Risk-behaviour in adolescence Ciairano, Silvia IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2004 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Ciairano, S. (2004). Risk-behaviour in adolescence: drug-use and sexual activity in Italy and the Netherlands s.n. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 13-01-2017
Risk-behaviour in adolescence: drug-use and sexual activity in Italy and The Netherlands Silvia Ciairano Stichting Kinderstudies Publisher
2004 by Silvia Ciairano ISBN: 90-5963-007-6 NUR-code: 865 Printed by Stichting Kinderstudies Publisher P.B. 102, 9700 AC Groningen, The Netherlands All rights reserved. No part of this publication may be reproduced or transmitted in any forms or by any means, electronic or mechanical, including photocopy, recording or any information storage and retrieval system, without permission in writing from the publisher. The research presented in this thesis was carried out at the Department of Developmental and Experimental Clinical Psychology, University of Groningen. Financial support for the research was received from the European Community, Directorate General XII - Science, Research and Development, Training and Mobility of Researchers (TMR) Programme, Marie Curie Research Training Grants. Financial support for this publication was received from the Fondazione Cassa di Risparmio di Torino (CRT), Torino (Italy). 2
RIJKSUNIVERSITEIT GRONINGEN RISK-BEHAVIOUR IN ADOLESCENCE: DRUG-USE AND SEXUAL ACTIVITY IN ITALY AND THE NETHERLANDS Proefschrift ter verkrijging van het doctoraat in de Psychologische, Pedagogische en Sociologische Wetenschappen aan de Rijksuniversiteit Groningen op gezag van de Rector Magnificus, dr. F. Zwarts in het openbaar te verdedigen op donderdag 2 december 2004 om 13.15 uur door Silvia Ciairano geboren op 26 mei 1960 te Torino (Italië) 3
Promotores: Prof. Dr. P.L.C. van Geert Prof. Dr. S. Bonino Copromotor: Dr. H.A. Bosma Beoordelingscommissie: Prof. Dr. R.C.M.E. Engels Prof. Dr. W. H. J. Meeus Prof. Dr. C. P.D.R. Schaap 4
Contents Foreword p. 9 1. Introduction 1.1. A general overview of the research project p. 11 1.1.1. Health and psychosocial risk behaviours of adolescents p. 11 1.1.2. Understanding adolescents risk behaviours: a challenge for researchers p. 13 1.1.3. Justifications for a cross-national approach p. 14 1.2. Adolescents and risk p. 15 1.2.1. Risk and the developmental tasks of contemporary adolescents p. 15 1.2.2. Characteristics of risk during adolescences p. 18 1.3. The theoretical framework of the research: an interactionistic-constructivistic model p. 20 1.3.1. Development as action in a context p. 20 1.3.2. The Problem Behaviour Theory p. 21 1.3.3. The dimensions and the risk behaviours on which the research focuses p. 25 1.4. Psychoactive substances in adolescence p. 26 1.4.1. The effects of psychoactive substances p. 26 1.4.2. Distinct patterns of use p. 28 1.4.3. Substance use during adolescence p. 30 1.4.4. Laws, social policies and cultural scripts related to substance use in Italy and The Netherlands p. 32 1.5. Sexual and contraceptive behaviours during adolescence p. 33 1.5.1. Sex between risk and developmental transition p. 33 1.5.2. Contemporary western society and sex p. 36 1.5.3. Contraception and prevention of STDs p. 37 1.5.4. Sexual education and health promotion: differences between Italy and The Netherlands p. 38 1.6. School and family: differences between Italy and The Netherlands p. 39 1.6.1. The educational system p. 40 1.6.2. Similarities and differences in school organization p. 41 1.6.3. The family and the transition to adulthood p. 43 1.7. Summary p. 45 2. Methodology of the research p. 47 2.1. Goals, research questions and expectations p. 47 2.2. Methods p. 50 2.2.1. The Health Behaviour Questionnaire p. 50 2.2.2. Using the Me and my health questionnaire for cross-national comparison p. 52 2.2.3. Risk behaviours and related attitudes, models and cognitions: strategy for analysis and measures p. 53 2.2.3.1. Drug use and related attitudes, models and cognitions p. 54 2.2.3.2. Sex and related attitudes, models and cognitions p. 58 2.2.3.3. The multiple index of risk behaviours p. 61 2.2.4. Protection and vulnerability: rationale, strategy for analysis and measures p. 62 2.2.4.1. First phase of the analysis: single predictors p. 64 2.2.4.2. Second phase of the analysis: first reduction of the predictors p. 72 2.2.4.3. Third phase of the analysis: further reduction at four predictors p. 76 2.2.4.4. Fourth phase of the analysis: only two predictors to control the moderating effect of resources on vulnerabilities p. 77 2.2.5. The Repertory Grids p. 79 2.2.5.1. The strategy of analyses of the Repertory Grids p. 83 2.2.6. Individual interviews p. 84 2.2.6.1. The strategy of analyses of the individual interviews p. 86 5
2.2.7. Summary of the methods and strategies of analyses p. 87 2.3. Sample p. 87 2.3.1. Participants in the Me & My Health Questionnaire study p. 87 2.3.2. Italian adolescents participating in repertory grids and interviews p. 89 2.4. The social context of the adolescents p. 89 2.4.1. Region or country of origin p. 89 2.4.2. Structure of the family, parental level of education and occupation p. 90 2.5.Summary p. 91 3. Psychoactive substances: a cross-national comparison p. 93 3.1.Tobacco smoking p. 94 3.1.1. Adolescents behaviour p. 94 3.1.2. Attitudes and models p. 95 3.2. Alcohol drinking p. 96 3.2.1. Adolescents behaviour p. 96 3.2.2. Attitudes and models p. 99 3.3. Marijuana use p. 100 3.3.1. Adolescents behaviour p. 100 3.3.2. Attitudes and models p. 102 3.4. Other drug use p. 103 3.4.1. Adolescents behaviour p. 103 3.4.2. Attitudes and models p. 104 3.5. Relationships between different psychoactive substances p. 105 3.5.1. Correlations between different substances p. 105 3.5.2. Cumulativity between different substances p. 105 3.6. Discussion: involvement in different substances p. 108 4. Patterns of sexual behaviours and contraception p. 113 4.1. A first glance on dates, sex, attitudes and friends p. 114 4.2. Being involved at least once p. 118 4.3. Sex during the last year p. 121 4.4. Changing partners p. 123 4.5. Discussion: sexual and contraceptive behaviour p. 124 5. Drugs & Sex: the role of individual and environmental protective and risk factors p. 129 5.1. Protective and risk factors p. 129 5.2. First phase of the analyses: using the single predictors p. 131 5.2.1. Which is the relation among single protective and risk factors and involvement? p. 131 5.2.2. Which is the relation among single protective and risk factors and level of involvement? p. 135 5.2.3. Which is the relation among single protective and risk factors and age of beginning p. 138 5.2.4. Discussion p. 140 5.3. From second to fourth phases: major sets of individual and environmental resources and vulnerabilities p. 142 5.3.1. Differences in protection, risk, and risk behaviours p. 144 5.3.2. Second phase of the analyses: using thirteen predictors p. 146 5.3.3. Third phase of the analyses: individual and environmental protection and risk p. 150 5.3.4. Fourth phase of the analyses: total resources and vulnerability p. 151 5.3.5. Fourth phase of the analyses: testing the moderator or buffering effect of resources on vulnerabilities p. 153 5.3.6. Discussion p. 158 6. Sex & Drugs: an in-depth investigation on the Italian sample p. 161 6.1. Emotions and feelings within different relational conditions p. 162 6.1.1. Emotions and feelings and sex p. 163 6.1.2. Emotions and feelings and drugs p. 165 6
6.2. The adolescents opinions about family, peers and school p. 168 6.3. Motivations for behaving in a risky way p. 171 6.3.1. Reasons for having sex p. 171 6.3.2. Reasons for taking drugs p. 172 6.4. Reasons likely to promote healthier or risky behaviours p. 174 6.4.1. Risk perception, information and communication about risk p. 174 6.4.2. Reasons for using or not using contraception p. 176 6.4.3. Reasons for giving up drug use p. 178 6.4.4. Relations between emotions and reasons p. 179 6.5. Discussion p. 180 6.5.1. Sociodemographic differences for emotions and reasons p. 181 6.5.2. The role of family, peers and school p. 183 6.5.3. Adolescents motivations for behaving more or less risky p. 184 7. Conclusions p. 187 7.1. Similarities and differences of involvement in risk behaviour of Dutch and Italian adolescents p. 188 7.1.1. Sociodemographic differences within each country p. 190 7.1.2. Risk perception and involvement in risk behaviours p. 193 7.1.3. Risk behaviours in relation to small and large social contexts p. 195 7.2. Protection and risk p. 198 7.2.1. Why some more than others? p. 198 7.2.2. The constellations of behaviours, resources and vulnerabilities p. 202 7.2.3. Buffering or direct effect of protection: which is more important? p. 205 7.3. Some reflections on the constructive functions of the adolescents risk behaviours p. 206 7.3.1. Appearing more adult p. 206 7.3.2. Transgression p. 207 7.3.3. Assertion and to experimentation of physical and psychological possibilities p. 208 7.3.4. Experimentation with sensations and feelings p. 208 7.3.5. Exploration of limits p. 209 7.3.6. Perception of control p. 209 7.3.7. Escape from reality and difficulties and the search for an emotional solution to problems p. 209 7.3.8. The construction of bonds with peers by sharing rituals with them p. 210 7.3.9. Communication p. 210 7.4. Final remarks p. 211 References p. 215 Nederlandse Samenvatting p. 229 Appendix p. 238 Variables used in the analyses p. 238 Statistical properties of protection and risk indexes p. 242 List of publications on «health related behaviours in adolescence» p. 245 7
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Foreword When I was first offered the opportunity of doing this research, I had no clear ideas of the difficulties that I would have to face and even more if I would have been able to really finish it, sooner or later. Nevertheless, this work is now almost finished and I still cannot fully comprehend it. However, I am perfectly aware of all the wonderful people who have helped me, realise and finalise this project. First of all, I would like to thank Silvia Bonino who had the original idea of this research project and contacted Sandy Jackson at the University of Groningen. Furthermore, she has strongly supported me with theoretical suggestions and also increasing warm personal support along time. I give my warmest regards to Sandy (A.E.) Jackson who first accepted me as being a doctoral student and secondly contributed to this project with great enthusiasm. Sandy, together with his wife Janet Jackson-Roy also invited me at their home every time I came in the Netherlands, helping me to feel at home although I was quite far from my family and my country. Unfortunately, Sandy died before this dissertation was finished: on the 12 th of July 2003. I had hoped that him could be one of the co-promoters of this dissertation, as he really is. I am sure that I will never find such a special person in my future career again: he was a father, friend, teacher and a trainer to me. What I can do, it is just to try to be able of continuing at least part of all the work he did in the field of the normal psychology of the adolescents. A good starting point might be the long discussions he had with my adolescent son about the quality of the Scottish whisky... Furthermore, I would like to thank very much also Richard (Dick) Jessor for his wonderful support during all the phases of this research project. Daarentegen werden in deze jaren Paul van Geert, samen met alle andere stafleden van de Universiteit van Groningen, zoals Harke Bosma en anderen, in toenemende mate belangrijk voor mij, terwijl Sandy s gezondheid slechter werd. Wijbrand van Schuur heeft mij veel geholpen in het verbeteren van mijn kennis over statistische technieken. Ook wil ik het aandeel van Rutger Engels en Wim Meeus benadrukken in het leveren van commentaar op de eerste versie van dit proefschrift, welke mij de intrinsieke complexiteit van het onderzoeksmodel hebben helpen te begrijpen. Tevens dank aan Cas Schaap voor de tijd en aandacht besteed aan dit proefschrift. Ik wil al deze Nederlandse vrienden en collega s van harte bedanken voor hun bijdrage aan het tot stand komen van dit proefschrift. Besides, I would like to express my thanks to the colleagues and collaborators at both the Department of Developmental and Experimental Clinical Psychology of Groningen and the Laboratory of Developmental Psychology of the University of Torino. The first that I would like to thank is Renato Miceli who has provided me with relevant help about statistics and data analysis. Among all the others, those who contributed more to the present work with theoretical discussion, but also relational and practical support there are: Jan Bijstra, Laura Bonica, Giorgio Barbareschi, Philippa Butcher, Fabrizia Giannotta, Reint Geuze, Saskia Kunnen, Roberta Molinar, Paola Molina, Giorgia Molinengo, Emanuela Rabaglietti, Antonella Roggero, Michele Settanni and Matty van der Meulen. A special thank also goes to the past and the present secretaries of the Dutch Department who were never bored by my sometimes strange questions: Fenna Krirst-Kuilman, Willy Landeweerd, and Wolly Ten Berge. 9
I would like to express my specials thanks to Janet Jackson-Roy, Els Blijd-Hoogewys, and also Laura Ballato, who are my supporting and perfect paranymphs. From the beginning of this work, Janet fulfils a very important role for me: she is the person who strongly pushed me towards the defence of this dissertation, who is able to understand my feelings without too many words and also to allow all my family to feel comfortable in an unknown environment. I can perfectly remind how much my daughter was happy to be allowed to touch the piano and to play with her in the wonderful home of Janet & Sandy in Zuidvelde. I am sure that the fact she accepted to be one of my paranymph is a very special event and that her presence at the defence will give a great contribute to its success: thank you very much Janet!!!!! Els also is very important for me: at the starting of our research work, we share the same room at the Department and along time we learned to share also opinions and thoughts, despite the differences in our research interests. During these long years she and her husband Carl became very close and true friends for me and all my family. Finally, I am really indebted to Els because of all the perfect work she did translating the summary of this research in Dutch. And finally, Laura who some years ago was a student of mine in Italy, while now she is an important collaborator in the Netherlands: together with all the other doctorate Dutch and Italian students I have mentioned in the previous page, you represent the future of the developmental adolescent research. Also my special thanks go to Sibel Köksal who has been very helpful in teaching me some skills in writing this dissertation in English and in reviewing my dissertation [Ayrica Sibel Köksal'a bana tezimin yazilmasi sirasinda ter yazma becerileri öqrettigi, ingilizcesine katkida bulunduqu ve tezimi görden qeçirdiqi icin cok tesekkur ederim: with the help of another dear friend, Nermin Celen, Uludağ University, Bursa Turkey]. Moreover, the major contribution is that of the adolescents themselves who participated in this research, that of the teachers and heads of secondary schools in Italy and the Netherlands who accepted to do this research and also that of the Dutch and Italian university students who collected the data. Without their contribution this study would have never been possible. Finally, I would like to thank all my family, my husband Francesco Saverio, my dear children Giuseppe & Renata, my mother Lidia, my uncle Giuseppe, and my dearest friends, Deborah & Daniele, Lina & Luciano, for their wonderful support and patience. Also when it seemed quite unlikely, all of them always believe in me and in my capacity of finishing, sooner or later, this work [Infine, voglio ringraziare tutta la mia famiglia, mio marito Francesco Saverio, i miei cari figli Giuseppe & Renata, mia madre Lidia, mio zio Giuseppe, ed i miei amici più cari, Deborah & Daniele, Lina & Luciano, per il loro magnifico sostegno e la loro pazienza. Anche quando sembrava improbabile, tutti hanno sempre creduto in me e nella mia capacità di portare a termine, prima o poi, questo lavoro]. Togetherness and closeness are very important protective factors in the normal daily life of the adolescents, as well as in promoting the conclusion of a doctorate dissertation during middle adulthood. 10