Inhalant, marijuana, and alcohol abuse among barrio children and adolescents.

Subst Use Misuse Downloaded from informahealthcare.com by McMaster University on 11/10/14 For personal use only.

The International Journal of the Addictions, 14(7), 945-964, 1979

Inhalant, Marijuana, and Alcohol Abuse among Barrio Children and Adolescents Eligio R. Padilla, Ph.D.

Amado

M. Padilla," Ph.D.

Armando Morales, D.S.W. Esteban L. Olmedo, Ph.D. University of California, Los Angeles Los Angeles, California 90024

Robert Ramirez Youth Opportunities Unlimited, lnc Los Angeles, California 90044

Abstract

Prevalence of inhalant, marijuana, and alcohol abuse was studied in a sample of 457 male and female Mexican-American children and adolescents between the ages of 9 and 17 years. Subjects interviewed resided in four housing projects located in East Los Angeles. All interviews were conducted by adolescents who *To whom requests for reprints should be addressed at Spanish Speaking Mental Health Research Center, UCLA, Los Angeles, California 90024. 945 Copyright @ 1979 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.

946

PADILLA ET AL.


resided in the same housing projects. Results indicated that compared to a national sample, Mexican-American adolescents were at least 14 times more likely to be currently abusing inhalants. The prevalence rate of marijuana was double the national rate, but the prevalence of alcohol was equal to that found nationally. Reasons for elevated substance abuse rates are explored. The use of commercial solvents as a popular means of achieving intoxication was first observed among adolescents in California during the late 1950s (Cohen, 1973). Model airplane glue was the most popular inhalant and its abuse spread quickly throughout the country. Concern about the prevalence and potential harm grew quickly, but then gradually subsided. Laws were enacted in many cities and states prohibiting the sale of glue to adolescents and children (Vargas, 1975). Some glue manufacturers began to include noxious additives, such as synthetic oil of mustard, in their compounds, making the glue extremely unpleasant to potential abusers. Most importantly, glue sniffing came to be accepted as an unfortunate but relatively harmless youthful activity which, in most cases, ceases spontaneously in mid-adolescence. Since the mid-1960s the public and agencies concerned with substance abuse have focused their attention, efforts, and funds on the problem of heroin addiction and the abuse of other so-called “hard drugs.” As a consequence, the development of treatment strategies and a base of information on inhalant usage received and continues to receive a very low priority; only 0.2% of the National Institute of Drug Abuse (NIDA) budget in fiscal year 1976 was allocated for these purposes (Vargas, 1975). Thus, with the seriousness of inhalant abuse effectively minimized and the concentration of resources given to the problems of addiction, the public and responsible governmental officials failed to recognize the emergence of a new, potentially far more hazardous pattern of inhalant use. In the last decade aerosols have replaced glue as the preferred means of obtaining an inhalant “high.” The effects of aerosol inhalation are felt almost immediately and dissipate quickly, permitting many “highs” to be experienced; “hangovers” are relatively mild. Aerosols are also inexpensive and widely available. Few households will not have aerosols in the kitchen, bathroom, laundryroom, or garage. Even if the sniffer has no money or has consumed all inhalants in the home, supply remains a minor problem. Supermarkets, drugstores, and other businesses have aerosols abundantly displayed and easily stolen.


INHALANT, MARIJUANA, AND ALCOHOL ABUSE

941

Aerosols contain active ingredients of varying toxicity plus a propellant, typically one of the Freons which are fluorinated or chlorinated hydrocarbons-usually substituted methane or ethane derivatives. Because of the relative lack of interest in inhalant abuse, it is difficult to be certain of the chronic side effects of many of the aerosol ingredients. No large-scale study has been conducted which systematically evaluates longterm side effects, nor have animal toxicology studies been methodically performed (Cohen, 1973). Despite the lack of conclusive evidence in most cases, some investigators have tentatively reported organ damage and associated diseases as side effects of prolonged inhalant abuse. Based on the available information, many researchers fear that although the longterm effects may not be immediately discernable, the accumulation of toxic substances in body tissues and organs may lead to physiological deterioration. The danger may be present, although to a lesser degree, even when the inhalants are used as directed. Dangers include anemia (Sokol, 1971), liver damage and kidney failure (O’Brian et al., 1971), brain damage (Graboki, 1961), chromosomal damage, bone marrow depression (Louria, 1969), and pancreas damage (Vargas, 1975), among other potential hazards. The above studies considered the toxic properties of the chemicals and the propellants. Metallic spray paints include additional ingredients which may greatly increase the hazards of inhalation. Heavy metals (copper, zinc, and tin), which are found in the pigments of these paints, are being inhaled or ingested in abnormal quantities, excreted in the urine, and possibly retained in body tissue, with long-term consequences unknown at this time (Wilde, 1975). According to Cohen (1973), the acute effects of these substances are better documented than chronic incapacity. Acute solvent poisoning annually kills hundreds of people in the United States, Japan, Mexico, and Western Europe, with the rest of the world beginning to report epidemics of abuse. Cardiac arrest and a variety of cardiac arrhythmias appear to be the most frequent cause of death. Suffocation also adds considerably to the death toll. The inhaler may continue to breathe the fumes after losing consciousness until the respiratory center fails. If the user has covered his head or entire body, or is sniffing in a sealed closet, the supply of oxygen may be exhausted, causing asphyxiation. It is also possible for the Freons to block the passage of oxygen across the alveolar space by mechanically preventing oxygen diffusion. Larynogospasm, or airway freezing due to rapid vaporization, may occlude the airway (Chapel and Thomas, 1970). Accidents are another not infrequent cause of death. A combination of


948

PADILLA ET AL.

feelings of recklessness and grandiosity along with impaired judgment and visual distortions leads to serious auto accidents and falls from high places. Given such a serious potential for harm to self and others, the questions remain as to who are most vulnerable to this form of substance abuse and, at a more fundamental level, why this practice is initiated and maintained. It has been suggested that the most likely to abuse inhalants are the young and naive who are specifically unaware of the hazards and consequences of their behavior and who are living a disorganized existence. In an attempt to explain the phenomenon, some have emphasized the disturbed personalities of heavy users (Wyse, 1973), others have focused on familial disorganization (Massingale et al., 1963), while still others believe that social disorganization is the major force. However, a review of the available information indicates that the specification of the primary causal factors are at this time speculative and premature. Sufficient reliable information does not exist to adequately describe the extent and trends of inhalant abuse, much less to explain its causes. Most of the original drug abuse surveys were at universities where inhalant abuse is known to occur infrequently. More recently, surveys have been conducted in high schools and junior high schools. While more valuable than university surveys, these surveys share the disadvantage of evaluating a group which tends to be absent frequently from school and to “drop out.” Moreover, despite the assurances of the investigation and the anonymity of the process, respondents may be reluctant to divulge information which could conceivably result in closer monitoring of their behavior. On the other hand, estimates based on appearances in juvenile court are similarly questionable, since juvenile court is a setting where inhalant abusers are likely to “drop in,” either for inhalant abuse, if illegal, or for activities conducted while under the substance’s influence. While there is some evidence that there is a growing subgroup of White middle class youngsters who abuse inhalants in their desire to explore every “high,” a few surveys (Medida and Cruz, 1972; Stybel et al., 1974), reviews of the literature (Cohen, 1973), and observations by community workers (Vargas, 1975) have concluded that inhalant abuse is particularly prevalent in poor, Mexican-American neighborhoods. In the present study this conclusion is treated as an hypothesis since the literature bearing on the issue of racial-ethnic differences has typically been sparse and anecdotal, characterized by small samples and some of the other methodological shortcomings previously mentioned. Community workers in these neighborhoods also suggest that the


INHALANT, MARIJUANA, A N D ALCOHOL ABUSE

949

prevalence of marijuana and alcohol abuse may be higher among Mexican-American youth. Originally, the use of marijuana was thought to be restricted to Mexican-American communities, a handful of Black ghettoes, and a few jazz bohemian circles (Carey, 1970), and was thus of little concern to public health officials. However, during the 1960s, rebellion against the beliefs of the establishment and knowledge of the intoxicating properties of marijuana spread quickly among the middle and upper classes. A plethora of studies documented a pattern of changing, more liberal attitudes toward the use of marijuana with a corresponding increase in the incidence and prevalence of marijuana smoking. Nevertheless, based on reports of individuals who work with Mexican-American youngsters, it is hypothesized that marijuana use has an even higher prevalence rate among barrio adolescents. Along with the abuse of inhalants and marijuana, alcohol abuse is considered to be an equally serious problem among Mexican-Americans. Estimates from various sources consistently suggest a higher rate of alcoholism among Mexican-Americans than for Anglos or Blacks. These estimates are typically based on the relative frequency of alcohol-related physical disorders or social phenomena. In one investigation it was found that 52% of all Mexican-American men between the ages of 30 and 60 who were autopsied at the Los Angeles County-University of Southern California Medical Center died of alcohol-related liver disease as compared to rates of 20 to 24% for Anglos, Blacks, and Mexican-American women (Edmondson, 1975). In another study the frequency of drunk driving arrests in East Los Angeles was compared with that in other Los Angeles County communities where there is no concentration of MexicanAmericans. In 1968 there were approximately 10,000 arrests for drunk driving compared to 1,500 in an Anglo community of comparable size (Morales, 1972). Because of the apparent higher prevalence of alcoholism among Mexican-American adults, it is predicted that a corresponding higher rate of alcohol abuse will be found among Mexican-American adolescents. Individuals who are most concerned and familiar with the substance abuse patterns of barrio children and adolescents believe that inhalants, marijuana, and alcohol are currently the major substances of abuse. Thus the prevalence of inhalant, marijuana, and alcohol abuse among barrio children and adolescents is considered in this study, and a comparison is made with the results of a recently published national survey of substance abuse in adolescence (Response Analysis Corporation, 1976). Because of the difficulty of intervewing youthful users, a unique method was em-

PADILLA ET AL.

950

ployed. The method entailed the use of same-age barrio adolescents as interviewers.

METHOD


The Community

Hispanic Americans (Cubans, Mexican-Americans, Puerto Ricans, and other groups of Hispanic descent) are the second largest ethnic minority group in the United States, numbering slightly more than 11 million persons. In the Southwest, persons of Mexican descent, most often designated as Mexican-Americans, are the largest minority group, numbering 6.5 million persons. California has approximately 3.1 million persons of Mexican descent, of which 1.6 million are residing in the greater Los Angeles area. They represent approximately 20% of the Los Angeles County population. In East Los Angeles they represent 87.8% of the population. Housing Projects

There are five governmental housing projects in East Los Angeles. Because of funding and staff constraints, four housing projects were selected for the study. The projects reflect the poorest, largest, and youngest families in East Los Angeles, averaging a gross annual income of $5,600. A majority of the families are single-parent families, with approximately 85% having children between the ages of 5 and 17. It was established that there are 1,729 Mexican-American families in the housing projects; of these, 457 (or 27%) were sampled. The families were selected randomly, utilizing housing unit maps. Recruitment of Interviewers

The selection of interviewers was an important aspect of the research effort. Twenty bilingual-bicultural Mexican American males and females ranging in age from 14 to 18 were recruited from each of the target housing projects. This was essential since there is a large number of delinquent gangs in the East Los Angeles community, with the highest concentration being found in the housing projects. It would have been practically impossible for an “outsider” to gain the trust and confidence of



951

project barrio youth. An “outsider,” even an adolescent of the same ethnic group, might have been in physical danger if attempting to conduct interviews in an unfamiliar housing project. It was also felt that adult interviewers, even of the same ethnic background, would have had difficulty in readily establishing rapport with the subjects and effectively communicating because of age and subcultural factors. Interviewer candidates were screened at the various housing projects and were given bilingual reading, writing, and speaking proficiency tests. An equal number of males and females were recruited. Interviewers were provided basic information about the philosophy and methods of scientific investigation, as well as principles of interviewing. Role playing was used to gain experience in administering the questionnaire. Pilot testing of the questionnaire in the housing projects reinforced this training. The interviewers were also involved in data reduction and were exposed to various methods of statistical analysis. They were paid $2.30 per hour as part of summer employment programs supported by the City and County of Los Angeles. Subjects

The subjects consisted of 457 randomly selected Mexican-American children and adolescents ranging in age from 9 to 17. There were 249 males (54.5%) and 208 females (45.5%). Of these, 313 were adolescents (161 males and 152 females) ranging in age from 13 to 17. The remaining 144 subjects (88 males, 56 females) were children ranging in age from 9 to 12. The median age of subjects was 13.7. The families averaged 3.5 children per family. Sixty percent of the subjects had both mother and father living at home. The Questionnaire

The questionnaire consisted of 65 items covering a variety of demographic factors, family and household compositions and other social characteristics, drug familiarity, substance use among peers and, of course, use of selected substances by subjects during varying periods of their lives-during the previous week, the previous 6 months, and ever. Interviewers worked closely with the investigators to insure that the questionnaire was readily understood by the subjects in their preferred language-English of Spanish. Pilot testing demonstrated that this goal was achieved.

PADILLA ET AL.

952


Procedure

Clearance to conduct the survey was obtained from the appropriate housing authorities. One week prior to the onset of the survey, a notice in English and Spanish was sent to all residents in the housing projects soliciting their cooperation in the study. The methods and purposes were outlined. The anonymity of the process, in addition to involvement of young people from their own community in the study, also served to secure cooperation from families who were contacted. Interviewers were given a list of randomly selected apartments. If the family in the household was Mexican-American, permission was asked to interview one of the children in the selected age range. If there was more than one child between the ages of 9 and 17, the one to serve as a subject was randomly selected by the roll of a die. While in the subject’s home, but away from the rest of the family, the interviewer then verbally administered the questionnaire.

RESULTS Tables 1,2, and 3 present the prevalence of drug use by sex and age for inhalants, marijuana, and alcohol, respectively. In each case, data are reported for three different time bases: used ever, used duing the last 6 months, and used during the last week. Three general trends are apparent: (1) the sample proportions of male users exceed those of female users, (2) prevalence of drug use increases with age, and (3) the prevalence of usage from inhalants to marijuana, and finally, to alcohol. To determine the significance of these relationships, tests of strength of association between age and drug use, and sex and drug use were performed for each drug-by-time category. Indices of contingency (Cramer’s 4; Hays, 1973) and associated x2 test statistics for each category indicate substantial and significant direct relationships between age and use of marijuana ( p < .001) and alcohol ( p < .001), but none between age and the use of inhalants, with the exception of a marginal relationship for the used-ever category ( p < .05). (Preliminary analyses indicated no substantial differences attributable to housing projects; therefore, they were collapsed for the purpose of the analyses presented here. Similarly, the prevalence of use of other drugs such as hallucinogens, cocaine, and opiates, and nonmedical use of sedatives, tranquilizers, and amphetamines was minimal and comparable to national norms; consequently, the corresponding results are not included in this report which focuses on

953


Table 1 Prevalence of Inhalants Used by Age and Sex

Used ever Age


17

Sex

Na

N

%

M

34 25 35 36 30

9 8 10 10 14 8 9 10 9 1 4 6 1 0 1 1 2 0 59 44 103

26.47 32.00 28.57 27.78 46.67 20.00 34.61 29.41 25.00 5.88 14.28 24.00 5.26 0.00 5.55 11.11 8.69 0.00 23.69 21.15 22.54

F 16

M F

15

M F M F M F M F M F M F

14 13 12 11 10 9

Total Total Total

M F M F

40 26 34 36 17 28 25 19 11 18 9 23 11 249 208 457

Used last 6 months N 6 2 5 7 8 5 6 4 8 1 4 6 1 0 0 1 2 0

40 26 66

% 17.65 8.00 14.28 19.44 26.67 12.50 23.08 11.76 22.22 5.88 14.28 24.00 5.26 0.00 0.00 11.11 8.69 0.00 16.06 12.50 14.44

Used last week N 3 2 4 5 7 4 3 3 8 0 4 5 0 0 0 1 2 0 31 20 51

% 8.82 8.00 11.43 13.89 23.33 10.00 11.54 8.82 22.22 0.00 14.28 20.00 0.00 0.00 0.00 11.11 8.69 0.00 12.45 9.62 11.16

“Numberof valid cases in age-by-sex category.

drugs inordinately abused in the particular population under consideration.) Associations between sex and drug use, on the other hand, are generally weak and fail to reach statistical significance. In order to provide a normative context for the relative prevalence of inhalant, marijuana, and alcohol use, a comparison was made between some of the results of this survey and those of a 1975-1976 nationwide survey (Response Analysis Corporation, 1976). The comparison involved responses of 12 to 17 year-olds in the used ever category. Table 4 shows the corresponding percentages for the sample in this survey and the national probability sample. It is immediately apparent than when compared with national prevalence rates for the same age group, the pro-

PADILLA ET AL.

954

Table 2 Prevalence of Marijoana Use by Age and Sex


Used ever Age

Sex

N"

N

17

M F M

34 25 35 36 30 40 26 34 36 17 28 25 19 11 18 9 23 11 249 208 457

23 15 24 17 16 14 14 8 14 2 3 2 3 0 0 1 0 0 97 59 I56

16

F 15 14 13 12 11 10 9

Total Total Total

M F M F M F M F M F M F M F M F

% 67.65 60.00 68.57 47.22 53.33 35.00 53.84 23.53 38.89 11.76 10.71 8.00 15.79 0.00 0.00 11.11 0.00 0.00 38.96 28.36 34.14

Used last 6 months N 21 13 21 15 14 13 13 6 9 1 2 2 0 0 0 1 0 0 80 51 131

% 61.76 52.00 60.00 41.61 46.67 32.50 50.00 17.65 25.00 5.88 7.14 8.00 0.00 0.00 0.00 11.11 0.00 0.00 32.13 24.52 28.66

Used last week N 17 9 19 13 11 8 11 5 8 1 2 1 0 0 0 1 0 0 68 38 106

% 50.00 36.00 54.28 36.11 36.67 20.00 42.31 14.70 22.22 5.88 7.14 4.00 0.00 0.00 0.00 11.11 0.00 0.00 27.31 18.27 23.19

'Number of valid cases in age-by-sex category.

portion of subjects in the present survey who report having ever used the specific drug is over three times as high for inhalants and almost twice as high for marijuana. In both cases the departure from the expected proportions is highly significant ( p < .001). The prevalence of alcohol use is slightly lower, but the difference is not significant ( p < .05). Although not directly comparable because of different time bases, the results of the present survey with respect to the used-last-week category are also presented in Table 4, and are contrasted with results of the nationwide survey pertaining to the used-last-month category. (The nationwide survey did not include a used-last-week category, while the present survey did not include a used-last-month category.) Even though extremely

JNHALANT, MARIJUANA, AND ALCOHOL ABUSE

955

Table 3 Prevalence of Alcohol Use by Age and Sex

Used last 6 months


Used ever Age

Sex

N"

N

17

M F

34 25 35 36 30 40 26 34 36 17 28 25 19 11 18 9 23 11 249 208 457

27 15 25 20 18 20 12 18 13 4 8 6

M

16 15 14 13 12 11 10 9 Total Total Total

F M F M F M F M F M F M F M F M F

5 0 3 2 4 0 115 85 200

%

N

%

79.41 60.00 71.43 55.56 60.00 50.00 46.15 52.94 36.11 23.53 28.57 24.00 26.31 0.00 16.67 22.22 17.39 0.00 46.18 40.86 43.76

27 14 23 19 18 18 12 14 10 4 5 4 5 0 2 2 4 0 106 75 181

79.41 56.00 65.71 52.78 60.00 45.00 46.15 41.18 27.78 23.53 17.86 16.00 26.31 0.00 11.11 22.22 17.39 0.00 42.57 36.06 39.61

Used last week

%

N

22 9 14 12 10 10 6 9 7 1 4 2 2 0 1 1 3 0 69

44 113

64.70 36.00 40.00 33.33 33.33 25.00 23.07 26.47 19.44 5.88 14.28 8.00 10.53 0.00 5.55 11.11 13.04 0.00 27.71 21.15 24.73

aNumber of valid cases in age-by-sex category.

Table 4 A Comparison of Prevalence of Drug Use among 12-17 Year-Olds with National Prevalence for the Same Age Cohort.

Used ever Local sample, Inhalants Marijuana Alcohol

%

National probability sample, %

26.8 41.5 50.8

8.1 22.4 53.6

'Response Analysis Corporation (1976).

Used last week, local sample,

Used last month,

%

national probability sample, %

13.1 28.7 29.6

0.9 12.3 32.4

PADILLA ET AL.


956

conservative, these comparisons provide additional evidence as to the inordinately high prevalence of use of inhalants and marijuana reported by the subjects in this study. To gain further insight into the correlates of drug use, it was hypothesized that certain background information on the subjects (including sex and age) would provide an explanation of variability in drug use. Consequently, six background variables, which are listed and defined in Table 5, were analyzed to determine their usefulness in explaining the prevalence of drug use. Two analyses are performed. The first procedure involved discriminating drug users from nonusers. The second procedure involved discriminating among three groups distinguishable by the reported frequency of drug use during the last 6 months-no use, moderate use (1 to 9 times), and high use (10 times). The first analysis consisted of regressing the six background variables on a dichotomous criterion valued 0 for subjects who report never having used the drug and valued 1 for subjects who report having used the drug at least once. (Multiple regression on a dichotomous criterion indicative of group membership is equivalent to two-group discriminant analysis.) A separate multiple regression analysis was conducted for each drug. The

+

Table 5 Definition of Background Variables Variable 1. Age: Age reported by subject to the

nearest year 2. Sex: Scored 1 for males and 2 for females 3. Family Size: Number of brothers, sisters, friends, and relatives living at home (other than parents) 4. Family Intactness: Ordinal measure of parental presence at home (scored 1 if both mother and father live at home; scored 0 otherwise) 5. Drug Familiarity: Number of affirmative responses to nine items pertaining to knowledge of use of drugs by other young people and resulting detrimental effects such as illness, death, and suicide 6. Number ofPeer Inhalers: Ordinal measure of the number of male and female friends who use inhalants (1 = none to 10 = 20f)

Possible range

M

SD

9-1 7

13.69

2.42

1.46 3.49

0.50

0-17 0-1

0.60

0.49

0-9

3.45

2.20

1-10

3.24

1.92

1-2

2.14



951

major background variable that predicts drug use in all cases (and hence the best discriminator between drug users and nonusers) is drug familiarity. Further, the analysis indicates that use of marijuana is most predictable (36% of the variance accounted for by the background variables), while use of alcohol (22% of the variance) and inhalants (18% of the variance) are less predictable. The second procedure consisted of three stepwise discriminant analyses (Timm, 1975), one for each drug, in which linear combinations of background variables were determined which best discriminate between groups reporting no use, moderate use, and high use during the last 6 months. Table 6 presents a summary of the discriminant analysis results for each of the three drugs. In each case, only the first of the two possible discriminant functions was significant and it accounted for over 90% of the predicted variance; thus the standardized coefficients (SDFCs) for the second function are omitted in Table 6 . The absolute magnitudes of the reported SDFCs indicate that drug familiarity is the best discriminator for inhalants, but not for alcohol or marijuana. The relative contribution of other variables may be determined in a similar fashion by examining their respective SDFCs. In general, the patterns of these contributions are different for marijuana, alcohol, and inhalants. In addition, a comparison of the canonical correlations for the three drugs indicates that background variables are least effective in discriminating among groups differing in frequency of inhalant use during the last 6 months. This finding, however, is moderated by an examination of the percentage of cases correctly classified (also shown in Table 6 ) . The discriminant function is quite successful in identifying subjects who report a high frequency of inhalant use ( l o + times). Of the 21 cases that actually belonged to this group, 17 (8 1%) were correctly identified on the basis of their discriminant classification scores. The foregoing analyses provide useful information concerning the nature of the relationships between background variables and drug use for the entire sample, including both drug users and nonusers. Another issue of interest, but obscured in the previous analyses, is that of the nature of these relationships for drug users only. This issue is addressed in Table 7, which presents descriptive statistics on background variables separately for inhalant, marijuana, and alcohol users. Although comparisons of inferential statistics across groups is inappropriate (because the groups are not mutually exclusive and the sample sizes are highly dissimilar), the data presented in Table 7 are of interest from a descriptive point of view. They show, once more, different patterns for different drugs. For alcohol users,

Age Number of peer inhalers Sex Drug familiarity

Age Drug familiarity Number of peer inhalers

Marijuana

Alcohol

.23 .ll

-.29

-.57 -.35

.28 -.27

-.49 - .48

-.02

.14

-.I9

-.40

- .70

SDFCb

97

97

92

%’

Relative

.51

.59

.33

1

197.7*

55.6*

X2

64

76

60

Group 1, no use

36

36

44

Group 2, 1-9 times

62

81

Group 3, 10+ times

*p

< .001.

58

69

59

Totald

Percent of cases correctly classified

‘Order of entry determined by smallest Wilk‘s L criterion; variables with partial multivariate F < 1 were not entered. bStandardized coefficients for significant discriminant function. ‘Relative percentage of predicted variance attributable to significant discriminant function. dPercent of “grouped” cases correctly classified.

Family intactness

Sex

Drug familiarity Number of peer inhalers Family intactness Sex Age

Discriminating variables”

Inhalants

Drug

Canonical R

Summary of Discriminant Analyses among Groups Differing in Frequency of Drug Use during Last 6 Months

Table 6


sex Family size Family intactness Drug familiarity Number of peer inhalers Inhalant useb Marijuana useb Alcohol useb

Age

1.88 0.50 1.94 0.50 1.93 2.20 1.55 1.87 1.70

14.60 1.43 3.41 0.52 4.52 2.54 3.04 3.38

5.05

SD

M

-.14 -.15

.05

.03 -.15 -.19* .14

-.04

r 15.20 1.37 3.11 0.49 4.92 4.43 1.58 3.62 3.55

M

.01

.61**

-

.04

0.50

.19* .01 .15

.15 -.06

1.59 0.49 2.12 1.85 2.25 1.24 1.58 1.63

r

SD

Marijuana users, N = 156

14.77 1.42 3.41 0.53 4.40 3.91 1.56 2.92 3.59

M

2.00 0.50 2.12 2.23 1.19 1.80 1.47

0.50

1.87

SD

*p < .05. **p < .001.

r

.55**

.14

.32** -.05 .ll -.14 .29** .28**

Alcohol users, N=200

"Defined as having used the specific drug at least once ever. Lordha] measure of the frequency of use during last 6 months (scored from 1 = no use, to 5 = used 10 or more times).

1. 2. 3. 4. 5. 6.

Variable

Inhalant users, N = 103

Table 7 Description of Inhalant, Marijuana. and Alcohol User9 in Terms of Six Background Variables: Means, Standard Deviations, and Correlations with Frequency of Drug Use during Last 6 Months


PADILLA ET AL.

960


the frequency of use is significantly correlated with several background variables; this is not true, however, for marijuana and inhalant users. Another finding of interest is that inhalant users also use marijuana and alcohol quite frequently, whereas marijuana and alcohol users report little use of inhalants. Finally, the frequencies of alcohol use and marijuana use are substantially intercorrelated but are not associated with the frequency of inhalant use.

DISCUSS ION The importance of the findings presented in this report rests on the extremely elevated prevalence rates of inhalant and marijuana use found in this inner city Mexican-American population. Comparisons with the national sample (Response Analysis Corporation, 1976) indicate that the probability of finding a history of inhalant intoxication is approximately three times greater among this population. Roughly one of four subjects in this study reported using inhalants at least once. Comparisons of current use are even more striking: young people in the barrios are at least 14 times more likely to be currently abusing inhalants. In this group of 12 to 17-year-olds, one of eight reported getting “high” on inhalants during the week prior to the interview. The prevalence rates of marijuana and alcohol are also very high among barrio adolescents, with the prevalence of marijuana double the national rate and the prevalence of alcohol equal to that found nationally. The prevalence of alcohol consumption found in the national and local surveys support the contention that alcohol abuse is reaching epidemic proportions across all segments of the nation’s youth. It is critical to note that a methodologist might have some question about the use of peer interviewers in this study. That is, the interviewers might have known some of the respondents, even if only by reputation, thus leading to the possibility that the respondents could have wanted to “impress’ the interviewers as being sophisticated, worldly, adolescentsabout-town. If so, they would exaggerate their usage of drugs. However, this concern can be ruled out since usage of a variety of other drugs showed no differential effect in comparison to national norms. If there was a simple exaggeration effect, this should have been observed. Obviously, an interaction of such an effect with a particular drug cannot be ruled out, but no interaction seems apparent. Furthermore, if one argues “popularity” of a drug as a crucial variable in determining subject response bias, the use of alcohol by barrio youth can be used to counter such an argument since there was no difference in usage of alcohol between this



961

sample and the national sample. Determining the correlates of drug use would have theoretical as well as practical ramifications. In this study, background variables were found which discriminate between drug users and nonusers, but which, at best, account for 36'j/, of the variance in marijuana use and only 22 and 18% in the use of alcohol and inhalants, respectively. Considering only those who report using drugs, it would be useful to evaluate background variables in relation to the frequency of use. Of particular interest would be those factors which differentiate heavy users, since occasional drug users have been described as more like nonusers than individuals who have developed a drug-oriented existence. Unfortunately, sampling and statistical constraints (lack of mutual exclusivity and greatly varying sample sizes) prevented such an analysis, although descriptive statistics are presented (Table 7) which should have heuristic value. Predictive research in drug abuse is bound to be difficult and may prove to be impossible in view of the multidimensional complexities of the phenomenon (for excellent discussions of the issues involved, see Eichberg and Bentler, 1975; Bentler and Eichberg, 1975). Perhaps most limiting is the fact that situational and environmental variables account for a high proportion of variance in behavior (Bentler and Eichberg, 1975). Survey techniques will have to give way to more sophisticated strategies if trends in substance abuse and the dynamics of the abusing populations are to be more adequately understood. The need for quasi-experimental and longitudinal methods is illustrated by an apparently paradoxical finding in this study. The best discriminator for inhalant use versus nonuse is drug familiarity, which includes knowledge of potential detrimental effects, such as illness and death. Drug familiarity, rather than serving as a deterrant to inhalant abuse, seems to be positively associated with inhalant use. Motivational and personality variables could possibly account for this finding. Adolescents heavily into drugs may gather more information-accurate and inaccurate-than nonusers or those who periodically indulge in these practices, but may not care as much about the consequences of substance abuse. Not concerned about the consequences, these individuals may be willing to try any mind-altering substance. Indirect support for this tentative hypothesis comes from the observation that inhalant users will also smoke marijuana and drink alcohol, but that drinkers and smokers will typically not use inhalants for purposes of intoxication. Clarification of this issue awaits a more intensive, refined investigation of the patterns of multiple drug abuse in this population.


962

PADILLA ET AL.

Of additional interest, inhalant abuse does not follow the age-defined pattern found with marijuana and alcohol abuse. That is, age does not correlate with inhalant use (see Table 6 ) . In previous reviews it was also suggested that male inhalant abusers will outnumber females by a ratio of 10:1 (National Clearinghouse for Drug Abuse Information, 1974). Sex differences in this survey are minimal (see Table 1). While inhalant abuse may not pose a serious threat to the structure of society (Cohen, 1973), the social costs to the individual may be substantial, especially individuals who also abuse other substances like marijuana and alcohol. Chronic deleterious effects of marijuana consumption, if any, have yet to be established, but the evidence regarding excessive alcohol consumption is conclusive. As indicated in the introduction, sufficient research has not been conducted to definitively establish the chronic physical effects of inhalant abuse, although enough information has been gathered to warrant serious concern. Beyond threats to the physical well-being of the adolescent abuser, the psychological costs of multiple substance abuse are very high. Adolescence, like early childhood, is an important developmental period in which demands on the individual proliferate in qualitative as well as quantitative terms. The evasion of stress through sniffing, snorting, “dropping,” smoking, “shooting” and drinking-or “better living through chemistry,” as suggested by those who profit from substance abuse-does not coincide with the kind of life experience necessary for the development of the emotional, social, academic, and practical skills required to function as a competent adult. The young multiple-substance abuser may remain psychologically immature during a period when he should be learning to deal with conflict and frustration (Cohen, 1973). The results of this survey are likely to be disturbing to anyone who has even a tangential interest in the psychosocial and physical development of Mexican-American children and adolescents. The need for further research-from basic pharmacological studies to quasi-experimental, longitudinal designs and surveys-is made patently clear. This presupposes sufficient interest in the development of ameliorative interventions for this neglected population who are victims of self-inflicted, but societally reinforced, destructive behavior. The age at which many childern begin to abuse substances suggests that educational-intervention programs must begin while the children are still in elementary schools. Efforts must be made to maximize parents’ participation if the influence of peers who abuse substances is to be lessened to any degree. The implication is clear: educational efforts should



963

not be limited to the schoolroom and the hours of 9 to 3. Intervention must take place in the projects themselves, at hours when working people can attend. In conclusion, cooperation from the community must be viewed as a necessary and highly desirable characteristic of research projects, whether they be laboratory studies or surveys. The assistance of barrio adolescents proved to be an extremely valuable methodological innovation. It is unlikely that many of the respondents would have consented to be interviewed or would have been as candid if the interviewers had been adults. The employment of members of the community to be studied should be carefully considered by investigators in similar studies. In addition to providing summer employment for these adolescents, the experience appears to have had some positive effects on the interviewers. Changes in attitudes toward substance abuse and actual behavior were observed by the investigator (R.R.) who knows them best. These unanticipated effects, and thus undocumented in this paper, should be considered systematically in future research efforts. AC KN0W LE DG M ENTS

This paper was in part made possible by USPHS Grant 5-Rol-MH 24854 from the Center for Minority Group Mental Health Programs, Dr James Ralph, Chief, National Institute of Mental Health, United States Department of Health, Education, and Welfare, and by funds for the summer employment of disadvantaged youth provided by the City and County of Los Angeles. The authors acknowledge the helpful comments and suggestions made by Peter M. Bentler. REFERENCES BENTLER, P.M., and EICHBERG, R.H. A social psychological approach to substance abuse construct validity: Prediction of adolescent drug use from independent data sources. In D. J. Lettieri (ed.) Predicting Adolescent Drug Abuse: A Review of Issues, Methods and Correlates. Washington, D.C.: Superintendent of Documents, 1975, pp. 131 - 146. CAREY, J.T. Marijuana use among the new bohemians. In D. E. Smith (ed.) The New Social Drug. Englewood Cliffs, New Jersey: Prentice-Hall, 1970. CHAPEL, J. L., and THOMAS, G . Aerosol inhalation for kicks. Mod. Med. 67: 378, 1970. COHEN, S. The volatile solvents. Public Health Rev. pp. 185-214, May 1973. EDMONDSON, H.A. Mexican-American alcoholism and deaths at LAC-USC Medical Center. Testimony before the subcommittee on Alcoholism of the California Senate Health and Welfare Committee, February 7, 1975.


964

PADILLA ET AL.

EICHBERG, R.H., and BENTLER, P.M. Current issues in the epidemiology of drug abuse as related to psychological studies of adolescent drug use. In D. J. Lettieri (ed.) Predicting Adolescent Drug Abuse: A Review of Issues, Methods and Correlates. Washington, D.C.: Superintendent of Documents, 1975, pp. 19-32. GRABOKI, D.A. Toluene sniffing producing cerebellar degeneration. Am. J . Psychiatry 118: 461, 1961. HAYS, W.L. Statistics f o r the Social Sciences, 2nd ed. New York: Holt, Rinehart and Winston, 1973. LOURIA, D.B. Medical complications of pleasure giving drugs. Arch. Intern. Med. 123: 82, 1969. MASSINGALE, O.N., GLASER, H.H., LELIEVRE, R.E., et al. Physical and psychologic factors in glue sniffing. N. Engl. J . Med. 269: 1340-1344, 1963. MEDIDA, M., and CRUZ, A. A Survey of Paint and Glue Inhalation among Phoenix Inner City Youth. Phoenix, Arizona: Valle del Sol, 1972. MORALES, A. Ando sangrando. La Puente, California: Perspectiva Publishers, 1972. NATIONAL CLEARINGHOUSE FOR DRUG ABUSE INFORMATION. The deliberate Inhalation of Volatile Substances (Report Series 30, No. 1). July 1974. O’BRIEN, E.T., YOMAN, W.B., and HOBLEY, J.A.E. Hepatorenal damage from toluene in “glue sniffer.” Br. Med. J . 5752: 29, 1971. RESPONSE ANALYSIS CORPORATION. Nonmedical Use of Psychoactive Substances. Princeton, New Jersey, 1976. SOKOL, J. Glue sniffing among juveniles. Am. J . Corrections 2 6 18, 1971. STYBEL, L., ALLEN, P., and LEWIS, F. Deliberate Hydrocarbon Inhalation Among Low Socioeconomic Adolescents Not Necessarily Apprehended by the Police. Dallas, Texas: Dallas County Mental Health and Mental Retardation Center, 1974. TIMM, N.H. Multivariate Analysis. Monterey, California: Brooks/Cole, 1975. VARGAS, P. Aerosols: A New Drug Danger. Drug Abuse Council, December, 1975. WILDE, C. Aerosol metallic paints: Deliberate inhalation. A study of inhalation and/or ingestion of copper and zinc particles. Int. J . Addict. 10: 127-134, 1975. WYSE, D.G. Deliberate inhalation of volatile hydrocarbons: A review. Can. Med. Assoc. J . 108: 71-74, 1973.

Inhalant abuse.

Prevalence and risk indicators of alcohol abuse and marijuana use among on-reserve First Nations youth.

Proximal and distal social influence on alcohol consumption and marijuana use among middle school adolescents.

Alcohol and marijuana use among adolescents: Long-term outcomes of the class of 1989 study.

Preventing alcohol, marijuana, and cigarette use among adolescents: peer pressure resistance training versus establishing conservative norms.

Children, adolescents, and substance abuse. Introduction.

Eating disorder symptoms and alcohol use among adolescents in substance abuse treatment.

Initiation of alcohol, marijuana, and inhalant use by American-Indian and white youth living on or near reservations.

Alcohol and marijuana consumption among undergraduate polydrug users.

Neurobiology of marijuana abuse.

Prevalence and abuse of psychoactive substances in children and adolescents.

Alcohol, Cannabinoids, and Opioids Abuse and Dependence Among Psychiatric Inpatients.

Group motivational interviewing for adolescents: change talk and alcohol and marijuana outcomes.

Parental Supervision and Alcohol Abuse Among Adolescent Girls.

Substance abuse and parenting among African American mothers of adolescents.

Drug abuse in children and adolescents: an update.

Drug abuse risk and protective factors among Hispanic adolescents.

Substance abuse among sexually abused adolescents and their families.

Testing for drugs of abuse in children and adolescents.

Child sexual abuse and premarital intercourse among high-risk adolescents.

Alcohol and drug abuse.

Alcohol abuse and osteoporosis.

The effects of mental health symptoms and marijuana expectancies on marijuana use and consequences among at-risk adolescents.

Lifetime use of cigarettes, alcohol, marijuana and inhalants in Latino early adolescents.