A research report submitted to the Faculty of Humanities, School of Social Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Arts in the field of Demography and Population Studies, 2016 / Background: Risky behaviours are notably the most important factors contributing to negative health outcomes among adolescents. A number of diseases and deaths have been linked to risky and harmful behaviours. Research has shown that being involved in one risky behaviour increases the likelihood of involvement in additional risky behaviours. Adolescents have been identified at the centre of sustainable development, particularly in achieving goals related to bringing poverty to an end, promoting health and well-being, attaining equitable and quality primary and secondary education as well as achieving inclusive and sustainable economic growth. Objectives: The objective of this study was firstly to examine the levels of social association membership and risky behaviour among adolescents. Secondly, to identify the determinants of risky behaviour among South African adolescents and lastly, to examine the relationship between social association membership and risky behaviour among adolescents. Methods: Data were drawn from the South African Youth Life Style Survey of 2008. A sample of 3335 adolescents aged 12 to 19 years was analysed. Four binary and one multinomial logistic regression analyses were conducted. The four binary dependent variables were for risky sexual behaviours, risky substance use behaviours, other risky behaviours and engaging in at least one type of behaviour. For each of these binary dependent variables the response category was yes or no. The dependent variable for the multinomial logistic regression model was any adolescent risky behaviour which was categorised as; no behaviour, any one category of behaviour, any two categories of behaviour and all three categories of behaviour. The key independent variables were firstly an index variable generated by merging all the different social associations into one variable that had the response yes or no to being a member of any social association. There were also five key independent variables that were the individual social associations namely; sports, religious groups, choir, drama and other associations. Results: The two most common social associations that adolescents engaged in were sports groups (515 per 1000 adolescents) and religious groups (342 per 1000 adolescents). Risky vii behaviours with the highest number adolescents engaging in them were driving without a seatbelt (32%), consuming alcohol (32%), being a passenger in a car driven by someone under the influence of alcohol (28%), tobacco use (21%) and lack of condom use (9%). Adolescents who were not members of social associations were found to have decreased the risk of engaging in one, two and all three categories of risky behaviours. Not being a member of religious groups increased the risk of engaging in one, two and all three categories of risky behaviour. Adolescents who were not members of sports groups were found to have lower risks of engaging in one, two and all three categories of risky behaviour, as well as decreased odds of engaging in at least one type of risky behaviour. Conclusion: The study found that there was a statistically significant relationship between social association membership and risky behaviours among adolescents in South Africa. More particularly, religious associations were found to be protective factors to risky behaviours and sports, drama and other associations were found to be platforms that could potentially increase the likelihood of risky behaviour among adolescents. / GR2017

Adolescent alcohol abuse increases across the adolescent years. If left unchecked, alcohol abuse can give rise to delinquency, poor grades, and risky sexual behavior (Stueve & O’Donnell, 2005; Ellickson, Tucker, & Klein, 2003). Past research suggests that minimal parental oversight increases the risk for adolescent alcohol abuse. There is also evidence, however, that parents withdraw from oversight in the face of adolescent problem behaviors (Barber & Olsen, 1997; Hafen & Laursen, 2009). Each may vary according to the child’s physical development. Parents may respond to pubertal maturation with reduced supervision and early maturing girls may be sensitive to parent supervision because of the additional pressures and attention they receive from older, possibly deviant, peers (Stattin, Kerr, & Skoog, 2011). / Includes bibliography. / Thesis (M.A.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

The way in which adolescents perceive themselves and interact with peers, teachers and caregivers could determine whether they would drink alcohol and smoke dagga or not. Without positive self-concept amongst adolescents and experiencing of positive communication with caregivers, it can be said, there is a likelihood of drinking alcohol and smoking of dagga by adolescents. A 52-item questionnaire was constructed on the basis of current international and South African research on the adolescents who drink alcohol and smoke dagga. The biographical data was used as independent variables in the questionnaire. These independent variables included questions on age, gender, grade and the person who takes care of adolescent. The questionnaire was completed by 443 adolescents in grade 9 and 11 from one secondary school in Soweto. Of this total, 48,1% were males (N=213) and 51,9% were females (N=230). A factor analysis of the questionnaire revealed two statistically significant constructs and they were termed “Experience of locus of control with respect to school” (Chronbach alpha of 0.900) and “Experience of communication with caregivers by adolescents (0.892). With respect to the bivariate analysis of the relationships between (1)the gender of adolescents (2)the age of adolescents and who is the caregiver to the adolescent and the (1)drinking of alcohol and the (2)smoking of dagga, the following was found: • adolescents who lived with stepparents are more inclined to drink alcohol than adolescents who lived with both mother and father, single parents and other. • a significantly higher proportion of males drink alcohol man females who drink alcohol. • a significantly higher proportion of older adolescents (17 years, 18 years and older) drink alcohol than younger adolescents (16 years, 15 years and younger). The impact of this research would indicate that adolescents with negative self-concept about themselves display a significantly greater inclination towards drinking alcohol and smoking of dagga. Also, adolescents who live with stepparents display a significantly more negative experience of drinking alcohol and smoking of dagga than adolescents who live with both mother and father, single parents and other. / Prof. C.P.H Myburgh

Alcohol use is the single most alarming behavior among youth in the United States. Adolescents especially are at risk for increases in heavy episodic drinking and drunkenness leading to alcohol-related problems such as academic failure, interpersonal violence, risky sexual behavior and death. In an effort to address this endemic issue, a number of alcohol use prevention programs have been developed and are currently implemented in the high school setting. Many of these programs, however, lack an empirical basis and have been unable to demonstrate significant reductions in alcohol use over time. The need for the development and dissemination of effective strategies to address adolescent drinking is evident. Recommendations for newly developing approaches encourage an emphasis on empiricallybased content and easily implemented protocols. Expectancy challenge-based interventions have been identified by the National Institute on Alcohol Abuse and Alcoholism as having strong evidence supporting their effectiveness in reducing alcohol use among college students. Recent efforts to translate such programs into forms effective with high school adolescents have been met with mixed results. The focus of the present study was to modify, implement and evaluate the Expectancy Challenge Alcohol Literacy Curriculum (ECALC), a program currently validated for use with college populations, for high school adolescents. The single session, high school version of the ECALC was infused into the existing Health Education high school curriculum and implemented with those in the 9th through 12th grades. Measures of alcohol expectancies and alcohol use were completed anonymously by each participant before delivery of the program and for 30 days thereafter. Impact of the ECALC was compared to classes randomly assigned to an attention-matched control condition. Findings revealed significant changes in alcohol expectancies and alcohol use reported by participants in the 11th and 12th grades following iv delivery of the ECALC. Changes were found across factor analytic and multidimensional scaling (MDS) statistical methods applied to the expectancy measure, as well as across measures of estimated intoxication and drinking quantity/frequency. Findings were consistent among both male and female participants. Reductions in alcohol use were not found among 9th and 10th grade participants, and expectancy changes were inconsistent. The assessment periods for baseline and follow-up were thirty days, which may reflect a limitation in that a longer follow-up may be more likely to capture significant behavioral changes over time. This study was the first to apply both factor analytic and MDS methods to analysis of the Comprehensive Effects of Alcohol questionnaire, with clear implications for expectancy measurement techniques likely to be most appropriate for capturing changes in expectancy activation patterns over time. Overall, this study represents an important advance in the development of an empirically-based and validated alcohol use prevention program effective for use with adolescents. In addition, the ECALC serves as a prevention program that is easily implemented in the high school setting, requiring only 50 minutes of class time, a classroom, and a motivated educator.

Effective school-based alcohol prevention programs do exist. However, the overall efficacy of these programs has been compromised by implementation failure and a focus on abstinence based outcomes. The current thesis attempted to overcome such concerns by developing a computer-delivered school-based alcohol prevention program founded on a harm-minimisation approach. The aims of this thesis were to assess whether (1) this program would be both a feasible and acceptable means of overcoming the obstacles encountered in the implementation of school-based drug prevention programs, and (2) it was effective in decreasing alcohol misuse and related harm. CLIMATE Schools: Alcohol Module was developed in collaboration with teachers, students and relevant health and legal professionals. The final curriculum based program consists of six lessons, each with two components. The first component involves students completing an interactive computer-based program, with the second consisting of a variety of individual, small group and class-based activities. The feasibility and efficacy of CLIMATE Schools: Alcohol Module was assessed utilising a cluster randomised controlled trial involving 1434, Year 8 students (13 years old) from sixteen schools. CLIMATE Schools: Alcohol Module was found to be both feasible and acceptable in the school setting. The provision of alcohol prevention information in the background of a computerised teenage drama provided young people with an education program they enjoyed in a context to which they could relate. Teachers reported a willingness to implement CLIMATE Schools: Alcohol Module in routine practice. They believed it to be a high quality program which was superior to other drug education programs. CLIMATE Schools: Alcohol Module led to significant increases in knowledge of harm minimisation skills and subdued alcohol related expectancies. It was effective in reducing alcohol use, misuse and related harms for females, but not for males. The differential effects of gender are extensively discussed and implications for future research considered. CLIMATE Schools: Alcohol Module was clearly both feasible and acceptable and has the potential to offer an innovative new platform for the delivery of prevention programs in schools.

Effective school-based alcohol prevention programs do exist. However, the overall efficacy of these programs has been compromised by implementation failure and a focus on abstinence based outcomes. The current thesis attempted to overcome such concerns by developing a computer-delivered school-based alcohol prevention program founded on a harm-minimisation approach. The aims of this thesis were to assess whether (1) this program would be both a feasible and acceptable means of overcoming the obstacles encountered in the implementation of school-based drug prevention programs, and (2) it was effective in decreasing alcohol misuse and related harm. CLIMATE Schools: Alcohol Module was developed in collaboration with teachers, students and relevant health and legal professionals. The final curriculum based program consists of six lessons, each with two components. The first component involves students completing an interactive computer-based program, with the second consisting of a variety of individual, small group and class-based activities. The feasibility and efficacy of CLIMATE Schools: Alcohol Module was assessed utilising a cluster randomised controlled trial involving 1434, Year 8 students (13 years old) from sixteen schools. CLIMATE Schools: Alcohol Module was found to be both feasible and acceptable in the school setting. The provision of alcohol prevention information in the background of a computerised teenage drama provided young people with an education program they enjoyed in a context to which they could relate. Teachers reported a willingness to implement CLIMATE Schools: Alcohol Module in routine practice. They believed it to be a high quality program which was superior to other drug education programs. CLIMATE Schools: Alcohol Module led to significant increases in knowledge of harm minimisation skills and subdued alcohol related expectancies. It was effective in reducing alcohol use, misuse and related harms for females, but not for males. The differential effects of gender are extensively discussed and implications for future research considered. CLIMATE Schools: Alcohol Module was clearly both feasible and acceptable and has the potential to offer an innovative new platform for the delivery of prevention programs in schools.

Using the stress process model, the relationship between pregnancy and depressive symptoms among adolescent girls was investigated. This model posits that stress resulting from social location and related disruptive life events may indirectly affect health by eroding coping, mastery, or social support mechanisms. The effect of low income, minority status and pregnancy on coping processes in adolescent girls was hypothesized and tested. Communication with parents, involvement in activities, and success in school were examined as positive coping strategies. Smoking tobacco, heavy alcohol use, and drug use were examined as negative coping. Data from the National Survey on Drug Use and Health were analyzed. After combining the available cases from the 2006, 2007, and 2008 datasets, selecting girls aged from 12 to 17 years, and removing missing cases; the sample consisted of a total of 22,854 adolescents. A series of binary logistic regression models were estimated. Findings included that coping strategies partially mediate the relationship between pregnancy and depressive symptoms. In particular, success in school, smoking tobacco, and drug abuse played a mediating role. When coping was accounted for, the relationship between pregnancy and depressive symptoms was reduced and became only marginally significant. Implications of the study include a focus on policy that promotes early intervention assisting at-risk adolescents with the development of coping strategies that may help them adjust to unexpected life events, such as pregnancy.

Context: There are two ways that digital media may influence alcohol use. The first is commercial alcohol marketing. The second is user-created alcohol promotion, defined as content distributed through new media that promotes consumption, but independent of commercial marketing. This thesis explores how both types of content promote alcohol, what association there is between exposure and alcohol-related attitudes and behaviour, and the differences between marketing and user-created promotion. Method: A mixed method design was employed, divided into two studies. The first was a content analysis of the design features, topical references, and messages suggested about alcohol in digital marketing and user-created promotion on Facebook, Twitter, and YouTube. The second was a cross-sectional survey with young adults (n = 405). This measured awareness of, and participation with, digital marketing and user-created promotion, and the association with consumption, higher-risk drinking, brand recall, expectancies, and drinking motives. Results: The content analysis found that digital marketing had personalised designs which contained subtle and positive messages about consumption, whereas user-created promotion had simpler designs, displayed little ethical practice, and contained overt messages about higher-risk drinking. The cross-sectional survey found that young adults were aware of, and participating with, both digital marketing and user-created promotion, with exposure greater for the latter. Exposure to both types of content was positively associated with alcohol use, higher-risk consumption, and drinking intentions. User-created promotion had a stronger association with all outcomes than marketing. The association between exposure and consumption, for both types of content, was mediated through drinking motives and expectancies. Conclusion: Young adults are aware of, and participating with, a range of digital marketing and user-created promotion. That such exposure is associated with alcohol-related attitudes and behaviour highlights the potential of new media to influence alcohol consumption. Further research is required to better understand young people’s experience with digital media and the challenges of addressing online health risk messages.

Indiana University-Purdue University Indianapolis (IUPUI) / Research in the alcohol preferring (P) rat has indicated that peri-adolescent alcohol (EtOH) consumption enhances the acquisition of oral operant EtOH self-administration, inhibits the extinction of responding for EtOH, augments EtOH-seeking behaviors, and increases relative reward value of EtOH during adulthood. Experiment 1 was conducted to determine if these adult effects of peri-adolescent EtOH intake could be observed using an Intracranial Self-Administration (ICSA) model. It was hypothesized that an increased sensitivity to the rewarding actions of EtOH would be manifested in peri-adolescent-EtOH-exposed subjects compared to naive subjects when the opportunity to self-administer EtOH to the posterior ventral tegmental area (pVTA) is available in adulthood. The pVTA is a primary site for EtOH’s reinforcing and rewarding properties in the mesolimbic dopamine (DA) system. Experiment 2 was a dose-response examination of the effects of EtOH administered to the pVTA on downstream DA efflux in the nucleus accumbens shell (AcbSh) via a joint Microinjection-Microdialysis (MicroMicro) procedure. Male P rats were given 24-h free-choice exposure to 15% volume/volume EtOH from postnatal day (PD) 30 to PD 60, or remained experimentally naive, with ad lib food and water. By the end of the periadolescent exposure period, average consumption was 7.3 g/kg/day of EtOH. After PD 75, periadolescent-EtOH-exposed and naïve rats were either implanted with an injector guide cannula aimed at the right pVTA for ICSA (Experiment 1), or two cannulae, one aimed at the right pVTA (injector) and one at the ipsilateral AcbSh (microdialysis) for MicroMicro (Experiment 2). Following one week of recovery from surgery, ICSA subjects were placed in standard two-lever (active and inactive) operant chambers. Test sessions were 60 min in duration and occurred every other day for a total of 7 sessions. Rats were randomly assigned to one of 5 groups (n=4-9/group) that self-infused (FR1 schedule) either aCSF (vehicle, 0 mg%), 50, 75, 100, or 150 mg% EtOH during 4 sessions, aCSF only for sessions 5 and 6 (extinction), and the initial concentration again for session 7 (reinstatement). MicroMicro subjects received six days of recovery from surgery, probe implantation the day before testing, and then continuous microdialysis for DA with 15 min microdialysis samples collected before, during, and then two hrs after 10-min pulse microinjection of either aCSF (vehicle, 0 mg%), 50, 75, 100, or 150 mg% EtOH. Neither EtOH-exposed nor naive groups of P rats self-infused the aCSF or 50 mg% EtOH concentration. While the naive group did not self-infuse the 75 or 100 mg% EtOH concentrations, the peri-adolescent EtOH-exposed group of P rats did readily discriminate the active lever from the inactive lever at these concentrations. Both groups self-infused the 150 mg% EtOH concentration. Pulse microinjections of EtOH during the MicroMicro procedure revealed that 75 and 100 mg% concentrations of EtOH increased downstream DA in the AcbSh of EtOH-exposed, but not naïve, subjects. 150 mg% EtOH increased downstream DA in both adolescent treatment groups. Overall, the results indicate that consumption of EtOH by P rats during peri-adolescence increases the reinforcing properties of EtOH in the pVTA in adulthood. The results also indicate that there were differential effects of peri-adolescent EtOH exposure on DA efflux in the AcbSh. This provides evidence that peri-adolescent EtOH-exposure produces long-lasting alterations in neural circuitry involved in EtOH-reinforcement, during adulthood.

Indiana University-Purdue University Indianapolis (IUPUI) / Abuse of alcohol during adolescence continues to be a problem, and it has been shown that earlier onset of drinking predicts increased alcohol abuse problems later in life. High levels of impulsivity have been demonstrated to be characteristic of alcoholics, and impulsivity has also been shown to predict later alcohol use in teenage subjects, showing that impulsivity may be an inherent underlying biological process that precedes the development of alcohol use disorders. These experiments examined adolescent drinking in a high-drinking, relatively impulsive mouse population, and assessed its effects on adult drinking and adult impulsivity. Experiment 1: Selectively bred High-Alcohol Preferring (HAP II) mice, which are shown to be highly impulsive, were given either alcohol (free choice access) or water only for two weeks during middle adolescence or adulthood. All mice were given free choice access to alcohol following 30 days without access, in adulthood. Experiment 2: Adolescent HAP II mice drank alcohol and water, or water alone, for two weeks, and were then trained to perform a delay discounting task as adults to measure impulsivity. In each experiment, effects of volitional ethanol consumption on later behavior were assessed. We expected adolescent alcohol exposure to increase subsequent drinking and impulsivity. Adolescent mice consumed significant quantities of ethanol, reaching average blood ethanol concentrations (BECs) of 142 mg/dl in Experiment 1 and 108 mg/dl in Experiment 2. Adult mice reached average BECs of 154 mg/dl in Experiment 2. Mice pre-exposed to alcohol in either adolescence or adulthood showed a transient increase in ethanol consumption, but we observed no differences in impulsivity in adult mice as a function of whether mice drank alcohol during adolescence. These findings indicate that HAP II mice drink intoxicating levels of alcohol during both adolescence and adulthood, and that this volitional intake has long-term effects on subsequent drinking behavior. Nonetheless, this profound exposure to alcohol during adolescence does not increase impulsivity in adulthood, indicating that long-term changes in drinking are mediated by mechanisms other than impulsivity. Importantly, this research demonstrates that the HAP II mouse is a good candidate for a model of heavy adolescent alcohol consumption.