Epidemiology of substance use in adolescence: Prevalence, trends and policy implications

Drug and Alcohol Dependence

Volumn 55, Issue 3, 1999, Pages 187-207

  Bauman, Adrian ^a   Phongsavan, Philayrath ^a  

^a UNIVERSITY OF NEW SOUTH WALES   (Australia)

Author keywords

Adolescent; Alcohol; Epidemiology; Prevalence; Substance use; Tobacco

Indexed keywords

ALCOHOL; ANABOLIC AGENT; CANNABIS; DIAMORPHINE; ILLICIT DRUG; PSYCHEDELIC AGENT;

ADOLESCENT; ALCOHOLISM; CHILD; CIGARETTE SMOKING; DRUG DEPENDENCE; DRUG MISUSE; HEALTH STATUS; HUMAN; MONITORING; POLICY; PREVALENCE; PREVENTION; PRIORITY JOURNAL; PUBLIC HEALTH; REVIEW; SUBSTANCE ABUSE; TOBACCO;

NICOTIANA TABACUM;

EID: 0032998012     PISSN: 03768716     EISSN: None     Source Type: Journal    
DOI: 10.1016/S0376-8716(99)00016-2     Document Type: Article

References (116)

1. Acuda S.W., Eide A.H. Epidemiological study of drug use in urban and rural secondary schools in Zimbabwe. Centr. Afr. J. Med. 40(8):1994;207-212.
2. Diagnostic and Statistical Manual of Mental Disorders. 4th ed:1994;American Psychiatric Association, Washington, DC.
3. Battjes R.J. Prevention of adolescent drug abuse. Int. J. Addict. 20:1985;1113-1134.
4. Bauman A., Chen X.C., Dobbinson S., Cooney A., Flaherty B. Primary School Smoking in 1993. 1995;NSW Health Department, Sydney. Monograph, Drug and Alcohol Directorate.
5. Bell R.M., Ellickson P.L., Harrison E.R. Do drug prevention effects persist into high school? How Project ALERT did with ninth graders. Prev. Med. 22:1993;436-438.
6. Berg-Kelly K. Normative developmental behavior with implications for health and healthy promotion among adolescents: a Swedish cross-sectional survey. Acta Paediatr. 84:1995;278-288.
7. Berkelman R.L., Stroup D., Bueler J.W. Public health surveillance. Detels R., Holland W.W., McEwan J., Omenn G.S. Oxford Textbook of Public Health. 3rd ed:1997;735-750 Oxford University Press, New York. Vol II, 20.
8. Best J.A., Thomson S.J., Santi S.M., Smith E.A., Brown K.S. Preventing cigarette smoking among school children. Ann. Rev. Public Health. 9:1988;161-201.
9. Botvin G.J., Baker E., Dusenbury L., Tortu S., Botvin E.M. Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: results of a 3-year study. J. Consult. Clin. Psychol. 58:1992;437-446.
10. Botvin G.J., Baker E., Dusenbury L., Botvin E.M., Diaz T. Long-term follow-up results of a randomized drug abuse prevention trial in a white middle-class population. J. Am. Med. Assoc. 273(14):1995;1106-1112.
11. Bruvold W.H. A meta-analysis of adolescent smoking prevention programs. Am. J. Public Health. 83(6):1993;872-880.
12. Campanelli P.C., Dielman T.E., Shope J.T. Validity of adolescents' self-reports of alcohol use and misuse using a bogus pipeline procedure. Adolescence. 22(85):1987;7-22.
13. Tobacco use among high school students-United States, 1990. Mortality Morbidity Weekly Rep. 40:1991;617-619.
14. Current tobacco, alcohol, marijuana, and cocaine use among high school students-United States, 1990. Mortality Morbidity Weekly Rep. 40:1991;659-663.
15. Alcohol and other drug use among high school students-United States, 1990. Mortality Morbidity Weekly Rep. 40:1991;776-777.
16. Alcohol and other drug use among high school students-United States, 1990. Mortality Morbidity Weekly Rep. 40:1991;783-784.
17. Selected tobacco-use behaviors and dietary patterns among high school students-United States, 1991. Mortality Morbidity Weekly Rep. 41:1992;417-421.
18. Tobacco, alcohol, and other drug use among high school students-United States, 1991. Mortality Morbidity Weekly Rep. 41:1992;698-703.
19. Chapman S., Lupton D. The Fight for Public Health: Principles and Practice of Media Advocacy. 1994;British Medical Journal, London.
20. Chou C.P., Montgomery S., Pentz M.A., Rohrbach L.A., Johnson C.A., Flay B.R., MacKinnon D.P. Effects of a community-based prevention program on decreasing drug use in high-risk adolescents. Am. J. Public Health. 88(6):1998;944-948.
21. Clayton R.R., Cattarello A., Walden K.P. Sensation seeking as a potential mediating variable for school-based intervention: a 2-year follow-up of DARE. Health Commun. 3:1991;229-239.
22. Clayton R.R., Catarello A.M., Johnstone B.M. The effectiveness of Drug Abuse Resistance Education (DARE)-5-year follow-up results. Prev. Med. 25:1996;307-318.
23. Clements K., Gleghorn A., Garcia D., Katz M., Marx R. A risk profile of street youth in Northern California: implications for HIV prevention. J. Adolesc. Health. 20:1997;343-353.
24. Coggan C.A., Disley B., Patterson P., Norton R. Risk taking behaviours in a sample of New Zealand adolescents. Aust. New Zealand J. Public Health. 21:1997;455-461.
25. Cooney A., Dobbinson S., Flaherty B. 1992 Survey of Drug Use by NSW Secondary School Students. 1994;NSW Department of Health, Sydney. NSW Drug and Alcohol Directorate, NSW Department of Health, In-House Report Series, 1994, ISBN: 0 7310 1542 2.
26. Crockett L.J., Petersen A.C. Adolescent development: health risks and opportunities for health promotion. Millstein S.G., Petersen A.C., Nightingale E.O. Promoting the Health of Adolescents: New Directions for the Twenty-First Century. 1993;13-37 Oxford University Press, New York.
27. Cummings K.M., Hyland A., Saunders-Martin T., Perla J., Coppola P.R., Pechacek T.F. Evaluation of an enforcement program to reduce tobacco sales to minors. Am. J. Public Health. 88(6):1998;932-935.
28. DiFranza J., Brown L.J. The Tobacco Institute's 'Its the Law' campaign: has it halted illegal sales of tobacco to children? Am. J. Public Health. 82:1992;1271-1273.
29. Douglas K.A., Collins J.L., Warren C., Kann L., Gold R., Clayton S., Ross J.G., Kolbe L.J. Results from the 1995 National College Health Risk Behavior Survey. J. Am. Coll. Health. 46:1997;55-66.
30. Eccles J.S., Lord S.E., Roeser R.W., Barber B.L., Jozefowicz D.M.H. The association of school transitions in early adolescence with developmental trajectories through high school. Schulenberg J., Maggs J.L., Hurrelmann K. Health Risks and Developmental Transitions During Adolescence. 1997;Cambridge University Press, Cambridge.
31. Elder J.P., Wildey M., de Moor C., Sallis J.F., Eckhardt L., Edwards C., Erickson A., Golbeck A., Hovell M., Johnston D., Levitz M.D., Molgaard C., Young R., Vito D., Woodruff S.I. The long-term prevention of tobacco use among junior high school students: classroom and telephone interventions. Am. J. Public Health. 83(9):1993;1239-1244.
32. Ellickson P.L., Bell R.M., McGuigan K. Preventing adolescent drug use: long-term results of a junior high program. Am. J. Public Health. 83:1993;856-861.
33. Ennett S., Rosenbaum D.P., Flewelling R.L., Bieler G.S., Ringwalt C.L., Bailey S.L. Long-term evaluation of drug abuse resistance education. Addict. Behav. 19:1994;113-125.
34. Fergusson D., Horwood L. Transition to cigarette smoking during adolescence. Addict. Behav. 20(5):1995;627-642.
35. Flay B.R., Koepke D., Thomson S.J., Santi S., Best J.A., Brown K.S. Six-year follow-up of the first Waterloo school smoking prevention trial. Am. J. Public Health. 79(10):1989;1371-1376.
36. Flisher A.J., Ziervogel C.F., Charlton D.O., Leger P.H., Robertson B.A. Risk-taking behaviour of Cape Peninsular high-school students. Part III. Cigarette smoking. S. Afr. Med. J. 83:1993;477-479.
37. Flynn B.S., Worden J.K., Secker-Walker R.H., Badger G.J., Geller B.M. Cigarette smoking prevention effects of mass media and school interventions targeted to gender and age groups. J. Health Educ. 26(Suppl. 2):1995;S45-S51.
38. Franzkowiak P. Risk-taking and adolescent development: the functions of smoking and alcohol consumption in adolescence and its consequences for prevention. Health Promot. 2(1):1987;51-61.
39. Fukushima T., Fujiwara T., Matsumoto J., Isobe A., Shiwaku K., Ishizaki E., Tsuchiya S., Yamane Y. Children's smoking habits in an agricultural community in Japan and the importance of a no smoking program integrating family, school and community health. Public Health. 111:1997;289-292.
40. Gemson D.H., Moats H.L., Watkins B.X., Ganz M.L., Robinson S., Healton E. Laying down the law: reducing illegal tobacco sales to minors in central Harlem. Am. J. Public Health. 88(6):1998;936-939.
41. Gilpin E.A., Lee L., Pierce J.P. Smoking initiation rates in adults and minors: United States, 1944-1988. Am. J. Epidemiol. 140:1994;535-543.
42. Gold D.R., Wang X., Wypij D., Speizer F.E., Ware J.H., Dockery D.W. Effects of cigarette smoking on lung function in adolescent boys and girls. New Engl. J. Med. 335(13):1996;931-937.
43. Goldberg L., Elliot D.L., Clarke G.N., MacKinnon D.P., Zoref L., Moe E., Green C., Wolf S. The Adolescents Training and Learning to Avoid Steroids (ATLAS) prevention program: background and results of a model intervention. Arch. Pediatr. Adolesc. Med. 150:1996;713-721.
44. Goldberg L., Elliot D.L., Clarke G.N., MacKinnon D.P., Zoref L., Green C., Wolf S.L., Miller D., Lapin A. Effects of a multi-dimensional anabolic steroids prevention intervention: the A.T.L.A.S. (Adolescents Training and Learning to Avoid Steroids) program. J. Am. Med. Assoc. 276:1996;1555-1562.
45. Gostin L.O., Arno P.S., Brandt A.M. FDA regulation of tobacco and youth smoking: historical, social, and constitutional perspectives. J. Am. Med. Assoc. 277(5):1997;410-418.
46. Hansen W.B. School-based substance abuse prevention: a review of the state of the art in curriculum, 1980-1990. Health Educ. Res. 7(3):1992;403-430.
47. Hansen W.B., O'Malley P. Drug use. DiClemente R.J., Hansen W.B., Ponton L.E. Handbook of Adolescent Health Risk Behavior. 1996;161-190 Plenum, New York.
48. Harmon M.A. Reducing risk of drug involvement among early adolescents: an evaluation of Drug Abuse Resistance Education (DARE). Eval. Rev. 17:1993;221-239.
49. Hawkins J.D., Catalano R.F., Miller J.Y. Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention. Psychol. Bull. 112(1):1992;64-105.
50. The Substance of Young Needs. 1996;HMSO, London. Health Advisory Report.
51. Hewitt N., Elliott B., Shanahan P. A Review of Risk Behaviours Among 15-24 Year Olds. A Report for the Commonwealth Department of Human Services and Health, National Road Trauma Advisory Council, and Land Transport Safety Authority of New Zealand. 1995;Commonwealth Department of Human Services and Health, Auckland. Monograph Series No. 3, November.
52. Hill D., Wilcox S., Gardner G., Houston J. Tobacco and alcohol use among Australian secondary schoolchildren. Med. J. Aust. 146:1987;125-130.
53. Hill D.J., White V.M., Pain M.D., Gardner G.J. Tobacco and alcohol use among Australian secondary schoolchildren. Med. J. Aust. 152:1990;124-130.
54. Hill D.J., White V.M., Williams R.M., Gardner G.J. Tobacco and alcohol use among Australia secondary school students in 1990. Med. J. Aust. 158:1993;228-234.
55. Hill D., White V., Segan C. Prevalence of cigarette smoking among Australian secondary school students in 1993. Aust. J. Public Health. 19(5):1995;445-449.
56. The Health of a Nation: A Strategy for Health in England. 1992;HMSO, London.
57. Hovell M.F., Slymen D.J., Jones J.A., Hofstetter C.R., Burkham-Kreitner S., Conway T.L., Rubin B., Noel D. An adolescent tobacco use prevention trial in orthodontic offices. Am. J. Public Health. 86(12):1998;1760-1766.
58. Idris A.M., Ibrahim Y.E., Warnakulasuriya K.A.A.S., Cooper D.J., Johnson N.W., Nielsen R. Toombak use and cigarette smoking in the Sudan: estimates of prevalence in the Nile state. Prev. Med. 27:1998;597-603.
59. Jason L.A., Ji P.Y., Anes M.D., Birkhead S.H. Active enforcement of cigarette control laws in the prevention of cigarette sales to minors. J. Am. Med. Assoc. 266(22):1991;3159-3161.
60. Johnston L.D., O'Malley P.M., Bachman J.G. Secondary School Students. National Survey Results on Drug Use from the Monitoring the Future Study, 1975-1995. I:1996;National Institute on Drug Abuse, Rockville, MD. NHI Pub. No. 97-4139.
61. Kann L., Warren C.W., Harris W.A., Collins J.L., Douglas K.A., Collins M.E., Williams B.I., Ross J.G., Kolbe L.J. Youth risk behavior surveillance-United States, 1993. Morbidity Mortality Weekly Rep. 44(No. SS-1):1995;1-56. CDC Surveillance Summaries, March 24, 1995.
62. Kann L., Warren C.W., Harris W.A., Collins J.L., Williams B.I., Ross J.G., Kolbe L.J. Youth risk behavior surveillance-United States, 1995. Morbidity Mortality Weekly Rep. 45(No. SS-1):1996;1-84. CDC Surveillance Summaries, September 27, 1996.
63. Kann, L., Kinchen, S.A., Williams, B.I., 1999. Youth Risk Behaviour Survey, USA 1997, MMWR 14, 1-89.
64. King A.J.C., Coles B. The Health of Canada's Youth: Views and Behaviours of 11-, 13- and 15-year-olds from 11 Countries. 1992;Minister of National Health and Welfare, Ottawa.
65. King A., Wold B., Tudor-Smith C., Harel Y. The Health of Youth: A Cross-National Survey. A Report of the 1993-94 Survey Results of Health Behaviour in School-Aged Children. 1996;WHO, Geneva. A WHO Cross-National Study. WHO Regional Publications, European Series No. 69.
66. King C.A., Ghaziuddin N., McGovern L., Brandt E., Hill E., Naylor M. Predictors of comorbid alcohol and substance abuse in depressed adolescents. J. Am. Acad. Child Adolesc. Psychiatry. 35(6):1996;743-751.
67. Konings E., Dubois-Arber F., Narring F., Michaud P. Identifying adolescent drug users: results of a national survey on adolescent health in Switzerland. J. Adolesc. Health. 16:1995;240-247.
68. Kraft P., Svendsen T. Tobacco use among young adults in Norway, 1973-95: has the decrease levelled out? Tobacco Control. 6:1997;27-32.
69. Lambert E.Y., Caces M.F. Correlates of drug abuse among homeless and transient people in Washington DC in 1991. Public Health Rep. 110:1995;455-461.
70. Lindsay G.A., Rainey J. Psychosocial and pharmacologic explanations of nicotine's 'gateway drug' function. J. School Health. 67(4):1997;123-126.
71. Lowry R., Holtzman D., Truman B.I., Kann L., Collins J.L., Kolbe L.J. Substance use and HIV-related sexual behaviors among US high school students: are they related? Am. J. Public Health. 84(7):1994;1116-1120.
72. Lowry R., Kann L., Collins J., Kolbe L. The effect of socioeconomic status on chronic disease risk behaviors among US adolescents. J. Am. Med. Assoc. 276(10):1996;792-797.
73. Madianos M.G., Gefou-Madianou D., Richardson C., Stefanis C.N. Factors affecting illicit and licit drug use among adolescent and young adults in Greece. Acta Psychiatr. Scand. 91:1995;258-264.
74. Mickey R.M., Goodwin G.D. The magnitude and variability of design effects for community intervention studies. Am. J. Epidemiol. 137:1993;9-18.
75. Miller P., Plant M. Drinking, smoking, and illicit drug use among 15 and 16 years olds in the United Kingdom. Br. Med. J. 313:1996;394-397.
76. Monitoring the Future study, National Survey Results on drug use 1991-1997. URL://www.isr.umich-edu/src/mtf.
77. Mosher J. The merchants, not the customers; resisting the alcohol and tobacco industry strategy to blame young people for illegal alcohol and tobacco sales. J. Public Health Policy. 16:1995;412-432.
78. Murray D.M., Perry C.L. The measurement of substance use among adolescents: when is the 'bogus pipeline' method needed? Addict. Behav. 12(3):1987;225-233.
79. Murray D.M., Pirie P., Luepker R.V., Pallonen U. Five- and six-year follow-up results from four seventh-grade smoking prevention strategies. J. Behav. Med. 12(2):1989;207-218.
80. Murray D.M., Perry C.L., Griffin G., Harty K.C., Jacobs D.R., Schmid L., Daaly K., Pallonen U. Results from a statewide approach to adolescent tobacco use prevention. Prev. Med. 21:1992;449-472.
81. Nutbeam D., Wise M., Bauman A., Harris E., Leeder S.R. Review and Revision of National Health Goals and Targets for Australia. Commonwealth Department of Health, Human Services and Housing. 1993;Australian Government Publishing Service, Canberra.
82. O'Malley P.M., Bachman J.G., Johnston L.D. Reliability and consistency in self-reports of drug use. Int. J. Addict. 18(6):1983;805-824.
83. Osaki Y., Minowa M. Cigarette smoking among junior and senior high school students in Japan. J. Adolesc. Health. 18:1996;59-65.
84. Palinkas L.A., Atkins C.A., Miller C., Ferreira D. Social skills training for drug prevention in high risk females. Prev. Med. 25:1996;692-701.
85. Patrick D.L., Cheadle A., Thompson D.C., Diehr P., Koepsell T., Kinne S. The validity of self reported smoking: a review and meta-analysis. Am. J. Public Health. 84(7):1994;1086-1093.
86. Patton G.C., Hibbert M., Rosier M.J., Carlin J.B., Caust J., Bowes G. Patterns of common drug use in teenagers. Aust. J. Public Health. 19(4):1995;393-399.
87. Pentz M.A., Dwyer J.H., MacKinnon D.P., Flay B.R., Hansen W.B., Wang E.Y., Johnson C.A. A multicommunity trial for primary prevention of adolescent drug abuse. J. Am. Med. Assoc. 261:1989;3259-3266.
88. Perry C.L., Staufacker M.J. Tobacco use. DiClemente R.J., Hansen W.B., Ponton L.E. Handbook of Adolescent Health Risk Behavior. 1996;53-59 Plenum, New York.
89. Perry C.L., Kelder S.H., Murray D.M., Klepp K.-I. Communitywide smoking prevention: long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 Study. Am. J. Public Health. 82(9):1992;1210-1216.
90. Perry C.L., Williams C.L., Veblen-Mortenson S., Toomey T.L., Komro K.A., Austine P.S., McGovern P.G., Finnegan J.R., Forster J.L., Wagenaar A.C., Wolfson M. Project Northland: outcomes of a community-wide alcohol use prevention program during early adolescence. Am. J. Public Health. 86:1996;956-965.
91. Pierce J., Gilpin E. How long will today's new adolescent smoker be addicted to cigarettes? Am. J. Public Health. 86(2):1996;253-256.
92. Pierce J.P., Naquin M., Gilpin E. Smoking initiation in the United States. J. Natl. Cancer Inst. 83:1991;1009-1013.
93. Poulin C., Elliott D. Alcohol, tobacco and cannabis use among Nova Scotia adolescents: implications for prevention and harm reduction. Can. Med. Assoc. J. 156(10):1997;1387-1393.
94. Resnick M.D., Bearman P.S., Blum R.W., Bauman K.E., Harris K.M., Jones J., Tabor J., Beuhring T., Sieving R.E., Shew M., Ireland M., Bearinger L.H., Udry J.R. Protecting adolescents from harm: findings from the National Longitudinal Study on Adolescent Health. J. Am. Med. Assoc. 278(10):1997;823-865.
95. Ringwalt C., Ennett S.T., Holt K.D. An outcome evaluation of Project DARE (Drug Abuse Resistance Education). Health Educ. Res. 6:1991;327-337.
96. Roberts H. Children, inequalities, and health. Br. Med. J. 314:1997;1122-1125.
97. Rouse B.A. Epidemiology of illicit and abused drugs in the general population, emergency department drug-related episodes, and arrestees. Clin. Chem. 42:1996;1330-1336.
98. Sells C.W., Blum R. Current trends in adolescent health. DiClemente R.J., Hansen W.B., Ponton L.E. Handbook of Adolescent Health Risk Behavior. 1996;5-29 Plenum, New York.
99. Shope J.T., Dielman T.E., Butchart A.T., Campanelli P.C., Kloska D.D. An elementary school-based alcohol misuse prevention program: a follow-up evaluation. J. Stud. Alcohol. 53:1992;106-121.
100. Shope J.T., Kloska D.D., Dielman T.E., Maharg R. Longitudinal evaluation of an enhanced alcohol misuse prevention study (AMPS) curriculum for grades six-eight. J. School Health. 64:1994;160-166.
101. Shrier L.A., Emans S.J., Woods E.R., DuRant R.H. The association of sexual risk behaviors and problem drug behaviors in high school students. J. Adolesc. Health. 20:1996;377-383.
102. Sussman S., Burton D., Dent C.W. et al. Use of focus groups in the development of an adolescent tobacco use cessation program. J. Appl. Soc. Psychol. 21:1991;1772-1782.
103. Taylor R. Risks of premature death from smoking in 15-year-old Australians. Aust. J. Public Health. 17(4):1993;358-364.
104. Tobler N.S. Meta-analysis of 143 adolescent drug prevention programs: quantitative outcome results of program participants compared to a control or comparison group. J. Drug Issues. 16(4):1986;537-567.
105. Tobler N.S. Drug prevention programs can work: research findings. J. Addict. Dis. 11(3):1992;1-28.
106. Torabi M.R., Bailey W.J., Majd-Jabbari M. Cigarette smoking as a predictor of alcohol and other drug use by children and adolescents: evidence of the 'Gateway Drug Effect'. J. School Health. 63(7):1993;302-306.
107. Tressider J., Macaskill P., Bennett D., Nutbeam D. Health risks and behaviour of out-of-school 16-year-olds. Aust. New Zealand J. Public Health. 21(2):1997;168-174.
108. Preventing Tobacco Use Among Young People. A Report of the Surgeon General. 1994;Public Health Service, Centers for Disease Control and Prevention, Office on Smoking and Health, Atlanta, GA. US Government Printing Office No S/N 017-001-00491-0.
109. Vartiainen E., Fallonen U., McAlister A.L., Puska P. Eight-year follow-up results of an adolescent smoking prevention program: the North Karelia Youth Project. Am. J. Public Health. 80:1990;78-79.
110. Vartiainen E., Paavola M., McAlister A., Puska P. Fifteen-year follow-up smoking prevention effects in the North Karelia Youth Project. Am. J. Public Health. 88(1):1998;81-85.
111. Wada K., Price R.K., Fukui S. Cigarette smoking and solvent use among Japanese adolescents. Drug Alcohol Depend. 46:1997;137-145.
112. Wang C., Chou P. The prevalence and motivating factors of adolescent smoking at a rural middle school in Taiwan. Subst.Use Misuse. 31(10):1996;1447-1458.
113. Windle M., Shope J.S., Bukstein O. Alcohol use. DiClemente R.J., Hansen W.B., Ponton L.E. Handbook of Adolescent Health Risk Behavior. 1996;121-124 Plenum, New York.
114. Winters K.C., Stinchfield R.D., Henley G.A., Schwartz R.H. Validity of adolescent self-report of alcohol and other drug involvement. Int. J. Addict. 25(11A):1991;1379-1395.
115. Yu J., Williford W.R. The age of alcohol onset and alcohol, cigarette, and marijuana use patterns: an analysis of drug use progression of young adults in New York State. Int. J. Addict. 27(11):1992;1313-1323.
116. Zhu B.P., Liu M., Shelton D., Liu S., Giovino G.A. Cigarette smoking and its risk factors among elementary school students in Beijing. Am. J. Public Health. 86(3):1996;368-375.