Transcript Youth at risk

Dangerous Journeys
A metaphor for passage through the teen years
Marvin Krank
How can we help youth get
through these perilous times
Mixed messages
Just
say no!
Project on Adolescent Trajectories and
Health (PATH): social context, cognition,
risk-taking behaviour, and health
outcomes
• Three-year
•
•
longitudinal
study
Funded by
the SSHRC
and CIHR
Partnership
with SD#23
Overview of theoretical approach
Social
Context
Cognition
Behavior
Health
Outcome
Social factors modify cognitions about risky behaviors
Cognitions affect transitions to risk-taking behavior
Risk-taking behaviors impact on health outcomes
Life style choices begin in
adolescence
• Drug and alcohol use
begin in the early teens
– Many smokers begin
before age 14
• Risky choices have longterm consequences for
youth
–
–
–
–
early pregnancy
accidents
unhealthy lifestyles
lost opportunities
Grades 7-10 are a time of significant transitions in drug and alcohol use
Drug and alcohol use
Percent used in past year
90%
80%
Alcohol
70%
Drunkenness
60%
Tobacco
50%
Marijuana
40%
Stimulants
30%
Opiates
20%
Club Drugs
10%
Hallucinogens
0%
Seven
Eight
Nine
Grade
Ten
Different patterns in use of
marijuana
Percent
Figure 2: Marijuana use
Experimentation with marijuana
occurs during the study period
Lifetime use
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Used in past
Regular use of marijuana
also
month
occurs during the study period
Used more than
3 times in past
month
Used in past
week
7
8
9
10
11
12
Grade
Source Krank and Johnson (1999a,b)
A small, but significant percentage of these
youth used drugs and alcohol in the past
week
Male
Female
Eight
Nine
Ten
Eight Nine
Ten
Alcohol
20%
33%
36%
18%
25%
29%
Drunkenness
10%
16%
21%
8%
19%
20%
Cigarettes
4%
4%
9%
5%
12%
13%
Marijuana
7%
13%
20%
7%
17%
20%
Hallucinogens
4%
2%
2%
3%
3%
3%
Inhalants
5%
4%
4%
4%
5%
2%
Why we
should care
Adolescent risk is based on what
they do
• Unsafe sex in youth
leads to teen
pregnancy, low birth
weight babies, and
STDs including HIV
• Drug and alcohol use
increase
unintentional
injuries, the leading
cause of death in
youth
Early and heavy alcohol use is correlated
with many negative outcomes
• Health
– Aches and pains
– Accidents
– Hospitalization
• Violence
– Victim
– Perpetrator
– Various kinds
• Sex
• Bullying
• Assault
– Early sex
– Regretted sex
– Sexual assault
• Problem behaviours
• Skipped school
• Stayed out all night without
parent permission
• Damaged property
• Warned or detained by police
• School detention
• Stole something outside of home
• Stole at home
• Suspended out of school
• Suspended in school
• Ran away from home
• Carrying weapons
High risk behaviours tend to
co-exist
• Drug and alcohol
use, early and unsafe
sexual activity, and
violence tend to cooccur
• For example, heavier
drug and alcohol use
is linked to being
both a victim and a
perpetrator of sexual
assault.
Drug and alcohol use are highly
correlated
Used alcohol
Percent used marijuana
No
2.8%
Yes
44.9%
General Bullying - Past Year
Percent of Students Involved
Male
Female
Victim
56.4%
46.3%
Aggressor
60.3%
38.2%
Aggressor violence is related to alcohol use
Drank alcohol
Bullied***
Physically harmed***
Threatened harm***
Internet***
Verbal***
Excluded ***
Never
In the Past
Week
1.09
0.59
0.69
0.26
1.24
1.41
2.34
1.70
1.99
1.00
2.48
2.26
Dating and sex
• 1/3 of grade eleven students have had sex
• 2/3 of females had sex under influence of alcohol
• 43% of the girls have given oral sex
• ½ of the girls regretted having sex
• 14% of grade 9-11 girls have been physically harmed by
•
•
their dating partner
26% of drinkers and 28% of marijuana users have been
physically harmed by their partner.
General problems and alcohol use
Alcohol Use
Never
In the
Past Week
Skipped school
11%
62%
Stayed out all night without
parent permission
3%
49%
14%
3%
11%
53%
29%
49%
Stole something outside of
home
4%
39%
Stole at home
5%
31%
Damaged property
Warned or detained by police
School detention
The social and cultural roots
of these cognitions
•
•
•
•
Parents
Peers
Personality
Pop Culture
The effects of
advertising
–
–
–
–
$1Billion/yr
70% on TV
22% magazines
50% on
Saturday and
Sunday
– 33% between 811 pm
Tuborg
Crying
Thoughts lead to actions
Social
Context
Cognition
Behavior
Social factors modify cognitions about risky behaviors
Cognitions affect transitions to risk-taking behavior
What do you expect to happen if you
drank a moderate amount of alcohol
• Write down three or four things that would
happen to you.
Thoughts precede actions
Score
Cognitive changes
occur during these
years. These
changes predict
who will take
risks.
Figure 3: Alcohol
Outcome Expectancies
5
4.5
4
3.5
3
2.5
2
Changes in expectancies occur
before changes in behaviors
Positive
expectancy
score
7
8
9 10 11 12
Grade
Negative
expectancy
score
Modern Risk
Prevention Programs
• Discuss social influences
• Offer skills training – alternative
behaviours
• Correct misperceptions about norms
• Focus on changing false expectations
Contemporary Evidence-based
Methods
• Less confrontational – empathetic and roll with
•
•
resistance
Motivate change – encourage discrepancies by
realistic feedback
Meet individuals where they are – Age and
Stage appropriate
– Non-users
– Experimenters
– Users
• Brief interventions
Cognitive Expectancy challenge
Positive
Expectancy
So what’s wrong with that?
Have fun
Artificial high
Replace safer and healthier choices for
having fun
Feel sexier
Not how others see you
Bad judgement – embarrassment
Regret actions
Relax
Replace more effective ways of relaxing
Actually makes things worse
What else could
you do?
Talk more easily Say stupid things that you will regret
Fail to listen
“More is less” is a general point
What else could you do is an exercise for the youth, ask questions,
but be ready to help answer with healthy alternatives that they would like.
What can you do?
• Goal is to change or
•
prevent risky
expectancies
Parents can and do
make a difference
The problem is how
do you do that?
When to talk to them
• Quiet times when the opportunity arises
• Away from friends and siblings
• In the car
• Watching TV – e.g. TV commercials
Try to speak their language
How to talk to your kids
• Listening first
• Four principles
– Be understanding and try to
see things from their
perspective “That must be
difficult”
– Present facts contrary to what
their long term goals
“Smoking marijuana interferes
with learning and memory. I
wonder how that might
influence getting into
university?”
– Don’t confront or challenge
work around the issue
– Be supportive and positive
about your child “You can do
it”
• Be prepared and tell the truth
– www.ouc.bc.ca/path
Conclusion
• The real war on
drugs is the battle
for the hearts and
minds of our youth
• We don’t want to
prevent them from
taking the journey,
but we do want
them prepared for
challenges along
the way.