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Adolescent health brief

Substance Use Among Early Adolescent Girls: Riskand Protective Factors

Steven P. Schinke, Ph.D.*, Lin Fang, Ph.D., and Kristin C.A. Cole, M.S.School of Social Work, Columbia University, New York, New York

Manuscript received August 23, 2007; manuscript accepted December 21, 2007

bstract Disquieting rates of alcohol and drug use among adolescent girls call for original research ongender-specific risk and protective factors for substance use. Particularly salient are data ontheory-driven factors that can inform prevention programming. Surveying 781 adolescent girls andtheir mothers, we found relationships between girls’ use of alcohol, prescription drugs, and inhalantsand girls’ after-school destinations, body images, depression, best friend’s substance use, maternaldrinking behavior, mother– daughter interactions, and family norms surrounding substance use.Study findings have implications for the design of responsive gender-specific prevention programs.© 2008 Society for Adolescent Medicine. All rights reserved.

Journal of Adolescent Health 43 (2008) 191–194

eywords: Drug and alcohol use; Female adolescents; Risk and protective factors

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Adolescent girls are beginning to surpass adolescent boys inheir substance use [1,2]. Among 8th and 10th graders, girlsrink more than their male counterparts; girls are also moreikely than boys to use inhalants and stimulants. Girls startmoking at younger ages, and they subsequently smoke moreegularly than boys. Once girls use harmful substances, theyre more apt than boys to become dependent.

Family interaction theory offers a framework to under-tand the forces that may move girls toward and away fromubstance use [3]. According to this theory, girls’ intraper-onal characteristics, social influences from their environ-ents and peers, and emotional attachment to their parents

ombine to influence substance use. The theory focuses onarent– child attachment, especially that between mothernd child. If mothers have warm, nurturing relationshipsith their daughters, girls may be less likely to drink and

ake drugs. Conversely, if mothers fail to supervise andupport their daughters, girls may attach to their peers,articularly deviant ones.

*Address correspondence to: Steven Schinke, Ph.D., Columbia Uni-ersity School of Social Work, 1255 Amsterdam Avenue, New York, NY0027.

cE-mail address: schinke@columbia.edu

054-139X/08/$ – see front matter © 2008 Society for Adolescent Medicine. Alloi:10.1016/j.jadohealth.2007.12.014

Studies find that girls are more likely than boys to smoke,rink, and use drugs when they overly concerned with peerpproval [4]. Around puberty, girls are vulnerable to de-ression, a risk factor for substance use and abuse [5].trong family bonds are associated with lower rates ofubstance use for all youths. Yet low parental attachmentorrelates more highly with smoking, drinking, and drug usemong girls than among boys [6]. Low parental monitoringnd concern and an unstructured home environment aretrongly correlated with substance use among girls; parents’ailure to monitor their children’s activities can put girls atisk [7]. To learn more about gender-specific risk and pro-ective factors that might inform prevention programming,e surveyed a sample of early adolescent girls and mothers

bout relevant correlates of alcohol, prescription drug, andnhalant use.

ethods

tudy sample and procedures

Study participants were recruited through advertise-ents, buses, and a radio station serving greater Nework City. The advertisements directed respondents to aebsite that gave details about the study, specified in-

lusion criteria, and asked for contact information so

rights reserved.

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192 S.P. Schinke et al. / Journal of Adolescent Health 43 (2008) 191–194

nterested persons could receive informed consent forms.igned consent forms were returned by 1562 respon-ents, representing 781 mother– daughter pairs. Consent-ng mothers and assenting girls who had parental consenteceived usernames and passwords to access online sur-eys. Survey items came from previously validated ques-ionnaires on adolescent and adult substance use andelated risk and protective factors [8 –10]. Internal reli-bilities for girls’ and mothers’ questionnaires were 0.75nd 0.74, respectively.

ata analysis

To control for girls’ ages, ethnic–racial backgrounds, andchool grades, and for their mothers’ places of birth, edu-ations, and nature of employment, multivariate logisticegression was employed to analyze the relationship be-ween each independent variable and girls’ alcohol, pre-cription drug, or inhalant use.

esults

Over three-fourths of girls in the sample were Africanmerican or Latina (Table 1). Girls had an average age of2.6 years. Most girls reported that their school grades wereostly As or Bs. Across the sample, 40.6% of girls had

runk alcohol, 12.6% had illicitly taken prescription drugs,nd 9% had used inhalants. Slightly more than one-half ofirls’ mothers were single parents, most were born in thenited States, and all but 16% had attended or graduated

rom college. Almost 86% of the mothers were in paidmployment. Roughly one-half of the mothers regularlyttended church.

Girls who engaged in unstructured activities after schoolrank more (odds ratio [OR] � 2.56, p � .001) and usedore inhalants (OR � 2.96, p � .01) than girls who went

ome after school (Table 2). Girls who reported a positivemage of their bodies (4.0 or higher on a five-point scale,here 5 � completely satisfied with my body) were less

ikely to drink (OR � 0.56, p � .01) and to illicitly userescription drugs (OR � 0.45, p � .01) than girls whoeported relatively less satisfaction with their bodies (thoseho scored 3.99 or lower). Girls with higher levels ofepression (4.0 or higher on a six-point scale, where 6 �ery depressed) reported more use of alcohol (OR � 2.13,� .01), prescription drugs (OR � 2.94, p � .001), and

nhalants (OR � 2.67, p � .001) than less depressed girlsthose who scored 3.99 or lower). Girls whose best friendsed substances were more apt to drink (OR � 5.52, p �

001), illicitly take prescription drugs (OR � 5.11, p �001), and use inhalants (OR � 7.17, p � .001), than girlshose best friend did not use substances.Maternal alcohol use was positively related to girls’

rinking (OR � 1.51, p � .01) and inhalant use (OR �.82, p � .05). Mothers’ knowledge of their daughters’

hereabouts was linked with girls’ reduced use of alcohol p

OR � 0.48, p � .001). Similarly, mothers’ knowledge ofheir daughters’ companions predicted girls’ reduced alco-ol (OR � 0.57, p � .001) and prescription drug use (OR �.55, p � .01). Girls’ ability to always contact their mothersas associated with girls’ reduced drinking (OR � 0.58,� .001), illicit use of prescription drugs (OR � 0.45, p �

001), and inhalant use (OR � 0.41, p � .001).Girls whose families had rules against substance use

ere less likely to drink (OR � 0.44, p � .001) and usenhalants (OR � 0.36, p � .01). Girls whose parents en-ouraged their children to abstain from substance use re-orted commensurately lower rates of alcohol (OR � 0.37,

able 1aughter and mother sample characteristics

%a n

aughters (N � 781)thnic/racial backgroundAfrican American 46.7 365Latina 29.6 231White 13.6 106Asian American 1.3 10American Indian 2.7 21

ge in years (M, SD) 12.59 (1.07)�11 16.0 12512 32.9 25713 30.2 236�14 20.9 163

chool gradesMostly As 32.9 257Mostly Bs 44.8 350Mostly Cs or below 16.2 135

ifetime substance useAlcohol 40.6 317Prescription drugsb 12.9 101Inhalantsc 9.0 70others (N � 781).S. BornYes 80.8 631No 19.2 150

ingle parentYes 52.4 409No 47.6 372

ducation�High school 16.4 128Attended or graduated from college 64.1 501Graduate degree 19.5 152

egular church attendanceYes 50.7 396No 49.2 384

aid employmentYes 85.8 670No 14.2 111

a Within-category percentages may not add to 100 because of roundingnd missing data.

b Prescription drugs are defined as those used recreationally, used forff-label purposes, or taken by other than the intended recipient.

c Inhalants include glue, spray paint, cleaning fluid, and any chemicalnhaled for intoxication purposes.

� .001) and inhalant use (OR � 0.37, p � .01).

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iscussion

Study findings suggest that where adolescent girls gofter school, how they view and think about themselves,ho their friends are, what their mothers know about their

omings and goings, and whether their families articulateonuse messages are associated with girls’ use of alcohol,rescription drugs, and inhalants. Whereas the roles of pos-tive after-school activities, peer use, and certain psychos-cial variables in explaining substance use risk amongouth are well examined, little previous work has studiedhe contributions of parental behavior, monitoring, andorms. Clearly, if girls do not go home after school, they areot helped by simply hanging out and engaging in unstruc-ured activities. That girls’ body images and affective statesf depression relate to substance use is evident in our data.hether girls use substances to change their bodies or numb

erceptions of their bodies cannot be verified by our results.ikewise, study data cannot address whether depressed girlsse substances or whether substance use exacerbates de-ression. The well-known influence of best friends in de-ermining adolescent substance use is underscored by largeRs in our findings.Maternal factors associated with adolescent girls’ sub-

tance use are complex, yet understandable. Mothers’ingle-parent status and tobacco habits appear to offer littlexplanation for their daughters’ drinking and drug taking.ut mothers’ alcohol use behavior and knowledge of their

able 2isk and protective factors related to alcohol, prescription drug, and inha

ndependent variable Alcohol

% OR (95% CI)a

fter-school activityHome 19.7 1.00Formal program 12.7 0.76 (0.55–1.05)Hang out 6.1 2.56*** (1.49–4.43)

sychosocial factorsBody image 24.7 0.56** (0.39–0.80)Depression 7.4 2.13** (1.37–3.31)Best friend uses substances 18.2 5.52*** (3.60–7.56)aternal factorsSingle parent 20.6 1.28 (0.95–1.72)Drinks 17.4 1.51** (1.12–2.05)Smokes 4.4 1.00 (.62–1.64)Knows where I am 32.6 0.48*** (0.31–0.74)Knows who I am with 27.3 0.57*** (0.41–0.80)Always able to reach her 26.5 0.58*** (0.42–0.81)

amily normsAntidrug rules 21.3 0.44*** (0.28–0.69)Urges abstinence 8.6 0.37*** (0.26–0.52)

a OR � odds ratio; CI � confidence interval from multivariate logisticb Prescription drugs are defined as those used recreationally, used for oc Inhalants include glue, spray paint, cleaning fluid, and any chemical i* p � .05.** p � .01.*** p � .001.

aughters’ whereabouts, companions, and accessibility m

elped explain girls’ substance use. Finally, our data pointp the value of overt family expectations about their chil-ren’s substance use. Parents who set rules about drugonuse and who articulate messages of abstinence fromrugs may raise daughters who incorporate those rules andessages into their own reduced risk behavior. These con-

lusions fit well with family interaction theory.Our research is not without flaws. The self-selection of

irls and mothers is a major limitation. Although partici-ants’ demographic profiles matched the population fromhich they came, girls and mothers responding to an invi-

ation for an online survey are likely more motivated, com-uter savvy, and on better terms with one another than thoseho chose not to be in our sample. The cross-sectionalesign precludes causal inferences regarding our indepen-ent and dependent variables. Boys were not engaged in thetudy, thereby leaving unanswered questions about genderifferences. Last, lifetime use reports of drinking and drugaking are not the most sensitive indicators.

Subsequent research can address these weaknesses tourther advance the scientific database of why girls arescalating their substance use behavior. The loss of protec-ive factors that heretofore may have accounted for girls’ower risks is an appealing topic for further study. Stillreater investment should be made in work that can directlynform prevention programming for girls. The potential forarent involvement, especially the participation of girls’

among adolescent girls (N � 781)

rescription drugsb Inhalantsc

OR (95% CI) % OR (95% CI)

.4 1.00 3.5 1.00

.6 0.67 (0.41–1.09) 2.6 1.01 (0.55–1.87)

.9 1.59 (0.83–3.08) 2.0 2.96** (1.45–6.02)

.8 0.45** (0.27–0.74) 4.8 0.58 (0.32–1.04)

.3 2.94*** (1.75–4.95) 2.4 2.67*** (1.46–4.90)

.1 5.11*** (2.89–9.03) 4.5 7.17*** (4.14–12.43)

.0 0.99 (0.65–1.52) 4.5 1.21 (0.73–2.02)

.7 1.01 (0.65–1.57) 4.5 1.82* (1.09–3.03)

.5 1.03 (0.51–2.05) .9 0.92 (0.39–2.18)

.2 0.91 (0.49–1.71) 7.6 1.06 (.52–2.15)

.3 0.55** (0.35–0.86) 5.8 0.68 (0.40–1.17)

.4 0.45*** (0.29–0.69) 4.9 0.41*** (0.24–0.69)

.0 0.79 (0.41–1.52) 4.2 0.36** (0.18–0.69)

.9 0.65 (0.33–1.27) 1.4 0.37** (0.19–0.74)

ion tests of each independent variable within substance use categories.purposes, or taken by other than the intended recipient.

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194 S.P. Schinke et al. / Journal of Adolescent Health 43 (2008) 191–194

erhaps our findings will stimulate follow-up research tonvestigate and prevent substance abuse among adolescentirls.

cknowledgments

This study was funded by the National Institute on Drugbuse (Grant No. DA17721).

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