1993;92;32-38 PediatricsJean L. Richardson, Barbara Radziszewska, Clyde W. Dent and Brian R. Flay

Taking, Depressed Mood, and Academic AchievementRelationship Between After-School Care of Adolescents and Substance Use, Risk

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32 PEDIATRICS Vol. 92 No. I July 1993

Relationship Between After-School Care of Adolescents and Substance

Use, Risk Taking, Depressed Mood, and Academic Achievement

Jean L. Richardson, DrPH*; Barbara Radziszewska, PhD*; Clyde W. Dent, PhD*; and Brian R. Flay, PhD�

ABSTRACT. Objective. To examine the relationshipbetween parental monitoring and six negative behaviors:cigarette, alcohol, and marijuana use; depressed mood;risk taking and lower academic grades.

Design. Survey of 3993 ninth-grade students in sixschool districts in southern California.

Subjects. The sample consisted of 1930 boys and 2063girls, self-classified as non-Hispanic white (32%), Afri-can-American (13%), Hispanic (46%), or Asian (9%).

Results. A relationship was found between unsuper-vised care after school and susceptibility to cigarette, al-cohol, and marijuana use; depressed mood; risk takingand lower academic grades. Adolescents who were unsu-pervised at home were slightly more likely to engage inproblem behavior than those who were supervised athome. Adolescents at a neighbor’s house, at school, or ata job and especially those who “hang out” were mostlikely to engage in problem behavior. Risk was higher ifthe parent had an unengaged parenting style. Althoughgirls were less likely than boys to engage in problembehavior when supervised, as supervision decreased theywere significantly more likely to have each of these prob-lems. Family structure had little impact on risk.

Conclusions. Self-care, especially when it occurs out-side of the home, is associated with substance use, risktaking, depressed mood, and lower academic grades.Pediatrics 1993;9232-38; after-school care, alcohol, man-juana, smoking, cigarettes, depression, risk-taking behav-ion, academic performance, adolescence.

Estimates of the number of children in self-carewho are younger than 13 years of age range from 2million to 6 million,� with the highest prevalenceamong adolescents.7 To clarify the impact of self-care, the characteristics of the self-care situation needto be specified in terms of age of the child, number ofhours in self-care, location, presence of adults, andparental monitoring.8’9

Several studies report no differences between chil-dren in self-care and those in adult care in personal-ity, social adjustment, and academic achieve-ment,1#{176}�4 yet others report important differences onthe same outcomes.6”5”6 Unfortunately, several ofthese studies are limited by small sample size andself-selection bias.6’10’14

In a prior study, we found17 that self-care amongeighth graders increased the risk of substance use

From the *In5ti�te for Health Promotion and Disease Prevention Research,Department of Preventive Medicine, University of Southern California, Los

Angeles; and 5School of Public Health, University of Illinois at Chicago.

Received for publication Sep 29, 1992; accepted Mar 3, 1993.

Reprint requests to (J.L.R.) USC School of Medicine, 1420 San Pablo St.A-301, Los Angeles, CA 90033.

PEDIATRICS (ISSN 0031 4005). Copyright © 1993 by the American Acad-

emy of Pediatrics.

two fold. Of those in self-care zero hours a week 6.2%smoked one or more packs of cigarettes, 11.1% drank11 or more drinks of alcohol, and 14.0% tried mari-juana, whereas for those in self-care more than 10hours pen week the proportions were 12.8%, 22.6%,and 23.5%. The two fold increase in risk held at alllevels of sociodemographic status, extracurricular ac-tivities, sources of social influence, and stress.

Steinberg18 found no difference between those athome in self-care vs those at home in adult care onresponses to hypothetical antisocial situations (eg,stealing, vandalism, truancy). If the parent did notknow the adolescents’ whereabouts on they were“hanging out” with friends, the responses to the hy-pothetical situations were more negative. The influ-ence of self-care was reduced if the parent was moreauthoritarian. Galambos and Maggs’9 similarlyfound that self-care in the home did not confer addedrisk for problem behavior or self-esteem while self-cane out of the home did. Parental monitoring also isan important deterrent to delinquent activity.15

Parenting style may also impact on after-schoolcare arrangements. Adolescents whose parents par-ticipate less in decision making are more likely toengage in problem behavior than adolescents whoseparents are more involved.’�21

This study extends our research on the relationshipbetween after-school care arrangements and sixproblem behaviors: drug use (cigarettes, alcohol, andmarijuana), risk taking, depressed mood, and aca-demic achievement. In contrast to prior studies thatused more homogeneous samples, this study in-cludes subjects from a wide range of ethnic and so-cioeconomic backgrounds. Since other studies19 sug-gest that girls may be more likely to be negativelyaffected by lack of supervision than boys, we exam-med the impact of gender. Since adolescents who livewith both natural parents are reported to be lesslikely to engage in deviant behavior than adolescentswho live in single-parent households,’8’� we exam-med the impact of family structure. We also exam-med a component of parenting style characterized bythe level of parent and adolescent involvement indecision making.

We evaluated the influence of monitoring on prob-lem behavior and we tested the following hypothe-ses:

I . Adolescents who spend afternoons in settingswhere no adult is present are more likely to en-gage in problem behaviors.

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ARTICLES 33

2. There is no difference in the six problem behaviorsbetween adolescents who are or are not super-vised when the parents of unsupervised adoles-cents consistently monitor their whereabouts.

3. Among unsupervised adolescents, problem be-havior is related to lack of parental knowledge oftheir whereabouts and to unengaged and permis-sive parenting styles.

4. Problem behavior is related to a combined effectof location and supervision and will be orderedfrom the least to the greatest: in home/supervised,home/unsupervised, school (job, communitycenten)/supervised, friends (neighbors)/super-vised, school (job, community center)/unsuper-vised, friends (neighbors)/unsupervised, and“hanging out.”

5. Unsupervised adolescents at home are more likelyto engage in positive behaviors (eg, homework)and to contact their parents by phone than areunsupervised adolescents at other settings.

6. Lack of supervision will have a greater effect onadolescents from single-parent households and ongirls.

Subjects

METHODS

Data were gathered in February 1988 as part of a larger surveyof adolescent smoking and drug use.� Letters describing thestudy were sent to the parents; fewer than 8% did not participatebecause of parental or student refusal. Trained data collectorsprovided instructions and administered the questionnaires to en-tire classes of students. The sample consisted of 1930 male and2063 female ninth-grade public school students in Los Angeles andSan Diego counties self-classified as non-Hispanic white (32%),

African-American (13%), Hispanic (46%), or Asian (9%) (“others”

were dropped from analysis).

Measures

Classroom time constraints required our subscales to be brief.

Substance Use. We categorized substance use based on lifetimeuse and current use. Cigarette use was categorized into eightlevels: (1) never used (40.9%); (2) puffs or one cigarette but not inthe past 12 months (18.2%); (3) more than two cigarettes but not inthe past 12 months (15.1%); (4) few cigarettes in the past 12 months(12.5%); (5) one cigarette in the past month (2.5%); (6) few ciga-

rettes in the past month (3.7%); (7) one or a few cigarettes per week(3.6%); and (8) several per day or more (3.6%).

Alcohol use was categorized into seven levels: (1) never used(21.3%); (2) sips or part of a drink but not in the past month(26.1%); (3) more than 2 drinks but not in the past month (21.4%);(4) several drinks lifetime and I in the past month (10.3%); (5)several drinks lifetime, 2 to 3 in the past month (10.2%); (6) several

drinks lifetime, 4 to 7 in the past month (6.2%); and (7) more than10 drinks lifetime, more than 8 in the past month (4.4%).

Marijuana use was categorized into five levels: (1) never used

(75.2%); (2) used one to four times but not in the past month(12.1%); (3) used five or more times but not in the past month(5.2%); (4) used one to seven times in the past month (5.9%); and(5) used more than seven times in the past month (1.7%).

Depressed Mood. The Children’s Depression Inventory24 is a 27-item self-report measure. We used 7 items of the Children’s De-pression Inventory, corresponding to the first two factors isolated

by Saylor et a1.� Factor one reflected a feeling of not being lovedby others, hating oneseff, and feeling responsible for all bad

things. The second factor reflected feelings of being tired all the

time, of doing everything wrong, of anxiety over ominous events,and of being alone all the time. Cronbach’s a for the abbreviatedDepressed Mood scale was .76.

Academic Grades. Students were asked to categorize the ace-demic grades that they generally receive on a 9-point rating de-

creasing from 8 to 0 corresponding to responses of “mostly A’s,”

“A’s and B’s,” to “mostly F’s.”

Risk Thking. This scale includes five items: “I don’t want to waitseveral years before I can live the life that suits me”; “1 like peopleto think I’m older than I really am”; “It is worth getting into

trouble to have fun”; “I like to take risks”; “I enjoy doing thingsthat people say shouldn’t be done” (Cronbach’s a reliability = .75).

After-School Care. Supervision was assessed by asking the stu-

dents whether there generally were adults present where theywere after school. Monitoring was assessed by asking whether theparent always, usually, or never knew their whereabouts after

school. These two items were combined to provide a category of

adolescents who were adult supervised and three unsupervised

categories with different levels of monitoring. Location of self-carewas assessed by asking whether the student was at home, at a

school or community center, at a friend or relative’s house, or“hanging out” after school. Seven location/supervision categorieswere defined by combining location of care and supervision sta-tus. We also asked the number of hours each week that the ado-lescent was in self-care after school.

Parenting Style. We asked about parents’ control over decisionsrelevant to the adolescent’s daily life and categorized the parents

as either authoritarian (parents make all decisions), authoritative

(joint decision-making, but parents have the final say), permissive(the adolescent has greater influence on decision making than theparents), and unengaged (the adolescent makes all decisions).Similar single-item measures were previously employed by Kan-

del and Davies,26 Kandel and Lesser,27 and Elder�8; the categoriesapproximate the descriptions of parenting styles developed byBaumrind.29�#{176}

Data Analyses

Mean scores for substance use, risk taking, grades, and de-

pressed mood by different descriptors of after-school care (adults

present, location, parental knowledge of their location, and hoursalone) were compared using analysis of variance. Duncan multiplet test comparisons were computed to test for differences betweeneach pair of means. We examined the relationship of gender, eth-nicity, parenting style, and family structure with the six problembehaviors and also examined interactions between these charac-teristics and self-care.

RESULTS

The six outcomes were highly intercorrelated (Ta-ble 1). The correlations between the three substanceuse variables were r > .45. Risk taking was correlatedat r > .30 with all other variables except with grades(r = -.16). Academic grades were negatively come-lated with all other variables, ranging between r

-.16 and r = -.25. Depressed mood was highly con-

TABLE 1. Correlati ons Between Outcomes*

Alcohol Marijuana Risk Taking Depressed

MoodGrades

Cigarettes

AlcoholMarijuanaRisk taking

Depressed mood

.53 .56

.46.33

.39.31

.24

21.19

.31

-.25-.17-.24

-.16

-.20

* All correlations are significant at P � .0001.

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34 ADOLESCENT AFFER-SCHOOL CARE

related with risk taking (r .31) and with othervariables in the range of r = .19 to r = .24.

The first set of analyses examines the relationshipbetween adult supervision and the six outcomes (Ta-ble 2). In each case high scones indicate greater prob-lems except for grades, where higher scores indicatebetter grades. In all cases adolescents who were notsupervised by adults after school had significantlygreater problem behavior (more substance use, risktaking, depressed mood, and poorer grades) thanthose who were supervised by an adult.

The second set of analyses indicated that therewere no significant differences between those whowere supervised and those who were unsupervisedif their parents always knew their whereabouts. Ineach case those whose parents “usually” knew theirwhereabouts had significantly more problems andthose whose parents never knew their whereaboutshad the greatest number of problems. All of thesedifferences were significant at P � .0001.

A third set of analyses examined the combinedeffect of supervision by an adult and where the stu-dent spent time after school: home; school, job, orcommunity center; friend or neighbor’s house; on“hanging out.” The hypothesized order for problembehavior for these categories, given in Table 2, and isbased on prior work by Steinberg.18 In each case theF statistic was significant at P � .0001. Duncan mul-tiple t test comparisons were used to assess differ-ences between pairs of means. For alcohol use, de-pressed mood, and risk taking, being at homewithout supervision conferred greater risk over be-ing at home with supervision.

In general, supervision was more protective thanno supervision in the same location. The order ofmeans was in the direction expected, with the excep-tion of depressed mood, for which students whowere supervised regardless of location were at lessrisk. Those who were at a friend or neighbor’s housewithout supervision or were “hanging out” were atgreater risk and those unsupervised at a school/job/community center were at greatest risk.

Our exploration of the number of hours per weekthat students were alone after school also indicatedsignificantly greater risk for those who are alone formore hours (P values < .0001). For substance use, thegreatest increase in risk occurred between 4 hours/week or less and 5 hours/week or more. For de-pressed mood and grades the risk occurred for thosealone more than 10 hours pen week and for risktaking the differences occurred progressively at alllevels.

Activities in Different Levels of Supervision

We examined how adolescents who were unsuper-vised spend their time after school for each of theself-care situations. Adolescents who were unsupen-vised at home were more likely to cook (x� = 14.2,P = .003), to read or do homework (� = 46.5, P <

.0001), and to watch television (� = 37.6, P < .0001).

Those who were at home on at a friend’s house wereslightly more likely to take lessons (� = 10.1, P =

.02). There was no difference with regard to whetherthey took care of other children. Among those whowere at home, 50% indicated that their parents “al-ways” knew their whereabouts, compared with 46%,

TABLE 2. After-School Arrangements and Six Outco mes (Ana lysis of Variance)*

n Cigarettes Alcohol Marijuana Depressed Risk Grades

Mood Taking

Supervised

Unsupervised

1865

1091

2.3

3.02.8

3.51.3

1.72.0

2.78.3

10.56.6

6.3t 9.4 11.1 8.2 6.8 12.3 4.1

P .0001 .0001 .0001 .0001 .0001 .01

Supervised 1865 2.3c 2.8c 1.3c 2.0’ 8.3c 6.6a

Unsupervised/parents always know where you areUnsupervised/parents usually know where you are

391546

2.4c3#{149}3b

3.0c3#{149}7b

1.5c1#{149}7b

2.1c26b

8.7’11#{149}1b

6.7”6#{149}2b

Unsupervised/parents don’t know where you are 138 3.9” 4.1” 2.1” 4.7” 12.9” 5.7’

F 60.7 65.6 41.4 53.3 90.0 16.4P .0001 .0001 .0001 .0001 .0001 .0001

Home/supervised

Home/no supervisionSchool, job, community center/supervised

Friends, neighbors/supervisedSchool, job, community center/no supervisionFriends, neighbors/no supervisionHangout

1161407343

232

102261364

2.l’�2.4’�2.4c42.8’�

2.8c3.3”3.6”

2#{149}5d

3.0c3.0c3.1’�3�6b

3.8”-”3.8”

1.2’1.4c4�1#{149}4d�

1.5’�”1#{149}6b.c

1#{149}7b

1.9”

1#{149}9d

2#{149}4b�c

2.1c42.1’��

3�9�2.71’

2.8”

7.8’8�9d

9.0�

8.7c4

10#{149}8b

11.1��1�11.9”

6.7””6.7””’7.0”�6�4b�c

6.2c45.9’�

F 39.0 42.7 24.7 14.1 38.8 16.8P .0001 .0001 .0001 .0001 .0001 .0001

Length of time0 h 749 2#{149}3b 2.6c 13b 20b 79d 6.6”1-4 h 987 24b 29b 14b 21b 8.7c 6.6”5-10 h 403 2.9” 3.3” 1.6” 2.2” 97b 6.5”�11 h 877 3.0” 3.4” 1.6” 2.6” 10.2” 6.2”

F 26.4 34.1 22.7 7.9 38.7 7.6P .0001 .0001 .0001 .0001 .0001 .0001

* All statistical tests are significant at P < .0001 and indicate that there are significant differences between means. The Duncan multiple

t test comparisons test for differences between each pair of means; means not sharing a common superscript letter are significantlydifferent from each other (P < .05).

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ARTICLES 35

27%, and 19% for those at school, at a friend’s house,or “hanging out,” respectively; in contrast, 5%, 15%,15%, and 25% in the same ordered categories neverknew their whereabouts (�-� = 104.4, P < .0001). Ofthose adolescents who were unsupervised afterschool, 14% of those who were “hanging out” always

phoned their parents, compared with more than 20%in each of the other groups (�-� 34.1, P < .0001).

Role of Family Structure, Gender, and Ethnicity

Response to supervision or no supervision maydiffer by family structure and by gender. We consid-ered the case of two-parent vs mother-only; therewere too few students from households with a fa-then-only or “other” to analyze.

There were no differences between two-parent andmother-only families in terms of cigarette use, alco-hol use, depressed mood, or risk taking (Table 3).Marijuana use was lower and grades were higher intwo-parent families (P < .0001). These two differ-ences persisted when there were adults present, butwhen there were no adults present the advantage fortwo-parent families disappeared. Only one interac-tion between supervision and family structure wassignificant; adolescents from two-parent familieswere at less risk of marijuana use when supervisedbut at greater risk when unsupervised (interactionP = .01).

There were also few differences when we com-pared girls and boys, except that boys were signifi-cantly more likely to be risk takers and girls weremore likely to get better grades (Table 3). There wasa significant interaction between supervision andgender for each of the six dependent variables aftercontrolling for main effects: P = .0008 for cigarettes,P = .0021 for alcohol, P = .0028 for marijuana, P =

.0046 for depressed mood, P = .0090 for risk taking,and P = .0739 for grades. In each case girls were lesslikely than boys to use substances, be depressed, getpoor grades, or engage in risk-taking behavior whensupervised by an adult, but when unsupervised andparental knowledge of their whereabouts decreasedthey were more likely to have each of these problems(the significant interaction between gender and mon-itoning for risk taking is shown in the Figure; inter-actions between gender and monitoring for otherproblem behaviors indicate a similar pattern).

Mean scores on each outcome were significantlydifferent between ethnic groups for all outcomes ex-cept depressed mood, with means generally higherfor whites and Hispanics for substances and risk tak-ing and higher for grades for Asians (Table 3). Therewas one significant interaction between ethnicity andsupervision after controlling for main effects for mar-ijuana use (P .02) and marginally for grades (P =

.06). When unsupervised, Asian adolescents experi-enced the greatest increase and black adolescents ex-penenced the least increase in marijuana use, butacademic grades of Asians were not adversely asaffected by less supervision as they were for all otherethnic groups.

Role of Parental Decision-Making Style

Of adolescents in “authoritarian” households,30.6% were not adult supervised, nor were 35.4% ofadolescents in “authoritative” households, 40.2% in“permissive” households, and 55.3% in “unengaged”households (� = 63.9, P < .0001). Among two-parentfamilies 33% were authoritarian, 37% authoritative,20% permissive, and 10% unengaged. In the sameorder, for one-parent families the proportions were27%, 40%, 22%, and 11% (� = 8.6, P = .04). Adoles-

TABLE 3. Relationshi p Between Individua 1 and Family Cha racteristics and Pro blem Behaviors An alysis of Variance*

Cigarettes Alcohol Marijuana Depressed Risk GradesMood Taking

Ethnicity

Black 22b 2.6’� 1.6� 2.3” 84b 58d

White 2.8” 3.3” 1.6” 2.5” 9.9” 6.7”

Hispanic 2.6” 3.0” 1.4” 2.2a 87b 6.0c

Asian 21b 2.4c 1.2c 2.3” 88b 7�5�

F 18.2 37.9 13.7 2.4 18.9 106.4P .0001 .0001 .0001 .07 .0001 .0001

Family structure

Both 2.5 3.0 1.4 2.2 9.1 6.4

Mother only 2.7 2.9 1.6 2.3 9.0 6.0t -1.6 .44 -4.2 -.49 .14 5.4P .11 .63 .0001 .63 .89 .0001

GenderGirls 2.6 3.0 1.4 2.2 8.4 6.5

Boys 2.5 2.9 1.5 2.2 9.8 6.2

t 1.2 .46 -2.1 -.27 -8.1 4.8

P .23 .64 .03 .78 .0001 .0001Parenting style

Authoritarian 26b 26b 13b 20b 79b 6.6”Authoritative 25b 30b 14b 20b 90b 6.7”

Permissive 27b31b 15b 2.4’� 93b 65b

Unengaged 3.3” 3.6” 1.8” 3.1” 11.3” 6.2cF 10.8 8.6 9.0 14.1 19.7 7.7P .0001 .0001 .0001 .0001 .0001 .0001

* All statistical tests are significant at P < .0001 and indicate that there are significant differences between means. The Duncan multiple

t test comparisons test for differences between each pair of means; means not sharing a common superscript letter are significantlydifferent from each other (P < .05).

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Monitoring

Always know Mostly know Never know

Mean score

36 ADOLESCENT AFTER-SCHOOL CARE

Fig 3. Effect of gender and monitoringon risk taking. F = 3.87, P = .009.

0

Adult present

cents in unengaged families were much more likelyto report that they were unsupervised and their par-ents did not know their whereabouts (16%), com-pared with 5% for permissive, 3% for authoritative,and 3% for authoritarian families (� = 146.0, P <

.0001).There was significantly more problem behavior

when the parental decision-making style was unen-gaged. There was no significant difference betweenauthoritarian and authoritative parenting style forany dependent variable. Authoritative parentingstyle indicated the best outcomes, although not sig-nificantly so, and unengaged parenting style consis-tently indicated the worst outcomes (Table 3).

We examined interactions between parenting styleand adult supervision to determine whether partic-ular parenting styles are protective even when adultsare absent. For both cigarette smoking (F = 3.74, P =

.01) and marijuana smoking (F = 2.12, P = .10) theeffect of not having an adult present was less if theparent was authoritarian or authoritative but in-creased at a greater rate if the parent was permissiveor unengaged; if the parent was present, there wasvirtually no effect for parenting style.

DISCUSSION

Our results demonstrate a relationship betweenlack of supervised care after school and susceptibilityto cigarette use, alcohol use, marijuana use, de-pressed mood, risk taking, and academic grades.While these results are consistent with those of Stein-berg’8 and Galambos and Maggs,19 the number ofstudents studied is much larger, the sample includessizable numbers of students from four ethnic groups,and the outcomes studied are more clearly indicativeof problem behaviors.

Numerous theories have been developed andtested concerning the development of antisocial be-haviors in adolescents; however, the characteristicsof after-school care and self-care have not explicitlybeen incorporated. Prior research3�33 suggests thatproblem behaviors such as substance use and lower

academic performance have common causes, thatthese behaviors covary, and that initiation of thesebehaviors may be influenced by the opportunity toengage in the behavior and the developmental stageof the youth.�’�5 Studies suggest that these behaviorscomprise a problem behavior syndrome32 and ourdata indicate that depressed mood, substance use,risk taking, and academic grades are significantlyrelated to each other (r values = .16 to .56) and aresimilarly associated with self-care.

Adolescents who spend time after school withoutan adult present are at higher risk of engaging inproblem behavior, and these behaviors increase asparental knowledge of the adolescents’ whereaboutsdecreases. Being unsupervised does not significantlyincrease the risk of problem behavior if parents con-sistently monitor the adolescent’s whereabouts, butthe risk increases if the adolescent is unsupervisedand parents inconsistently or never know the adoles-cents’ whereabouts. The more hours pen week theadolescent remains unsupervised, the greater the riskof problem behavior.

Adolescents who are supervised at home are onlyslightly less likely to engage in problem behaviorthan are adolescents unsupervised at home. The lat-ten, however, are less likely to engage in problembehavior than adolescents who are not at home butare at a neighbor’s house, at school, or at a job; thosewho “hang out” are most likely to engage in problembehavior. The home setting not only protects unsu-pervised adolescents from engaging in undesirablebehavior, to some extent because they are more likelyto be in contact with their parents by telephone, butalso results in more positive behaviors (cooking,reading, or doing homework) than those unsuper-vised elsewhere. Those at home in self-care are in anprotected setting and are less exposed to peers whomay already be involved in problem behaviors or tosituations in which adolescents stimulate each otherto greater risk-taking and problem behavior.

Prior research has shown that youth in self-care aremore likely to have weakened parent bonding, poor

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ARTICLES 37

communication, and increased conflict.36 Strongbonding with deviant peers caused by weakenedconventional bonds with parents and school (as ev-idenced by less time spent on school activities andlower education expectations and aspirations) hasbeen shown to be a primary cause of delinquentbehavior including drug use.37 Self-derogation (andrelated concepts such as low self-esteem and de-pressed mood) also plays a central role in determin-ing problem behavior.�’39 Adolescents who fail tomeet the standards of conventional society are be-lieved to develop a negative self-image that may leadto attempts to conceal disappointment, often by gain-ing the acceptance of more deviant peer groups, me-suiting in greater risk-taking, substance use, andpoorer grades.

The characteristics of the parent-adolescent rela-tionship is likely to be related to whether self-careleads to more deviant behaviors. Authoritarian pan-ents monitored more than the authoritative or per-missive parents, but the distinction was most impon-tant between all of these and unengaged parents,who were least likely to know the whereabouts oftheir adolescent after school. Consistent with others’findings,18”#{176}�2 our results show that the risk of sub-stance use, depressed mood, risk taking, and poorgrades increases when parents are unengaged. Sinceunengaged parenting is most detrimental, it is im-portant to note that this is no more likely to occur inone-parent (11%) than two-parent families (10%). Anauthoritative style of decision making, on the otherhand, was associated with lower rates of problembehavior. However, the interactions between parent-ing style and supervision were significant only forcigarette and marijuana use; thus the thought thatadolescents left alone would be protected if the par-ent had a particular parenting style was only par-tially supported. Other dimensions of parenting stylesuch as warmth and psychological control were notexplored and might be of interest for future study(for example, warmth may have a protective effect ondepressed mood for adolescents in self-care, inas-much as some investigators have found that lack ofparental closeness and depressed mood are related).Although prior studies’�#{176}demonstrated an associa-tion between deviant behavior and single-parentfamily structure, in our sample, family structure (twovs one parent) had little impact on risk.

The way in which girls perceive self-care may bequite different from the way in which boys perceiveit. Although girls were less likely than boys to engagein problem behavior when supervised, as supervi-sion decreases they were more likely to have each ofthese problems; the interactions were significant orborderline for all six variables. This is consistent withprevious work by Galambos and Maggs,19 indicatingthat lack of supervision was more detrimental forgirls. Since girls are traditionally more protected thanboys, a failure on the part of parents to fulfill thisexpected role may lead girls to believe that they areless cared for than expected; boys, on the other hand,may be less likely to regard this autonomy as a lackof caring. Because girls mature earlier they may beperceived by others and by themselves as more ma-

tune than they actually are and they may choose toassociate with older peers.

It is possible that those adolescents who are morepeer oriented choose to spend their time with peersrather than adults; this would suggest that it is theimmutable predisposition of the adolescent that in-fluences the level of parental supervision. We do notbelieve this is the case; although adolescents maystruggle for independence, it is unlikely that parentssupervise less as a response to their adolescent’s levelof peer orientation.18 In fact, the perceptive parent ismore likely to struggle harder to protect adolescentswho appear to be initiating problem behaviors; how-ever, if the parental bond is already weakened or theadolescent has already experienced less supervision,reversing these relationships is especially difficult.More detailed examination of the evolution of paren-tal bonding as it relates to the development of prob-lem behaviors during the adolescent years is sorelyneeded.

Adolescents may also believe that they are lesssupervised because they participate in more deviantbehavior. We think this alternate explanation is lessfeasible because our prior work indicated that paren-tal measures of duration of self-care lead to the sameassociations, thus suggesting that the measurementof supervision is accurate and the associations arereal.

The data clearly show that self-care is associatedwith problem behaviors that are of great concern forthe long-term development and opportunities of ad-olescents. The self-care setting, parental monitoring,and gender of the adolescent are important determi-nants of the influence of self-care on their behavior.Not all adolescents experience these negative out-comes, but parents should carefully consider thecharacteristics of the adolescent and plan to monitortheir activities and location even while they are inself-care.

ACKNOWLEDGMENT

This study was supported by grant ROl DA6307 from the Na-tional Institute on Drug Abuse.

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York, NY: Academic Press; 1982;4:63-105

MALAISE IN THE MEDICAL SCHOOLS

Rather than attacking these problems at the root source, faculty and administra-tons are often doing what physicians have long been used to doing in modernmedicine, that is, they are trying to cure the disease, with little thought to preven-tive medicine that might eliminate treatment and the considerable expense andtrauma usually involved. The resultant malaise that then is afflicting the faculty,administration, and, often, the student body is undermining all functions of theschool and is threatening to become catastrophic if allowed to continue. Regretta-

bly, a “Band-Aid” approach is being used in numerous medical schools unwillingto change long ingrained habits and prejudices. The result is all too plain to see:fiscal deficits, demoralized faculty, resentful students, and a massive decline inloyalty of institutions to personnel, reciprocated by all employees of the institution.

Rapp F. Malaise in the medical schools. The Pharos. Spring 1992:21.

Noted by J.F.L., MD

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1993;92;32-38 PediatricsJean L. Richardson, Barbara Radziszewska, Clyde W. Dent and Brian R. Flay

Taking, Depressed Mood, and Academic AchievementRelationship Between After-School Care of Adolescents and Substance Use, Risk

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