Adolescent Protective Behavior to Reduce Drug and Alcohol Use, Alcohol-related Harm and...

J. DRUG EDUCATION, Vol. 39(3) 289-301, 2009

ADOLESCENT PROTECTIVE BEHAVIOR TO REDUCE

DRUG AND ALCOHOL USE, ALCOHOL-RELATED

HARM AND INTERPERSONAL VIOLENCE*

LISA BUCKLEY

MARY SHEEHAN

REBEKAH CHAPMAN

Queensland University of Technology,

Kelvin Grove, Australia

ABSTRACT

Typically adolescents’ friends are considered a risk factor for adolescent

engagement in risk-taking. This study took a more novel approach, by

examining adolescent friendship as a protective factor. In particular it investi-

gated friends’ potential to intervene to reduce risk-taking. Five-hundred-forty

adolescents (mean age 13.47 years) were asked about their intention to inter-

vene to reduce friends’ alcohol, drug and alcohol-related harms and about

psychosocial factors potentially associated with intervening. More than half

indicated that they would intervene in friends’ alcohol, drug use, alcohol-

related harms and interpersonal violence. Intervening was associated with

being female, having friends engage in overall less risk-taking and having

greater school connectedness. The findings provide an important understand-

ing of increasing adolescent protective behavior as a potential strategy to

reduce alcohol and drug related harms.

*The authors would like to acknowledge the financial support of Injury Prevention and Control

Australia (IPCA) Pty Ltd.

289

� 2009, Baywood Publishing Co., Inc.

doi: 10.2190/DE.39.3.e

http://baywood.com

Worldwide, injury is the leading cause of death and disability for young people

(Krug, McGee, & Peden, 2002). Much of the injury among young people is asso-

ciated with risk-taking behavior, including transport risks and violence both of

which may occur in association with underage alcohol use. The risk-taking

behavior of adolescents, while it can be considered a normative developmental

process, has injury consequences. Pickett, Garner, Boyce and King (2002) found

that 11-15 year olds who reported the highest number of risk-taking behaviors

were 2.46 times more likely to report medically treated injuries. Adolescents

involved in fighting (Herrenkohl, Maguin, Hill, Hawkins, Abbott, & Catalono,

2000), and who get drunk, take drugs and/or engage in harming behaviors such as

drinking and then operating a bicycle or car are at increased risk of injury

(Chapman & Sheehan, 2005). This suggests a need to better understand ways that

might reduce such risk taking and inform education initiatives.

Adolescents’ associations with their friends or peers is a commonly identified

factor in their engagement in risk-taking behavior such as alcohol and drug use and

interpersonal violence. Such behaviors are social activities (Gerrard, Gibbons,

Vande Lune, Pexa, & Gano, 2002) and provide situations in which a friend may be

physically present and know that an adolescent is about to engage in risk taking

(Mayer, Forster, Murray, & Wagenaar, 1998). The presence of friends has been

shown to be negative, for example both Arnett (2002) and Preusser, Ferguson, and

Williams (1998) found that adolescents with more than two people present in the

car were more likely to have motor vehicle crashes. This study explores the

possibility that the role of adolescent friendship could be used as a protective

factor for reducing or limiting engagement in risk-taking and thereby limiting

injury.

Several studies of older adolescents or young adults suggest that friends might

indeed be a source of active protection. Evidence from college student samples

suggests friends may provide protection by actively intervening in risk-taking

behavior by attempting to prevent drunk driving (Monto, Newcomb, Rabow, &

Hernandez, 1992; Rabow, Newcomb, Monto, & Hernandez, 1990). Similarly

among 16 to 25 year olds Ulleberg (2004) found passengers were willing to speak

up to a risky driver. There are a few studies with adolescents and they too indicate

protecting their friends from engaging in drug or alcohol use or would do so given

the opportunity.

Flanagan, Galley, and Elek (2004) examined the responses to hypothetical

vignettes of 2,697 U.S. adolescents in grades five to twelve (ages 10 to 17 years).

They found that older students compared with younger students were more likely

to ignore their friends’ behavior however, in the case of driving risks, they would

take the keys away from a friend who had been drinking. The potential strategies

of the younger group included talking to the friend or an adult or ending the

friendship. Gender differences were evident with females being more likely than

males to talk to their friends and less likely to ignore the behaviors or stop

being a friend. The focus of Flanagan and colleagues’ research was on the

290 / BUCKLEY, SHEEHAN AND CHAPMAN

types of protective strategies used rather than on factors that might explain the

behavior. Understanding the characteristics of individuals who might be pro-

tective may provide insight into ways the behaviors might be encouraged in a

school based intervention.

Smart and Stoduto (1997) examined individual and friendship factors asso-

ciated with active protection from drug use in a large sample (n = 1184) of U.S.

students in grades 7, 9, 11 and 13. They found that a substantial minority (35.2%)

reported they had protectively intervened in their friends’ illegal drug use, 48.4%

in their smoking tobacco, 36.8% when they were drinking too much, and 34.0% in

their drunk driving. The researchers found that those most likely to intervene were

older, had more close friends who used marijuana, were less likely to take drugs

themselves, were more disapproving of drug use and were more likely to report

being exposed to drug education.

This evidence of protective behavior suggests that intervention programs and

educational strategies might be able to be designed to encourage adolescents to

reduce their friends’ risk-taking. Many psychosocial factors have been examined

in relation to adolescent’s risk-taking including their relationships with their

friends, parents and school. The relationship with parents is predictive of alcohol

use (Chassin & Handley, 2006; Power, Stewart, Hughes, & Arbona, 2005; Urberg,

Goldstein, & Toro, 2005) and the likelihood of involvement in motor vehicle

crashes and driving related offences is reduced by more positive parental influ-

ences such as monitoring, nurturing and family connectedness (Shope, 2001). A

lack of bonding or connectedness of the adolescent to their school has been asso-

ciated with more traffic violations (Bingham, 2006). Experiencing peer pres-

sure has been shown to relate to increased alcohol and drug use (Argrawal,

Lynskey, Bucholz, Madden, & Heath, 2007; Parker & Benson, 2004; Urberg,

Degrimencioglu, & Pilgrim, 1997).

Peer relationships marked by greater anger and poor control of temper have

been associated with general delinquency and violent behavior (Herronkohl et al,

2000; Sigfusdottir, Farkas & Silver, 2004). Further Hussong and Chassin (1994)

found anger predicted adolescent alcohol use. An individual’s ability to regulate

temper may reflect their ability to think through the consequences of their behavior

(Colder & Stice, 1997) and may also be amenable to peer intervention. Clearly

there is a spectrum of psychosocial factors that have been identified to predict risk-

taking behaviors and it is also important to know the characteristics of those young

people who do engage in protective behavior (Buckley & Sheehan, 2004).

In the main most adolescent behavior change programs (i.e., Perry, 1999) have

included strategies to strengthen adolescent resistance to peer pressures to engage

in unsafe behaviors. An alternate form of intervention that encourages protective

behavior has been less common. This study sought to understand protective

behavior in order to inform an intervention design to reduce adolescent risk-taking

and injury. The study examined whether those key variables of connectedness (to

parents and school), perceived peer involvement in risk-taking, peer pressure,

ADOLESCENT INTERVENING IN FRIENDS’ RISK-TAKING / 291

delinquency and self-control (of temper) could predict protective behavior toward

friends’ risk-taking.

METHOD

Participants and Procedure

The protocol used in this study was granted ethical permission from the relevant

university and education boards. All Year 9 students with written parental per-

mission who were present at school on the day of data collection completed a

questionnaire in a class time that was most convenient to the school. Sampling was

not undertaken in any specific class. 540 students of 5 schools in the South East

region of Queensland, Australia (mean age 13.47 years, 51% female) participated.

Standardised instructions (e.g. about the confidential nature of the survey) were

read by a researcher prior to administering the questionnaire. The legal drinking

age is 18 years and driver licensing age at the time of the survey was 17 years.

Helmet wearing is compulsory when riding a bicycle.

Measures

Peer Protection

Intention to protect a friend was measured using an amended version of the peer

influence survey (Western, Lynch, & Ogilvie, 2003). In response to 11 possible

risk-taking behaviors by their friends, participants were asked whether they would

(i) “report them” or “try and stop them” (coded as protective behavior) or (ii) “join

in,” “do nothing” or “walk away” (coded as not protective). The study examined

protective behavior in the context of “getting drunk a lot,” “using drugs,” “driving

after drinking,” “riding a bicycle after drinking” and “getting into fights.”

Demographics

Students were asked to provide demographic information including age, sex,

and ethnic background.

Risk Taking

The measure of risk-taking behavior was based on the Australian Self-Report

Delinquency Scale, ASRDS (Mak, 1993) and adjustments made by Western and

colleagues (2003). Each item was the description of an act and participants were

asked to respond as to whether or not they had engaged in the act during the past

three months. The co-efficient Chronbach’s alpha for the 25-item measure was .88


indicating strong internal consistency. The computation of total delinquency score

was developed using item severity weightings based on reported prevalence rates.

A weighting was applied to each behavior which the student indicated that they

engaged in. The severity weighting was based on the proportions of students

reporting the behavior. For example, more serious items (e.g., stealing a car to go

for a joyride) reported by 1.5% of students was weighted higher than the score for

wagging or skipping school reported by 20.7% of students. The total risk taking

score involved summing the weighted scores to reflect severity and prevalence.

Those with more than one third missing data were excluded from the analysis.

Self-control (Temper)

The Temper subscale of the Measures of Self-Control (Grasmick, Tittle, Bursik,

& Arneklev, 1993) was selected to assess adolescents’ self-control. The 4 items

(scale range 1-4 per item, “not like me at all” to “a lot like me”) were summed to

produce a total score. The measure had good internal consistency, Cronbach’s

alpha = .79.

Peer Pressure

The 8 items of the peer pressure subscale of the Peer Pressure, Conformity, and

Popularity Questionnaire (Santor, Messervey, & Kusumaker, 2000) were summed

to produce a total score with a higher score indicating greater susceptibility to peer

pressure. The measure had good internal consistency, Cronbach’s alpha = .80.

Friends’ Risk Taking Behavior

To assess students’ perceptions of the amount of risk-taking by friends parti-

cipants were asked how many of their good friends had done each of several risk-

taking behaviors in the past 3 months (scaled I “none” to 4 “most”’). Friends’ risk-

taking included drinking alcohol, taking part in fights, and four transport-related

risks (driven a car or motorbike, ridden with a dangerous driver and ridden a

bicycle without a helmet). Item responses were summed to produce a total score of

perceived friends’ involvement in risk taking and had good internal consistency,

Cronbach’s alpha = .80.

Maternal and Paternal Bonding

To measure adolescent bonding or connectedness to mother and father an

amended version of the “care” subscale from the Parental Bonding Instrument

(Parker, Tupling, & Brown, 1979) was used. Eight items (scaled, I to 4) were

summed to produce a total score with a higher score indicating greater care from


the parent. The measures had strong internal consistency, (Mother bonding,

Cronbach’s alpha = .93 and Father bonding, Cronbach’s alpha = .94).

School Connectedness

To measure school connectedness a shortened version (8-item) of the School as

a Caring Community Profile-II (Lickona & Davidson, 2003) was used. The items

(scaled, 1 to 10) were summed to produce a total score with a higher score indi-

cating greater levels of school caring of support. The items measure connectedness

to teachers and to fellow students, such as “students treat classmates with respect”

and “teachers go out of their way to help students.” The measure had adequate

internal consistency, Cronbach’s alpha = .71.

RESULTS

Some descriptive statistics were first calculated both on the frequency of the risk

taking behavior and the frequency of protective behavior. Just over 30% of the

sample reported having consumed alcohol in the 3 months prior to the survey,

1.5% indicated that they had driven a car after drinking and 8% indicated that they

had ridden a bicycle after drinking. Further 6% indicated that they had smoked

marijuana and 36% indicated that they had been involved in at least one violent

behavior. More than half of the students reported they had taken protective behav-

ior to prevent their friends’ taking risks by; getting drunk a lot (50.2%), using

drugs (67.0%), drink driving (82.2%), riding a bicycle after drinking (63.7%) and

getting into fights (50.3%).

Table 1 presents the results of the logistic regression analyses which were used

to predict each of the alcohol and drug related risk-taking behaviors from demo-

graphic factors, peer pressure, delinquency, perceived friends’ risk-taking, paren-

tal connectedness and school connectedness. Results could not be obtained for the

model on protection of drunk driving. For the drunk driving logistic regression the

percentage correctly predicted of non-protective behavior of drink driving was

only 7.2%.

Results of the other logistic regressions showed that being female increased the

likelihood of protection in all the contexts of friends’ risk-taking. Lower risk-

taking among friends was predictive of preventing alcohol use, drug use and drink

cycling. Further, school connectedness but not parental connectedness was pre-

dictive of protective behavior including intervening in friends’ drink cycling and

getting into fights. Only protecting friends from fights was predicted by being of

Aboriginal or Torres Strait Islander or Pacific Islander background compared with

being of White/Caucasian background. None of the models were predicted by

self-control of temper.



Tab

le1

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Pre

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nific

an

tP

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(B)

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lot

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a

Peer

pre

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Perc

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ed

frie

nd

s’ri

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s

Sex

Perc

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frie

nd

s’ri

sk-t

akin

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Dri

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ling

Sex

Perc

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ed

frie

nd

s’ri

sk-t

akin

g

Sch

oo

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ecte

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ess

Ge

ttin

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tofig

hts

Sex

Ab

ori

gin

alo

rT

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es

Str

ait

Isla

nd

er

backg

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nd

b

Pacific

Isla

nd

er

backg

rou

nd

Peer

pre

ssu

re

Sch

oo

lco

nn

ecte

dn

ess

6.3

10

5.0

88

17

.08

9

10

.41

5

9.8

10

4.8

53

8.0

24

7.1

50

21

.09

0

4.3

96

4.1

98

10

.44

5

6.2

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–.5

01

–.0

20

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37

–.7

37

–.1

06

–.4

58

–.0

90

.02

9

–.9

52

–1

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9

–.7

78

–.3

03

.02

8

.19

9

.00

9

.03

3

.22

8

.03

4

.20

8

.03

2

.01

1

.20

7

.53

4

.38

0

.00

9

.01

1

.60

6*

.98

0*

.87

2**

.47

9**

.90

0**

.63

3*

.91

4**

1.0

29

**

.38

6**

.32

7*

.45

9*

.97

0**

1.0

28

*

.41

0-.

89

6

.96

2-.

99

7

.81

7-.

93

1

.30

6-.

74

9

.84

2-.

96

4

.42

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95

1

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97

3

1.0

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7-.

57

9

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93

0

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96

7

.95

2-.

98

8

1.0

06

-1.0

50

No

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are

inclu

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fco

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uct.

aR

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fem

ale

.bR

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Wh

ite/C

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nb

ackg

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nd

.

*p

<.0

5,**p

<.0

1

DISCUSSION

The study demonstrated that more than half of participants would try to protect

their friends from risk behaviors, the largest proportion indicating that they would

intervene in their friends’ drunk driving (83%). This is generally consistent with

the research on adolescent protective behavior which indicated a sizeable minority

(close to one-half) would protect their friends from alcohol and drug use (Smart &

Stoduto, 1997). The findings are important in that they indicate there is potential

for interventions to encourage adolescents to play a role in protecting friends from

risk taking. It is encouraging that more than half would protect their friends, and

while there is a sizeable minority who wouldn’t try to encourage protection to stop

or report their friends’ risk-taking these data support including such strategies in

relevant drug and alcohol related interventions.

It is of note that the least prevalent (e.g., drink driving) behavior is the most

likely behavior that students indicate they would protect their friends from engag-

ing in. This may be associated with perceived higher levels of risk associated with

this behavior. There is both substantial evidence of the harms that can be asso-

ciated with drink driving (Shope, Waller, & Lang, 1996) and of the very strong

community disapproval of drink driving (Pennay, 2006). This is perhaps con-

sistent with other research in that Flanagan et al. (2004) found greater intended

intervening with friends’ marijuana use compared with alcohol use. Similarly

Adeybo (1988) reported college students would intervene in friends’ drunk

driving if they perceived the potential consequences as serious. In a study by

Ulleberg (2004) about passenger intervening, females at least were more likely to

speak up to the driver if they felt the driving was unsafe. Syversten, Flanagan, &

Stout (2009) highlight personal values of privacy may be a reason young people do

not intervene. Thus students might only break such privacy if they perceive the

outcome of not intervening is sufficiently likely to cause harm. It must also be

noted that students may have greater difficulty understanding the seriousness of

certain situations. Again there may be implications here for educational

instructions to inform students of the likelihood of harm from particular behavior.

A number of psychosocial factors predicted the intended protective behavior.

Interestingly, the only significant predictor of protection for all the examined risk-

taking behaviors was sex (suggesting that there may be different factors operating

in different contexts). Females were more likely to indicate that they would try and

stop or report a friend who was getting into fights, getting drunk, drug use or drink

cycling. This was particularly the case for protecting friends from getting into

fights (Adjusted Odds Ratio = .39). This finding is consistent with other literature

on adolescent protective behavior. Flanagan et al. (2004) found that females were

more inclined than males to talk to their friends about drinking, smoking and drugs

and less inclined to ignore the behavior. Further, Ulleberg (2004) found that

females (16-24 years) were more likely to speak up as a passenger of a risky driver.

The research found that female passengers of risky drivers saw fewer costs to


speaking up, felt more confident to do so and were less accepting of risk-taking

compared with males. Preparedness to engage in protective behavior appears to

differ between the sexes and any effort to facilitate greater protection of peers

should explore the context and basis for such differences.

The findings showed that the psychosocial factors that predicted adolescents’

intention to protect their friends are somewhat consistent across the different types

of friends’ risk-taking behavior. A perception of lower risk-taking of friends was

associated with greater protection from alcohol risks, drug use and drink cycling.

This finding is not consistent with Smart and Stoduto (1997) who found that

protective behavior for alcohol and drug use among friends was predicted by per-

ceived greater marijuana use by friends. The current study used a slightly younger

sample and importantly, students were responding to hypothetical situations rather

than reporting on previous behaviors. There may be a reduction of the association

between intended and actual protective behavior in the risk situation. This would

have implications for school intervention design if supported further.

Only connectedness to school, and not to either parent, was predictive of inter-

vening behavior for any one of the friends’ risk-taking behaviors. The concept of

school connectedness in this study relates closely to protection, in that the measure

relates to an environment characterised by high bonding and students who

look out for and care about fellow students (Lickona & Davidson, 2003). Bonding

to school has been shown to relate to lower levels of self-reported delinquent

behavior (McBride, Curry, Cheadle, Anderman, Wagner, & Dieher, et al., 1995;

Simons-Morton, Davis Crump, Haynie, & Saylor, 1999). In this study school con-

nectedness was not predictive of protection for friends’ excessive alcohol or drug

use however it does confirm the role schools can play in fostering a supportive

relationship among students and a climate that may lead to benefits in reducing

adolescent risk-taking.

Reported susceptibility to peer pressure related to less engagement in protec-

tion for alcohol use and from getting into fights, the most common of the risk-

taking behaviors at this age. It may be that protection is affected by a context of a

wider social group influence and in a high alcohol consumption community ado-

lescents might feel that they are under greater pressure to comply with a group

norm of drinking.

There are a number of limitations that must be considered in assessing these

findings. Firstly, the study reports on hypothetical responses to situations. It is pos-

sible that adolescents would not actually intervene despite their best intentions in

the case of alcohol use where normative modeling and peer pressure appear to play

important roles. Further, there is no guarantee that an intervention promoting

protection would actually reduce friends’ engagement in risk-taking. Some sup-

portive evidence comes from Shore and Compton (2000) who found in their

research on college students’ drunk driving interventions that participants thought

that their intervention was successful in more than half of all cases. Other previous

research indicates that adolescents self-report that they do indeed protect their


friends from alcohol and drug use (Smart & Stoduto, 1997) and intentions have

been shown to be predictive of future behavior among adolescents (Armitage &

Conner, 2000).

The study was also limited in the range of predictive factors entered into the

model. Although the aim of the study was to focus on individual psychosocial and

demographic factors, the measures did not take the nature of friendship into

account. Prosocial behavior among adolescents and intervening among college

student’s drunk driving has been shown to be affected by the closeness of the

friendship with more likelihood of protective outreach taking place among close

friends (McNamara Barry & Wentzel, 2006; Rabow et al., 1990). Newcomb,

Bukowski, and Pattee (1993) reported that peer approval was positively related to

adolescents’ engagement in prosocial behavior.

The research lends further support to approaches that enlist adolescents to inter-

vene to protect their friends’ from alcohol-related harming behavior. There has been

substantial research to indicate young people turn to their friends for support during

adolescence. The results of this and other studies (i.e., Flanagan et al., 2004; Smart

& Stoduto, 1997) suggest that targeting prevention strategies toward encouraging

adolescents to protect their friends is an important initiative. The current findings

have important implications for intervention design. Classroom based behavior

change programs are a commonly used and potentially effective way in which to

change adolescent behavior (Botvin & Griffin, 2004; Perry, 1999). The research

reported here suggests that facilitating and strengthening protective behaviors may

be a useful addition to the more common approaches concerned with reducing or

resisting peer pressure to use alcohol and drugs. The techniques that have been

demonstrated to be generally effective include interactive programs such as role

plays and discussions (Tobler, Roona, Ochshorn, Marshall, Streke, & Stackpole,

2000). It is likely that students can role play how they might intervene to protect a

friend or participate in a guided discussion about intervening. Given that the

findings of this study highlight that perceptions of friends risk-taking and peer

pressure are associated with intervening the strategies used in alcohol prevention

programs to address peer pressure are also relevant. Supportive school bonding

was shown to relate positively to protecting, at least in the case of drink cycling

and getting into fights. A whole of school bonding approach such as that applied to

reducing risk-taking behavior (e.g., Battistich, Solomon, Watson, & Schaps,

1997) might also be effective in the context of protective behavior.

Overall, this study demonstrated strong pro-social and protective behaviors by

early adolescents. It suggests that different strategies for protection exist between

girls and boys and that the likelihood of protection is affected by adolescent’s

perceptions of friends’ risk-taking, their own engagement in delinquent behaviors,

connectedness to their school and peer pressure. These research findings could

inform interventions including curriculum programs and the targeting of health

promotion advertising campaigns.


ACKNOWLEDGMENTS

The authors would like to thank the staff and students of the participating

schools. We wish to acknowledge the wider research team, including John

Western, Vic Siskind and Christine Bond.

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Direct reprint requests to:

Lisa Buckley

Centre for Accident Research

and Road Safety—Queensland

Queensland University of Technology

K Block

Victoria Park Road

Kelvin Grove, Queensland 4059

Australia

e-mail: [email protected]


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