken into consideration as in the following matrix, (i) a completed family currently living with father and mother with siblings, such as brothers and/or sisters; (ii) a completed family currently living with father and mother without siblings, such as a single child in family; (iii) a single parent family currently living with either father or mother with siblings, such as brothers and/or sisters; (iv) a single parent family currently living with either father or mother without siblings, such as brothers and/or sisters; and (v) no parent family currently only living with grandparents and relatives with or without siblings. Step-father, step-mother and step-siblings are also taken into account as the divorce rate has been rising in Hong Kong over time. Family members socio-economic and demographic backgrounds are 21

22 also of prime importance in the study. The characteristics of family members including the level of educational attainment, the occupation of their parents, the length of work of their parents, income and financial situation, the place of residence, the type of housing, social class (i.e. whether CSSA family recipient), culture diversity (such as whether one of the parents (i.e. mother) coming from Mainland China in Hong Kong less than 1 year and whether the mother is still staying in Mainland China) etc. will be investigated. 2. Family members reactions to youth drug abusers youth drug abuse affects the family unit. Family members reactions could also affect the decision of youth drug abusers. The discovery of proof of drug abuse may be devastating and making a familial relationship greatly deteriorated. Youngsters could become more hostile if they are not positively supported by the family. They could find themselves using drugs as escapist. Youth drug abusers interactions within family and family members reactions are essential to understand the mechanisms behind why some youth drug abusers have fallen prey to drugs. This aspect is also related to whether the youth drug abusers would be able to successfully get rid of the drugs. Reactions can widely cover on different aspects, such as verbal/linguistic responses and skills of communication which can be negative or positive, time dedication and understanding (i.e. how often and long parents and/or family members speak and 22

23 interact with the youth drug users), patience, realization and taking immediate actions (i.e. whether and/or when the parents discover or realize their child(ren) who have been involved with drug abuse and whether any immediate actions have been taken such as seeking professional advice and assistance from social workers from the community or at school). In this regard, the research question is to examine whether those adolescents with poor family relationship and interactions are more prone to be drug abusers. 3. How the family can cope and help the youth drug abusers it is a proactive and multi-directional process between not only the youth drug abusers and the family members, but also clinical professionals (such as medical doctors and clinical psychologists) and non-clinical professionals (such as social workers and teachers) and peers and classmates. The process sets off from (i) a stage one - realization of the facts by a parent or other professionals (revealed the evidence that a teen is a drug addict that could be grouped into different extents such as causally/ recreationally abused, progressively used and severely addicted. The last refers to the occurrence of the psychiatric illusions and physical impairments; (ii) the family involvement the addicted teen probably also hurts for transgressions. Learn and listen what the family members such as parents cope with this problem and whether they have any difficulty in accessing the trained addiction specialists to their 23

24 addicted child(ren) and themselves are one of the focuses in the study; and (iii) family and peers conjunction the youth drug abusers could be affected by their peers group. The linkage between the family members and the peer groups reflects the familial relationship and how much the parents know the world of teen drug abusers. Questions are posed such as do the parents know with whom their teen addicted child(ren) is/are acquainted? How many? And how often they meet each other and where? Where did the parents seek help? Can the family relationship be improved after the treatment services? 4. Specific measures and recommendations will be given to the Family Council based on the results of the study. Methodology and plan This study is organized in two Phases (Phases I and II). Each part of the work is led by one Co-I and other team members and presented in each chapter individually. In PHASE I 1. An extensive and thorough literature review on family role in helping teen drug abusers with a family perspective review including the results and evidence of the local and overseas studies and Eastern and Western practices dealing with 24

25 teen drug addictions is being led by Dr. Sandra Tsang with the help of Miss Erica Tong. The literature review covers three major areas: (1)the trends and statistics in Hong Kong; (2) overarching framework of understanding the youth drug issues problem, and studies that utilize this framework; and (3) current practices and intervention strategies from seven countries (i.e. Australia, Canada, PRC, Taiwan, Singapore, the U.K. and the U.S.A.) on how to prevent youth drug use. The literature review is presented in Chapter For the secondary data analysis to examine the prevalence of drug/substance abuses collaborated by the Centre, the Family Planning Association and Hospital Authority which is being led by Prof. Paul Yip and Dr. Karen Cheung with the help of Mr. Derek Cheung. Based on the Youth Sexuality Study (The Family Planning Association 2006), the longest running community-based sexuality survey in Hong Kong, we estimate the prevalence of substance use including alcohol, cigarettes, inhalants and psychotropic substances among Hong Kong in-school adolescents and young adults (aged 18-27) and examine how family relationship and qualities affect the likelihood of substance use. In the dataset, the participants of in-school survey were recruited from day schools through random sampling, while the young adults survey was conducted though random 25

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