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Official websites use. Share sensitive information only on official, secure websites. Address correspondence to Brian A. Primack, M. We aimed to determine which media exposures are most strongly associated with marijuana and alcohol use among adolescents. In , we surveyed 1, students at a large high school in suburban Pittsburgh regarding substance use, exposure to entertainment media, and covariates. They reported average exposure to 8. In adjusted models, exposure to music was independently associated with marijuana use, but exposure to movies was independently associated with alcohol use. Implications, limitations, and suggestions for further research are discussed. Keywords: alcohol, marijuana, mass media, entertainment media, adolescence, music, movies, television, video games, books. Adolescents in the United States are currently exposed to media for over 8. This includes substantial engagement with various types of media such as television, films, music, internet, video games, and magazines Rideout et al. Recently, certain media exposures were shown to have significant associations with substance abuse 1 behaviors. In particular, it is now established that viewing smoking-related mass media messages is associated with adolescent smoking initiation Centers for Disease Control and Prevention, ; Dalton et al. Some researchers have even concluded that, based upon established criteria Hill, , the relationship between smoking-related media messages and adolescent smoking is causal DiFranza et al. Fewer studies, however, have examined the relationship between marijuana use and media exposure. Marijuana is the most common illicit drug used by children and adolescents in the United States Heyman et al. More than half of U. Additionally, its use is associated with use of other illicit drugs Raphael, Wooding, Stevens, and Connor, , poor school performance Lynskey and Hall, , depression Degenhardt, Hall, and Lynskey, , and psychosis Arseneault, Cannon, Witton, and Murray, ; Green, Young, and Kavanagh, ; Raphael et al. Although many factors are associated with risk of marijuana use—including genetic predisposition, demographic characteristics, temperament and parenting style Gruber and Pope, ; Hall, ; Heyman et al. Similarly, more studies are necessary to elucidate the relationship between alcohol use and media exposure. Alcohol use is responsible for 75, deaths in the United States each year Stahre, Brewer, Naimi, and Miller, , making it the third leading preventable cause of death Mokdad, Marks, Stroup, and Gerberding, It is considered the leading cause of death in the adolescent years, since it is responsible for a substantial proportion of three major causes of death in this age group: motor vehicle accidents, other accidents, and violence Columbia University Center on Addiction and Substance Abuse, ; Smith, Branas, and Miller, ; Stahre et al. A relationship between alcohol use and media exposure is highly plausible Austin, Chen, and Grube, , and initial evidence suggests that early use of alcohol may be linked to movie exposure Dalton et al. Studies have also shown a relationship between viewing alcohol in advertising and promotions and actual alcohol use in adolescence Austin et al. Several years ago, a series of three content analyses published by the Office of National Drug Control Policy documented that alcohol and marijuana use are portrayed in multiple media, including television, films, music lyrics, and music videos Christenson, Henriksen, and Roberts, ; Roberts, Christenson, Henriksen, and Brandy, ; Roberts, Henriksen, and Christenson, In every case, marijuana was the illicit drug most commonly represented Christenson et al. In contrast, video games seem to contain fewer substance use related messages. The most recent content analysis of M mature rated video games revealed references to illicit drugs in five 3. The most recent content analysis of T-rated teen rated games revealed that none contained references to illegal drugs and that only six 1. There have been important concerns raised regarding the presence of substance use related messages on the internet Ribisl, ; Ribisl, Lee, Henriksen, and Haladjian, For instance, content analyses have revealed that smoking-related Web sites are easily accessible to youth who search for them Ribisl et al. Knowing more about which media exposures are more strongly associated with actual substance use will enable us to focus our research, educational, and policy efforts on the most relevant and important media exposures related to both marijuana and alcohol use. The purpose of this study is to determine the associations between various media exposure types and marijuana and alcohol use in adolescents, after controlling for multiple demographic, intrinsic, and environmental risk factors for substance use. Our a priori hypothesis was that media exposures more likely to contain references to marijuana and alcohol—such as television, films, and music—would be associated with marijuana and alcohol use, whereas exposure to media such as video games, internet, and books with less established substance-related content would not be associated with marijuana and alcohol use. A detailed description of the overall study methodology has been published elsewhere Primack, Gold, Land, and Fine, a ; Primack et al. In brief, in January we surveyed all students at a large suburban high school outside Pittsburgh. We selected this school because it draws from a large region of middle-income families. The min survey assessed media exposure, substance use, and sociodemographic characteristics. The survey was distributed by all social studies teachers on the same day. Prior to the study, we conducted a session with all social studies teachers instructing them how to minimize bias in administration of the survey. Students did not place their names or any other unique identifiers on their surveys. Students were not required to complete the survey for a grade, extra credit, or any other school-based incentive. However, those who completed the survey received a bag of trail mix as thanks for their time. Although there were not enough research personnel to be present in each classroom, two research personnel were continuously available for questions that arose. Since the survey was anonymous, both the University of Pittsburgh IRB and the school superintendent approved the study with opt-out parental informed consent. Although the primary objective of this study was to develop and validate a battery of items measuring the media literacy of individuals, an important secondary goal of the study was to examine the interrelationships between media exposure and adolescent substance use. The high school selected for this study is located in a blue-collar neighborhood about 20 min from the city center of Pittsburgh. Although students at this school are drawn from a relatively wide region, they represent primarily a middle-income population with few families at socioeconomic extremes. The survey consisted of approximately items. It was designed to require no more than 30 min to complete. It was extensively reviewed by experts in public health, adolescent medicine, and psychometrics, and it was pilot tested in a convenient sample of adolescents. It contained empirically based items assessing substance use, media exposures, and covariates. For hours of watching television, we asked respondents for values for an average weekday, an average Saturday, and an average Sunday. We did this for television watching because our pilot studies showed that students were likely to have different responses for television watching on each of these separate days, but that their exposures to the other media were similar across weekdays and weekends. We classified all media exposure measures as categorical variables, consistent with how media exposures are reported in the literature Gidwani, Sobol, DeJong, Perrin, and Gortmaker, ; Gutschoven and Van den Bulck, ; Sargent et al. We selected cut-off points roughly approximating quartiles or quintiles that were appropriate for each media exposure. We assessed several relevant covariates. We also assessed important intrinsic and environmental characteristics of the adolescents including authoritative parenting, stress level, depression, self-esteem, rebellious behavior, and sensation seeking. Although we based our measures on established scales when they were available Blascovich and Tomaka, ; Jackson, Henriksen, and Foshee, ; Kroenke, Spitzer, and Williams, ; Smith and Fogg, ; Zuckerman, Ball, and Black, , we were not able to include all items from each scale because of unacceptable respondent burden. All covariate items are included in the tables. We first performed a descriptive analysis of the valid questionnaires by computing the number of responses to each survey item and calculating the means and standard deviations for continuous variables. We computed these figures in the total sample, among ever users of marijuana, and of ever users of alcohol. We then used chi-squared tests for categorical variables and t -tests for continuous variables to determine which covariates were significantly different in ever users of marijuana versus never users and ever users of alcohol versus never users. Finally, we used bivariate and multivariate logistic regression techniques to assess the association between the dependent variables ever smoking marijuana and ever drinking alcohol and each of the independent variables exposures to each form of media. However, we also ran analyses with all measured covariates in order to test the robustness of our results. We developed a different multivariable model for each of the independent media exposure variables. We searched for significant interactions between media exposure variables and age, sex, and race. Official records show that, of the 1, students enrolled in the school, 1, Of those eligible, 1, The mean age of the 1, respondents was The respondents were exposed to an average of 8. They were exposed to an average of 1. Male and female exposures were similar with the exception of video games: males were exposed to 1. Media exposures, marijuana use, and alcohol use by demographic group a. Unless otherwise specified, table values are in hours per day SD. Based upon parental education. Level 1: At least one parent did not graduate high school. Level 2: Both parents graduated high school but neither graduated college. Level 3: One parent graduated college. Level 4: Both parents graduated college. Nearly all of the measured covariates were significantly related to use of both marijuana and alcohol. Of the covariates, only race was not statistically significantly associated with alcohol use. Unless otherwise noted, items used to measure these characteristics used a four-level Likert scale with responses ranging from strongly agree to strongly disagree. Higher values correspond to more of each characteristic. These p -values were computed with t -tests comparing characteristics in ever users of marijuana with never users of marijuana. These p -values were computed with t -tests comparing characteristics in ever users of alcohol with never users of alcohol. In the fully adjusted and trimmed models, ever using marijuana retained a significant dose—response relationship with music exposure Table 3. All levels of video game exposure above the reference group were associated with lower odds of having ever smoked marijuana. The trimmed multivariate model for marijuana was adjusted for age, gender, race, socioeconomic status, demanding parenting, responsive parenting, stress, sensation seeking, rebelliousness, depression, and school achievement. The trimmed multivariate model for alcohol was adjusted for age, gender, sex, socioeconomic status, demanding parenting, responsive parenting, stress, sensation seeking, rebelliousness, depression, self-esteem, and school achievement. Multivariate results involving alcohol showed that all levels of movie exposure above the reference group were associated with increased odds of ever using alcohol Table 3. Those exposed to two to four movies during the previous 2 weeks versus those with exposure to less than two movies during the previous 2 weeks had odds of 1. We also ran all analyses with untrimmed models including all measured covariates. These results were no different in terms of levels of significance. Specifically, the association between movie exposure and alcohol use was stronger for participants who were 16 years old or younger compared to those who were older than 16 years. The adjusted odds ratio for having tried alcohol for those with the highest level of movie exposure was 3. We find that, after controlling for multiple demographic, intrinsic, and environmental risk factors, marijuana use is independently associated with increased music exposure. In contrast, alcohol was independently associated with increased movie exposure but not music exposure. Finally, we find that exposure to video games and books were associated with reduced odds of having used either substance. Total hours of adolescent media exposure found in this study were also similar to those reported in recent national surveys. In particular, the Kaiser Family Foundation found in that youth are exposed to 8 hr and 33 min of electronic mass media when accounting for multitasking Rideout et al. We found a strong multivariate association between alcohol use and movie exposure but no association between marijuana use and movie exposure. However, it is also possible that there are qualitative differences between the portrayals of the substances. Alternatively, the visual portrayal of alcohol may be more compelling in some way than the visual portrayal of marijuana. It is noteworthy that marijuana use but not alcohol use was independently associated with music exposure in a dose—response fashion, despite the fact that marijuana and alcohol are thought to be equally represented in popular music Roberts et al. There are several potential explanations for the link we found between music exposure and marijuana use. First, it could be that lyrics related to marijuana are currently either more prevalent—or that marijuana is portrayed in more of a positive light in music—than has been previously thought. It will be important to perform new content analyses to answer this question. It is also possible that music induces mood states that predispose to marijuana use, regardless of the presence of references to marijuana. The presence, volume, and type of music played have been shown to affect accessibility of subjects to the use of alcohol and tobacco Gueguen, Guellec, and Jacob, ; Lazev, Herzog, and Brandon, ; McKee, Wall, Hinson, Goldstein, and Bissonnette, ; Willner, Field, Pitts, and Reeve, , but perhaps these elements even more profoundly predispose to marijuana use. Finally, it may be that those who smoke marijuana like to listen to music to enhance their experience, but this is also likely to be true with regard to alcohol. Clearly more investigation into the complex relationship between music exposure and marijuana use is warranted. Interestingly, video game exposure was associated with reduced odds of having used either substance. As previously mentioned, video games contain few if any references to these substances. However, this does not fully explain the lower odds of substance use we observed in video game players. One possibility is that video games tend to be played during times after school and on weekends that might otherwise be spent engaging in risk-taking behavior such as substance use. It is also possible that the time spent playing video games reduces exposure to other forms of media that have more frequent portrayals of alcohol and marijuana use. Thus, while video games may still represent a public health concern in terms of their potential association with aggressive behavior Gentile and Stone, , desensitization to violence Funk, , and attention deficit disorder Chan and Rabinowitz, , they potentially also may represent an activity that removes them from situations leading to substance use. Our finding that exposure to books is associated with less use of either substance will also be important to investigate in more detail. It is unlikely that books contain specific antisubstance use messages. As with video games, it is possible that these activities simply remove students from 1 situations that may lead to substance use; or 2 time spent with other media that portray substance use. However, it is also possible that exposure to books is a marker for an underlying variable or variables for which we did not adequately control. Although we controlled for a number of demographic, intrinsic, and environmental variables, it is certainly possible that other unmeasured covariates exist. Future research should attempt to better characterize this relationship so we can appropriately tap the power of these potentially protective activities. We found one interesting interaction worth considering. Specifically, we found that movie viewing was more significantly associated with alcohol use among younger students 16 or less than among older students. This may suggest that younger adolescents are more susceptible to alcohol-related messages in movies. The differential associations between movie exposure and alcohol in those of different ages should continue to be explored and considered. External generalizability of our findings is limited since our study population was drawn from a single large high school. Another limitation is that we focused on the outcomes of having ever smoked marijuana and having ever used alcohol, so we do not know how these exposures may relate to the frequency of use of these substances. However, we do know that adolescent triers of alcohol and marijuana are at greatest risk for continued use of these substances, and thus having ever tried a substance is a standard outcome for populations in this age range Best et al. Importantly, the cross-sectional design of this study precludes our ability to determine the temporal relationship of the observed associations. Although it is theoretically plausible that media exposure precedes substance use behavior, longitudinal research is needed to definitively determine this. Also, our measure of media use was self-reported did not allow us to specifically quantify exposure to episodes of substance use in the various media studied. Although self-reported frequency of media use is often used in observational studies with large sample sizes Brown et al. Finally, we acknowledge that using statistical models such as these offer only a limited view of what is clearly a much more complex system. It is our hope that future researchers will be able to build upon these results using more complex and nuanced methodologies. We found that marijuana use was linearly and independently related to music exposure but not movie exposure. In contrast, alcohol use was independently associated with movie exposure but not music exposure. This suggests that different forms of media may have varying influences on health risk behaviors. Further research is needed to determine the direction of the relationships and to explore the mechanistic reasons for the diverse associations between various types of media exposure and use of different substances in adolescents. Brian A. Primack , M. After graduating Yale University magna cum laude in with degrees in English literature and mathematics, Dr. Primack combines his expertise in education, technology, human development, and medicine by researching the effect of the mass media messages on health. Specifically, he focuses on the use of media literacy education in preventing adolescent smoking, underage drinking, and other harmful adolescent health behaviors. Kevin L. Kraemer, M. He is a general internist and substance abuse researcher with a special interest in screening and brief intervention and the application of cost-effectiveness and cost-utility analyses to substance abuse prevention and treatment services. He is currently principal investigator of NIH-supported research on improving the quality of care for patients with unhealthy alcohol use and the measurement of utilities for a spectrum of alcohol and drug problems. He serves as co-investigator and site PI for the Veterans Aging Cohort Study, a national observational study of the impact of alcohol and drug abuse on health outcomes in HIV-infected veterans. Michael J. Fine, M. As Director of the VA CHERP, he is particularly interested in conducting research to detect, understand, and eliminate disparities in health and health care among vulnerable patient populations. His past research employed retrospective and prospective cohort designs, with extensive emphasis on assessment of patient-centered outcomes. His current research utilizes randomized clinical trial design to test the effectiveness and safety of medical practice guidelines to improve the quality and efficiency of care for patients with common medical illnesses. Fine has successfully mentored over 25 medical students, residents, fellows, graduate students, and junior faculty, the majority of whom currently hold academic positions. Madeline A. Dalton, Ph. An accomplished scientific researcher in behavioral epidemiology, Dr. She has been Principal Investigator of multiple NIH-funded studies, several of which examine the social and environmental risk factors for tobacco use. Her investigations span from early childhood to adulthood and address a wide range of issues related to smoking prevention, uptake, and progression. For the past 10 years, Dr. Substances are used or misused; living organisms are and can be abused. As a library, NLM provides access to scientific literature. Subst Use Misuse. Published in final edited form as: Subst Use Misuse. PMC Copyright notice. The publisher's version of this article is available at Subst Use Misuse. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. SES c. I do whatever my teacher says to do d. 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The chapters were written by Caribbean scholars, legal practitioners and criminal justice professionals. We had gathered in Paramaribo, Suriname late in , after meeting in Santo Domingo in , and examined regional cooperation, research, and policy formation among and between the English-, French-, Spanish- and Dutch-speaking Caribbean countries. Crime is examined in country-specific terms and, in several cases, city-specific terms, with no attention paid to regional or international connections. This is a preview of subscription content, log in via an institution to check access. Institutional subscriptions. Unable to display preview. Download preview PDF. Google Scholar. Ivelaw L. Armonk: M. Sharpe, ;. Ivelaw Griffith ed. Westport: Praeger, Young and Phillips, writing in the s use the authoritarian state, Commies, and imperialists model. Bananas too are a security issue, because banana producing countries, particularly in the Eastern Caribbean, fear that the elimination of their banana preference to European Common Market through the Lome Convention would result in the collapse of banana cultivation, a dramatic drop in national revenues, massive unemployment, and a breakdown of internal security and order. Article Google Scholar. The government of Suriname denounces this reportage as overblown. Amsterdam: Spinhuis, on the Paramaribo-Amsterdam connection and his thoughts on international consumerism. Download references. You can also search for this author in PubMed Google Scholar. Brana-Shute, G. Narco-criminality in the Caribbean. In: Griffith, I. International Political Economy Series. Palgrave Macmillan, London. Publisher Name : Palgrave Macmillan, London. Print ISBN : Online ISBN : Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Policies and ethics. Skip to main content. The Political Economy of Drugs in the Caribbean. Access this chapter Log in via an institution. Chapter EUR Softcover Book EUR Hardcover Book EUR Tax calculation will be finalised at checkout Purchases are for personal use only. Preview Unable to display preview. Google Scholar Ivelaw L. Sharpe, ; Google Scholar Ivelaw Griffith ed. Google Scholar Bananas too are a security issue, because banana producing countries, particularly in the Eastern Caribbean, fear that the elimination of their banana preference to European Common Market through the Lome Convention would result in the collapse of banana cultivation, a dramatic drop in national revenues, massive unemployment, and a breakdown of internal security and order. Google Scholar Download references. Authors Gary Brana-Shute View author publications. About this chapter Cite this chapter Brana-Shute, G. Studies Collection Political Science and International Studies R0 Share this chapter Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard. Publish with us Policies and ethics. Search Search by keyword or author Search. Navigation Find a journal Publish with us Track your research.

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