Topic 4 Risk and Protective Factors for Problematic Use of Tobacco, Alcohol and Internet among Children and Adolescents
Risk factors for problematic use of tobacco
| Individual | Family | School and Peers | Neighbourhood and Community |
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Early onset |
Low socioeconomic status |
Peer smoking |
Accessibility - availability of cigarettes |
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Low self-esteem, poor self-image |
Non-intact family |
Low academic achievement |
Exposure to advertising, to smoking in films |
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Impulsivity, sensation-seeking, rebelliousness |
Adverse childhood events in family |
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Depression |
Parents talking (too) frequently about smoking |
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Low knowledge of the adverse effects of smoking |
Parental approval of smoking |
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Not intending to stay on in full-time education after 16 |
Sibling and/ or parental smoking |
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Intention to smoke in the future |
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Receptivity to tobacco promotion efforts; susceptibility to smoking; having less negative views about smoking |
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Source: see Hiemstra et al., 2017, Wellman et al., 2016
Protective factors for problematic use of tobacco
| Individual | Family | School and Peers |
|---|---|---|
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Higher self-esteem |
Greater social support |
Attachment to friends |
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Setting norms (complete household smoking ban), parental monitoring/ supervision |
School achievement |
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Quality of communication (talking in a constructive and respectful manner) |
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Attachment to family |
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Source: see Hiemstra et al., 2017, Wellman et al., 2016
Activity 1
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.”
- Which risk and/or protective factors are present?
- What is the primary motivation for her problematic tobacco use?
- Which described risk factors are controllable and which are uncontrollable?
- What can alter the influence of the factors she has limited or no control over?
Risk factors for problematic use of Internet
| Individual | Family | School and Peers | Neighbourhood and Community |
|---|---|---|---|
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Male gender |
Non-intact family |
Less school connectedness |
Accessibility, advertising |
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Socially anxious, shy, poor social competences, feeling lonely |
Economic disadvantage |
Lower grades |
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Fear of missing out, need to belong |
Fear of missing out, need to belong |
Withdrawal from the peer group |
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Poor self and emotional control |
Living in dysfunctional families – parental/marital conflicts and/or victims of abuse |
Cyber-bullied, peer aggression |
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Novelty seeking |
Low level of family support |
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Impulsivity |
Authoritarian parenting style |
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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 |
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Boredom in an individual's leisure time |
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Attention deficit; hyperactivity disorder (ADHD) |
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Stress vulnerability |
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Low agreeableness |
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Depressive symptoms |
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Neuroticism |
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Higher positive outcome expectancy of internet use and lower refusal self-efficacy of internet use |
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Low self-esteem, negative self-perception |
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Low subjective well-being |
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Hostility |
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Source: see Fumero et al., 2018; Koo & Kwon, 2014; Kuss & Griffiths, 2012; Lau et al., 2017; Lin et al., 2018; Shek, Chi & Yu, 2015
Protective factors for problematic use of Internet
| Individual | Family | School and Peers |
|---|---|---|
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Positive youth development |
Harmonic family life |
Social support in school |
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Psychological needs satisfaction |
Protective parenting styles |
Positive peer relationships |
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Conscientiousness |
Parental supervision |
Academic orientation |
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Self-control/ regulation, self-identity |
Parental responsiveness, communication |
School achievement |
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Emotional competence |
Clear family roles |
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Source: see Fumero et al., 2018; Koo & Kwon, 2014; Kuss & Griffiths, 2012; Lau et al., 2017; Lin et al., 2018; Shek, Chi & Yu, 2015
Activity 2
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.”
- Which risk and/or protective factors are present?
- What is the primary motivation for his problematic computer use?
- Which described risk factors are controllable and which are uncontrollable?
- What can alter the influence of the factors he has limited or no control over?
Risk factors for problematic use of alcohol
| Individual | Family | School and Peers | Neighbourhood and Community |
|---|---|---|---|
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Heritable genetic influences |
Low parental education |
Alcohol-using peers |
Perception that alcohol use is socially acceptable |
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Under-controlled behaviour (e.g., Impulsive, restless, distractible; disinhibited, aggressive) |
Low socio-economic status |
Low socio-economic status |
Generally permissive societal attitude towards drinking |
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High novelty-seeking, sensation-seeking, low harm-avoidance |
Non-intact family |
School misbehaviour (e.g. skipping classes) |
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Attention deficit, hyperactivity disorder (ADHD) |
Parental substance use disorders |
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Neuroticism and negative affectivity, social anxiety and generalized anxiety |
Poor parenting practices - harsh, inconsistent discipline and hostility or rejection toward children |
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Introversion-hopelessness |
Providing alcohol to adolescents and/or allowing them to drink in their parents’ home |
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Positive alcohol-related expectations or expectancies |
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Presence of enhancement and coping motives for drinking |
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Source: see https://www.therecoveryvillage.com/teen-addiction/alcohol/teen-alcoholism/teen-alcohol-abuse-risk-factors/ ; https://pubs.niaaa.nih.gov/publications/aa37.htm , Conger et al., 1994
Protective factors for problematic use of alcohol
| Individual | Family | School and Peers |
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Higher self-control substances |
Emotional warmth and support |
School achievement |
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Negative expectancies related to alcohol use |
Parental monitoring (setting and enforcing reasonable rules; setting and maintaining curfews) |
Peer support |
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Parental involvement in adolescent lives, time spent together |
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Parent-adolescent communication |
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Encouragement of adolescent involvement in more conventional and pro-social activities, valuing academic achievement |
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Consistent disapproval of substance use |
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Activity 3
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”
- Which risk and/or protective factors are present?
- What is the primary motivation for his problematic alcohol use?
- Which described risk factors are controllable and which are uncontrollable?
- What can alter the influence of the factors he has limited or no control over?
Activity 4
Please try to list couple of risk factors across domains.
Activity 5
Please try to list couple of shared risk factors for problematic tobacco, alcohol, and internet use.
Activity 6
Please try to list couple of shared protective factors for problematic tobacco, alcohol, and internet use.