Ch. 13- Problems in Adolescence and Emerging Adulthood

Avoidant coping

Another harmful coping strategy is avoidant coping, which involves ignoring a problem and hoping it will just go away (Wadsworth & others, 2011). A recent study found that adolescents who relied on avoidant coping and emotion-focused coping were more likely to be depressed and engage in suicidal ideation (Horwitz, Hill, & King, 2011)

Cocaine

Cocaine is a stimulant that comes from the coca plant, native to Bolivia and Peru. Cocaine can have a number of seriously damaging effects on the body, including heart attacks, strokes, and brain seizures.

Emotion-focused coping

Emotion-focused coping is Lazarus' term for responding to stress in an emotional manner, especially by using defense mechanisms. Emotion-focused coping includes avoiding a problem, rationalizing what has happened, denying it is occurring, laughing it off, or calling on religious faith for support. If you use emotion-focused coping, you might avoid going to a class that you find difficult. You might say the class doesn't matter, deny that you are having a problem, or laugh and joke about it with your friends. This is not necessarily a good way to face a problem. For example, in one study, depressed individuals tried to avoid facing problems more than individuals who were not depressed (Ebata & Moos, 1989). In one study of inner-city youth, emotion-focused coping was linked to an increased risk for developing problems (Tolan & others, 2004).

Inhalants

Inhalants are ordinary household products that are inhaled or sniffed by children and adolescents to get high. Examples of inhalants include model airplane glue, nail polish remover, and cleaning fluids. Short-term use of inhalants can cause intoxicating effects that last for several minutes or even several hours if the inhalants are used repeatedly. Eventually the user can lose consciousness. Long-term use of inhalants can lead to heart failure and even death.

Internalizing problems

Occur when individuals turn their problems inward. Examples of internalizing problems include anxiety and depression.

Externalizing problems

Occur when individuals turn their problems outward. An example of an externalizing problem is juvenile delinquency.

Biological Factors

Scientists who adopt a biological approach focus on factors such as genes, puberty, hormones, and the brain as causes of adolescent and emerging adult problems.

Stimulants

Stimulants are drugs that increase the activity of the central nervous system. The most widely used stimulants are caffeine, nicotine, amphetamines, and cocaine. Cigarette smoking is decreasing among adolescents (see Figure 5). Cigarette smoking among U.S. adolescents peaked in 1996 and 1997 and has gradually declined since then (Johnston & others, 2015). Following peak use in 1996, smoking rates for U.S. eighth-graders have fallen by 50 percent. In 2014, the percentages of adolescents who said they had smoked cigarettes in the last 30 days were 14 percent (twelfth grade), 7 percent (tenth grade), and 4 percent (eighth grade). Since the mid-1990s an increasing percentage of adolescents have reported that they perceive cigarette smoking as dangerous, that they disapprove of it, that they are less accepting of being around smokers, and that they prefer to date nonsmokers (Johnston & others, 2015).

Contexts and Coping

The contextual approach to coping points to the importance of coping flexibility, the ability to modify coping strategies to match the demands of the situation.

Conduct disorder

The psychiatric diagnostic category used when multiple behaviors occur over a six-month period

Depression

Adolescent depression is a concern not just in the United States but around the world (Bazrafshan & others, 2015; Chen & others, 2015; Gong & others, 2014; Lee & Choi, 2015; Midgley, Ansaldo, & Target, 2014). An adolescent who says "I'm depressed" or "I'm so down" may be describing a mood that lasts only a few hours or a much longer-lasting mental disorder. In major depressive disorder, an individual experiences a major depressive episode and depressed characteristics, such as lethargy and hopelessness, for at least two weeks or longer and daily functioning becomes impaired. According to the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-V) classification of mental disorders (American Psychiatric Association, 2013), nine symptoms define a major depressive episode, and to be classified as having major depressive disorder, at least five of these must be present during a two-week period: Depressed mood most of the day Reduced interest or pleasure in all or most activities Significant weight loss or gain, or significant decrease or increase in appetite Trouble sleeping or sleeping too much Psychomotor agitation or retardation Fatigue or loss of energy Feeling worthless or guilty in an excessive or inappropriate manner Problems in thinking, concentrating, or making decisions Recurrent thoughts of death and suicide In adolescence, pervasive depressive symptoms might be manifested in such ways as primarily wearing black clothes, writing poetry with morbid themes, or being preoccupied with music that has depressive themes. Sleep problems can appear as all-night television watching, difficulty in getting up for school, or sleeping during the day. Lack of interest in usually pleasurable activities may show up as withdrawal from friends or staying alone in the bedroom most of the time. A lack of motivation and energy level can show up in missed classes. Boredom might be a result of feeling depressed. Adolescent depression also can occur in conjunction with conduct disorder, substance abuse, or an eating disorder. Family factors are involved in adolescent and emerging adult depression (Morris & others, 2014; Olino & others, 2015; Waller & Rose, 2013; Yap & others, 2014a, b). Reflecting the developmental cascade approach, Deborah Capaldi, Gerald Patterson, and their colleagues (Capaldi, 1992; Capaldi & Stoolmiller, 1999; Patterson, DeBaryshe, & Ramsey, 1989; Patterson & others, 1992) have proposed that behavior problems arising in the family in the early childhood years that are connected to inept parenting are carried forward into school contexts, producing problems in academics (poor grades, for example) and social competence (difficulty in peer relations, for example). This cascade of connecting relationships and contexts is expected to contribute to depressive symptoms.What type of treatment is most effective in reducing depression in adolescence? A recent research review concluded that treatment of adolescent depression needs to take into account the severity of the depression, suicidal tendencies, and social factors (Clark, Jansen, & Cloy, 2012). In this review, cognitive behavioral therapy and interpersonal therapy were recommended for adolescents with mild depression and in combination with drug therapy for adolescents experiencing moderate or severe depression. However, caution needs to be exercised when using antidepressants, such as Prozac, with adolescents (Morrison & Schwartz, 2014). In 2004, the U.S. Food and Drug Administration assigned warnings to such drugs, stating that they slightly increase the risk of suicidal behavior in adolescents. In the study just described, 15 percent of depressed adolescents who only took Prozac had suicidal thoughts or attempted suicide compared with 6 percent who only received cognitive behavioral therapy and 8 percent who received both Prozac and cognitive behavioral therapy. Nonetheless, a recent research review concluded that Prozac and other SSRIs (selective serotonin reuptake inhibitors) show clinical benefits for adolescents at risk for moderate and severe depression (Cousins & Goodyer, 2015).

The 20 internal assets include the following:

Commitment to learning (such as being motivated to achieve in school and doing at least one hour of homework on school days) Positive values (such as helping others and demonstrating integrity) Social competencies (such as knowing how to plan and make decisions and having interpersonal competencies like empathy and friendship skills) Positive identity (such as having a sense of control over life and high self-esteem)

Role models and the media

Girls who were highly motivated to look like female celebrities were more likely than their peers to become very concerned about their weight (Field & others, 2001). Watching commercials with idealized thin female images increased adolescent girls' dissatisfaction with their bodies (Hargreaves & Tiggemann, 2004). Also, a study of adolescent girls revealed that frequently reading magazine articles about dieting and weight loss was linked with unhealthy weight-control behaviors such as fasting, skipping meals, and smoking more cigarettes five years later (van den Berg & others, 2007). And a recent study of female undergraduates revealed that they spent considerably more time viewing online appearance-oriented media than reading image-focused magazines (Bair & others, 2012). In this study, the college females' appearance-oriented Internet use was associated with eating pathology, especially internalization of the ideal of having a thin body.

Coping

Managing taxing circumstances, expending effort to solve life's problems, and seeking to master or reduce stress. involves managing taxing circumstances, expending effort to solve life's problems, and seeking to master or reduce stress. What makes the difference between effective and ineffective efforts to cope? Adolescents have a wider range of coping strategies than do children, and the ability to choose among more coping options is likely adaptive (Aldwin & others, 2011). A recent research review concluded that two types of age trends occur from childhood through adolescence in coping: (1) an increase in coping capacities reflected in more self-reliance and less reliance on adults; greater use of planful problem solving; and greater reliance on cognitive strategies; and (2) an improvement in the deployment of different coping strategies depending on which ones are more effective in dealing with certain kinds of stressors (Zimmer-Gembeck & Skinner, 2011).

Overweight and Obese Adolescents

Obesity is a serious and pervasive health problem for many adolescents and emerging adults (Donatelle, 2015; Lynch, Elmore, & Kotecki, 2015). The Centers for Disease Control and Prevention (2014) has a category of obesity for adults but does not have an obesity category for children and adolescents because of the stigma the label obesity may bring. Rather, they have categories for being overweight or at risk for being overweight in childhood and adolescence. These categories are determined by body mass index (BMI), which is computed by a formula that takes into account height and weight. Only children and adolescents at or above the 95th percentile of BMI are included in the category of overweight, and those at or above the 85th percentile are included in the category of at risk for being overweight. National data indicated that the percentage of overweight U.S. 12- to 19-year-olds increased from 11 percent in the early 1990s to nearly 21 percent in 2011-2012 (Ogden & others, 2014). In another recent study, 12.4 percent of U.S. kindergarten children were overweight but by 14 years of age, 20.8 percent were overweight (Cunningham, Kramer, & Narayan, 2014). U.S. children and adolescents are more likely to be overweight or obese than their counterparts in most other countries (Lu & others, 2013; Spruijt-Metz, 2011). One comparison of 34 countries found that the United States had the second highest rate of childhood obesity (Janssen & others, 2005). In another study, U.S. children and adolescents (6 to 18 years of age) were four times more likely to be classified as obese than their counterparts in China and almost three times more likely to be classified as obese than their counterparts in Russia (Wang, 2000). Eating patterns established in childhood and adolescence are strongly linked to obesity in adulthood. One study revealed that 62 percent of the male and 73 percent of the female adolescents in the 85th to 94th percentile of BMI became obese adults (Wang & others, 2008). In this study, of those at the 95th percentile and higher for BMI, 80 percent of the males and 92 percent of the females became obese adults. A study of more than 8,000 12- to 21-year-olds found that obese adolescents were more likely to develop severe obesity in emerging adulthood than were overweight or normal-weight adolescents (The & others, 2010). Both heredity and environmental factors are involved in obesity. Some individuals inherit a tendency to be overweight (Tutone & others, 2014). Only 10 percent of children who do not have obese parents become obese themselves, whereas 40 percent of children who become obese have one obese parent, and 70 percent of children who become obese have two obese parents. Identical twins, even when they are reared apart, have similar weights. Environmental factors play a role in obesity (Willett, 2013). Strong evidence of the environment's role in obesity is the doubling of the rate of obesity in the United States since 1900, as well as the significant increase in adolescent obesity since the 1960s, as described earlier. This dramatic increase in obesity likely is due to greater availability of food (especially food high in fat), energy-saving devices, and declining physical activity. A recent international study of adolescents in 56 countries found fast-food consumption is high in childhood but increases further in adolescence (Braithwaite & others, 2014). In this study, adolescents in the frequent and very frequent categories of eating fast food had higher body mass indices than adolescents in the lower frequency categories. Further, increases in screen time in adolescence are associated with adolescent overweight and obesity (Saunders, Chaput, & Tremblay, 2014).

What Is Juvenile Delinquency?

The term juvenile delinquency refers to a broad range of behaviors, from socially unacceptable behavior (such as acting out in school) to status offenses (such as running away from home) to criminal acts (such as burglary). Males are more likely to engage in delinquency than are females (Colman & others, 2009). However, U.S. government statistics revealed that the percentage of delinquency caseloads involving females increased from 19 percent in 1985 to 27 percent in 2005 (Puzzanchera & Sickmund, 2008). A distinction is made between early-onset (before age 11) and late-onset (after age 11) antisocial behavior. Early-onset antisocial behavior is associated with more negative developmental outcomes than late-onset antisocial behavior (Schulenberg & Zarrett, 2006). Early-onset antisocial behavior is more likely to persist into emerging adulthood and is associated with more mental health and relationship problems (Loeber & Burke, 2011; Loeber, Burke, & Pardini, 2009).

The Biopsychosocial Approach

he biopsychosocial approach emphasizes that biological, psychological, and social factors interact to produce the problems experienced by adolescents, emerging adults, and people of other ages (see Figure 1). Thus, if an adolescent or emerging adult engages in substance abuse it may be due to a combination of biological factors (heredity and brain processes, for example), psychological factors (low conscientiousness and low self-control, for example), and social factors (relationship difficulties with parents and peers, for example). In other chapters we have explored biological, psychological, and social factors that can contribute to the development of problems in adolescence. In our further examination of the biopsychosocial approach, we will especially highlight biological, psychological, and social factors that adolescence uniquely contributes to these problems.

Acculturative stress

Acculturative stress refers to the negative consequences that result from contact between two distinctive cultural groups. Many individuals who have immigrated to the United States have experienced acculturative stress (Fuligni & Tsai, 2015). A recent study found that acculturative stress was linked to body image disturbance in Latino college students through an emphasis on the high status of a thin body (Menon & Harter, 2012). Poverty can cause considerable stress for individuals and families (Duncan & others, 2015; Leventhal, Dupere, & Shuey, 2015). One expert on coping in youth, Bruce Compas (2004, p. 279), calls poverty "the single most important social problem facing young people in the United States." Chronic conditions such as inadequate housing, dangerous neighborhoods, burdensome responsibilities, and economic uncertainties are potent stressors in the lives of the poor (Bradley, 2015; Murry & others, 2015). Adolescents are more likely to experience threatening and uncontrollable life events if they live in low-income contexts than if they live in more economically robust contexts (McLoyd, Purtell, & Hardaway, 2015).

Bullimia nervosa

Although anorexics control their eating by restricting it, most bulimics cannot. Bulimia nervosa is an eating disorder in which the individual consistently follows a binge-and-purge eating pattern. The bulimic goes on an eating binge and then purges by self-induced vomiting or use of a laxative. Although some people binge and purge occasionally and some experiment with it, a person is considered to have a serious bulimic disorder only if the episodes occur at least twice a week for three months (Cuzzalaro, 2014). Bulimia nervosa typically begins in late adolescence or early adulthood. About 90 percent of the cases are women. Approximately 1 to 2 percent of women are estimated to develop bulimia nervosa. Many women who develop bulimia nervosa were somewhat overweight before the onset of the disorder, and the binge eating often began during an episode of dieting. One study of adolescent girls found that increased dieting, pressure to be thin, exaggerated importance placed on appearance, body dissatisfaction, depression symptoms, low self-esteem, and low social support predicted binge eating two years later (Stice, Presnell, & Spangler, 2002). Another study of individuals with anorexia nervosa or bulimia nervosa revealed that attachment insecurity was linked with body dissatisfaction, which was a key aspect of predicting and perpetuating these eating disorders (Abbate-Daga & others, 2010). In this study, need for approval was an important predictor of bulimia nervosa. As with anorexia nervosa, about 70 percent of individuals who develop bulimia nervosa eventually recover from the disorder (Agras & others, 2004). Drug therapy and psychotherapy have been effective in treating anorexia nervosa and bulimia nervosa (Campbell & Peebles, 2014; Thompson-Brenner & others, 2014). Cognitive behavior therapy has especially been helpful in treating bulimia nervosa (Hay, 2013; Knott & others, 2015; Thompson-Brenner, 2015).

Anorexia Nervosa

Although most U.S. girls have been on a diet at some point, slightly less than 1 percent ever develop anorexia nervosa. Anorexia nervosa is an eating disorder that involves the relentless pursuit of thinness through starvation. It is a serious disorder that can lead to death. Three main characteristics apply to people suffering from anorexia nervosa: (1) a clinically significant level of being underweight; (2) an intense fear of gaining weight that does not decrease with weight loss; (3) a distorted image of their body shape (Herpertz-Dahlmann, 2015; Hagman & others, 2015; Hartmann & others, 2015; Herpertz-Dahlmann & others, 2015). Obsessive thinking about weight and compulsive exercise also are linked to anorexia nervosa (Breithaupt, Payne, & Rose, 2014; Godier & Park, 2014). Even when they are extremely thin, they see themselves as too fat. They never think they are thin enough, especially in the abdomen, buttocks, and thighs. They usually weigh themselves frequently, often take their body measurements, and gaze critically at themselves in mirrors. Anorexia nervosa typically begins in the early to middle adolescent years, often following an episode of dieting and some type of life stress (Bakalar & others, 2015; Fitzpatrick, 2012). It is about 10 times more likely to occur in females than males. When anorexia nervosa does occur in males, the symptoms and other characteristics (such as a distorted body image and family conflict) are usually similar to those reported by females who have the disorder (Ariceli & others, 2005). Most individuals with anorexia are non-Latina White adolescent or young adult females from well-educated, middle- and upper-income families and are competitive and high achieving (Darcy, 2012). They set high standards, become stressed about not being able to reach the standards, and are intensely concerned about how others perceive them (Woelders & others, 2010). A recent study found that anorexics had an elevated level of perfectionism in comparison with non-anorexic individuals (Lloyd & others, 2014). Unable to meet their high expectations, they turn their focus to something they can control—their weight. Offspring of mothers with anorexia nervosa are at risk for becoming anorexic themselves (Striegel-Moore & Bulik, 2007). Problems in family functioning are increasingly being found to be linked to the appearance of anorexia nervosa in adolescent girls (Machado & others, 2014), and family therapy is often recommended as a treatment for adolescent girls with anorexia nervosa (Campbell & Peebles, 2014; Engman-Bredvik & others, 2015; Silber, 2013). A recent study revealed that family therapy was effective in helping adolescent girls with anorexia nervosa to gain weight over the course of one year (Gabel & others, 2014).

Psychological Factors

Among the psychological factors that have been proposed as important influences on adolescent and emerging adult problems are identity, personality traits, decision making, and self-control. Developing a positive identity is central to healthy adjustment and academic success in adolescence and emerging adulthood (Cooper, Gonzales, & Wilson, 2015; McLean & Syed, 2015). The search for a coherent identity may lead to experimentation with different identities, one or more of which may involve problems. Wide emotional swings characterize adolescence, especially early adolescence. When such emotional swings become intensely negative, as in the emotion of sadness, depression may result (Consoli & others, 2015). Recall the Big Five personality traits (openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism) and remember that adolescents who are low in conscientiousness are more likely to have substance abuse and conduct problems than their high-conscientiousness counterparts (Anderson & others, 2007). Adolescence is a time of increased decision making, and for many adolescents their emotions may overwhelm their decision-making ability and contribute to the development of problems (Steinberg, 2015a, b). Another psychological factor that is important in understanding adolescent problems is self-control. For example, adolescents who have not adequately developed self-control are more likely to develop substance-abuse problems and to engage in delinquent acts than those who have higher levels of self-control (Loeber & Burke, 2011).

Risk Factors in Alcohol Abuse

Among the risk factors in adolescents' and emerging adults' abuse of alcohol are heredity, early alcohol consumption, family influences, peer relations, and education. There is evidence of a genetic predisposition to alcoholism, although it is important to remember that both genetic and environmental factors are involved (Neiderhiser, Marceau, & Reiss, 2013). Parents play an important role in preventing adolescent drug abuse (Abar & others, 2015; Zehe & Colder, 2014). Positive relationships with parents and others can reduce adolescents' drug use (West & others, 2013). Researchers have found that parental monitoring is linked with a lower incidence of drug use (Hurt & others, 2013; Williams, Burton, & Warzinski, 2014). A research review concluded that the more frequently adolescents ate dinner with their families, the less likely they were to have substance abuse problems (Sen, 2010). And recent research revealed that authoritative parenting was linked to lower adolescent alcohol consumption (Piko & Balazs, 2012) while parent-adolescent conflict was related to higher adolescent alcohol consumption (Chaplin & others, 2012). Further, a recent study found that neighborhood disadvantage was linked a higher level of adolescent alcohol use two years later, mainly through a pathway that included exposure to delinquent peers (Trucco & others, 2014).

Anabolic steroids

Anabolic steroids anabolic steroids Drugs derived from the male sex hormone testosterone. They promote muscle growth and increase lean body mass. are drugs derived from the male sex hormone testosterone. They promote muscle growth and increase lean body mass. Nonmedical uses of these drugs carry a number of physical and psychological health risks (National Clearinghouse for Alcohol and Drug Information, 1999). Both males and females who take large doses of anabolic steroids usually experience changes in sexual characteristics. Psychological effects in both males and females can include irritability, uncontrollable bursts of anger, severe mood swings (which can lead to depression when individuals stop using the steroids), impaired judgment stemming from feelings of invincibility, and paranoid jealousy.

Index offenses

Are criminal acts, whether they are committed by juveniles or adults. They include such acts as robbery, aggravated assault, rape, and homicide

Resilience

Are there certain characteristics that make adolescents resilient? Ann Masten and her colleagues (Masten, 2006, 2009, 2011, 2013, 2014a, b, c; Masten, Liebkind, & Hernandez, 2012; Masten & Monn, 2015; Masten & Narayan, 2012; Masten, Obradovic, & Burt, 2006; Masten & others, 2014, 2015; Masten & Tellegen 2012; Motti-Stefanidi, Masten, & Asendorpf, 2015) have discovered a number of factors, such as good intellectual functioning and effective parenting, that are often seen in children and adolescents who show resilience in the context of a wide range of stressful and even life-threatening circumstances. Figure 3 describes the individual, familial, and extrafamilial contexts that often have been found to characterize resilient children and adolescents (Masten & Coatsworth, 1998). Masten and her colleagues (2006) concluded that being resilient in adolescence is linked to ongoing resilience in emerging adulthood, but that resilience also can develop in emerging adulthood. They also indicated that during emerging adulthood some individuals become motivated to better their lives and develop an improved ability to plan and make more effective decisions that place their lives on a more positive developmental course. In some instances, a specific person may influence an emerging adult in very positive ways, as was the case for Michael Maddaus, whose story was provided at the beginning of the "Introduction" chapter. You might recall that after a childhood and adolescence filled with stress, conflict, disappointment, and problems, his connection with a competent, caring mentor in emerging adulthood helped him to turn his life around, and he went on to become a successful surgeon. According to Masten and her colleagues (2006), a romantic relationship or the birth of a child also may stimulate change and motivate an emerging adult to develop a stronger commitment to a positive future.

A longitudinal study conducted by Kenneth Dodge and his colleagues (2006) examined the joint contributions of parents and peers to early substance use. The following sequence of factors was linked with the likelihood that an adolescent would take drugs by 12 years of age:

Being born into a high-risk family (especially with a poor, single, or teenage mother) Experiencing an increase in harsh parenting in childhood Having conduct problems in school and getting rejected by peers in childhood Experiencing increased conflict with parents in early adolescence Having low parental monitoring Hanging out with deviant peers in early adolescence and engaging in increased substance use

Binge Eating Disorder (BED)

Binge eating disorder (BED) binge eating disorder (BED) Involves frequent binge eating without compensatory behavior like the purging that characterizes bulimics. involves frequent binge eating but without compensatory behavior like the purging that characterizes bulimics. Individuals with BED engage in recurrent episodes of eating large quantities of food during which they feel a lack of control over eating (Schag & others, 2013). Because they don't purge, individuals with BED are frequently overweight (Allen, Byrne, & Crosby, 2015; Field & others, 2012). For the first time, binge eating disorder was included by the American Psychiatric Association in the fifth edition of its classification of psychiatric disorders in 2013. Adults in treatment for BED number approximately 1 to 2 million people, and they often say that their binging problems began in childhood or adolescence (New, 2008). Common health risks of BED are those related to being overweight or obese, such as high blood pressure, diabetes, and depression (Peterson & others, 2012).

Body image

Body dissatisfaction and distorted body image play important roles in adolescent eating disorders (Kroon Van Diest & Perez, 2013). One study revealed that in general, adolescents were dissatisfied with their bodies, with males desiring to increase their upper body and females wanting to decrease the overall size of their body (Ata, Ludden, & Lally, 2007). In this study, low self-esteem and social support, weight-related teasing, and pressure to lose weight were linked to adolescents' negative body image. In another study, girls who felt negatively about their bodies in early adolescence were more likely to develop eating disorders two years later than were their counterparts who did not feel negatively about their bodies (Attie & Brooks-Gunn, 1989). And a recent study found that the key aspect of explaining depression in overweight adolescents involved body dissatisfaction (Mond & others, 2011).

Suicide

Depression is linked to an increase in suicidal ideation and suicide attempts in adolescence (Clarke & others, 2014; Thompson & Light, 2011). Suicidal behavior is rare in childhood but escalates in adolescence and then increases further in emerging adulthood (Park & others, 2006). Suicide is the third leading cause of death in 10- to 19-year-olds today in the United States (National Center for Health Statistics, 2014).Both early and later experiences may be involved in suicide attempts (Brockie & others, 2015; Esposito-Smythers & others, 2014). The adolescent might have a long-standing history of family instability and unhappiness. Lack of affection and emotional support, high control, and pressure for achievement by parents during childhood are likely to show up as factors in suicide attempts. Adolescents who have experienced abuse also are at risk for suicidal ideation and attempts (Rhodes & others, 2012; Yen & others, 2013). And a recent study revealed that adolescents who engaged in suicidal ideation perceived their family functioning to be significantly worse than did their caregivers (Lipschitz & others, 2012). Another recent study found that family discord and negative relationships with parents were associated with increased suicide attempts by depressed adolescents (Consoli & others, 2013). And in recent study, authoritative parenting was linked to fewer adolescent suicide attempts; rejecting/neglecting parenting was associated with a greater likelihood of adolescent suicide attempts (Donath & others, 2014). Further, a recent study found that having an insecure avoidant attachment style was linked to a higher incidence of suicide attempts in adolescence (Sheftall, Schoppe-Sullivan, & Bridge, 2014). Recent and current stressful circumstances, such as getting poor grades in school or experiencing the breakup of a romantic relationship, may trigger suicide attempts (Antai-Otong, 2003; Soller, 2014).

Sociocultural Factors

Do males and females respond to stressors in the same way? Shelley Taylor (2006, 2011a, b, c, 2015) proposed that females are less likely to respond to stressful and threatening situations with a fight-or-flight response than males are. Taylor argues that females are more likely to "tend and befriend." That is, females often respond to stressful situations by protecting themselves and others through nurturing behaviors (the tend part of the model) and forming alliances with a larger social group, especially one populated by other women (the befriend part of the model).

Depressants

Drugs that slow down the central nervous system, bodily functions, and behavior. are drugs that slow down the central nervous system, bodily functions, and behavior. Medically, depressants have been used to reduce anxiety and to induce sleep. Among the most widely used depressants is alcohol, which we discussed earlier; others include barbiturates and tranquilizers. Though used less frequently than other depressants, the opiates are especially dangerous. An alarming trend has recently emerged in adolescents' use of prescription painkillers. Many adolescents cite the medicine cabinets of their parents or of their friends' parents as the main source for their prescription painkillers. A 2004 survey revealed that 18 percent of U.S. adolescents had used Vicodin (acetaminophen and hydrocodone) at some point in their lifetime, whereas 10 percent had used OxyContin (oxycodone) (Partnership for a Drug-Free America, 2005). These drugs fall into the general class of drugs called narcotics, and they are highly addictive.

Ecstasy

Ecstasy, the street name for the synthetic drug MDMA, has both stimulant and hallucinogenic effects. Ecstasy produces euphoric feelings and heightened sensations (especially touch and sight). Ecstasy use can lead to dangerous increases in blood pressure, as well as an increased risk of stroke or heart attack.

The following factors (among others) have been proposed to account for the gender difference in depression among adolescents and emerging adults:

Females tend to ruminate in their depressed mood and amplify it. Females' self-images, especially their body images, are more negative than males'. Females experience more stress about weight-related concerns than do males. Females face more discrimination than males do. Hormonal changes alter vulnerability to depression in adolescence, especially among girls. Females may be more vulnerable to developing depression following the occurrence of relational victimization.

Emerging Adulthood and Early Adulthood

Fortunately, by the time individuals reach their mid-twenties, many have reduced their use of alcohol and drugs (Johnston & others, 2013). For example, in a longitudinal study of more than 38,000 individuals from the time they were high school seniors through their early thirties, Jerald Bachman and his colleagues (2002) found that binge drinking peaked at 21-22 years of age and then declined from 23-24 to 31-32 years of age (see Figure 7). Some of the main findings in the study are described below:

Hallucinogens

Hallucinogens, also called psychedelic (mind-altering) drugs, are drugs that modify an individual's perceptual experiences and produce hallucinations. First, we discuss LSD, which has powerful hallucinogenic properties, and then marijuana, a milder hallucinogen.

Effective Prevention and Intervention Programs

In a research review of effective juvenile delinquency prevention and intervention programs, the most successful programs are those that prevent juvenile delinquency from occurring in the first place (Greenwood, 2008). Home visiting programs that provide services to pregnant adolescents and their at-risk infants have been found to reduce the risk of delinquency for both the adolescent mothers and their offspring. For example, in the Nurse Family Partnership program, nurses provide child-care recommendations and social-skills training for the mother in a sequence of 20 home visits beginning during prenatal development and continuing through the child's first two years of life (Olds & others, 2004, 2007). Quality preschool education that involves home visits and working with parents also reduces the likelihood that children will become delinquents. Later in the chapter, we will discuss one such program—the Perry Preschool program. The most successful programs for adolescents who have engaged in delinquency focus on improving family interactions and providing skills to adults who supervise and train the adolescent (Baldwin & others, 2012). A recent meta-analysis found that of five program types (case management, individual treatment, youth court, restorative justice, and family treatment), family treatment was the only one that was linked to a reduction in recidivism for juvenile offenders (Schwalbe & others, 2012). Another recent research review revealed that prevention programs focused on improving the family context were more effective in reducing persistent delinquency than were individual and group-based programs (de Vries & others, 2015). Among the least effective programs for reducing juvenile delinquency are those that emphasize punishment or attempt to scare youth.

Characteristics of Adolescent and Emerging Adult Problems

In one study, depression, truancy, and drug abuse were more common among older adolescents, whereas arguing, fighting, and being too loud were more common among younger adolescents (Edelbrock, 1989). The behavioral problems most likely to cause adolescents to be referred to a clinic for mental health treatment were feelings of unhappiness, sadness, or depression, and poor school performance (see Figure 2). Difficulties in school achievement, whether secondary to other kinds of problems or primary problems in themselves, account for many referrals of adolescents.Many studies have shown that factors such as poverty, ineffective parenting, and mental disorders in parents predict adolescent problems (Cicchetti, 2016; Cicchetti & Toth, 2015; Duncan & others, 2015). Predictors of problems are called risk factors. A risk factor indicates an elevated probability of a problematic outcome in groups of people who have that factor. Children with many risk factors are said to have a "high risk" for problems in childhood and adolescence, but not every one of them will develop problems. Some researchers think primarily in terms of risk factors when they study adolescent problems, whereas others argue that conceptualizing problems in terms of risk factors creates a perception that is too negative (Lerner & others, 2015). Instead, they highlight the developmental assets of youth (Lerner & others, 2015). For example, Peter Benson (2006; Benson & others, 2006; Benson & Scales, 2009, 2011), former director of the Search Institute in Minneapolis, has prescribed 40 developmental assets that adolescents need in order to achieve positive outcomes in their lives. Half of these assets are external, half internal. Each of the 40 assets has been shown scientifically to promote healthy adolescent development.

In a review of the programs that have been successful in preventing or reducing adolescent problems, adolescent researcher Joy Dryfoos (1990, 1997; Dryfoos & Barkin, 2006a, b) described the common components of these successful programs. The common components include these:

Intensive individualized attention. In successful programs, high-risk youth are attached to a responsible adult who gives the youth attention and deals with the youth's specific needs (Glidden-Tracey, 2005; Nation & others, 2003). This theme occurred in a number of different programs. In a substance-abuse program, a student assistance counselor was available full-time for individual counseling and referral for treatment. Programs often require highly trained personnel, and they extend over a long period to remain successful (Dryfoos & Barkin, 2006a, b). Community-wide, multiagency collaborative approaches. The basic philosophy of community-wide programs is that a number of different programs and services have to be in place. In one successful substance-abuse program, a community-wide health promotion campaign was implemented that used local media and community education in concert with a substance-abuse curriculum in the schools. Community programs that include policy changes and media campaigns are more effective when they are coordinated with family, peer, and school components (Wandersman & Florin, 2003). Early identification and intervention. Reaching children and their families before children develop problems, or at the beginning of their problems, is a successful strategy (Cichetti & Toth, 2015).

Antecedents of Junvenile Deliquency

Let's further explore the role that family processes play in the development of delinquency. Parents of delinquents are less skilled in discouraging antisocial behavior and in encouraging skilled behavior than are parents of nondelinquents. Parental monitoring of adolescents is especially important in determining whether an adolescent becomes a delinquent (Fosco & others, 2012; Mann & others, 2015). For example, a recent study revealed that parental monitoring and youth disclosure in the fall of grade 6 were linked to a lower incidence of delinquency in grade 8 (Lippold & others, 2014). Also, a recent study found that parental monitoring in adolescence and ongoing parental support were linked to a lower incidence of criminal behavior in emerging adulthood (Johnson & others, 2011). Further, in a recent study, authoritative parenting increased adolescents' perception of the legitimacy of parents' authority, while authoritarian parenting reduced the perception of parental legitimacy of authority (Trinkner & others, 2012). In this study, youths' perception of parental legitimacy was linked to a lower level of future delinquency. And another study found that low rates of delinquency from 14 to 23 years of age were associated with an authoritative parenting style (Murphy & others, 2012). Although delinquency is less exclusively a phenomenon of lower socioeconomic status than it was in the past, some characteristics of the low-SES culture might promote delinquency (Dawson-McClure & others, 2015). Getting into and staying out of trouble are prominent features of life for some adolescents in low-income neighborhoods. Adolescents from low-income backgrounds may sense that they can gain attention and status by performing antisocial actions. Further, adolescents in communities with high crime rates observe many models who engage in criminal activities. Quality schooling, educational funding, and organized neighborhood activities may be lacking in these communities (Robinson & others, 2015). One study revealed that engaged parenting and the mothers' social network support were linked to a lower level of delinquency in low-income families (Ghazarian & Roche, 2010). And another study found that youth whose families had experienced repeated poverty were more than twice as likely to be delinquent at 14 and 21 years of age (Najman & others, 2010).

Marijuana

Marijuana, a milder hallucinogen than LSD, comes from the hemp plant Cannabis sativa. Because marijuana also can impair attention and memory, smoking marijuana is not conducive to optimal school performance. Marijuana use by adolescents decreased in the 1980s. For example, in 1979, 37 percent of high school seniors said they had used marijuana in the last month, but in 1992 that figure had dropped to 19 percent and then by 2006 to 18 percent. However, marijuana use by U.S. adolescents increased from 2008 to 2012, especially for twelfth-graders, but declined slightly in 2014 (Johnston & others, 2014). In 2013, 23 percent of U.S. twelfth-graders reported that they had smoked marijuana in the last 30 days, then declined to 21 percent in 2014. One reason that marijuana use has recently increased is the trend that fewer adolescents today perceive much danger associated with its use.

Early Substance Use

Most adolescents become drug users at some point in their development, whether their use is limited to alcohol, caffeine, and cigarettes or extended to marijuana, cocaine, and hard drugs. A special concern involves adolescents who begin to use drugs early in adolescence or even in childhood (Moss, Chen, & Yi, 2014; Trucco, Colder, & Wieczorek, 2011). One study revealed that individuals who began drinking alcohol before 14 years of age were more likely to become alcohol dependent than their counterparts who began drinking alcohol at 21 years of age or older (Hingson, Heeren, & Winter, 2006). A longitudinal study found that onset of alcohol use before 11 years of age was linked to increased adult alcohol dependence (Guttmannova & others, 2012). Also, a recent study found that early age of onset drinking and a quick progression to drinking to intoxication were linked to drinking problems in high school (Morean & others, 2014). And another recent study indicated that early- and rapid-onset trajectories of alcohol, marijuana, and substance use were associated with substance abuse in early adulthood (Nelson, Van Ryzin, & Dishion, 2015).

In another recent study, both depression and hopelessness were predictors of adolescents who repeated a suicide attempt across a six-month period (Consoli & others, 2015). The following studies document a number of factors linked with adolescent suicide attempts:

Overweight middle school students were more likely to think about, plan, and attempt suicide than their counterparts who were not overweight (Whetstone, Morrissey, & Cummings, 2007). Another study revealed that adolescent girls, but not boys, who perceived they were overweight were at risk for engaging in suicidal ideation (Seo & Lee, 2013). Playing sports predicted lower suicidal ideation in boys and venting by talking to others was associated with lower suicidal ideation in girls (Kim & others, 2014). More recent and frequent alcohol use among young adolescents increased the likelihood of suicidal ideation and attempts in African American youth (Tomek & others, 2015). Data from the National Longitudinal Study of Adolescent Health identified the following indicators of suicide risk: depressive symptoms, a sense of hopelessness, engaging in suicidal ideation, having a family background of suicidal behavior, and having friends with a history of suicidal behavior (Thompson, Kuruwita, & Foster, 2009). Frequent, escalating stress, especially at home, was linked with suicide attempts in young Latinas (Zayas & others, 2010). And in another study, Latina adolescents' suicidal ideation was associated with having a suicidal friend, as well as lower perceived parental and teacher support (De Luca, Wyman, & Warren, 2012). Sexual victimization was linked to a risk for suicide attempts in adolescence (Plener, Singer, & Goldbeck, 2011). Also, a recent study found that adolescent females who were the victims of dating violence were at a higher risk for planning and/or attempting suicide than were their counterparts who had not been victimized (Belshaw & others, 2012). No national studies have been conducted regarding suicide rates in gay, lesbian, and bisexual adolescents. However, a recent study in Boston found that sexual minority adolescents living in neighborhoods with higher rates of lesbian, gay, and bisexual crimes reported a higher rate of suicidal ideation and attempts (Duncan & Hatzenbuehler, 2014).

Parents, Siblings, Peers, and School

Parents play an important role in preventing adolescent drug abuse (Abar & others, 2015; Broning & others, 2014; Hargreaves & others, 2013). Positive relationships with parents, siblings, peers and others can reduce adolescents' drug use (Hohman & others, 2014). Researchers have found that parental monitoring and positive relationships with parents are linked with a lower incidence of drug use (Abar & others, 2015). One study revealed that negative interactions with parents were linked to increased adolescent drinking and smoking, while positive identification with parents was related to declines in use of these substances (Gutman & others, 2011). Further, in a recent study, a higher level of parental monitoring during the last year of high school was linked to a lower risk of alcohol, but not marijuana, dependence in the first year of college (Kaynak & others, 2013).

Problem-focused coping

Problem-focused coping is Lazarus' term for the strategy of squarely facing one's troubles and trying to solve them. For example, if you are having trouble with a class, you might go to the study-skills center at your college or university and enter a training program to learn how to study more effectively. Having done so, you have faced your problem and attempted to do something about it. A review of 39 research studies documented that problem-focused coping was associated with positive change following trauma and adversity (Linley & Joseph, 2004).

Developmental cascades

Recently considerable interest in the developmental psychopathology approach has focused on developmental cascades, which involve connections across domains over time that influence developmental pathways and outcomes (Cicchetti, 2016; Cicchetti & Toth, 2015; Masten, 2014a, b, c; Masten & others, 2015). Developmental cascades can encompass connections among a wide range of biological, cognitive, and social processes, including many social contexts such as families, peers, schools, and culture (Petersen & others, 2015; Zeiders & others, 2015). Further, links between domains that produce positive or negative outcomes may occur at various points in development, such as early childhood, later in adolescence or during emerging adulthood, and in intergenerational relationships. Gerald Patterson and his colleagues (Forgatch & Patterson, 2010; Forgatch & others, 2009; Patterson, Forgatch, & DeGarmo, 2010; Patterson, Reid, & Dishion, 1992) have conducted extensive research based on a developmental cascade approach. The theme of this approach is that high levels of coercive parenting and low levels of positive parenting lead to the development of antisocial behavior in children, which in turn connects children and adolescents to negative experiences in peer contexts (being rejected by nondeviant peers and becoming friends with deviant peers, for example) and school contexts (having academic difficulties, for example), which further intensifies the adolescent's antisocial behavior (Patterson & others, 2010).

What types of interventions and activities have been successful in reducing overweight in adolescents and emerging adults?

Research indicates that dietary changes and regular exercise are key components of weight reduction in adolescence and emerging adulthood (Omorou & others, 2015; Ryan & others, 2014; Thompson & Manore, 2015). A recent three-month experimental study found that both aerobic exercise and resistance exercise without caloric restriction were effective in reducing abdominal fat and insulin sensitivity in overweight adolescent boys compared with a no-exercise control group (Lee & others, 2012). A recent study also revealed that playing on a sports team was an important factor in adolescents' weight. In this study, among a wide range of activities (other physical activity, physical education, screen time, and diet quality, for example), team sports participation was the strongest predictor of lower risk for being overweight or obese (Drake & others, 2012).

Stress

Stress is the response of individuals to stressors, which are circumstances and events that threaten them and tax their coping abilities. A car accident, a low grade on a test, a lost wallet, a conflict with a friend—all these might be stressors in your life. Some stressors are acute; in other words, they are sudden events or stimuli such as being cut by falling glass. Other stressors are chronic, or long-lasting, such as being malnourished or HIV-positive. These are physical stressors, but there also are emotional and psychosocial stressors such as the death of a loved one or being discriminated against. Stress may come from many different sources for adolescents and emerging adults (Compas & Reeslund, 2009; Mash & Wolfe, 2015; Seiffge-Krenke, 2011). Sources of stress are life events, daily hassles, and sociocultural factors.

Status offenses

Such as running away, truancy, underage drinking, sexual promiscuity, and uncontrollability, are less serious acts. They are performed by youth under a specified age, which classifies them as juvenile offenses. One study found that status offenses increased through adolescence.

The 20 external assets include the following:

Support (such as family and neighborhood) Empowerment (such as adults in the community valuing youth and giving them useful community roles) Boundaries and expectations (such as the family setting clear rules and consequences and monitoring the adolescent's whereabouts, as well as the presence of positive peer influence) Constructive use of time (such as engaging in creative activities three or more times a week and participating three or more hours a week in organized youth programs)

The Developmental Psychopathology Approach

The developmental psychopathology approach focuses on describing and exploring the developmental pathways of problems. Many researchers in this field seek to establish links between early precursors of a problem (such as risk factors and early experiences) and outcomes (such as substance abuse, delinquency, and depression) (Cicchetti, 2016; Cicchetti & Toth, 2015; Fearon, 2015; Masten & others, 2015; Motti-Stefanidi, Masten, & Asendorph, 2015). A developmental pathway describes continuities and transformations in factors that influence outcomes. For example, Arnie's story (described at the beginning of the chapter) indicated a possible link between early negative parenting experiences, including his father's abuse of his mother, and Arnie's delinquency in adolescence. The developmental psychopathology approach often involves the use of longitudinal studies to track the unfolding of problems over time (Fraley, Roisman, & Haltigan, 2013; Nigg, 2015). This approach also seeks to identify risk factors that might predispose children and adolescents to develop problems such as substance abuse, juvenile delinquency, and depression (Melchior & others, 2014; St. Clair & others, 2015; Steinberg & Drabick, 2015), as well as protective factors that might help to shield children from developing problems (Englund & others, 2011; Zeiders & others, 2015). The identification of risk factors might suggest avenues for both prevention and treatment (Cicchetti & Toth, 2015; Masten & others, 2015; Motti-Stefanidi, Masten, & Asendorpf, 2015). For example, researchers have identified parental psychopathology as a risk factor for childhood depression: Specifically, parents who suffer from depression, an anxiety disorder, or substance abuse are more likely to have children who experience depression (Wilson & others, 2014). One study revealed that maternal depressive symptoms during a child's infancy were linked to the development of depressive symptoms in childhood and adolescence (Bureau, Easterbrooks, & Lyons-Ruth, 2009). Further, a recent study revealed that fathers' and mothers' alcohol use predicted early alcohol use by their children (Kerr & others, 2012). And in a recent study, parental psychiatric status (depressive and anxiety disorders, substance use disorder, and others), offspring personality (negative emotionality) at 11 years of age, offspring internalizing and externalizing symptoms, poor parent-child relationships, early pubertal onset, and child maltreatment predicted the subsequent development of major depressive disorder (Wilson & others, 2014).

Adolescents with Multiple Problems

The four problems that affect the largest number of adolescents are (1) drug abuse, (2) juvenile delinquency, (3) sexual problems, and (4) school-related problems (Dryfoos, 1990; Dryfoos & Barkin, 2006a, b). The adolescents most at risk have more than one of these problems. Researchers are increasingly finding that problem behaviors in adolescence are interrelated (Nakawaki & Crano, 2015). For example, heavy substance abuse is related to early sexual activity, lower grades, dropping out of school, and delinquency (Grigsby & others, 2014; Swartzendruber & others, 2015). Early initiation of sexual activity is associated with the use of cigarettes and alcohol, use of marijuana and other illicit drugs, lower grades, dropping out of school, and delinquency (Chan & others, 2015). Delinquency is related to early sexual activity, early pregnancy, substance abuse, and dropping out of school (Dudovitz, McCoy, & Chung, 2015; Pedersen & Mastekaasa, 2011). As much as 10 percent of the adolescent population in the United States have serious multiple-problem behaviors (adolescents who have dropped out of school, or are behind in their grade level, are users of heavy drugs, regularly use cigarettes and marijuana, and are sexually active but do not use contraception). Many, but not all, of these very high-risk youth "do it all." In 1990, it was estimated that another 15 percent of adolescents participate in many of these same behaviors but with slightly lower frequency and less deleterious consequences (Dryfoos, 1990). These high-risk youth often engage in two or three problem behaviors (Dryfoos, 1990). It was estimated that in 2005 the figure for high-risk youth had increased to 20 percent of all U.S. adolescents (Dryfoos & Barkin, 2006a, b).

Social Factors

The social factors that have especially been highlighted as contributors to adolescent problems are the social contexts of family, peers, schools, socioeconomic status, poverty, and neighborhoods. Many aspects of family processes can contribute to the development of problems in adolescence, including a persistent high level of parent-adolescent conflict, inadequate parental monitoring of adolescents, and insecure attachment (Kobak & Kerig, 2015; Smokowski & others, 2015).

Life Events and Daily Hassles

Think about your own life. What events have created the most stress for you? Some events are big problems and may occur in clusters, like the breakup of a long-standing relationship, the death of someone you loved, your parents' divorce, a life-threatening disease such as cancer, a personal injury, or the stress of a war or a disaster (Andreotti & others, 2015; Ganong, Coleman, & Russell, 2015; Howell & others, 2015; Masten & others, 2015; Schwarzer & Luszczynska, 2013). Other occurrences involve the everyday circumstances of your life, such as not having enough time to study, arguing with your girlfriend or boyfriend, or not getting enough credit for work you did at your job.

Thinking Positively

Thinking positively and avoiding negative thoughts are good strategies for coping with stress in just about any circumstance (Boyraz & Lightsey, 2012; Mavioglu, Boomsma, & Bartels, 2015). Why? A positive mood improves our ability to process information efficiently and enhances self-esteem. In most cases, an optimistic attitude is superior to a pessimistic one. It gives us a sense that we are controlling our environment, much like what Albert Bandura (2012) talks about when he describes the importance of self-efficacy in coping. Thinking positively reflects the positive psychology movement discussed in the introduction to this edition; recall that psychologists are calling for increased emphasis on positive individual traits, hope, and optimism (King, 2013, 2014, 2016). A prospective study of more than 5,000 young adolescents revealed that an optimistic thinking style predicted a lower level of depressive symptoms and a lower level of substance abuse and antisocial behavior (Patton & others, 2011b). And a recent study found that having a positive outlook was the most important cognitive factor associated with a decrease in depression severity in adolescents in the 36 weeks after they had been given antidepressant medication (Jacobs & others, 2014). Further, optimism was a key protective factor in lower depressive symptoms in Canadian Aboriginal youth (Ames & others, 2015). When adolescents experience severe stressors, such as the sudden death of a close friend or classmate, the event can be traumatic (Seiffge-Krenke, 2011). In these cases it is important for adolescents to reach out for support and share their feelings with others. One analysis found that online networking following a friend's death appears to help adolescents cope better (Williams & Merten, 2009).

National Longitudinal Study of Adolescent to Adult Health

This study initially was referred to as the National Longitudinal Study of Adolescent Health and was based on interviews with a nationally representative sample of adolescents in grades 7 to 12 in the United States, initially assessed during the 1994-1995 school year. Participants in the program (referred to also as Add Health) have been assessed in early adulthood, with the most recent interviews taking place with 24- to 32-year-olds in 2008 (National Longitudinal Study of Adolescent to Adult Health, 2015). The Add Health study has implications for the prevention of adolescent and emerging adult problems (Aronowitz & Morrison-Beedy, 2008; Allen & MacMillan, 2006; Beaver & others, 2009; Clark & others, 2015; Cubbin & others, 2005; Lynch & others, 2015; Richardson, Dietz, & Gordon-Larsen, 2014). Perceived adolescent connectedness to a parent and to a teacher were the main factors linked to preventing the following adolescent problems: emotional distress, suicidal thoughts and behavior, violence, use of cigarettes, use of alcohol, use of marijuana, and early sexual intercourse. This study also provides support for the first component of successful prevention/intervention programs as described in item 1 of the list at the beginning of this section. That is, intensive individualized attention is especially important when it comes from important people in the adolescent's life, such as parents and teachers (Greenberg & others, 2003; Kumpfer & Alvarado, 2003). Researchers are continuing to analyze data from the National Longitudinal Study on Adolescent Health to further understand how to prevent and intervene in adolescent problems (Abrutyn & Mueller, 2014; Chen & Jacobson, 2013; Hatzenbuehler, McLaughlin, & Xuan, 2015; Kane & Frisco, 2013; Lui & others, 2015; McQueen & others, 2015).

Trends in Overall Drug Use

Trends in Overall Drug Use The 1960s and 1970s were a time of marked increases in the use of illicit drugs. During the social and political unrest of those years, many youth turned to marijuana, stimulants, and hallucinogens. Increases in adolescent and emerging adult alcohol consumption during this period also were noted (Robinson & Greene, 1988). More precise data about drug use by adolescents and emerging adults have been collected in recent years. Each year since 1975, Lloyd Johnston and his colleagues at the Institute of Social Research at the University of Michigan have monitored the drug use of America's high school seniors in a wide range of public and private high schools. Since 1991, they also have surveyed drug use by eighth- and tenth-graders. In 2014, the study surveyed more than 41,000 secondary school students in more than 400 public and private schools (Johnston & others, 2015). In the late 1990s and the early part of the twenty-first century, the proportion of secondary school students reporting the use of any illicit drug has been declining. The overall decline in the use of illicit drugs by adolescents during this time frame is approximately one-third for eighth-graders, one-fourth for tenth-graders, and one-eighth for twelfth-graders. The most notable declines in drug use by U.S. adolescents in the twenty-first century have occurred for LSD, cocaine, cigarettes, sedatives, tranquilizers, and Ecstasy. Marijuana is the illicit drug most widely used in the United States and Europe (Hibell & others, 2004; Johnston & others, 2015). Even with the recent decline in use, the United States still has one of the highest rates of adolescent drug use of any industrialized nation. In 2012, 37.4 percent of U.S. college students reported having had five or more drinks in a row at least once in the last two weeks (Johnston & others, 2013). The term extreme binge drinking describes individuals who had 10 or more drinks in a row. In 2010 approximately 13 percent of college students reported drinking this heavily (Johnston & others, 2011). While drinking rates among college students have remained high, drinking, including binge drinking, has declined in recent years. For example, binge drinking declined by 4 percent from 2007 to 2012 (Johnston & others, 2013). Drinking alcohol before going out—called pregaming—has become common among college students (Ahmed & others, 2014). One study revealed that almost two-thirds of students on one campus had pregamed at least once during a two-week period (DeJong, DeRicco, & Schneider, 2010). Another recent study found that two-thirds of 18- to 24-year-old women on one college pregamed (Read, Merrill, & Bytschkow, 2010). Drinking games, in which the goal is to become intoxicated, also have become common on college campuses (LaBrie & others, 2011). Higher levels of alcohol use have been consistently linked to higher rates of sexual risk taking, such as engaging in casual sex, having sex without contraceptives, and being the perpetrator or victim of sexual assaults (Khan & others, 2012).