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Exploration of the prevalence and correlates of substance use among sheltered adolescents in South Korea.

During the past 30 years, South Korea has undergone dynamic social changes in the process of rapid industrialization and urbanization. Traditionally, the family and the school have played key roles in caring for and educating adolescents. However, the nation is facing critical challenges. Family disorganization and income disparity are becoming major social issues. The family and the school are no longer exerting a positive influence as a social security network (National Youth Commission, 2005). In the process of unprecedented social change, a growing number of Korean adolescents have been experiencing various problems, such as poverty, school dropout, runaway, exposure to violence, delinquency, substance use, criminal activities, and prostitution. These problems have beeome more serious, particularly among runaway adoleseents (Korea Youth Shelter Association, 2005).

In 2004, an estimated 304,000 adolescents in South Korea ran away from home. Although 70% of them returned, the remaining 30% used shelter services or stayed on the street. To respond to the needs of these adolescents in trouble, the first adolescent shelter was opened in Seoul in 1992. Since then, the number of shelters has been steadily increasing, today there are 46 shelters throughout the country (National Youth Commission, 2005).

Substance use among runaway and homeless adolescents is prevalent in other countries as well (Kipke, Montgomery, & Mackenzie; Whitbeck & Hoyt, 1999; Votta & Mamion, 2003; Johnson, Whitbeck, & Hoyt, 2005). These adolescents tend to use substances earlier and more often than their non-runaway counterparts (Johnson et al., 2005). Similarly, adolescents in shelters use substances more often and in greater quantity than the adolescents in school (Slesnick, Meyers, Meade, & Segelken, 2000).

South Korean at-risk adolescents are found to use substances much like their counterparts in Western nations (Whitbeck & Hoyt, 1999; Johnston, OMalley, & Bachman, 2002). According to national data compiled by the National Youth Commission, 70.5% of middle and high school students had used alcohol, 29.2% smoked cigarettes, and 10.3% used other drugs (National Youth Commission, 2002). In contrast, the figures for runaway and homeless adolescents are much higher: 90.6% used alcohol, 84.9% smoked cigarettes, 22.4% used nalbuphine hydrochloride, 9.2% amphetamines, 7.8% benzodiazepine, and 8% mariuana and philopon. This data indicates how serious substance use is among both non-runaway adolescents and runaway adolescents in South Korea, particularly the latter.

Because runaway and homeless adolescents tend to be caught up in various problems such as being out of school, violence, substance use, gang activity, and prostitution, early intervention is important. Data from the Korea Youth Shelter Association (2005) in fact, indicates the seriousness of their problem: 48.2% of adolescents using shelter services used alcohol and smoked cigarettes, 37% committed crimes of theft and violence, and 3.4% were involved in prostitution.

Despite the fact that substance abuse by adolescents in shelters is an increasingly serious issue, so far in South Korea, few studies have investigated its prevalence and the risk factors involved. Although there are some studies regarding substance use among adolescents in the country, most have focused only on alcohol consumption by high school students. The present study sought to add to the body of information on substance use by exploring the problems presented by adolescents living in shelters in South Korea.

Risk Factors Associated with Substance Use

Adolescence is a stressful period for many young people since it is a time of physical, psychological, and social change. It has been found that adolescents from disadvantaged socioeconomic environments tend to use substances frequently in order to reduce stress.

Previous studies conducted in the West have reported on the risk factors. For instance, demographic factors, such as gender and age can be involved (e.g., males use alcohol and other drugs more than do females (Johnson, Pentz, Weber, Baer, MacKinnon, Hansen, & Flay, 1990; Lang, 1985); male adolescents are more likely to use alcohol than do females in South Korea (Kim, 1999; Finn, 2006). Callen (1985) reported that the period of major risk for initiation of alcohol and marijuana use peaks between the ages of 16 and 18. Similar findings were reported on high school students in South Korea (Kim & Shin, 2004).

Substance abuse is also related to self-esteem--an individual risk factor. Runaway adolescents were found to have lower self-esteem than non-runaways. Barrett (1990) demonstrated that adolescents with poor self-concept had a greater propensity for abuse of alcohol and other drugs than those with a positive self-concept. Substance abuse can be the means by which adolescents escape from the negative feelings they have about themselves as a result of psychological and developmental difficulties (Beman, 1995).

Alcohol expectancy is an important individual risk factor predicting alcohol abuse (Kim, 1999; Kim, 2004; Reese, Chassin, & Molina, 1994). Alcohol use often precedes cigarette smoking and leads to use of illicit drugs. Previous studies have shown that positive alcohol expectancy had a significant relation to alcohol use. In a study on problem drinking among American adolescents, Kim (2004) reported that negative perceptions about drinking had a direct impact and buffering effect, e.g., moderating friends' negative influences on adolescents' opportunities for problem drinking. The more Korean high school students had positive alcohol expectancy, the more they tended to drink and to binge drink (Yoon, Kim, & Chang, 1999).

Social risk factors involve the negative influence of family, peers, and school. Previous studies have shown that adolescents in families where parents use alcohol heavily were more likely to use substances (Johnson, Whitbeck, Hoyt, 2005; Johnson et al., 1990; Barrett, 1990).

Child abuse is one of the most serious risk factors for alcohol use by late adolescents and adults. Adolescents with a history of physical abuse are more likely to use substances than are those without such a history. The physical abuse rate of adolescent substance users was 6-12 times higher than that of non-substance users (Johnson et al., 2005; Clark, Lesnick, & Hegedus, 1997). A study of Korean girls residing in shelters for runaways found that they frequently ran away because of family conflict, especially violence from their parents or other family members (Kim, 1997).

Sexual abuse, another risk factor for substance abuse, was more common in females, while victimization by other violent acts was more common in males. Adolescents with alcohol abuse or dependence, compared with a control group, were 18-21 times more likely to have a history of sexual abuse (Clark et al., 1997).

Peer pressure was a strong predictor of such risk behaviors as substance use, delinquency, and poor academic performance (Johnson et al., 2005; Bauman & Ennett, 1996; Santor, Messervey, & Kusumakar, 2000; Rice et al., 2005). Pressure by a best friend was the strongest factor leading to substance use (Kandel, Kessler, & Margulies, 1978).

On the other hand, school is an important social environment in which connectedness and perception of care may offset risk (Dryfoos, 1990). An appropriate level of monitoring by parent or school personnel encourages youthful exploration and learning within the confines of supervision and control, thus reducing adolescents' conduct problems and delinquency. Wright and Fitzpatrick (2004) reported that good grades in school were a protective factor against substance use among youth.

METHOD

Sample and Procedures

The study sample consisted of 132 runaway and homeless adolescents living in shelters. They were recruited from 13 adolescent shelters in Seoul and Kyung-gi Province surrounding the capital city--the largest metropolitan area that also has the largest concentration of adolescents in trouble in South Korea (National Youth Commission, 2005). A sample of 13 shelters was drawn from 24 shelters in the metropolitan area. These shelters endorsed the present study and participated in the subsequent survey.

The study complied with Korean Statistics Law, wherein the identity of the study subjects was protected by not recording data on their identity. The study was approved by the Seoul City Health and Welfare Bureau which is responsible for the administration of the health of adolescents.

A total of 150 questionnaires were distributed to the adolescents living in the shelters who had agreed to participate in the survey. Each adolescent who answered the questionnaires was given a multi-use coupon (with a value of US $5) as a reward. Subjects were assured of the voluntary nature of answering the questionnaire and the confidentiality of their responses. Data were collected over a 2-month period (October through November, 2005). Of the 150 questionnaires distributed, 132 were returned and used in the final analysis (response rate 88%).

More than two-thirds (67.2%) of the adolescents were female. The ages ranged from 12 to 20 years (M = 15.8, SD = 1.62). Less than half (46.5%) reported being of low economic status; the rest (53.5%) were of middle and higher economic status. Before admission to the shelter, 27.9% of these subjects had lived with their biological parents, 26.1% with step-parents, 23.4% with a single parent, and 9% with friends. An additional 13.5% reported other living arrangements including institutional care or company dormitory. In all, 38.6% had dropped out of school.

A national survey of runaway youth using shelter services conducted by the Korean Youth Shelter Association (2005) reported similar demographic characteristics in terms of gender and age distribution. In that study, 31% were male, 69% were female, and age ranged from 9 to 19 years. Thus, since the demographics were similar, the subjects of the present study to some degree are representative of the runaway youths using shelter services in the nation.

Measures

The Problem-Oriented Screening Instrument for Teenagers (POSIT), designed to identify adolescents needing further assessment in 10 functional areas, was adopted for this study. Substance abuse was measured here with a 17-item standard scale from 139 POSIT items. Each of the items referred to alcohol and drugs rather than to specific drugs (Latimer, Winters, & Stinchfield, 1997). The 17 yes/no questions were recorded as 1 = yes, 0 = no in this study. The reliability of POSIT scores in the present study was adequate (Cronbach's alpha = .867).

Independent variables which explain substance use risk were as follows:

Demographic characteristics. Age and gender were selected as critical characteristics.

Self-esteem. Self-esteem was measured with 4 items drawn from the Rosenberg Self-Esteem Scale (Rosenberg, 1979). Items on the scale, were rated on a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). Cronbach's alpha was .622.

Alcohol expectancy. Negative alcohol expectancy was measured with six items used in a previous study by Johnston, OMalley, and Bachman, 2002, and translated by Kim (2004). Items were rated on a 4point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree) about the harm of everyday drinking and heavy drinking. Cronbach's alpha was .927.

Parental alcoholism. The Children of Alcoholics Screening Test (CAST) was used to psychometrically identify individuals who have lived with chemically dependent parents. This instrument includes 30 yes/no questions associated with behavior, experiences, and affect on the individual. Jones (1985) found that a cutoff score of six or more reliably identified 100% of the clinically diagnosed children of chemically dependent parents and 100% of the self-reported alcoholics. In the present study, the Korean version of CAST was administered (Kim, Chang, & Kim, 1995). Cronbach's alpha was .955.

Physical abuse/sexual abuse. Physical abuse and sexual abuse were assessed separately by single questions. Physical abuse was measured by a yes/no question that asked whether the respondent had experienced physical violence from others over the past year. Sexual abuse was measured by a yes/no question that asked if the respondent had been sexually abused at any time during his/her life.

Peer pressure. Peer pressure was measured by one question that asks how much the respondent had felt pressured by peers to try drugs. Responses were rated on a 4-point scale ranging from 1 (strongly disagree) to 4 (strongly agree).

School dropout. School dropout was measured by a yes/no question recorded as 1 = attending school, 0 = dropout.

RESULTS

Prevalence of Substance Use

Subjects were asked about their use of alcohol, cigarettes, and other drugs without medical prescriptions over the prior 6 months. Responses were either yes or no. Of the 132 adolescents surveyed, 81.1% had used alcohol, 78.5% had smoked cigarettes, and others had used drugs without medical prescription (Table 1). The drugs used included dextromethophane (40.2%); nalbuphine hydrochloride (28.0%); benzodiazepine (14.0%)i barbiturates (13.8%); anabolic steroids (5.4%); and amphetamines (3.2%). Also 4.3% used drugs such as philopon, cocaine, and marijuana.

As shown in Table 1, there were variations in substance use by gender. Female adolescents tended to use illicit drugs, such as barbiturates, dextromethophane, and nalbuphine hydrochloride, while males were more likely to use alcohol, cigarettes, amphetamines, anabolic steroids, philopon, cocaine, and marijuana.

Factors Affecting Substance Use Risk

Risk factors are presented in Table 2. In all, only 40.9% of subjects responded that they were attending school at the time of this survey. As mentioned, we used CAST to identify if parents of sheltered adolescents were alcoholic. Two-thirds (66.9%) of the adolescents scored 6 or higher on the CAST, which suggests that they were from homes where parental alcoholism was a serious problem.

Compared to findings of a previous study (Nho & Huh, 2003), which reported that about 30% of fathers of non-homeless adolescents were alcoholics, the parental alcoholism rate of adolescents in the present study was twice as high (66.9%). As for violence, 29.8% of the adolescents reported physical violence from others and 18.3% reported being sexually abused.

The POSIT scale is designed to screen consequences associated with alcohol and drug use. We used a POSIT cutoff point of 2. In the present study, 78% of respondents scored 2 or higher on the 17 scale items, which indicated that they were at significant risk for drug use and were to be recommended for further diagnostic assessment (Rahdert, 1991).

As for continuous variables, the score for self-esteem was 2.58 (SD = .56), the score for alcohol expectancy was 2.33 (SD = .79), and the score for peer pressure was 1.71 (SD = .80).

Logistic regression was used to investigate the likelihood of substance abuse. Table 3 shows regression coefficients by POSIT score, which as a dependent variable was divided into two categories (less than one = 0, two or more = 1) for logistic regression analysis. Independent variables--age, gender, self-esteem, alcohol expectancy, parental alcoholism, school dropout, physical abuse, sexual abuse, and peer pressure--were analyzed in this model.

We found that alcohol expectancy, physical abuse, and peer pressure were all statistically significant factors related to substance abuse. However, neither gender nor age was found to be statistically significant for substance use. This supports earlier findings that the rate for school adolescents at high risk for substance use did not differ by gender (Kim & Shin, 2004). On the other hand, the present study does not support an earlier finding that high school students were more likely to use substances than were middle school students (Kim & Shin, 2004).

DISCUSSION

The purpose of the present study was to explore the prevalence of substance use and the specific risk factors for use among sheltered adolescents in South Korea. Compared with non-homeless adolescents, the sheltered adolescents were found to have more serious substance abuse problems. As for the risk of substance abuse, 78% of sheltered adolescents in our study scored at least 2 on the POSIT scale, which suggests that four-fifth were at high risk for substance use and in need of further diagnostic assessment.

Multivariate analyses of the likelihood of meeting problematic criteria for substance abuse provide findings about the sheltered adolescents in South Korea, some of which are similar to those reported in the West.

In the present study, the findings suggest that risk factors, such as physical abuse, alcohol expectancy, and peer pressure, have a significant impact on the likelihood of meeting problematic criteria for substance abuse (a score of 2 or higher on the POSIT).

The present study found that the adolescents in South Korea subjected to physical abuse were more likely to meet problematic criteria for substance abuse. This result is similar to that reported in previous studies (Johnson et al., 2005; Clark et al., 1997; Wright & Fitzpatrick, 2004). These findings in the West and in South Korea suggest that adolescents in both cultures who are physically abused tend to seek relief from associated tension and stress through substance abuse, especially alcohol and marijuana (Clark et al., 1997; Kim, 1997; Resnick et al., 1997).

Second, the present study found that alcohol expectancy is an important factor for predicting substance use risk among sheltered adolescents. This is similar to the findings reported by previous studies (Kim, 2004; Reese et al., 1994). Alcohol expectancy prospectively indicates the onset of adolescent problem drinking (Yoon et al., 1999). Our findings also confirm that alcohol expectancy among sheltered adolescents plays a key role in substance abuse. Korean people tend to tolerate to some degree the use of alcoholic beverages. Nevertheless, alcohol expectancy needs to be taken far more seriously by researchers and practitioners because alcohol use among adolescents precedes other problems, e.g., cigarette smoking and abuse of drugs.

Third, peer pressure was found to be the strongest risk factor for substance abuse. This is also similar to the finding of previous studies (Johnson et al., 2005; Kim & Shin, 2004; Wright & Fitzpatrick, 2004; Diaz, Dusenbury, Botvin, & Farmer-Huselid, 1997). According to these studies, peer association was suggested to be a precursor of risky behaviors or a factor that reinforces and perpetuates preexisting behaviors. Negative peer interaction can be a powerful predictor of unhealthy choices and actions (Ennett & Bauman, 1993). Once on the street, adolescents may be immersed in the subculture of deviant peers who encourage a lifestyle that is conducive to substance abuse (Whitbeck & Hoyt, 1999; Wright & Fitzpatrick, 2004).

An unexpected finding in our study was that gender and age were not statistically significant in predicting substance use. This suggests that, regardless of gender and age, sheltered adolescents are more likely to abuse substances than those who are non-sheltered. Ordinarily, male adolescents use substances more than do female adolescents (Johnson et al., 1990; Lang, 1985; Finn, 2006; Kim & Shin, 2004). However, in the present study, the degree of prevalence among sheltered female adolescents was found to be nearly the same as that among the sheltered male adolescents. Also, female adolescents were found to be using substances which were different from those used by male adolescents. Taking these facts into consideration, future studies should focus on the abuse behaviors of high-risk adolescents living in shelters, particularly female adolescents.

The present study has limitations. As the data were obtained by self-report, the results may suffer from the general weakness associated with this methodology. Further, due to the small size of the sample, the study could not examine all potential factors associated with substance use. Besides, because the study focused mainly on the adolescents' substance abuse, it did not investigate various risk factors associated with family structure and immediate factors that might have influenced the adolescents to run away.

Despite these limitations, the results have several important implications. First, the high prevalence of substance use among sheltered adolescents suggests that policy makers and practitioners working with runaway and homeless adolescents need to be aware of the critical nature of the problem. Furthermore, the degree and extent of substance abuse and addiction among these adolescents clearly indicate that professional intervention programs in shelters are urgently needed in order to treat them and to prevent higher risk-taking behaviors.

Further, since the history of physical violence from others has. a strong influence on substance use as a means of coping with the resulting stress, policy makers and shelter staff need to provide services, including training in coping skills, counseling, referral for addiction treatment, and recreational activities.

In addition, since alcohol expectancy had a significant relationship with the use of drugs and alcohol, preventive intervention targeting at-risk adolescents is urgently needed. Unfortunately, in South Korea, intervention programs for substance use have had little positive effects partly because alcohol prevention services have been provided primarily for college students. Such programs should include adolescents. It seems also necessary to develop cognitive behavioral intervention programs designed to modify misconceptions about drinking by adolescents which stem from the negative alcohol expectancy learned in childhood.

Since peer pressure for alcohol use is probably the most insidious risk factor for predicting substance use, early intervention designed for sheltered adolescents is likely to decrease that influence. Also, services such as ongoing outreach and financial assistance could ameliorate the need for peer dependence. Emergency shelters such as drop-in centers should focus on interventions that promote more positive peer relationships in order to minimize the influence of deviant peer networks on the streets.

The findings of this exploratory study clearly suggest that there are multiple risk factors for substance abuse among sheltered adolescents, and that these factors range from individual characteristics to social and environmental conditions. Future studies need to assess the impact of specific environmental factors upon runaway and substance abuse among adolescents--a growing social concern of a dynamically changing society. Also, longitudinal studies would help explore the problems in depth.

Furthermore, we need to examine family resources of adolescents in a recently industrialized and urbanized society. There is an increasing need to develop ways of resolving the problems inherent in informal networks and supplementing some of the support roles of these networks, particularly the family, by publicly supported services.

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This study was supported by Seoul City, South Korea, in 2005.

Sookyung Park, Ph.D., Department of Social Welfare, Daejin University, Pochon City, Kyonggi-Do, South Korea.

Hae Sung Kim, Ph.D., School of Social Welfare, Kangman University, Yongin City, Kyonggi-Do, South Korea.

Haeryun Kim, Ph.D., Department of Social Work, Seoul Women's University, Nowon-Gu, Seoul, South Korea.

Send reprint requests to Kyu-taik Sung. Ph.D., School of Social Work, University of Michigan, Ann Arbor, Michigan 48109. E-mail: ktsung@umich.edu
Table 1 Prevalence of substance use by gender

 Male Female Total
Used in the past 6 months n(%) n(%) n(%)

Alcohol (n=132) 7 (84.1) 70(79.5) 107(81.1)
Cigarettes (n=130) 37(84.1) 65(75.6) 102(78.5)
Barbiturate (n=94) 2(7.7) 11(16.2) 13(13.8)
Dextromethophane (n=97) 9(32.1) 30(43.5) 39(40.2)
Nalbuphine hydrochloride (n=93) 4(14.8) 22(33.3) 26(28.0)
Benzodiazepine (n=93) 4(14.8) 90(13.6) 13(14.0)
Amphetamine (n=93) 2(7.4) 1(1.5) 3(3.2)
Philopon, cocaine, marijuana (n=93) 2(7.4) 2(3.0) 4(4.3)
Anabolic steroids (n=93) 2(7.4) 3(4.5) 5(5.4)

Table 2
Descriptive statistics of variables used in logistic regression models

Variable N (%) / Mean (SD)
Gender
 Male 44 (32.3)
 Female 88 (66.7)
Age 15.86 (1.62) *
Drop out
 Yes 54 (40.9)
 No 78 (59.1)
Physical abuse
 Yes 39 (9.9.8)
 No 92 (70.2)
Sexual abuse
 Yes 23 (18.3)
 No 103 (81.7)
CAST score
 [less than or 40 (33.1)
 equal to] 6
 [greater than or 81 (66.9)
 equal to] 6
POSIT score
 [less than or 26 (22.0)
 equal to] 6
 [greater than or 92 (78.0)
 equal to] 6
Self esteem 2.58 (.56) *
Alcohol expectancy 2.33 (.79) *
Peer pressure 1.71 (.80) *

* Continuous Variable

Table 3
Logistic regression model predicting substance abuse (POSIT stores)

Variable B SE Exp (B)

Gender -.654 .656 .520
Age -.003 .204 .997
Self-esteem 1.109 .681 3.031
Alcohol expectancy -1.298 .478 .273 **
Parental alcoholism .980 .663 2.665
Physical abuse 1.974 .941 7.201 *
Sexual abuse -.342 .967 .710
Peer pressure 1.692 .584 5.432 **
School dropout .607 .703 1.836

Constant -2.359 3.942 .095
Model Chi-square 37.837 ***
-2 Log likelihood 67.003

*p < .05; **p < .01; ***p < .001
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Author:Park, Sookyung; Kim, Hae Sung; Kim, Haeryun; Sung, Kgu-taik
Publication:Adolescence
Article Type:Report
Geographic Code:9SOUT
Date:Sep 22, 2007
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