Social Inequality and Substance Use and Problematic Gambling among Adolescents and Young Adults: A Review of Epidemiological Surveys in Germany

The current review provides an overview of socioepidemiological research in Germany about the prevalence of addictive behaviours (smoking, binge and hazardous drinking, consumption of cannabis and other illegal drugs, the non-medical use of prescription drugs and problematic gambling) among adolescents (11-17 years) and young adults (18-25 years), also differentiating between different socioeconomic status (SES) indicators (attended school type, family affluence, parental occupational status, parental SES, employment status) and migration background. 

The authors evaluated data from ten national surveys and one regional survey conducted between 2002 and 2012, which included different samples. The trends over this time frame reveal that the proportion of adolescents who smoke tobacco, show problematic patterns of alcohol consumption, use cannabis or other illegal drugs has generally declined over the investigated time span in Germany. 

The results nevertheless suggest that some strong associations still exist between social inequalities and the prevalence of substance use. The detailed results are summarised in twelve tables. The main results are as follows: 

• Low SES (school type, employment status) was consistently associated with more cigarette smoking, and, where such data was available, this pattern was observed in both males and females. 
• With regard to family affluence, two surveys show that boys with low and middle FAS are significantly less likely to have binge drinking experience compared to boys with high FAS. 
• There were no significant associations between problematic alcohol use and parental SES, and not all results of the surveys show that binge drinking is more prevalent among HS-students. 
• Employment status was associated with gender differences; problematic patterns of alcohol consumption were significantly more prevalent among young unemployed males compared to GY-students (secondary high school/grammar school) of the same age. 
• The opposite was true for females. 
• Another consistent finding was that among adolescents and young adults with a Turkish/Asian migration background, a problematic use of alcohol was significantly less common compared to adolescents and young adults of the same age without a migration background. 
• In terms of the consumption of cannabis, the unemployed and students with low educational level (`Hauptschule´) emerge as high-risk groups. 
• The results concerning problematic gambling significantly overlap with and reflect the findings of international research: 
• being male, of low educational attainment, 
• unemployed, 
• receiving social welfare, 
• and having a migration background significantly increased the risk of problematic gambling habits. 
• The highest lifetime prevalence rates for the consumption of illegal drugs (other than cannabis) were observed among students with low educational level. 

It should be noted that other SES indicators, in addition to school type, have not been examined to date. The review concludes by outlining gaps and future research areas, as well as presenting several implications for prevention initiatives.

Purchase full article at:   http://goo.gl/RiAc39

By:   Henkel D1, Zemlin U.

• 1Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt a.M., Germany. 

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Relationship Dynamics and Sexual Risk Reduction Strategies among Heterosexual Young Adults: A Qualitative Study of Sexually Transmitted Infection Clinic Attendees at an Urban Chicago Health Center

Few studies have examined risk-reduction alternatives to consistent condom use for HIV prevention among heterosexual young adults. We used qualitative methodology to explore risk reduction strategies and contextual factors influencing attempts to reduce risk in an urban, high morbidity sexually transmitted infection (STI) clinic. 

Focus groups were conducted October–December 2014 with heterosexually identified men (n = 13) and women (n = 20) aged 18–29 seeking STI screening at an urban clinic. Groups were audio recorded, transcribed verbatim, and analyzed for thematic content using Atlas.ti software. Quantitative information included sociodemographics, HIV/STI testing history, and 6-month sexual behaviors. 

Among 33 predominantly African-American participants with a median age of 22, risk-reduction strategies included monogamy agreements, selective condom use with casual and high-risk partners, and frequent HIV/STI testing, though testing was commonly used as a post-hoc reassurance after risk exposure. Many men and women used implicit risk assessment strategies due to mistrust or difficulty communicating. Concurrency was common but rarely discussed within partnerships. Despite attempts to reduce risk, monogamy agreements were often poorly adhered to and not openly discussed. Alcohol and substance use frequently interfered with safer sexual decisions. 

Participants were aware of HIV/STI risk and commonly practiced risk-reduction strategies, but acknowledged faulty assumptions and poor adherence. This work provides insights into risk-reduction approaches that are already used and may be strengthened as part of effective HIV/STI prevention interventions.

Purchase full article at:  http://goo.gl/CgUkhD

By:  Anna L. Hotton, PhD, MPH,^1,4 Audrey L. French, MD,^1,2 Sybil G. Hosek, PhD,³ Sabrina R. Kendrick, MD,^1,2Diana Lemos, PhD, MPH,³ Jennifer Brothers, MPH,³ Stacey L. Kincaid, MPH,¹ and Supriya D. Mehta, PhD, MHS⁴

¹Department of Medicine, CORE Center/John Stroger Hospital of Cook County, Chicago, Illinois.

²Rush University Medical Center, Chicago, Illinois.

³Department of Psychiatry, CORE Center/John Stroger Hospital of Cook County, Chicago, Illinois.

⁴Department of Epidemiology and Biostatistics, University of Illinois Chicago School of Public Health, Chicago, Illinois.

 

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An Interactive Text Message Intervention to Reduce Binge Drinking in Young Adults: A Randomized Controlled Trial with 9-Month Outcomes

Background

Binge drinking is associated with numerous negative consequences. The prevalence and intensity of binge drinking is highest among young adults. This randomized trial tested the efficacy of a 12-week interactive text message intervention to reduce binge drinking up to 6 months after intervention completion among young adults.

Methods and Findings

Young adult participants (18–25 y; n = 765) drinking above the low-risk limits (AUDIT-C score >3/4 women/men), but not seeking alcohol treatment, were enrolled from 4 Emergency Departments (EDs) in Pittsburgh, PA. Participants were randomized to one of three conditions in a 2:1:1 allocation ratio: SMS Assessments + Feedback (SA+F), SMS Assessments (SA), or control. For 12 weeks, SA+F participants received texts each Thursday querying weekend drinking plans and prompting drinking limit goal commitment and each Sunday querying weekend drinking quantity. SA+F participants received tailored feedback based on their text responses. To contrast the effects of SA+F with self-monitoring, SA participants received texts on Sundays querying drinking quantity, but did not receive alcohol-specific feedback. The control arm received standard care. Follow-up outcome data collected through web-based surveys were provided by 78% of participants at 3- months, 63% at 6-months and 55% at 9-months. Multiple imputation-derived, intent-to-treat models were used for primary analysis. At 9-months, participants in the SA+F group reported greater reductions in the number of binge drinking days than participants in the control group, lower binge drinking prevalence, less drinks per drinking day and lower alcohol-related injury prevalence. Participants in the SA group did not reduce drinking or alcohol-related injury relative to controls. Findings were similar using complete case analyses.

Conclusions

An interactive text-message intervention was more effective than self-monitoring or controls in reducing alcohol consumption and alcohol-related injury prevalence up to 6 months after intervention completion. These findings, if replicated, suggest a scalable approach to help achieve sustained reductions in binge drinking and accompanying injuries among young adults.

Below:  Self-reported alcohol consumption and alcohol-related injuries at 3-, 6- and 9-months follow-ups

Full article at: http://goo.gl/AKZTno

By: 

Brian Suffoletto, Jeffrey Kristan

Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America

Tammy Chung, Duncan B. Clark

Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America

Kwonho Jeong, Anthony Fabio

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America

Peter Monti

Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, United States of America

 

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Gender and Ethnicity in Dating, Hanging Out, and Hooking Up: Sexual Scripts Among Hispanic and White Young Adults

We examined the scripts associated with heterosexual Hispanic and White young adults' most recent initial sexual or romantic encounter using two samples of heterosexual undergraduates: 224 Hispanic students (49% female) and 316 White students (51% female). 

Scripts were identified for three types of encounters: dating, hanging out, and hooking up. The three scripts had more than half of their actions in common. Items such as get to know one another, feel aroused, and engage in physical contact were present across all scripts for all participant groups. 

As expected, traditional gender roles were present within all scripts, but more so for dates than for hangouts and hookups. Men reported a higher presence of traditional gender roles than women across scripts and put a higher priority on the goal of physical intimacy across all scripts. Dating was the most prevalent script for all young adults, contradicting contemporary claims that "dating is dead." 

In terms of ethnicity, a higher proportion of Hispanic than White young adults went on dates, and a higher proportion of White students went on hookups, implying that social and contextual variables are important in understanding young adults' intimate relationships.

Purchase full article at: http://goo.gl/VRm34R

By: Eaton AA1, Rose SM1, Interligi C2, Fernandez K3, McHugh M1.

• 1a Department of Psychology , Florida International University.
• 2b Department of Psychology , Indiana University of Pennsylvania.
• 3c Department of Psychology , Nova Southeastern University. 

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