Kaplan + Sadock's Synopsis of Psychiatry, 11e - page 499

31.1 Introduction: Infant, Child, and Adolescent Development 1105
from smoking-related diseases. Cigarettes are the most common
type of tobacco used among middle-school students followed by
cigars, smokeless tobacco, and pipes.
cannabis. Marijuana is the most popular illicit drug, with
14.6 million people using it (6.2 percent of the population),
two thirds being under the age of 18. Its use, however, is slowly
declining. About 6 percent of 12th graders report daily use of
marijuana.
One of the major reasons for such prevalence of marijuana
use among teenagers is because many find that marijuana is eas-
ier to get than alcohol or cigarettes. This belief has declined in
recent years. Once teenagers are dependent on marijuana, they
often tumble into truancy, crime, and depression.
cocaine. About 13 percent of high school seniors use cocaine.
exceeding the national average of 3.6 percent. In addition, about
1 percent of 12th graders admit to using phencyclidine (PCP).
Crystal methamphetamine (ice) has an annual prevalence in
12th graders of about 2 percent.
opioids. In recent years, the number of teens using prescrip-
tion pain relievers for nonmedical reasons has increased. Pre-
scription drug abuse by people ages 18 to 25 has increased
15 percent. Drugs of specific concern are the pain relievers oxy-
codone (OxyContin) and hydrocodone (Vicodin). OxyContin
has gained ground among high school students since its emer-
gence in 2001, with 5 percent of 12th graders, 3.5 percent of 10th
graders, and 1.7 percent of 8th graders reporting use. Vicodin was
used by 9.3 percent of 12th graders, 6.2 percent of 10th graders,
and 2.5 percent of 8th graders.
heroin. Heroin use is prevalent among adolescents, although
less so than cocaine. The average age of use is 19, but it is used
by almost 2 percent of 12th graders, the nasal route (snorting)
being the most common method of use.
Violence. Although rates of violent crime have decreased
throughout the United States in recent years, violent crimes
by young offenders are on the increase. Homicides are the
second leading cause of death among persons ages 15 to 25.
(Accidents are first; suicides are third.) Black male teenag-
ers are far more likely to be murder victims than are boys
from any other racial or ethnic group or girls of any race.
The factor most strongly associated with violence among
adolescent boys is growing up in a household without a
father or father surrogate; this factor aside, race, socioeco-
nomic status, and education show no effect on the propen-
sity toward violence.
bullying. Bullying is defined as the use of one’s strength
or status to intimidate, injure, or humiliate another person of
lesser strength or status. It can be categorized as physical, ver-
bal, or social. Physical bullying involves physical injury or
threat of injury to someone. Verbal bullying refers to teasing
or insulting someone. Social bullying refers to the use of peer
rejection or exclusion to humiliate or isolate a victim.
Approximately 30 percent of 6th through 10th grade students
are involved in some aspect of moderate-to-frequent bullying,
either as a bully, the target of bullying, or both. Approximately
1.7 million children within this age group can be identified as
bullies. Boys are more likely to be involved in bullying and vio-
lent behavior than girls. Girls tend to use verbal bullying rather
than physical.
An estimated 160,000 students miss school each day
because of fear of attack or intimidation from peers; some are
forced to drop out. Stresses of “victimization” can interfere
with student’s engagement and learning in school. Children
who bully other children are at risk for engaging in more seri-
ous violent behaviors, such as frequent fighting and carrying
a weapon.
Cyber Bullying. During the last decade, electronic or internet
bullying has become of great concern to adolescents. Cyber bul-
lying is defined broadly, to convey the use of electronic means to
intentionally intimidate or harm someone. The reported preva-
lence of cyber bullying is variable, reports ranging from 1% to
62% of youth reporting that they were victims of cyber victim-
ization. A study of about 700 Australian students, recruited at
age 10 years, and followed until age 14 to 15 years, found that
15% had engaged in cyber bullying, 21% had engaged in tra-
ditional bullying, and 7% had engaged in both. Another study
of self-reported information collected from 399 teens in the 8th
to 10th grades, found that involvement in cyber bullying, either
as a victim or a bully, specifically contributed to the prediction
of depressive symptoms and suicidal ideation. This correlation
of cyber bullying and depressive symptomatology was found to
be stronger than the association of traditional bulling and affec-
tive disorder.
Gangs. Gang violence is a problem in various communities
throughout the United States. There are 2,000 different youth
gangs around the country with more than 200,000 teens and
young adults as members. Most members are between the ages
of 12 and 24 years, with an average of 17 to 18 years. Gang
membership is a brief phase for many teenagers; one half to two
thirds leave the gang by the 1-year mark. Boys are more likely to
join gangs than girls; however, female gang membership may be
underrepresented. Female gang members are more likely to be
found in small cities and rural areas and tend to be younger than
male gang members. Female gang members are also involved
in less delinquent or criminal activity than males and commit
fewer violent crimes.
weapons. Each day, on average, nearly tenAmerican children
younger than the age of 18 years are killed in handgun suicides,
homicides, and accidents. Many more are wounded. One in five
youths in grades 9 to 12 carries a weapon: knife, gun, or club.
By law, firearms cannot be sold to anyone younger than the
age of 18 years. Two thirds of students in grades 6 to 12 say
that they can get a firearm within 24 hours, however. More than
22 million children live in a home with a firearm. In 40 percent
of these homes, at least one gun is kept unlocked and 13 percent
are kept unlocked and loaded. Two of three students involved in
school shootings acquired their guns from their own home or
that of a relative. At least 60 percent of suicide deaths in teens
involve the use of a handgun.
school violence. According to the CDC of all youth homi-
cides in 2010 about 2 percent occurred in schools. Approxi-
mately 7 percent of teachers report they have been threatened