Topic 4 Risk and Protective Factors for Problematic Use of Tobacco, Alcohol and Internet among Children and Adolescents

Table 10 Risk factors for problematic use of tobacco

Individual Family School and Peers Neighbourhood and Community

Early onset

Low socioeconomic status

Peer smoking

Accessibility - availability of cigarettes

Low self-esteem, poor self-image

Non-intact family

Low academic achievement

Exposure to advertising, to smoking in films

Impulsivity, sensation-seeking, rebelliousness

Adverse childhood events in family

Depression

Parents talking (too) frequently about smoking

Low knowledge of the adverse effects of smoking

Parental approval of smoking

Not intending to stay on in full-time education after 16

Sibling and/ or parental smoking

Intention to smoke in the future

Receptivity to tobacco promotion efforts; susceptibility to smoking; having less negative views about smoking

Source: see Hiemstra et al., 2017, Wellman et al., 2016

Table 11 Protective factors for problematic use of tobacco

Individual Family School and Peers

Higher self-esteem

Greater social support

Attachment to friends

Setting norms (complete household smoking ban), parental monitoring/ supervision

School achievement

Quality of communication (talking in a constructive and respectful manner)

Attachment to family

Source: see Hiemstra et al., 2017, Wellman et al., 2016

Real case – problematic use of tobacco (Bordnick, Traylor,  Graap, Copp,  & Brooks, 2005)

“Ruby (17) had smoked approximately 10 cigarettes per day (4–5 packs per week) for approximately 1.5 years. She first started smoking at the age of 15 years, after some of her friends began smoking, and cites stress relief and a feeling that it is normal to smoke as current reasons for continuing. Ruby has had 3–4 past quit attempts of longer than a few days. Ruby currently smokes outside or at teen clubs. Current specific smoking cues/triggers include arguing with her parents, being in school (where she is not able to smoke), seeing other smokers, cigarettes, and alcoholic beverages. Past history includes treatment for anxiety symptoms for approximately 9 months. She reported no current medical or psychological problems.”

Source: Bordnick, P. S., Traylor, A. C., Graap, K. M., Copp, H. L., & Brooks, J. (2005). Virtual reality cue reactivity assessment: A case study in a teen smoker. Applied Psychophysiology and Biofeedback, 30(3), 187-193.

  1. Which risk and/or protective factors are present?
  2. What is the primary motivation for her problematic tobacco use?
  3. Which described risk factors are controllable and which are uncontrollable?
  4. What can alter the influence of the factors she has limited or no control over?

Hint!

  1. Examples of risk factors: early onset, peer smoking, previous failures in giving up smoking, history of anxiety symptoms, Examples of protective factors: potential support from the family, school attendance, good health (absence of medical or psychological problems), socializing with peers, not smoking at home
  2. Peers influence, stress relief
  3. Examples of controllable factors: choosing friends that do not smoke, Examples of currently uncontrollable factors: early onset, history of anxiety issues
  4. Changing lifestyle (diet, healthy food, exercising), trying to solve issues with parents without arguing, stress management, improving parental connections, better parental monitoring, and involvement; developing school attachments, evaluating risky situations - exercising good judgment and make thoughtful decisions, taking control over smoking triggers, avoiding use of other substances (alcohol, drugs)

Table 12 Risk factors for problematic use of Internet

Individual Family School and Peers Neighbourhood and Community

Male gender

Non-intact family

Less school connectedness

Accessibility, advertising

Socially anxious, shy, poor social competences, feeling lonely

Economic disadvantage

Lower grades

Fear of missing out, need to belong

Fear of missing out, need to belong

Withdrawal from the peer group

Poor self and emotional control

Living in dysfunctional families – parental/marital conflicts and/or victims of abuse

Cyber-bullied, peer aggression

Novelty seeking

Low level of family support

Impulsivity

Authoritarian parenting style

More time spent on internet, especially in applications with an interactive, real-time component (e.g., instant messaging, texting, chatting)

Lack of family rules and parental control, lack of communication about the internet use, parental permission to use the internet

Boredom in an individual's leisure time

Attention deficit; hyperactivity disorder (ADHD)

Stress vulnerability

Low agreeableness

Depressive symptoms

Neuroticism

Higher positive outcome expectancy of internet use and lower refusal self-efficacy of internet use

Low self-esteem, negative self-perception

Low subjective well-being

Hostility

Source: (see Fumero et al., 2018; Koo & Kwon, 2014; Kuss & Griffiths, 2012; Lau et al., 2017; Lin et al., 2018; Shek, Chi & Yu, 2015)

Table 13 Protective factors for problematic use of Internet

Individual Family School and Peers

Positive youth development

Harmonic family life

Social support in school

Psychological needs satisfaction

Protective parenting styles

Positive peer relationships

Conscientiousness

Parental supervision

Academic orientation

Self-control/ regulation, self-identity

Parental responsiveness, communication

School achievement

Emotional competence

Clear family roles

Source: (see Fumero et al., 2018; Koo & Kwon, 2014; Kuss & Griffiths, 2012; Lau et al., 2017; Lin et al., 2018; Shek, Chi & Yu, 2015)

Real case – problematic use of Internet (Griffiths, 2000)

“Gary (15) is an only child and spends many hours on his home computer, averaging at least 3–4 hours a day in school term, with up to 5 or 6 hours or more a day at weekends. During the school holidays it increases even more, especially because he is on his own in the house whilst his parents are at work. Gary’s mother describes him as “extremely good technically, very bright and very good at computer programming.” His mother claims “he is computer mad, but not for computer games, rather for serious computing — programming etc.” His General Certificate of Secondary Education homework has been increasingly suffering because of the time he spends on his computer. When he is not working on his computer, he watches television.

According to his mother, Gary has always had problems socially. He has had difficulty in making friends, difficulty in coping with teasing and minor bullying (usually of a verbal nature). His parents feel he views his computer as a “friend” and, therefore, tends to spend much of his time on the machine. Gary also suffers from an inferiority complex and lack of confidence when dealing with his peers. As a consequence, he gets very depressed. This condition worsened when he got his own computer. At the same time, his general behaviour worsened. He refused to do his normal household chores when requested, was generally awkward and difficult, and provoked confrontational situations between himself and other members of the family.

His parents had his general practitioner refer him to a psychiatrist for counselling and help. Whilst Gary viewed this as a possible “quick fix” for his problems, it was very slow progress. He is still getting the help of the local psychological services. Gary’s own view is that he does not have a problem with his computer use and that he does not spend too much time on the computer.”

Source: Griffiths, M. (2000). Does Internet and computer” addiction” exist? Some case study evidence. CyberPsychology and Behavior3(2), 211-218.

  1. Which risk and/or protective factors are present?
  2. What is the primary motivation for his problematic computer use?
  3. Which described risk factors are controllable and which are uncontrollable?
  4. What can alter the influence of the factors he has limited or no control over?

Hint!

  1. Examples of risk factors: male gender, time spent in front of computer, peer bullying, socially anxious/shy, poor social competences, feeling lonely, lower grades, depression, lack of interest for anything else except computer, lack of family rules and parental control, withdrawal from the peer group, hostility, disobedience, Examples of protective factors: computing/programming skills, intelligence
  2. Interest in computers
  3. Examples of controllable factors: time spent in front of computer, peer bullying, social competences, grades, interests, family rules and control, Examples of uncontrollable factors: male gender
  4. Continuation of counselling, promoting positive youth development and self-confidence, social skills’ development and promoting alternative ways for psychological needs satisfaction, developing positive peer relationships, developing academic interests, clear family rules and control, using computer for education, structuring activities and free time

Table 14 Risk factors for problematic use of alcohol

Individual Family School and Peers Neighbourhood and Community

Heritable genetic influences

Low parental education

Alcohol-using peers

Perception that alcohol use is socially acceptable

Under-controlled behaviour (e.g., Impulsive, restless, distractible; disinhibited, aggressive)

Low socio-economic status

Low socio-economic status

Generally permissive societal attitude towards drinking

High novelty-seeking, sensation-seeking, low harm-avoidance 

Non-intact family

School misbehaviour (e.g. skipping classes)

Attention deficit, hyperactivity disorder (ADHD)

Parental substance use disorders

Neuroticism and negative affectivity, social anxiety and generalized anxiety

Poor parenting practices - harsh, inconsistent discipline and hostility or rejection toward children

Introversion-hopelessness

Providing alcohol to adolescents and/or allowing them to drink in their parents’ home

Positive alcohol-related expectations or expectancies

Presence of enhancement and coping motives for drinking

Table 15 Protective factors for problematic use of alcohol

Individual Family School and Peers

Higher self-control substances

Emotional warmth and support

School achievement

Negative expectancies related to alcohol use

Parental monitoring (setting and enforcing reasonable rules; setting and maintaining curfews)

Peer support

Parental involvement in adolescent lives, time spent together

Parent-adolescent communication

Encouragement of adolescent involvement in more conventional and pro-social activities, valuing academic achievement

Consistent disapproval of substance use

Real case – problematic use of alcohol (Sachdeva, Gandhi, Verma, Kaur, & Kapoor, 2015)

“16-year-old adolescent male belonging to low socioeconomic status; was brought to the outpatient department by his mother. There was significant family history of alcohol dependence (father). Alcohol abuse began approximately 18 months ago. The alcohol abuse began when the patient’s friends circle changed to include older pupils. The patient used to steal money from his house to fetch alcohol. The child was a school dropout as he faced inability to concentrate and low grades at school. Moreover, he often was involved in assaultive behaviour at school. A progressively increasing tendency of violence, disorientation, restlessness was noticed by the mother and his family in the form of anger outbursts, abusive and assaultive behaviour in the last two months during which alcohol intake was accelerated. The child presented to the clinic in a state of withdrawal since the mother had not let the child consume any substances since the last 2 days. The child tried to abstain from alcohol a few times; but each episode of abstinence was followed by increase in the use. During the phase of abstinence, the child complained of increasing slurring of speech and sleep disturbances. The central nervous examination exhibited symptoms of withdrawal including combativeness, irritability, aggressiveness, an impaired long-term recall. The psychometric tests scored low on aptitude and skills. On the Family Environmental Scale, there was a low score in all subgroups like personal, relationship, and system maintenance. The areas of behaviour control, problem solving, communication, affective response scored low. When the condition of the child stabilized; a short- term course of supportive psychotherapy which included cognitive behavioural therapy, a family-based approach and person-centred general counselling”

Source: Sachdeva, S., Gandhi, R., Verma, P., Kaur, A., & Kapoor, R. (2015). A 16-year-old boy with combined volatile and alcohol dependence: a case report. Journal of clinical and diagnostic research: JCDR, 9(8), VD01.

  1. Which risk and/or protective factors are present?
  2. What is the primary motivation for his problematic alcohol use?
  3. Which described risk factors are controllable and which are uncontrollable?
  4. What can alter the influence of the factors he has limited or no control over?

Hint!

  1. Examples of risk factors: male gender, low family socioeconomic status, family history of alcohol dependence, early onset, peer influence, stealing to get money for alcohol, school drop-out, assaultive and abusive behaviour at school and at home, previous failures in giving up alcohol, neuro-psychological difficulties during the alcohol abstinence, low aptitude and skills, under-controlled behaviour, inadequate problems solving skills, deficits in communication skills and affective response, insufficient relationship with family. Examples of protective factors: mother’s care, no family history of physical and mental illness
  2. Peer influence, under-controlled behaviour
  3. Examples of controllable factors: skills and behaviour, Examples of currently uncontrollable factors: male gender, family history of alcohol dependence, early onset
  4. Continuation of counselling, alcohol abstinence, intensive skills and aptitude trainings, family support, control and monitoring, promotion of self-control

Please try to list couple of risk factors across domains.

Hint!

Low harm avoidance;  Low self-esteem; Low emotional control

Under-controlled behaviour; Rebelliousness; More time spent using applications that include real-time components

Positive alcohol-related expectations; Low knowledge of the adverse effects of smoking; Poor social skills

Poor parenting practices: Parental approval of smoking; Lack of family rules and parental control

Alcohol using peers; Peer smoking; Peer aggression

School misbehaviour; Low academic achievement; Less school connectedness

Generally permissive societal attitude toward drinking; Easy accessibility of tobacco; Internet use advertising

Please try to list couple of  shared risk factors.

Hint!

Examples of shared risk factors: under-controlled behaviour, positive attitudes toward substance/internet use, low academic achievement, substance/internet accessibility

Please try to list couple of  shared protective factors.

Hint!

Examples of shared protective factors: parental support, communication, monitoring; school attachment and achievement, positive peer relationships