Reasons for drug abstention: a study of drug use and resilience.
Despite extensive prevention efforts, recent years have seen an
increase in illicit drug use among young people. However, many people
choose to not use drugs while they are growing up. This study sought to
uncover reasons why some individuals seem to have more resilience when
faced with drug use than others. Fear of the physical damage drugs
caused, parental disapproval of drug use, and a belief that drugs would
interfere with goals were cited most often as reasons for not using.
Furthermore, students who had never used drugs had more positive
relationships with family and peers compared to those who had used them.
Keywords--drug use, prevention, protective factors, resilience
Children (Health aspects)
Davis, Sharon J.
|Publication:||Name: Journal of Psychoactive Drugs Publisher: Taylor & Francis Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 Taylor & Francis Ltd. ISSN: 0279-1072|
|Issue:||Date: March, 2011 Source Volume: 43 Source Issue: 1|
|Product:||Product Code: E121920 Children|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
According to the 2009 National Survey on Drug Use, an estimated
21.8 million people in the United States aged 12 or older were current
users of illicit drugs, such as cocaine/crack, marijuana, heroin,
hallucinogens, inhalants, and nonmedical users of prescription
psychotherapeutics. This number increased by nearly 1% from 2008 (SAMHSA
2010a). In 2009, $1,854,700,000 or 12.1% of the federal drug control
budget was spent on drug prevention efforts (ONDCP 2010). Referring to
recent increases in substance use among adolescents, Pamela Hyde, the
administrator of the Substance Abuse and Mental Health Services
Administration, stated "Our strategies of the past have stalled a
bit with 'Generation Next'. We must find new ways to
communicate with our youth about the dangers of substance abuse"
In 2007, 77.9% of adolescents age 12 to 17 were exposed to prevention messages or drug prevention programs while outside of school and 75.8% during school (SAMHSA 2009). With so much effort and funding being placed on drug prevention, it is vital that prevention programs be evidence-based; effective prevention programs need to be developed based on research. While many research studies have examined risk factors leading to drug use, fewer studies have focused on protective factors, which include characteristics, situations and experiences that may keep a person from using drugs.
Decades of research have shown that the development of substance use disorders is influenced by both genetic and environmental factors (Edwards et al. 2009; Agrawal & Lynskey 2008; Kumpfer & Bluth 2004; Legrand, McGue & Iacono 1999; Gurling et al. 1985). Having a parent who uses, having drug-using peers, family dysfunction, abuse as a child, low motivation to achieve, and violent behavior are all associated with adolescent substance abuse (Agrawal et al. 2008; Enoch 2006; DeWit, Silverman, Goodstadt & Stoduto, 1995).
This study seeks to expand the research foundation on which prevention programs can be developed. Rather than focusing on risk factors, this article will identify protective factors as they relate to resilience.
The concept of resilience evolved from hardiness literature first described by Kobasa (1979). Attributes associated with hardiness include a sense of control over one's life, commitment to goals even when confronted with stressors, and a perception that change is not a threat, but rather a challenge (Kobasa 1979). According to Dyer and McGuinness (1996: 276) resilience is a "process whereby people bounce back from adversity and go on with their lives. It is a dynamic process highly influenced by protective factors." Protective factors can be both intrinsic, such as creativity, cognition, and humor or extrinsic, such as family, community or other social support (Sutherland et al. 2009; Schweizer, Beck-Seyffer & Schneider 1999).
Resilience in an ecosystemic context was first described by Waller (2001). The ecosystemic context specifically looks at the interconnectedness of individuals and social systems, such as families and communities. According to Waller, resilience comes from not just individual factors (e.g. self-confidence, emotional regulation, and a sense of purpose), family factors (e.g. family cohesion, involvement in school and religious activities, and modeling of competent behavior), and community factors (e.g. adequate resources, prosocial role models, and opportunities for belonging), but is highly related to the synergistic effect of these factors. Given the right combination of such protective factors, a child may develop into a healthy well-functioning adult despite adverse experiences. For example, Coyle and colleagues (2009) found that some families function well even when there is parental alcohol abuse. They suggest that families are more resilient when there is positive parenting, parent-child involvement, monitoring, and discipline. An earlier study by Johnson, Glassman, Fiks and Rosen (1989) found that children of drug-abusing mothers were more resilient when their environments were supportive and nurturing when compared with other drug-exposed children.
According to Kumpfer and Bluth (2004), there are certain ingredients necessary for developing resilience. These ingredients can be thought of as protective factors for helping young people avoid drug use. Below are a few of the factors identified by Kumpfer and Bluth:
1) Positive interpersonal relationships with a caring adult
2) Secure attachment (bonding) with a caring adult early in life
3) Parental warmth and emotional support
4) Positive parent/child time spent together
5) Healthy role models
6) Consistent discipline and supervision
7) Reduced stress through family routines and traditions
8) Parental disapproval of drug use
9) Having a purpose in life
10) Strong extended family relationships Researchers and prevention professionals can build more effective prevention programs when they understand the reasons behind resilience. Moreover, prevention programs should increase extrinsic protective factors and encourage the development of intrinsic protective factors. More research is needed on what protective factors keep people from using illicit drugs.
According to the Centers for Disease Control and Prevention (2010), in 2009, 36.8% of high school students had used marijuana at some point in their lives, 20% had used a prescription drug for nonmedical purposes, 11.7% had used inhalants, 6.4% had used cocaine/crack, and 4.1% had used methamphetamine. The purpose of this study was to examine the differences between individuals who have used illicit drugs and those who have never used. Additionally, the researchers sought to uncover the reasons why some people do not use drugs. The Drug Abuse Resiliency Survey was given to a sample of undergraduate college students in order to answer the following questions: (1) what factors do students identify as reasons for not using illicit drugs? (2) Are there significant differences in family and peer relationships between students who have used and those who have not used illicit drugs? (3) What factors are associated with positive family and peer relationships?
The Drug Abuse Resiliency Survey is a 40-item survey developed by the authors. The survey was designed to measure a person's illicit drug use and his or her experiences during childhood and adolescence. Illicit drugs were defined as "marijuana, cocaine/crack, heroin, inhalants, LSD or other hallucinogens, ecstasy, PCP, amphetamines, methamphetamines, and non-medical use of prescription drugs." The survey consists of a combination of demographic, multiple choice and Likert-type items. The authors conducted a reliability analysis on the data used in this study and found satisfactory reliability (Cronbach alpha = .77). As part of the survey, respondents were asked to identify reasons for having not used drugs. Each respondent was presented with 18 common reasons for not using drugs as identified by past research (Dillon et al. 2007; Johnston 1998) and was instructed to choose all that applied to him or her.
The second half of the survey consists of 30 items describing various experiences respondents may have had while growing up. Using a Likert-type scale, each respondent was asked to rate the degree to which each of these items applied to him or her. These 30 items were combined into three separate scales: the Positive Parental Relationship Scale, the Positive Peer Relationship Scale, and the Positive Extended Family Relationship Scale. Each scale is made of several items aimed at measuring whether or not a participant had a positive relationship with family members and friends while growing up. The Positive Parental Relationship Scale was made up of items that reflect a more positive relationship with parents or guardians. Examples of these items include "growing up, I had a warm, positive relationship with my parents/caregivers," "my parents/caregivers were aware of where I was when I left the house," "I felt comfortable talking to my parents/caregivers about problems I was having," and "my parents/caregivers attended activities I was involved in." Other items in this scale reflected a negative relationship such as "I lied to my parents/caregivers." These items were reverse-scored prior to scaling.
The Positive Peer Relationship Scale was made up of items reflecting positive relationships with friends, such as "I felt comfortable talking to my friends about problems I was having." Likewise, the Positive Extended Family Scale was made of items reflecting positive relationships with extended family, including grandparents, aunts, uncles, and cousins. Each item was given a score between 1 and 5 (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). The item scores were combined to yield a total score for each scale. Higher scores indicate more positive relationships.
Participants were recruited from several introductory psychology courses at a university in the mid-South during fall semester 2010. There were 254 students enrolled in those courses. Surveys were handed out at the end of each class and students were told that survey completion was voluntary and the results would be confidential. A total of 199 students agreed to complete the survey. Two participants were not included in the data because they were below the age of 18. The final sample consisted of 197 participants. Seventy-four (37.6%) were male and 123 (62.4%) were female. Ages ranged from 18 to 44. The majority (94%) of the participants were between 18 and 22 years of age, 4% were between 23 and 30 and 2% were between 31 and 44. Most of the participants were either freshman (48.2%) or sophomores (36.5%). Juniors made up 11.7% of the sample and seniors accounted for 3.6%. This study was approved by the university's Institutional Review Board.
A total of 155 (78.7%) of the sample identified their race/ethnicity as White/Caucasian, 30 (15.2%) were African American/Black, four (2.0%) were Asian/Pacific Islander, two (1.0%) were American Indian, and six (3.0%) responded as "other." Each participant was asked whether he or she had used illicit drugs while growing up, as an adult, or ever. A total of 41 (20.8%) reported having used drugs while growing up, 46 (23.4%) reported using as an adult, and 133 (67.5%) reported never using illicit drugs.
Research Question 1
Descriptive statistics were used to measure the factors cited as reasons for students not using illicit drugs. There were 18 factors from which a student could choose. Students were instructed to choose all applicable items. The "physical damage drugs cause" was identified by 72.1% (n = 142) of the students as a reason for having not used drugs when growing up. This factor was identified more often than any other factor followed by "parents would disapprove" (70.6%, n = 139) and "drugs would interfere with my goals" (69.0%, n = 136). The least identified factor was "a drug prevention program", which was identified by 8.1% (n = 16) of the students. Table 1 shows the responses for each factor.
Research Question 2
Independent samples t-tests were used to measure significant differences in family and friend relationships between students who had used and those who had never used illicit drugs. Students were grouped according to how they responded to "have you ever used illicit drugs?" All students responding "yes" made up one group and those responding "no" made up the other group. A total of 133 students reported never using drugs and 64 reported having used. Levene's Test for Equality of Variances showed the variances to be approximately equal for each scale.
The three relationship scales were used in this analysis. Higher means indicate more positive relationships. The first scale was the Positive Parental Relationship Scale. Those who had used had a mean score of 51.44 and those who never used had a mean score of 54.56. Results of the t-test showed significant differences between the two groups (t = 2.51, p < .01). Results for the Positive Peer Relationship Scale showed those who had used had a mean score of 12.72 and those who had never used had a mean of 14.12. A t-test showed significant differences (t = 4.23,p < .01). The third scale was the Positive Extended Family Relationship Scale. The mean for those who had used was 10.39 and for those who had never used the mean was 11.18. Results showed significant differences between groups (t = 2.73,p < .01).
Research Question 3
Last, a Pearson-product correlation test was used to determine if certain factors measured by the Drug Abuse Resiliency Survey were associated with relationships with family and friends. These five factors included: (1) feeling poor when growing up; (2) having a lot of stress when growing up; (3) fitting in at school; (4) getting good grades; (5) having a happy childhood. Each factor was presented to participants using a Likert-type scale and participants were asked to rate the degree to which they agreed or disagreed with the items. Table 2 shows the percent of student agreement and disagreement with these items.
A significant correlation was found between having a happy childhood and a positive parental relationship (r = .632). A weaker, yet statistically significant (at alpha = .01) negative correlation was also found between having a lot of stress when growing up and a positive relationship with parents (r = -.475). No other factors were significantly correlated with positive parental relationships. A statistically significant relationship was also found between having a happy childhood and positive relationships with extended family (r = .438). There were no significant correlations between any of the above-mentioned factors and positive relationships with peers.
The federal government has emphasized the importance of drug prevention and most young people are exposed to drug prevention messages during their preteen and teen years. The results of this study found the main reason for students not using drugs was a concern over the physical damage that drugs can cause. This finding corroborates research by Johnston (1998). According to Johnston, fear of physical damage caused by marijuana use was cited as a reason for not using by 71% of twelfth graders and by 96% as a reason for not using both cocaine and crack. Fear of the effect on physical health was also identified in a study by the British Home Office as a motivator for abstaining from drugs (Dillon et al. 2007).
The second most identified reason for not using drugs was parental disapproval. Studies show that parents are especially important in influencing young people's drug-using behaviors (Macaulay et al. 2005). When parents hold negative attitudes toward drug use their children also tend to disapprove of drugs (Young & Werch 1991). According to Johnston (1998), 60% of twelfth graders did not use marijuana because of parental disapproval. Moreover, 88% reported not using cocaine for the same reason. The third most cited reason for not using was that drugs would interfere with personal goals. Goals help to give a person a sense of purpose. Both parental disapproval of drugs and having a sense of purpose are ingredients of resilience (Kumpfer & Bluth 2004).
It is interesting that only 8.1% of the students in this study reported not using drugs because of a drug prevention program. Currently, there are 34 drug prevention programs identified in the National Registry of Evidence-based Programs and Practices (SAMHSA 2011). Many of these are targeted toward youth. One of the most popular school-based prevention efforts is the Keepin' It Real model used as part of Drug Abuse Resistance Education (DARE). DARE is a 10 week program aimed at 12 to 14 year olds and is conducted in the schools by law enforcement officers. Keepin' It Real seeks to educate adolescents on the risks associated with substance abuse, enhance decision making and resistance strategies, and increase antidrug normative beliefs. Despite its popularity, several studies have questioned the effectiveness of DARE (Thombs 2000; Ennett et al. 1994; Rosenbaum et al. 1994).
Many prevention programs, like DARE, seek to educate children on the effects of illicit drugs. It is possible that although few students identified a drug prevention program as a reason for not using, many of them may have acquired knowledge about the physically damaging effects of drug use through such programs. It is equally likely, however, that they learned about the physical effects of drugs through other sources, such as parents, teachers, peers, or elsewhere. It is beyond the scope of this study, however, to speculate as to where the students acquired knowledge about illicit drugs.
The second part of this study examined the differences in family and peer relationships between those who had ever used drugs and those who had not. Students who had never used drugs had more positive relationships with their parents, extended family, and friends. In an ecosystemic context, resilience is nurtured in environments where there is a close positive relationship with a caring adult (Waller 2001). Furthermore, this study found that having a happy childhood and less stress when growing up were associated with positive relations with parents. These finding corroborate the findings of Kumpfer and Bluth (2004) that positive interpersonal relationships with at least one adult, parental warmth and support, quality time spent with parents, and healthy role models aid in the development of resilience. This study did not ask students to recall how many times they had been offered drugs in the past or whether they had experienced much adversity as a child, so it is impossible to assess whether or not these students had to "bounce back from adversity and go on with their lives." What is known is that resilience is closely related to protective factors and the more protective factors a person has, the more likely he or she is to be resilient. Resilience may be one key to keeping people from taking drugs. Prevention specialists have little or no control over certain factors. If someone is born to a drug-using family, experiences abuse, and has no emotional support at home, there is little that prevention specialists can do to change that child's home life. However, if resilience can be developed in that child, he or she can withstand that environment and overcome his or her circumstances.
This study identified a broad set of protective factors. It would take a multifaceted approach to drug prevention to educate youth on the physical impact of drugs, increase parental disapproval of use, foster a sense of purpose, and develop positive youth, peer and family relationships. According to Waller (2001), protective factors have a cumulative effect and having multiple factors increases a person's resilience. Prevention programs may need to take on a team approach and involve parents, extended family, mentors, teachers, religious leaders, and community members in working toward building protective factors in young people. An example of one such program has been developed by the Search Institute. It is known as the Forty Developmental Assets. This program seeks to increase protective factors such as support, empowerment, boundaries and expectations, positive values, social competency, and motivation. A unique feature of this program is its team approach to building assets. According to the Search Institute (2010), "everyone's an asset builder." Parents, educators, religious leaders, youth organizations, and community leaders are encouraged to participate.
In order to find "new ways to communicate with our youth" (SAMHSA 2010b) prevention experts, researchers, and other concerned individuals are going to have to be creative. It will take innovative thinkers, collaboration, and new ideas. Drug use is increasing among youth. Protective factors can help keep adolescents from using illicit drugs and resilience can enable them to bounce back from adversity and develop into healthy adults.
One limitation of this study was the inclusion of only college students in the sample. It is likely that a sample that included people who were not attending college would have yielded different results. It is possible that people who go to college may have more protective factors and significantly different backgrounds from those who perhaps did not have the opportunity to attend college. Furthermore, the sample consisted of students from only one college. The results, therefore, may not be generalizable.
IMPLICATIONS AND CONCLUSION
Billions of dollars are being spent every year on drug use prevention, yet drug use among young people continues to rise. This trend is alarming and calls for more research on effective prevention efforts. This study found that a fear of physical damage caused by drugs, parental disapproval of drug use, and an attitude that drugs would interfere with personal goals were prevalent among reasons for student abstention from drugs. These factors along with positive family and peer relationships helped to build resilience in the students who participated in this study. Including these types of elements in prevention programs can, perhaps, build resilience in our youth.
By knowing more about why some people do not use drugs, we can better understand effective prevention. Very few students listed drug prevention programs among their reasons for not using. More research is needed on building protective factors and how to implement these factors in prevention programs. Drug prevention is a priority. It is imperative that we find effective ways to go about it.
Agrawal, A. & Lynskey, M. 2008. Are there genetic influences on addiction: Evidence from family, adoption, and twin studies. Addiction 103: 1069-81.
Centers for Disease Control and Prevention (CDC). 2010. National Center for Chronic Disease Prevention and Health Promotion: Healthy Youth. Available at http://www.cdc.gov/HealthyYouth/alcoholdrug/ index.htm#3.
Coyle, J.P.; Nochajski, T.; Maguin, E.; Safyer, A.; DeWit, D. & Macdonald, S. 2009. An exploratory study of the nature of family resilience in families affected by parental alcohol abuse. Journal of Family Issues 30: 1606-33.
DeWit, D.J.; Silverman, G.; Goodstadt, M. & Stoduto, G. 1995. The construction of risk and protective factor indices for adolescent alcohol and other drug use. Journal of Drug Issues 25: 837-63.
Dillon, L.; Chivite-Matthews, N.; Grewal, I.; Brown, R.; Webster, S.; Weddell, E.; Brown, G. & Smith, N. 2007. Risk, Protective Factors and Resilience to Drug Use: Identifying Resilient Young People and Learning from Their Experiences. Available at http://rds.homeoffice. gov.uk/rds/pdfs07/rdsolr0407.pdf.
Dyer, J. & McGinness, T. 1996. Resilience: Analysis of a concept. Archives of Psychiatric Nursing 10 (5): 276-82.
Edwards, A.C.; Svikis, D.S.; Pickens, R.W. & Dick, D.M. 2009. Genetic influences on addiction. Primary Psychiatry 16: 40-46.
Ennet, S.T.; Tobler, N.S.; Ringwalt, C.L. & Flewelling, R.L. 1994. How effective is Drug Abuse Resistance Education: A meta-analysis of project DARE outcome evaluations. American Journal of Public Health 84: 1394-1401.
Enoch, M.A. 2006. Genetic and environmental influences on the development of alcoholism: Resilience vs. risk. Annals of the New York Academy of Sciences 1094: 193-201.
Gurling, H.M.D.; Phil, M.; Grant, S. & Dangl, J. 1985. The genetic and cultural transmission of alcoholism, cigarette smoking, and coffee drinking: A review and an example using a log linear cultural transmission model. British Journal of Addiction 80: 269-79.
Johnson, H.L.; Glassman, M.B.; Fiks, K.B. & Rosen, T.S. 1989. Resilient children: Individual differences in developmental outcome of children born to drug abusers. Journal of Genetic Psychology 151: 523-39.
Johnston, L. 1998. Reasons for use, abstention, and quitting illicit drug use by American adolescents: A report commissioned by the Drugs Violence Task Force of the National Sentencing Commission. Monitoring the Future Occasional Paper 44: 1-27.
Kobasa, S. C. 1979. Stressful life events, personality, and health: An inquiry into hardiness. Journal of Personality and Social Psychology 37: 1-11.
Kumpfer, K.L. & Bluth, B. 2004. Parent/child transactional processes predictive of resilience or vulnerability to "substance abuse disorders." Substance Use and Misuse 39: 671-98.
Legrand, L.N.; McGue, M. & Iacono, W. G. 1999. Searching for interactive effects in the etiology of early-onset substance use. Behavior Genetics 29: 433-44.
Macaulay, A.P; Griffin, K.W.; Gronewold, E.; Williams, C. & Botvin, G.J. 2005. Parenting practices and adolescent drug-related knowledge, attitudes, norms, and behavior. Journal of Alcohol and Drug Education 49: 67-83.
Office of National Drug Control Policy (ONDCP). 2010. National Drug Control Strategy: FY 2011 Budget Summary. Available at http://www.whitehousedrugpolicy.gov/publications/policy/11 budget/index. html.
Rosenbaum, D.; Flewelling, R.; Bailey, S.; Ringwalt, C. & Wilkinson, D. 1994. Cops in the classroom: A longitudinal evaluation of Drug Abuse Resistance Education (DARE). Journal of Research in Crime and Delinquency 31: 3-31.
Schweizer, K.; Beck-Seyffer, A. & Schneider, R. 1999. Cognitive bias of optimism and its influence on psychological well-being. Psychological Reports 84: 627-36.
Search Institute. 2010. Developmental Assets Tools. Available at http:// www.search-institute.org/assets.
Substance Abuse and Mental Health Services Administration (SAMHSA). 2011. National Registry of Evidence-based Programs and Practices. Available at http://www.nrepp.samhsa.gov/AdvancedSearch.aspx.
Substance Abuse and Mental Health Services Administration (SAMHSA). 2010a. Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings. NSDUH Series H-38A, HHS Publication No. SMA 10-4586Findings.Rockville, MD: Office of Applied Studies.
Substance Abuse and Mental Health Services Administration (SAMHSA). 2010b. New Survey Shows Drug Use Rising. Available at http:// www. samhsa. gov/samhsaNewsLetter/Volume_18_Number_5/ DrugUseRising.aspx.
Substance Abuse and Mental Health Services Administration (SAMHSA). 2009. National outcome measures for the strategic prevention framework. As retrieved on 11/03/2010 from http://www. nationaloutcomemeasures.samhsa.gov/PDF/NOMS/NOMSSPF2k9. pdf.
Sutherland, J.A.; Cook, L.; Stetina, P. & Hernandez, C. 2009. Women in substance abuse recovery. Western Journal of Nursing Research 31: 905-22.
Thombs, D.L. 2000. A retrospective study of DARE: Substantive effects not detected in undergraduates. Journal of Alcohol and Drug Education 46: 27-41.
Waller, M.A. 2001. Resilience in ecosystemic context: Evolution of the concept. American Journal of Orthopsychiatry 71: 290-97.
Young, M. & Werch, C. 1991. Keep a clear mind: A parent-child program in drug education. Wellness Perspectives 8: 73-77.
Sharon J. Davis, Ph.D., C.R.C., L.C.P.C., Assistant Professor/MRC Program Coordinator, Department of Psychology and Counseling, Arkansas State University Jonesboro.
Stephanie Spillman, B.A., Graduate Assistant, Arkansas State University Jonesboro.
Please address correspondence and reprint requests to Sharon J. Davis, Ph.D., Assistant Professor/MRC Program Coordinator, Department of Psychology and Counseling, P.O. Box 1560, Arkansas State University, State University, AR 72467; email: firstname.lastname@example.org
TABLE 1 Reasons for Not Using Illicit Drugs Reason Percent Number of Students of Students Physical Damage Drugs Cause 72.1% 142 Parents Would Disapprove 70.6% 139 Would Interfere With Goals 69.0% 136 Psychological Damage Drugs Cause 63.5% 125 Drug Use is Against my Morals 63.5% 125 Fear of Becoming Addicted 60.4% 119 Drugs are Illegal 59.9% 118 Don't Want to Lose Control 51.3% 101 I Might Get Arrested 50.8% 100 It May Lead to Stronger Drug Use 46.2% 91 It is Against my Religious Beliefs 43.7% 86 I Don't Like Drug Users 34.5% 68 My Boy/Girlfriend Would Disapprove 33.5% 66 Drug Dealers Are Dangerous 33.0% 65 My Friends Would Disapprove 27.4% 54 Drugs Are Too Expensive 26.4% 52 I Don't Know Where to Find Drugs 12.2% 24 A Drug Prevention Program 8.1% 16 TABLE 2 Percent of Student Agreement to Experiences While Growing Up Experience Strongly Disagree Neutral Agree Strongly Disagree Agree Felt Poor 28.9% 38.1% 14.7% 9.1% 9.1% Lot of Stress 11.7% 32.0% 28.9% 16.2% 11.2% Fit in at School 2.5% 11.2% 15.7% 43.1% 27.4% Good Grades .5% 2.0% 10.7% 31.5% 55.3% Happy Childhood 2.5% 3.6% 13.7% 33.0% 47.2%
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