ALCOHOL USE AND DEPRESSION AMONG AFRICAN-AMERICAN AND CAUCASIAN ADOLESCENTS John W. Maag and Deborah M. Irvin
ABSTRACT
The purpose of this study was to determine differences in reported alcohol use and depressive S5miptomatology among a sample of 524 African-American and Caucasian adolescents. Of specific interest was determining if ethnicity, gender, and age predicted severity of scores obtained on the Re5Tiolds Adolescent Depression Scale (RADS) and Adolescent Drinking Index (ADI). Extreme groups were formed using upper (> 75%) and lower (< 25%) quartiles. Three other groups were formed using each instrument's normatively derived cutoff scores: depressed only (RADS > 77), heavy drinking (ADI > 16) and mixed (RADS > 77, ADI > 16). Several results were obtained. First, Caucasians obtained significantly higher scores on the ADI than African-Americans, although no differences were obtained for the RADS. Females scored higher on the RADS but lower on the ADI than males. In terms of extreme scores, females were less likely to belong to the severe depression group, while older adolescents in general and African-Americans in particular had a greater probability of belonging to the heavy-drinking group. Finally, using RADS and ADI cutoff scores, females were less likely than males to belong to the depression only group as were African-Americans. Older adolescents, in general, and African-Americans in particular had a greater probability of belonging to the mixed group than did their counterparts. Adolescence is a time of enormous physical, emotional, social, and psychological transition. Adolescents face a series of important decisions involving family and peer relationships, sexual expression, vocational/educational development, and experimenting with drugs and alcohol. Perhaps as a consequence of these developmental transitions, the number of stressful life events is arguably at its maximum during adolescence (e.g., Merikangas & Angst, 1995). Attaining a stable sense
John W. Maag, Department of Special Education and Communication Disorders, University of Nebraska-Lincoln. Deborah M. Irvin, Department of Special Education and Communication Disorders, University of Nebraska at Omaha. Requests for reprints should be sent to Dr. John W. Maag, 202 Barkley Memorial Center, University of Nebraska-Lincoln, NE 68583-0732. E-mail:
[email protected] ADOLESCENCE, VoL 40, No. 157, Spring 2005 Libra Pubiishers, inc., 3089C dairemont Dr., PMB 383, San Diego, CA 92117
of self requires adolescents to successfully navigate these transitions. This task—depending on one's personality structure and dsmamics—^is more difficult for some adolescents whose ability to cope with stress, anxiety, and interpersonal relationships is compromised (Khantzian, 1985). As a result, they are at greater risk for developing a variety of mental health problems—two of the most common being alcohol abuse and depression. There has been much research throughout the past two decades indicating that alcohol is the most commonly used psychoactive substance among both male and female adolescents and across ethnic groups (e.g., Grunbaum et al., 2002; Johnston, O'Malley, & Bachman, 1998; Windel & Davies, 1999). A National Institute on Drug Abuse report indicated that 80% of high school seniors had consumed alcohol (Johnston, O'Malley, & Bachman, 2001). Older adolescents consistently have reported higher levels of alcohol use than their younger peers (Galaif & Newcomb, 1999; Grunbaum et al., 2002; Parker, Calhoun, & Weaver, 2000). Depression is the most common mental health problem among adolescents. In one of the most comprehensive studies conducted in high school settings, Lewinsohn, Rohde, Seeley, and Hops (1991) found that about 25% of adolescents reported severe depressive symptomatology. In general, older adolescents have obtained higher depression scores than their younger peers (Grunbaum et al., 2002; Roberts, Roberts, & Chen, 1997; Schraedley, Gothb, & Hayward, 1999). A more complex pattern of depression emerges between males and females. For example, Smucker, Craighead, Craighead, and Green (1986) found that acting-out behaviors were more highly correlated with overall depression scores for adolescent males than for adolescent females. These gender differences were not observed in children (grades 3-6). They also found that a generally dysphoric mood and a negative view of self correlated more highly with total depression scores for both preadolescent and adolescent females (grades 3-9) than for same-aged males. Teri (1982) found that adolescent females experienced higher levels of depression than did males. McGree, Feehan, Williams, and Anderson (1992) found that boys had higher rates of depression than girls up to age 12 years; after that age, adolescent females had higher rates. Given the extent of adolescent alcohol abuse and depression, it should come as no surprise that several researchers have found positive relations between both variables (e.g., Borges, Walters, & Kessler, 2000; Brent, 1995; Henry, Feehan, McGee, Stanton, Moffitt, & Silva, 1993). In general, symptoms of depression predate alcohol abuse (Cos88
tello, Erkanli, Feerman, & Angold, 1999; Kessler et al., 1996). For example, Fergusson and Woodward (2002) found that adolescents who were depressed were significantly more likely to abuse alcohol than were their nondepressed peers. Kandel, Johnson, Bird, and Camino (1997) suggested that depression is one of the major risk factors for adolescents using licit and illicit substances. A popular explanation for these findings is that adolescents who are depressed begin consuming alcohol as a way to self-medicate (Khantzian, 1985). Other researchers have suggested that the earher misMse of alcohol hegins, the greater the likelihood that psychiatric problems, such as depression, will occur. For example, Buydens-Branchey, Branchey, and Noumair (1989) reported that adults who had started abusing alcohol in their teens were three times as likely to be depressed as their non-abusing peers. There have been several gender-related findings between adolescent depression and alcohol abuse. Bukstein, Brent, and Kaminer (1989) found that the most common antecedents of substance use or abuse were depression in girls and antisocial behavior in boys. In a comprehensive study of depression and alcohol use among adolescents, Windel and Davies (1999) fovmd that, first, girls had a higher prevalence of depression than did boys with a ratio of approximately 2.5:1. Second, boys had about a 2:1 higher prevalence of drinking. Third, between 24% and 28% of adolescents who were identified as depressed also met the criteria for heavy drinking, and between 23% and 27% identified as heavy drinkers also met the criteria for depression. Fourth, between 33% and 37% of boys identified as depressed also met the criteria for heavy drinking whereas only 16% to 18.5% of depressed girls met the criteria. Some interesting patterns emerge when the extent of adolescent depression and alcohol use among Caucasians and African-Americans is examined. In terms of alcohol use, researchers have consistently found that African-American adolescents consume less alcohol than do their Caiicasian cOMnterpaTts (.e.g., Adlaf, Smart, & Tan, 1989; Harford, 1986; Prendergast, Austin, Maton, & Baker, 1989; Singer & Petchers, 1987). Singer and Petchers (1987) found that Caucasian males had the highest rate of alcohol consumption. African-American males and Caucasian females consumed approximately the same amount of alcohol. In terms of depression, results are contradictory. Garrison, Jackson, Marsteller, and McKeown (1990) found no evidence of racial differences in adolescent depression. Other researchers have reported greater levels of depression for African-American adolescents (Emslie, Weinberg, Rush, Adams, & Rintelmann, 1990; Schoenbach, Kaplan, Grimson, & Wagner, 1982). Still other researchers have re89
ported that Caucasian adolescents experienced greater levels of depression than their Afiican-American counterparts (Dearden & Jekel, 1971; Doerfler, Felner, Rowlinson, Raley, & Evans, 1988; Roberts & Sobhan, 1992). What has been conspicuously missingfromthe literature are studies directly comparing Caucasian and African-American adolescents' levels of depression and alcohol use. Several studies have examined the relation between depression and alcohol abuse among Caucasian and African-American adults (e.g., Compton et al., 2000; Pavkov, McGovem, & Gef&ier, 1993; Pavkov, McGovem, Lyons, & Geffner, 1992). Besides focusing on adults, these studies also used psychiatric patients—a group that may not he representative of the general population. The one notable exception was a study conducted by Guiao and Thompson (2004) examining depression and alcohol use among African-American and Caucasian female adolescents. They found that the risk for depression was lower among both ethnicities for early-age adolescent females. Middle-age African-American females showed a higher risk for alcohol use than did their Caucasian counterparts. Finally, middle- and late-age adolescent Caucasian females were at risk for higher alcohol use than were their African-American peers. The overall purpose of the present study was to extend the database on the relation of depression and alcohol abuse between AfricanAmerican and Caucasian adolescents using a school-based sample which may he more representative of the general population than clinic-based or psychiatric samples t5^ically used. Three areas were addressed that corresponded to obtaining general information and progressing in a more specific direction. The first was to determine if there were any significant differences in depression and alcohol scores between African-Americans and Caucasians with respect to age and gender. Second, the sample was divided into two extreme groups: mild and severe depressive symptomatology and alcohol consumption, respectively. The idea was to determine whether different patterns emerged between ethnicities when extreme scores served as the independent variable. Third, three subgroups were formed: (a) depressed only, (b) heavy drinking, and (c) mixed (depressed and heavy drinking). It was hoped that common and distinctive features between ethnicities would be found. METHOD
Participants Participants for this study were selected from a pool of 6,734 7th through 12th grade studentsfromfiveschools in a Midwest metropoU90
tan school district. The ethnic makeup of students in this pool was 29% African-American, 66% Caucasian, 3% Hispanic, 1% Native American, and 1% Asiem. Representative samples of African-American and Caucasian student^ were obtained from the five participating schools {N = 1,285). Because the school principals thought that a total random sample of students would be too disruptive to the daily routine, a random cluster sampling technique with pre-existing classrooms was used (Fink, & Kosecoff, 1998). Two hundred and seven (39%) African-Americans and 317 (59%) Caucasian students returned a signed consent letter by a parent ot legal guardian for participation in the study. Table 1 provides the demographic composition of participants by ethnicity, grade level, gender, and age. Independent ^-tests and Chi-square tests for categorical demographic variables revealed no significant differences. Dependent Measures Two dependent measures were administered to assess alcohol use/ abuse and depression: Reynolds Adolescent Depression Scale (RADS; Reynolds, 1987) and the Adolescent Drinking Index (ADI; Harrell & Wirtz, 1989). In addition, information was collected on. demographic variables: age, gender, ethnicity, and grade in school. Reynolds Adolescent Depression Scale (RADS). The RADS is a 30item self-report questionnaire that measures severity of depressive symptomatology in adolescents. The 30 items describe various feelings and are answered using a Likert-type format. Response options for 24 of the 30 items range from 1 to 4 (1 = almost never, 2 = hardly ever, 3 = sometimes, 4 ^ most of the time). Six of these items are listed as "critical items." Each presumably has the power to differentiate between clinically depressed and nondepressed adolescents. An adolescent's full endorsement of four or more of these critical items is judged as an indication of serious risk for depression, irrespective of the total RADS score. An additional six items are reverse-scored (4 = almost never, 3 = hardly ever, 2 = sometimes, 1 = almost never). The total RADS score is calculated by summing the scores for each item. The possible range of RADS total scores is from 30 to 120. A score of 77 or higher indicates the presence of clinically significant depressive symptomatology. Studies have been conducted examining the internal consistency and reliability of this instrument (Reynolds, 1987; Reynolds & Miller, 1985). Reliability coefficients ranged from .89 to .93 with a total alpha of .93. A split-half reliability coefficient of .91 was achieved for the total pilot sample of 6,485 subjects. Support for construct validity 91
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comes from studies conducted by Reynolds and his colleagues, involving over 11,000 adolescents from diverse racial, socioeconomic, and geographic backgrounds (Reynolds, 1987; Reynolds, Anderson, & Bartell, 1985). The RADS appears to be a reliable measure with value as a research tool and as a screening instrument for adolescents at risk for depression. No special training is required for administration. Typical completion time for this scale is between five and 10 minutes. Adolescent Drinking Index (ADI). The ADI is a 24-item self-report questionnaire that measures severity of adolescents' drinking problems. A total score (ADITOT) is obtained as well as two subscales indicating patterns of drinking-related difficulties. The first subscale, self-medicated drinking (ADIMED) is an indicator of drinking to alter mood or to self-medicate (e.g., drinking to cope with negative feelings or to achieve positive mood states). The second subscale refiects aggressive, rebellious behavior (ADIREB) related to drinking (e.g., fighting with others, delinquent behavior). Item scores range from 2 to 0 (2 = like me a lot, 1 = like me some, 0 = not like me at all) for items one through 10 and from 3 to 0 (3 = 4 or more times, 2 = 2 to 3 times; 1 = once; 0 = never) for items 11 through 24. Scores ranges from 0 to 62 with a cutting score of 16 or higher indicating alcohol abuse. The ADI total score is obtained by simiming the item scores for all 24 items. The two subscale scores are obtained by summing items marked MED (items 2, 3, 6, and 7) and RED (items 12, 15, 16, 18, 19, 21, and 25). Scores for both subscales correlated with the ADI total scores (r = .74 with MED, r = .85 with REB) and with each other (r = .46). Psychometric properties of the ADI have been reported by Harrell and Wirtz (1989). Internal consistency coefficients range from .80 to .95 for the total score and two subcales. In terms of validity, correlations between the ADI and the Michigan Alcoholism Screening Test (MAST) were between .59 and .63. The ADI also discriminated between severity of problems identified by clinicians as being either a substance abuse or psychological disorder. The ADI can be completed in about five minutes by most adolescents (Harrell & Wirtz, 1989). Procedure
Random cluster sampling technique was conducted by building principals with 38 pre-existing classrooms. Class size ranged from 15 to 60 students. This process jdelded 1,285 adolescents selected to take home consent letters. An initial return rate of 440 (34%) was obtained. After teacher reminders, another 84 signed consent letters and were returned for a total of 524 students participating in the study. 93
One of the researchers visited each class at least two weeks prior to the date the dependent measures were administered to explain the nature of the "surveys" and to huild rapport. Students were told that they would remain completely anonjnnous—even to their classroom teachers and parents—and that all answers would remain confidential. All surveys were administered within a 5-week period. The two instruments were handed out to participants in a packet with a Student Greneral Information form stapled on top. This form required students to fill in their age, gender, grade level, and ethnicity. They were assured that information from this form would he used only for statistical analysis and would not he used in any way to identify them. RESULTS
Descriptive statistics are presented in Tahle 2. Means and standard deviations for the RADS and ADI are presented hy grade level for Caucasian and African-American males and females. Several types of inferential statistics were computed. The goal was to determine general differences hetween Caucasian and African-Americans and then move to more specific differences involving prediction of group memhership based on extreme scores obtained on the dependent measures. The first task was to determine if there were any significant differences in depression and alcohol scores hetween Caucasians and African-Americans. Two ^-tests were initially computed. There was no significant difference in RADS scores hetween Caucasians and AfricanAmericans «[522] = 1.767, p = .078). A significant difference was obtained between Caucasians and African-Americans on ADI scores (^[522] = 7.370, p < .001). Caucasians scored much higher (M = 11.63) than African-Americans (M = 6.56). Second, multiple regi'ession analyses were performed to determine how much infiuence was exerted by ethnicity, gender, and age in predicting RADS and ADI scores. For statistical analyses, age was categorized into three groups: (a) 13-0 to 14-11, (b) 15-0 to 16-11, and (c) 170 to 19-5). Gender significantly predicted RADS scores when holding ethnicity and age constant ((3 = .173, ^[520,3] = 4.018, p < .001). Specifically, females had higher scores on the RADS than males by a factor of 6.31. Both age (p = .297, ^[520,3] = 7.421, p < .001) and ethnicity O = -.285, f [520,3] = -7.118, p < .001) significantly predicted ADI scores. Specifically, being one year older increased ADI scores by a factor of 1.78 points when holding gender and ethnicity constant. African-Americans obtained ADI scores of 6.02 points lower than Caucasians when holding age and gender constant. 94
Table 2 Mean Scores and Standard Deviations for RADS and ADI RADS Grade Level Grade 7 African-Americans Males Females Caucasians Males Females Grade 8 African-Americans Males Females Caucasians Males Females Grade 9 African-Americans Males Females Caucasians Males Females Grade 10 African-Americans Males Females Caucasians Males Females Grade 11 African-Americans Males Females Caucasians Males Females Grade 12 African-Americans Males Females Caucasians Males Females
ADI
n
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SD
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35 16 19 52 29 23
53.34 48.94 57.05 55.35 57.83 52.22
21.660 19.533 23.162 20.802 16.145 25.556
1.49 1.00 1.89 4.42 5.41 3.17
2.582 2.477 2.664 8.837 9.210 8.376
34 15 19 44 17 27
57.26 57.00 57.47 63.64 60.24 65.78
26.617 23.019 29.776 17.436 14.311 19.090
2.68 1.20 3.84 6.18 3.76 7.70
5.855 2.366 7.433 10.221 7.378 11.535
36 11 25 84 36 48
59.83 59.73 59.88 64.82 58.75 69.37
17.359 12.768 19.275 16.213 11.996 17.539
3.92 3.18 4.24 10.89 8.39 12.77
5.784 5.636 5.932 11.653 10.680 12.101
37 18 19 57 26 31
55.35 57.89 52.95 58.98 49.42 67.00
18.479 12.357 22.938 16.620 14.892 13.609
3.32 5.00 1.74 11.11 8.69 13.13
5.488 6.499 3.856 12.142 10.851 12.953
29 8 36 14 22
58.90 57.88 59.29 54.56 48.57 58.36
14.304 13.389 14.937 14.824 13.749 14.496
6.41 6.50 6.38 12.83 14.50 11.77
7.023 8.832 6.461 10.449 9.087 11.305
36 17 19 44 22 22
57.97 53.06 62.37 57.77 53.68 61.86
12.110 12.492 10.161 15.949 13.268 17.600
8.28 8.00 8.53 16.20 16.91 15.50
8.876 7.665 10.041 12.322 13.144 11.710
21
SD
95
Third, the sample was suhdivided into extreme groups: mild and severe depressive symptomatology and mild and severe alcohol consumption by grouping the sample based on low (< 25%, N = 114) and high (>75%, N = 148) quartiles. This method was deemed more representative of extreme scores rather than using each instrument's normatively derived cutoff scores because it could be argued that the "mild" group was really a mix of mild and moderate scores. The purpose was to determine whether different patterns emerged between ethnicities when extreme scores served as the independent variable using a series of logistic regression analyses (the Wald statistic is equal to the slope and standard error and is where significance is relevant). Gender significantly predicted extreme scores on the RADS (Wald = 21.283, ldf, p < .001). Specifically, being female decreased the probability of being in the severe RADS group by a factor of 1.216 when holding age and ethnicity constant. Age (Wald = 54.048, ldf, p < .001) and ethnicity (Wald = 30.782, ldf p < .001) were significant predictors of extreme scores on the ADI. In terms of age, getting older was associated with a higher probability of scoring in the severe range by a factor of 1.885 when controlling for gender and ethnicity. In terms of ethnicity, being Afiican-American was associated with a higher probability of obtaining ADI scores in the severe range by a factor of 5.553 when keeping age and gender constant. Fourth, the sample was subdivided into three groups (N = 169): (a) depressed only (RADS > 77, AT = 85), (b) heavy drinking (ADI > 16, N = 55), and (c) mixed group of depressed and heavy drinking (RADS > 77, ADI > 16, iV = 29). Three logistic regression analyses were computed to determine predictors for each group. Age (Wald = 21.993, ldf p < .001), gender (Wald = 8.079, ldf p < .01), and ethnicity (Wald = 13.987, ldf p < .001) were all significant predictors of the depressed only group. Specifically, growing older decreased the probability of experiencing severe depressive symptomatology by a factor of .727 when holding gender and ethnicity constant. In terms of gender, being female significantly decreased the probability of experiencing severe depressive symptomatology by a factor of 1.315. African-Americans had a significantly lower probability, by a factor of 1.96, of experiencing severe depressive symptomatology than did Caucasians. There were no significant predictors for the heavy drinking group. However, age (Wald = 10.018, 2df p < .01) and ethnicity (Wald = 4.523, ldf p < .05) did significantly predict membership in the mixed group. Specifically, as adolescents get older, there is a greater probability, by a factor of .659, of experiencing the concomitant symptomatology of high depression and heavy alcohol use. Finally, being African-American increased the probability, by a factor of 1.42, of being in the mixed group. 96
DISCUSSION
The purpose of this study was to determine whether differences in scores on measures of depression and alcohol use existed between a sample of Caucasian and African-American adolescents. Statistical analyses initially focused on general differences and then moved to more specific differences by examining the roles of age and gender. Finally, data were divided into extreme scores and analyses focused orv detenrviivitig vfhether gro\xp merabersbip coM\d be pTfed\tted by etbnicity, age, and gender. First, in terms of overall differences, Caucasians were more likely to report heavier alcohol use them were African-Americans—a finding commensurate with previous research (e.g., Adlaf et al., 1989; Harford, 1986; Prendergast et al., 1989; Singer & Petchers, 1987). However, in terms of depression, few differences existed between Caucasians and African-Americans. This finding supports some, but not all, previous research. For example. Garrison et al. (1990) found no significant racial differences in adolescent depression. Conversely, some researchers have found greater levels of (depression among African-American adolescents (e.g., Emslie et al., 1990; Schoenbach et £il., 1982) while others have found greater levels in Caucasians (e.g., Doerfier et al., 1988; Roberts & Sobhan, 1992). Clearly, results are mixed and may not shed much additional light because of the global nature of the data. More meaningful and consistent results may be obtained by factoring in age and gender. Second, regardless of age and ethnicity, females were more likely to report higher levels of depressive symptomatology than their male counterparts. This result, in general, supports previous reseeirch (e.g., Smucker et al., 1986; Windel & Davies, 1999). However, when groups of extreme depression scores were formed, females were more likely to obtain scores in the extremely low range. This result runs counter to previous researcK \tv whiclv fevaales were TRore Vilely to be\oi\g to high depressive symptomatology groups (e.g., Teri, 1982). It is possible that females obtained higher scores up to a point, and then begin to decline when reaching an extreme range (i.e., >75% ile). Clearly, more research is require to delineate variables that may affect female membership in groups with extremely high depression scores. In terms of alcohol consumption, the older adolescents became, the more likely they were to be members of the extremely severe group. Thisfindingis consistent with previous research which has found that regardless of ethnicity and gender, older adolescents are more at risk for heavy drinking than their younger counterparts, (e.g., Galaif & Newcomb, 1999; Guiao & Thompson, 2004; Grunbaum et al., 2002, 97
Parker et al., 2000). However, unlike previous research, African-American adolescents were more likely to belong to the extremely high group than were Caucasians. Researchers have tried to explain why AfricanAmericans do not have higher levels of alcohol use than Caucasians. One theory was that African-Americans who were most likely to abuse alcohol had dropped out of school. However, nat;ional household and community surveys failed to support this hjrpothesis (Morgan, Wingard, & Felice, 1984; Zucker & Harford, 1983). Another theory was that African-American adolescents did not start drinking until very late adolescence or early adulthood (Atkins, Klein, & Mosley, 1987; Jackson, Carhsi, Greenway, & Zalesnick, 1981). Perhaps the finding of the present study was an anomaly that, nevertheless, indicated that more research is required among African-American adolescents. Finally, results were presented for predicting membership in three groups: depressed only, heavy drinking, and mixed (depressed and heavy drinking). Using cutoff scores to assign group membership, growing older decreased the probability of membership in the depressed only group. Therefore, older adolescents were less depressed, but drank more than their younger counterparts. In general, s3Tnptoms of depression predate alcohol abuse (Costello, Erkani, Federman, & Angold, 1999; Kessler et al., 1996). In fact, in the present study, older adolescents were more likely to belong to the mixed (depressed and heavy drinking) group than were their younger counterparts. The most surprisingfindingfromthe three groups was that older African-Americans of both genders were more likely to belong to the mixed group than were their younger Caucasian counterparts. Therefore, in isolation, African-Americans may experience less depression and alcohol use than Caucasians but are more likely to experience both concomitantly. Although the association between depression and alcohol use is well documented, the causal sequence is still unclear—especially among Caucasian and African-American adolescents. Results of the present study shed some light on variables associated with adolescents reporting extreme depressive symptomatology and heaving drinking. However, more research is required to delineate reasons why AfricanAmericans may be at greater risk for concomitantly experiencing depression and alcohol use than their Caucasian counterparts. REFERENCES Adlaf, E. M., Smart, R. G., & Tan, S. H. (1989). Ethnicity and drug use: A critical look. International Journal of the Addictions, 24, 1-18.
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Atkins, B. J., Klein, M. A., & Mosley, B. (1987). Black adolescents' attitudes toward and use of alcohol and other drugs. International Journal of the Addictions, 22, 120-121. Borges, G., Walters, E. E., & Kessler, R. C. (2000). Associations of substance use, abuse, and dependence with subsequent suicidal behavior. American Journal of Epidemiology, 151, 781-789. Brendt, D. A. (1995). Risk factors for adolescent suicide and suicidal behavior: Mental and substance abuse disorders, family environmental factors, and life stress. Suicide and Life Threatening Behavior, 25(Suppl), 52-63. Bukstein, O. G., Brent, D. A., & Kamainer, Y. (1989). Comorbidity of substance abuse and other psychiatric disorders in adolescents. American Journal of Psychiatry, 146, 1131-1141. Buydens-Branchey, L., Branchey, M. H., & Noumair, D, (1989). Age of alcoholism onset: Relationship to psychopathology. Archives of General Psychiatry, 46, 225-230. Compton, W. M., Cottier, L. B., Abdallah, A. B., Phelps, D. L., Spitznagel, E. L., & Horton, J. C. (2000). Substance dependence and other psychiatric disorders among drug dependent subjects: Race and gender correlates. American Journal of Addictions, 9, 113-125. Costello, E. J., Erkanli, A., Feerman, E., & Angold, A. (1999). Development of psychiatric comorbidity with substance abuse in adolescents: Effects of timing and sex. Journal of Clinical Child Psychology, 28, 29&-311. Dearden, M. H., & Jekel, T. F. (1971). Pilot program in high school drug education utilizing nondirective techniques and sensitivity training. Journal of School Health, 41, 118-124. Doerfier, L. A., Felner, R. A., Rowlison, R. T., Raley, P. A., & Evans, E. (1988). Depression in children and adolescents: A comparative analysis of the utility and construct validity of two assessment measures. Journal of Consulting and Clinical Psychology, 56, 769-772. Emslie, G. J., Weinberg, W. A., Rush, A. J., Adams, R. M., & Rintelmann, J. W. (1990). Depressive sjonptoms by self-report in adolescence: Phase I of the development of a questionnaire for depression by self-report. Journal of Child Neurology, 5, 114-121. Fergusson, D. M., & Woodward, L. J. (2002). Mental health, educational, and social role outcomes of adolescents with depression. Arc/ijyes of General Psychiatry, 59, 225-231. Fink, A., & Kosecoff, J. (1998). How to conduct surveys: A step-by-step guide (2nd ed.). Thousand Oaks, CA: Sage. Galaif, E. R., & Newcomb, M. D. (1999). Predictors of polydrug use among four ethnic groups: A 12-year longitudinal study. Addictive Behaviors, 24, 607-631. Garrison, C. Z., Jackson, K. L., Marsteller, F., & McKeown, R. (1990). A longitudinal study of depressive S3miptomatology in young adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 581-585. Grunbaum, J. A., Kann, L., Kinchen, S. A., Williams, B., Ross, J. G., Lowry, R., & Kolbe, L. (2002). Youth risk surveillance—United States, 2001. Morbidity and Mortality Weekly Report, 51 (SS04), 1-64. Guiao, I. Z., & Thompson, E. A. (2004). Age and problem behaviors among adolescent multi-ethnic females. Issues in Mental Health Nursing, 25, 147-164.
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Harford, T. C. (1986). Drinking patterns among Black and nonblack adolescents: Results of a national survey. In R. Wright & T. D. Watts (Eds.), Prevention of Black alcoholism (pp. 120-140). Springfield, IL: Thomas. Harrell, A. V., & Wirtz, P. W. (1989). Adolescent drinking index professional manuals. Odessa, FL: Psychological Assessment Resources. Henry, B., Feehan, M., McGee, R., Stanton, W., Moffitt, T. W., & Silva, P. (1993). The importance of conduct problems and depressive symptoms in predicting adolescent substance use. Journal of Abnormal Child Psychology, 21, 469-480. Jackson, N., Carlisi, J., Greenway, C , & Zalesnick, M. (1982). Age of initial drug experimentation among white and non-white students. International Journal of the Addictions, 16, 1373-1386. Johnston, L. D., O'Malley, P. M., & Bachman, J. G. (1998). National survey results on drug use from the Monitoring the Future Study, 1975-1997: Vol. 1. Secondary school students. Rockville, MA: National Institute on Drug Abuse. Johnston, L. D., O'Malley, P. M., & Bachman, J. G. (2001). The monitoring the Future national survey results on adolescent drug use: Overview of key findings, 2000 (NIH Publication No. 01-4923). Bethesa, MD: National Institute on Drug Abuse. Kandel, D., Johnson, J., Bird, H., & Camino, G. (1997). Psychiatric disorders associated with substance use among children and adolescents: Findings from the Methods for Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Journal of Abnormal Child Psychology, 25, 121-132. Kessler, R. C , Nelson, C. B., McGonagle, K. A., Edlund, M. J., Frank, R. G., & Leaf, P. J. (1996). The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization. American Journal of Orthopsychiatry, 66, 17-31. Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142, 1259-1264. Lewinsohn, P., Rohde, P., Seeley, J. R., & Hops, H. (1991). Comorbidity of unipolar depression: I. Major depression with dysthymia. Journal of Abnormal Psychology, 100, 205-213. McGee, R., Feehan, M., Williams, S., & Anderson, J. (1992). DSM-III disorders from age 11 to 15 years. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 50-59. Merikangas, K. R., & Angst, J. (1995). The challenge of depressive disorders in adolescence. In M. Rutter (Ed,), Psychosocial disturbances in young people (pp. 131-165). Cambridge: Cambridge University Press. Morgan, M. C , Wingard, D. L,, & Felice, M. E. (1984). Subcultural differences in alcohol use among youth. Journal of Adolescent Health Care, 5, 191-195. Parker, K. D., Calhoun, T., & Weaver, G. (2000). Variables associated with adolescent alcohol use: A multiethnic comparison. Journal of Social Psychology, 140, 51-62. Pavkov, T. W., McGovern, M. P., & Geffher, E, S. (1993). Problem severity and S3miptomatology among subtance misusers: Differences between AfricanAmericans and Caucasians. International Journal of the Addictions, 28, 909-922.
100
Pavkov, T. W., McGovem, M. P., Lyons, J. S., & Geffher, E. S. (1992). Psychiatric symptomatology among alcoholics: Comparisons between African Americans and Caucasians. Psychology of Addictive Behaviors, 6, 219-224. Prendergast, M. L., Austin, G. A., Maton, K. I., & Baker, R. (1989). Substance abuse among black youth (Western Center for Drug Free Schools and Communities, Prevention Research Update No. 4.) Available from Southwest Regional Laboratory, 4665 Lampson Ave., Los Alamitos, CA 90720. Reinherz, H. Z., Giaconia, R. M., Lefkowitz, E. S., Pakiz, B., & Frost, A. K. (1993). Prevalence of psychiatric disorders in a community population of older adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 369-377. Reynolds, W. (1987). Reynolds adolescent depression scale (Form HS): About myself. Odesssa, FL: Psychological Assessment Resources. Reynolds, W. M., Anderson, G., & Bartell, N. (1985). Measuring depression in children: A multimethod assessment investigation. Journal of Abnormal Child Psychology, 13, 513-526. Reynolds, W., & Miller, K. L. (1985). Depression and learned helplessness in mentally retarded and nonmentally retarded adolescents: An initial investigation. Applied Research in Mental Retardation, 6, 295-306. Roberts, R. E., & Sobhan, M. (1992). Symptoms of depression in adolescence: A comparison of Anglo, African, and Hispanic Americans. Journal of Youth and Adolescence, 21, 639-651. Roberts, R. E., Roberts, C. R., & Chen, Y. R. (1997). Ethnocultural differences in prevalence of adolescent depression. American Journal of Community Psychology, 25, 95-110. Schoenbach, V. J., Kaplan, B. H., Grimson, R. C , & Wagner, E. H. (1982). Use of a symptom scale to study prevalence of a depressive sjnndrome in young adolescents. American Journal of Epidemiology, 116, 791-800. Schraedley, P. K., Gotlib, I. H., & Hayward, C. (1999). Gender differences in correlates of" depressive symptoms in adolescents. Journal of Adolescent Health, 25, 98-108. Singer, M. I., & Petchers, M. K (1987). A biracial comparison of adolescent alcohol use. American Journal of Drug and Alcohol Abuse, 13, 461—474. Smucker, M. R., Craighead, W. E., Craighead, L. W., & Green, B. J. (1986). Normative and reliability data for the Children's Depression Inventory. Journal of Abnormal Child Psychology, 14, 25-39. Teri, L. (1982). The use of the Beck Depression Inventory with adolescents. Journal of Abnormal Child Psychology, 10, 277-284. Windle, M., & Davies, P. T. (1999). Depression and heavy alcohol use among adolescents: Concurrent and prospective relations. Development and Psychopathology, 11, 823-844. Zucker, R. A., & Harford, T. C. (1983). National study of the demography of adolecent practices in 1980. Journal of Studies on Alcohol, 44, 974-985.
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