Trajectories of substance use and substance use problems in adolescents and young adults

This thesis examines the determinants of substance use behaviours and substance use problems at several stages in adolescence and adulthood. Analysis is based on a large, representative US-based longitudinal data set, the National Longitudinal Study of Adolescent to Adult Health (Add Health). The thesis consists of four linked empirical studies. The first investigates the effects of parental beliefs about their adolescent children’s smoking and drinking on adolescents’ actual engagement in these behaviours. Previous literature has shown a strong association between parental beliefs and adolescent substance use, but has not addressed the issue of causality in this relationship. This chapter attempts to identify causal relationships via propensity score matching techniques. The second study investigates the effects of parenting styles on substance use problems in adulthood. Previous studies have found a significant association between parenting styles and adolescent substance use; I investigate whether this effect persists into adulthood. Using structural equation modelling, I find that parental warmth has long-term effects on substance use in adulthood. Parental control, while reducing the likelihood of initiation in adolescence, does not reduce the incidence of substance use problems in adulthood. The third study focuses on the determinants of substance use cessation, among adults who are smokers, drinkers and users of illicit drugs. The effects of parenting behaviours are relatively modest, but I find that the level of religiosity is an important determinant of cessation. In the final study, I examine the effect of religiosity on cessation and find that religious faith and (particularly) participation in church services and activities increase the likelihood of substance use cessation. Taken together, these studies provide a thorough explanation of the association between parent-adolescent relationships, religiosity, and substance use trajectories. More importantly, the thesis uncovers the underlying mechanisms that explain various stages and levels of substance use at different periods of life

Comparisons of home-based arts engagement across three national lockdowns during the COVID-19 pandemic in England

Between March 2020 and March 2021, the United Kingdom (UK) experienced three lockdowns due to the COVID-19 pandemic. Given the evident association between arts engagement and wellbeing, this study was designed to compare the predictors and patterns of home-based arts engagement during these lockdowns. Data analysed in this study were from the UK COVID-19 Social Study run by University College London. Multinomial logistic regression was used to identify predictors of arts engagement and compare (i) respondents’ engagement levels during the first lockdown in April/May 2020 and their levels in pre-pandemic times (N = 23,086), (ii) their engagement levels during the second lockdown in November/December 2020 with their levels during the first lockdown (N = 11,481), and (iii) their engagement levels during the third lockdown in January/February 2021 with their levels during the first lockdown (N = 13,270). During first lockdown, 1 in 4 increased their arts engagement and 1 in 6 decreased it. Of those who increased, 2 in 5 maintained or further increased their engagement in subsequent lockdowns, but just 7% of those who had decreased their engagement increased it. Younger adults (aged 18–29) showed initial increases in first lockdown, whilst people who were not employed and those with a physical health condition showed decreases and people with a mental health condition showed changes during the first lockdown (both increases and decreases). Females and people with higher education showed continuous changes across the three lockdowns, with women being more likely to increase their engagement and those with higher education being less likely to decrease. People of ethnic minorities and those with higher income declined their engagement in the third lockdown. This study provides insight into levels of arts engagement across the three national lockdowns in the UK and suggests that the pandemic may have affected long-term cultural behaviours for some groups

Mental health and wellbeing among people with informal caring responsibilities across different time points during the COVID-19 pandemic: a population-based propensity score matching analysis

AIMS: Due to a prolonged period of national and regional lockdown measures during the coronavirus (COVID-19) pandemic, there has been an increase reliance on informal care for informal carers. In light of this, the current study compared the experiences of carers and non-carers on various mental health and wellbeing measures across six key time points during the pandemic. METHODS: Data analysed were from the University College London (UCL) COVID -19 Social Study. Our study focused on six time points in England: (1) the first national lockdown (March-April 2020); (2) the beginning of first lockdown rules easing (May 2020); (3) the second national lockdown (November 2020); (4) the third national lockdown (January 2021); (5) the easing of the third lockdown (March 2021); and (6) the end of restrictions (July-August 2021). We considered five mental health and wellbeing measures: depressive symptoms, anxiety symptoms, loneliness, life satisfaction, and sense of being worthwhile. Propensity score matching was applied for the analyses. RESULTS: We found that informal carers experienced higher levels of depressive and anxiety symptoms than non-carers across much of the pandemic. During the first national lockdown, carers also experienced a higher sense of life being worthwhile. No association was found between informal caring responsibilities and levels of loneliness and life satisfaction. CONCLUSION: Given that carers are an essential national healthcare support, especially during a pandemic, it is crucial to integrate carers' needs into healthcare planning and delivery. These results highlight that there is a pressing need to provide adequate and targeted mental health support for carers during and following this pandemic

Frequency of leisure activity engagement and health functioning over a 4-year period: a population-based study amongst middle-aged adults

Rationale: Leisure activities have wide-ranging benefits for physical and mental health. However, previous studies have often focused on “leisure” as a homogeneous group of activities. This study was therefore designed to take a prospective and comparative approach exploring different types of leisure activities, as well as investigating whether frequency of engagement is associated with strength of benefits. / Method: Data from the 1970 British Cohort Study Waves 9 (age 42) and 10 (age 46) were analysed (N = 5,639). Eight domains derived from the SF-36 health survey questionnaire were used to measure health functioning (general health, vitality, bodily pain, social functioning, physical functioning, mental health, role limitations due to emotional, and role limitations due to physical problems). Leisure activities included physical activity, culture engagement, arts participation, volunteering or community engagement, and literature activities. Both ordinary least squares and logistic regressions were applied. / Results: Physical activity was associated with greater levels of physical functioning, general health, and vitality at higher frequencies, while cultural engagement was associated with social functioning and physical functioning when engaged in several times a year. Arts participation and literature activities had a general negative association with health functioning. Engagements in volunteering/community groups showed varying associations with health functioning (both positive and negative) depending on the levels of engagements. / Conclusion: This research suggests that the types of leisure activities and levels of engagement can have differential associations with health amongst middle-aged adults. This may be helpful for public health initiatives and programmes such as social prescribing schemes when formulating programmes, especially regarding ‘dosage’ of engagement. Further, the overall benefits of high engagement frequency suggest that increasing leisure engagement could play an important role in supporting improving health and wellbeing at a population level

Hobby engagement and mental wellbeing among people aged 65 years and older in 16 countries

Growing aging populations pose a threat to global health because of the social and psychological challenges they experience. To mitigate this, many countries promote hobby engagement to support and improve mental health. Yet, it remains unclear whether there is consistency in benefits across different national settings. We harmonized measures of hobby engagement and multiple aspects of mental wellbeing across 16 nations represented in five longitudinal studies (N = 93,263). Prevalence of hobby engagement varied substantially across countries, from 51.0% of Spanish respondents to 96.0% of Danish respondents. Fixed effects models and multinational meta-analyses were applied to compare the longitudinal associations between hobbies and mental wellbeing. Independent of confounders, having a hobby was associated with fewer depressive symptoms (pooled coefficient = −0.10; 95% confidence intervals (CI) = −0.13, −0.07), and higher levels of self-reported health (pooled coefficient = 0.06; 95% CI = 0.03, 0.08), happiness (pooled coefficient = 0.09; 95% CI = 0.06, 0.13) and life satisfaction (pooled coefficient = 0.10; 95% CI = 0.08, 0.12). Further analyses suggested a temporal relationship. The strength of these associations, and prevalence of hobby engagement, were correlated with macrolevel factors such as life expectancy and national happiness levels but overall, little variance in findings was explained by country-level factors (<9%). Given the relative universality of findings, ensuring equality in hobby engagement within and between countries should be a priority for promoting healthy aging

Who Engaged in Home-Based Arts Activities During the COVID-19 Pandemic? A Cross-Sectional Analysis of Data From 4,731 Adults in the United States

Arts engagement is a health-related behavior that may be influenced by social inequalities. While the COVID-19 pandemic provided new opportunities for some people to engage in the arts, it might have created barriers for others. We aimed to examine whether there was social patterning in home-based arts engagement during the pandemic in the United States, and whether predictors of engagement differed according to the type of arts activity. We included 4,731 adults who participated in the United States COVID-19 Social Study between April and July 2020. Three types of home-based arts engagement were considered: reading for pleasure, arts or crafts activities, and digital arts activities. Using logistic regression models, we tested cross-sectional associations between a broad range of demographic, socioeconomic, psychosocial, and health-related factors as well as adverse events and worries during lockdown and each type of arts engagement. The factors most strongly associated with all three types of arts engagement were social support, social network size, age, race/ethnicity, keyworker status, and experiencing physical or psychological abuse during the pandemic. However, most socioeconomic and health-related factors were not associated with arts engagement, including household income and mental and physical health problems. Overall, our findings indicate that the social gradient in arts engagement was reduced in the first 4 months of the COVID-19 pandemic in the United States. Given the health benefits of arts engagement, the potential diversification of arts audiences during the pandemic is promising for both population-level health and wellbeing and the future of the arts and cultural sector

Parental belief and adolescent smoking and drinking behaviors: A propensity score matching study

This research examines the effects of parental belief on adolescent later smoking and drinking behaviors. Previous studies show that parental belief may have detrimental or beneficial influences on adolescents' behaviors. Analysis is based on Wave 1 and 2 data from the National Longitudinal Study of Adolescent Health (Add Health), N = 3232, and is conducted using an OLS regression estimation and propensity score matching (PSM; nearest-neighbor and kernel matching). Results show that, of adolescents who used cigarettes and alcohol at Wave 1, they are more likely to continue the activity if their parents were aware of it. Adolescents are also more likely to use cigarettes if their parents believed they smoked when in fact they did not. Of adolescents who did not use alcohol, no significant association is found between parental belief and their later alcohol use. Self-fulfilling prophecy is proposed to explain the effects of parental belief. Results obtained from PSM show weaker effects of parental belief, suggesting that part of the effects is explained by shared factors which are responsible for the belief and adolescent substance use. Adolescent concealment is proposed as an important unobserved confounder that influences the association between parental belief and adolescent substance use. The study suggests that research on parent-adolescent communication affected by the self-fulfilling prophecy needs to consider adolescents' intentional concealment, which may help avoid conflicts elicited by discussing topics that adolescents feel uncomfortable confiding in. Keywords: Parental belief, Adolescent, Substance use, Propensity score matching, Self-fulfilling prophecy, Adolescent concealmen

What barriers do people experience to engaging in the arts? Structural equation modelling of the relationship between individual characteristics and capabilities, opportunities, and motivations to engage.

ObjectivesParticipation in the arts has well-documented benefits for health. However, participation in the arts is socially patterned, and it remains unclear why this is: what factors act as barriers or enablers of individual arts engagement. Therefore this study explored how individual characteristics predict individuals' capabilities, opportunities and motivations to engage in participatory arts activities.MethodsWe analysed data from 6,867 adults in the UK (61.2% female, average age 46.7 years) who engage infrequently in performing arts, visual arts, design and crafts, literature-related activities, or online, digital and electronic arts. We constructed a structural equation model to explore the relationship between demographic factors (including age, sex, ethnicity or socio-economic status), health factors (including physical and mental health) or social factors (including living alone, urban density, loneliness or socialising) and perceived barriers to arts engagement.ResultsIndividuals with poorer physical and mental health experienced more barriers affecting their perceived capabilities to engage in the arts, whilst individuals with poorer mental health also described experiencing more barriers affecting their motivations to engage. Individuals of lower SES reported more barriers in terms of opportunities to engage, whilst loneliness was related to more barriers around opportunities and motivations and living alone was associated with more opportunity barriers. Interestingly, adults who were older experienced fewer barriers relating to capabilities or opportunities, as did men, whilst being of white ethnicity was associated with fewer barriers across all three domains. Adults who were more socially engaged or who had poorer physical health experienced fewer barriers relating to motivations. Geographical area of dwelling was not related to any barriers.ConclusionsThis study has shown for the first time where the barriers leading to differential patterns of arts engagement lie. The findings could inform future behaviour change interventions designed to encourage arts engagement amongst individuals who are least likely to engage