Substance use among Hispanic and non-Hispanic adolescents.

This study compared lifetime prevalence data on substance use with demographic and psychosocial variables among 2,821 Hispanic and non-Hispanic white students from two Southwestern cities. Study findings revealed that ethnic-racial background factors were not the strongest predictors of substance use. Rather, when the analyses accounted for school grades and for maternal education, non-Hispanic youth had higher lifetime substance use rates than Hispanic youth. Study findings suggest that preventive intervention and treatment efforts for substance abuse problems among adolescents should consider sociodemographic risk factors as well as ethnic-racial factors.     

Age of first cigarette,alcohol, and marijuana use among U.S. biracial/ethnic youth: A population-based study

This study examines age of first cigarette, alcohol, and marijuana use among self-identified biracial youth, using data from the National Longitudinal Study of Adolescent Health (Add Health). We found an intermediate biracial phenomenon in which some biracial youth initiate substance use at ages that fall between the initiation ages of their 2 corresponding monoracial groups. When controlling for the covariates, our findings show that White-Asian biracial youth begin smoking marijuana and drinking alcohol at earlier ages than Whites and engaging in all forms of substance use at earlier ages than Asian youth. Results indicate that White-American Indian youth start smoking cigarettes at earlier ages than all biracial and monoracial groups. Our findings underscore the need for future research to examine substance-use initiation and progression among biracial/ethnic youth.     

The Effects of Age Composition of 12-Step Groups on Adolescent 12-Step Participation and Substance Use Outcome

Youth substance use disorder treatment programs frequently advocate integration into 12-Step fellowships to help prevent relapse. However, the effects of the predominantly adult composition of 12-step groups on adolescent involvement and substance use outcome remain unstudied. Greater knowledge could enhance the specificity of treatment recommendations for youth. To this end, adolescents (N = 74; M age = 15.9, 62% female) were recruited during inpatient treatment and followed up 3 and 6 months later. Greater age similarity was found to positively influence attendance rates and the perceived importance of attendance, and was marginally related to increased step-work and less substance use. These preliminary findings suggest locating and directing youth to meetings where other youth are present may improve 12-step attendance, involvement, and substance use outcomes.     

Religiosity and youth substance use in a Muslim context

The literature shows that young people are more vulnerable than adults to substance use. Religiosity is one of the factors that has been considered to protect youth from substance use and has also been interpreted as contributing to the substance abuse recovery process. Conceptualizing religiosity as a multidimensional construct, this study aimed to investigate the influence of religiosity on substance use among youth. Three dimensions of religiosity—belief about religion, religious self-practice, and religious social environment—were examined as predictors of substance use. The survey data collected in 2010 by the Governance of Istanbul, Istanbul Department of Education, and Istanbul Police Department were used. Participants were high school students (n = 31,272) between 14 and 18 years old. Structural equation modeling was used for statistical analysis and hypothesis testing. The study found a negative relationship between the three dimensions of religiosity and substance use. Religious social environment was found to be the strongest of the three dimensions. The findings suggest that religion has the potential to reduce the risk of substance use among youth. Implications for future research and policymakers were also discussed.     

Alcohol and Drug Use among Youth – The Interplay of Future Orientation,Parenting, and Housing Conditions

Background: Past research indicated that future orientation might protect against substance use; however, this potential had not yet been examined in the context of a multiple risk factor model that would include different parenting styles and indicators of the material situation. Additionally, past research draws primarily from a limited set of geographical regions, often using convenience samples of children and adolescents. Objectives: The current study addresses these issues by examining (in)direct relationships between substance use (alcohol, marijuana, hard drugs), future orientation, different parenting styles (authoritarian, authoritative, permissive), and family housing conditions, using a representative sample of Slovenian youth. Methods: Correlational and path analyses were used to test the proposed hypotheses. Additionally, possible mediating pathways were examined and evaluated. Results: Findings indicated a negative relation between future orientation and use of all substances. Next, future orientation fully mediated the effect of authoritative parenting on substance use. Finally, housing conditions had a direct and positive effect on authoritative parenting, a direct and an indirect effect on future orientation and only an indirect (through authoritative parenting and future orientation) effect on substance use. Conclusions: Results, besides indicating the relevance of future orientation in understanding substance use among youth, highlight the importance of authoritative parenting (that spans beyond childhood and adolescence) and housing conditions on the development of future orientation. In addition, findings highlight the importance of the material situation when examining antecedents of substance use among youth that might be missed if only direct effects are observed. Results are discussed in the context of the risk factor paradigm.     

Ethnic identity and substance use in multiracial youth: the moderating role of support networks

Background: Substance use in multiracial adolescents exceeds rates identified in the general population. Despite this fact, there is limited research examining risk and protective factors for multiracial substance use. Objectives: The current study examined the moderating effect of social support on the relationship between ethnic identity and substance use in a sample of multiracial adolescent youth. Methods: Multiracial youth (N?=?523) completed a survey that asked questions related to their ethnic identity, perceived social support, and substance use. A series of path analyses were conducted to test the hypothesized relationships between ethnic identity, social support, and substance use. Results: Analyses indicated that ethnic affirmation was negatively related to frequency of, but not quantity of substance use. Teacher support was negatively related to both frequency and quantity of substance use, while parent support was only related to frequency. Further, teacher and parent support emerged as moderators of ethnic affirmation and frequency and quantity of substance use respectively. Conclusions/Importance: Our findings add to the current understandings of the relationship between ethnic identity, social support, ethnic identity, and substance use among the understudied multiracial adolescent population.     

A national study of risk and protective factors for substance use among youth in the child welfare system

While child welfare services are intended, in part, to diminish maltreatment's negative impact on adolescents' development, there is evidence that receiving child welfare services affects adolescents' substance use adversely. The literature on the extent and correlates of this problem is still emerging. The present study aims to fill part of this gap by examining the association between baseline psychosocial risk and protective factors on engagement in substance use behavior over a period of 36 months for child welfare involved youth. It further compares substance use behavior between youth placed in out-of-home care and those who remained with their biological families. Data come from the National Survey of Child and Adolescent Well-Being (NSCAW), a national probability study of children and adolescents undergoing investigation for abuse or neglect. The sample for this analysis was restricted to 827 youth who were 11 years or older at baseline data collection. Key findings include a high rate of social substance use (47.7%) and illicit substance use (17.4%). There was a limited role of protective factors in mitigating risk behavior for social substance use (caregiver connectedness; OR=0.51, p<0.05). Avoiding foster care placement was a protective factor for illicit substance use (OR=0.43, p<0.05). Delinquency was a risk factor associated with both social substance use (OR=1.06, p<0.01) and hard substance use (OR=1.10, p<0.001). Given the high prevalence of substance use among child welfare involved youth, prevention efforts for this population require a better understanding of biological, psychological, and social protective factors. The child welfare system is an untapped resource that has the potential to be a gateway to and a platform for substance abuse prevention services that should be incorporated into child welfare safety and permanency interventions.     

Trajectories of Substance Use among Child Welfare-Involved Youth: Longitudinal Associations with Child Maltreatment History and Emotional/Behavior Problems

Background: Maltreated children experience a variety of adverse outcomes including substance use problems. Although previous research indicated that there may be distinct trajectories of substance use among these youth, studies have examined them as if they were a single homogeneous group. Objectives: The goals of this study were to explore substance use trajectories among child welfare-involved youth and to identify characteristics that distinguish substance use trajectories. Methods: Data from the National Survey of Child and Adolescent Well-Being (NSCAW II) were used. Multilevel latent growth mixture modeling (MLGMM) was performed using a subsample of 625 youth from ages 11–17 years investigated for maltreatment in 2008–2009. Measures included self-reported use of substance use during the previous 30 days, demographic characteristics, maltreatment history, placement in out-of-home care, and behavioral health problems. Results: MLGMM identified two distinct substance use trajectory classes including High Stable Substance Use and Rapid Progression Use. Findings suggest that the experience of physical abuse is the key factor that distinguishes the two groups. When the effects of class-specific covariates were examined, results suggest that involvement in substance use behavior and its escalation vary between groups and are affected by youth’s different previous experiences. Conclusions/Importance: The results have important implications for understanding individual differences in substance use behavior over time and how these differences were shaped by youth’s experiences of family adversity. Study findings may be helpful for developing and enhancing the effectiveness of interventions targeted at decreasing substance use behaviors in child welfare-involved youth.     

Peer victimization and substance use: Understanding the indirect effect of depressive symptomatology across gender

ObjectivePeer victimization in school is common, with emerging literature suggesting that it may also increase risk for substance abuse. Yet, little is known about the underlying mechanisms within this risk pathway. The objective of this study is to use a prospective 3-wave design to examine the mediating role of depressive symptomatology on the relationship between peer victimization and substance use, as well as examine if the pathway varies based on gender.Method801 youth between 6th and 12th grade completed surveys across three years, which included measures on school peer victimization, depression symptomatology and substance use. Models tested the mediational pathway between victimization, depressive symptoms, and substance use. Models were stratified by gender.ResultsControlling for grade and the effect of each variable across waves, a significant indirect effect of peer victimization on substance use through depressive symptoms was found for females, with a non-significant indirect effect for males.ConclusionResults suggest that female youth who are victimized by peers engage in substance use behaviors, at least in part, due to increases in depressive symptoms. Given its effect on depression, female victims may therefore benefit from coping skills training that targets emotion regulation and distress tolerance skills in order to combat increased risk for substance use behaviors as a coping response to their victimization. Further research is warranted to better understand the risk pathway for male youth who also experience peer victimization.     

Patterns of substance use onset among Hispanics in Puerto Rico and the United States

PURPOSE: Examine patterns of progression in substance use among Hispanic youth 13 to 17 years of age from two longitudinally representative studies. METHOD: Patterns of substance use among youth in Puerto Rico were examined using a longitudinal study (n=663) of adolescents living on the island. The National Longitudinal Study of Youth was used to examine patterns of substance use among Hispanics living in the United States (n=1,445). Latent transition analysis was used to estimate the probability of membership in each stage of substance use and incidence of transitions between different substance use stages over time. RESULTS: Six stages best described the heterogeneity in substance use among youth in Puerto Rico. Five stages were sufficient to describe patterns of substance use among youth in the United States. Youth living in Puerto Rico reported lower rates of smoking and illicit drug use, but higher rates of alcohol use, when compared with rates among Hispanics in the United States. DISCUSSION: Similar patterns of substance use were identified for Hispanic youth living in the United States and youth living in Puerto Rico.     

Pathway of protection: Ethnic identity,self-esteem,and substance use among multiracial youth

Fifty percent of adolescents have tried an illicit drug and 70% have tried alcohol by the end of high school, with even higher rates among multiracial youth. Ethnic identity is a protective factor against substance use for minority groups. However, little is known about the mechanisms that facilitate its protective effects, and even less is known about this relationship for multiracial youth. The purpose of the present study was to examine the protective effect of ethnic identity on substance use and to determine whether this relationship operated indirectly through self-esteem, a strong predictor of substance use for among adolescent populations. Participants included 468 multiracial youth in grades six through 12 (53% female). The results found that ethnic identity was indeed related to substance use, partially through changes in self-esteem. Findings from this study contribute to our understanding and development of models of risk and protection for an understudied population.     

Integrated family and cognitive-behavioral therapy for adolescent substance abusers: a stage I efficacy study

This study evaluated the efficacy of Integrated Family and Cognitive-Behavioral Therapy (IFCBT), a multisystems treatment for adolescent drug abuse, versus a Drugs Harm Psychoeducation curriculum (DHPE). A randomized controlled trial assessed youth and parents at baseline and at 1, 3 and 6-month posttreatment points. Youth participants (N=43) met diagnostic criteria for one or more psychoactive substance use disorders with most youth meeting criteria for alcohol and marijuana use disorders. IFCBT produced significant reductions in posttreatment substance use when compared against DHPE. Throughout the 6-month posttreatment period, youth receiving IFCBT used alcohol an average of 2.03 days each month, which was significantly lower than the average number of 6.06 days that DHPE youth used alcohol during the same period. Similarly, youth receiving IFCBT used marijuana an average of 5.67 days each month during the initial 6 posttreatment months which was also significantly lower than the average number of 13.83 days that DHPE youth used marijuana each month during the same period. IFCBT also reduced rates of any marijuana use and produced significant changes in targeted psychosocial risk and protective factors. IFCBT youth exhibited significantly higher levels of rational problem solving and learning strategy skills, and significantly lower levels of problem avoidance when compared with DHPE youths. IFCBT parents exhibited significantly more adaptive scores on communication, involvement, control, and values/norms indices when compared with DHPE parents. No iatrogenic effects were exhibited among youth in either IFCBT or DHPE conditions on the outcome measures examined. The present study findings suggest that IFCBT is a promising approach for the treatment of adolescents with psychoactive substance use disorders.     

Do improvements in substance use and mental health symptoms during treatment translate to long-term outcomes in the opposite domain?

Providers who treat adolescents with co-occurring substance use and mental health issues may prioritize treatment of one set of symptoms believing that improvements in one domain will result in improvements of the other. However, limited empirical data for adolescents provide evidence of such “spillover effects.” Using data from 2900 youth in an outpatient treatment, we examined whether during-treatment changes in substance use or mental health symptoms predicted 12-month outcomes in the analogous and opposite domains. There was very little evidence of spillover effects, only that youth with no internal distress at 0 and 3 months reported lower levels of substance use problems at 12-months relative to youth with internal distress that stayed the same from 0 to 3 months. These findings suggest that providers treat both sets of substance use and mental health symptoms in an integrated manner given that these symptoms commonly co-occur among youth with either set.     

Racial/ethnic differences in the protective effects of self-management skills on adolescent substance use.

A variety of cognitive and behavioral self-management skills have been posited as protective in terms of adolescent substance use. This study examined whether these skills measured in the 7th grade served a protective function in 9th grade substance use across ethnically diverse samples of adolescents. Participants consisted of Black (n = 461) and Hispanic (n = 320) urban youth and White suburban youth (n = 757). Structural equation modeling indicated that a second order Self-Management Skills latent factor consisting of first order latent factors of Decision-Making, Self-Regulation, and Self-Reinforcement skills was protective for adolescent substance use across racial/ethnic subgroups. However, Self-Management Skills were more strongly protective for suburban White youth and less protective for urban minority youth. These findings are consistent with previous research showing that predictive power of risk and protective factors derived from psychosocial theories varies widely across racial/ethnic subgroups of youth and is weaker among racial/ethnic minority youth compared to White youth. An important next step is to broaden the focus of etiology research from individual-level determinants to studying adolescent substance use behavior in the context of the cultural background and primary social settings of young people, such as family, school, and community environments.     

Computerized intervention to prevent drug use among at-risk adolescents in Central Asia: Preliminary family-level findings from a pilot mixed methods trial

BackgroundThe rapidly growing rates of HIV infection in Kazakhstan are largely driven by injection drug use. The study adapts a family-focused evidence-based HIV and substance use prevention intervention for at-risk adolescents from communities in Almaty that have been greatly affected by heroin trade and use.MethodsThis NIDA-funded pilot feasibility trial included 181 at-risk adolescents (ages 14–17) recruited through local schools and 181 of their parents or other adult family members. To be eligible, youth had to reside in city areas with high drug exposure and have at least one personal or family risk factor (e.g., substance-using family members or friends, parental criminal history). In addition to the standard school-based health education program on drug use and HIV, intervention arm adolescent–caregiver dyads received three pilot computerized sessions focused on caregiver-adolescent communication, support and monitoring. Adolescents and caregivers completed ACASI surveys in Russian at baseline, 3- and 6-month follow-ups and a subsample from the treatment group (n = 24 dyads) also participated in post-intervention focus group interviews.ResultsAt 6-month follow-up, small effect sizes were detected for parenting practices as the key theoretical mediating variable. Intervention arm participants reported a reduction in harsh discipline practices (Cohen’s d= −.35, p = .026), an increase in positive and supportive parenting (d = 0.26, p = .042), and a decline in poor monitoring (according to caregivers d = −0.23, p = .137 and adolescents d = −0.25, p = .113). Post-intervention focus groups provided examples of how the intervention content allowed caregivers to reconnect with their children and get more involved in each other's lives.ConclusionIn middle-income countries like Kazakhstan, interventions that integrate family involvement approaches and utilize interactive technologies may represent an engaging and potentially effective tool with high fidelity and easy scalability to reduce substance use and other risk-taking behaviors among at-risk youth.     

The relationship between depressive symptom levels and subsequent increases in substance use among youth with severe emotional disturbance

OBJECTIVE: This study examined the relationship between levels of depressive symptoms and subsequent increases in substance use among 784 youth with severe emotional disturbance enrolled in Medicaid-funded behavioral health care plans. METHOD: Youth at five sites nationwide were interviewed about their emotional and behavior problems, as well as their use of cigarettes, alcohol, and drugs--at both baseline and follow-up. RESULTS: (1) Levels of depressive symptoms were significantly associated with concurrent substance use at baseline. (2) Baseline levels of depressive symptoms predicted subsequent changes in substance use, especially use of illicit drugs and multiple drugs. (3) These findings remained significant, even after controlling for sociodemographic, family, and individual characteristics. CONCLUSIONS: These results indicate that depressive symptoms early in life may signal a risk for increasing involvement in substance use among severe emotional disturbed youth. This finding has important clinical implications for the prevention of substance misuse in this population.     

Trends of Youth Marijuana Treatment Admissions: Increasing Admissions Contrasted with Decreasing Drug Involvement

Background: Recent changes in marijuana policies and their potential negative effects on youth development are a public health concern. Identifying the most appropriate treatment approaches for problematic marijuana use is important. Objectives: The aim of this study was to track marijuana use among young people by examining national changes from 1995 to 2012 in the demographics, referral sources, and the substance use patterns related to youth admissions to substance abuse treatment programs. Methods: We examined first-time substance abuse treatment admissions among youth, utilizing the Treatment Episode Data Set - Admissions (TEDS-A) of the Substance Abuse Mental Health Services Administration (N = 12,025,787). Chi-squared analysis was used to examine differences between admission years and binomial logistic regression was used to examine trends over the 18 years. Results: We found increasing numbers of youth in dependent living situations (e.g. with parents) admitted to substance use disorder treatment for marijuana. We also found a dramatic drop in the degree of drug involvement for those admissions over nearly two decades of data. Conclusions/Importance: While availability and changing perceptions of marijuana might have caused an increase in admissions to substance abuse treatment, our findings indicate that the severity of drug use involved in those admissions has decreased. This study highlights the importance of identifying youth in actual need of treatment services and not overlooking tools such as screening, brief intervention, and motivational interviewing as effective for varying levels of marijuana use by youth.     

Racial/Ethnic Differences in the Protective Effects of Self-Management Skills on Adolescent Substance Use

Abstract

A variety of cognitive and behavioral self-management skills have been posited as protective in terms of adolescent substance use. This study examined whether these skills measured in the 7th grade served a protective function in 9th grade substance use across ethnically diverse samples of adolescents. Participants consisted of Black (n = 461) and Hispanic (n = 320) urban youth and White suburban youth (n = 757). Structural equation modeling indicated that a second order Self-Management Skills latent factor consisting of first order latent factors of Decision-Making, Self-Regulation, and Self-Reinforcement skills was protective for adolescent substance use across racial/ethnic subgroups. However, Self-Management Skills were more strongly protective for suburban White youth and less protective for urban minority youth. These findings are consistent with previous research showing that predictive power of risk and protective factors derived from psychosocial theories varies widely across racial/ethnic subgroups of youth and is weaker among racial/ethnic minority youth compared to White youth. An important next step is to broaden the focus of etiology research from individual-level determinants to studying adolescent substance use behavior in the context of the cultural background and primary social settings of young people, such as family, school, and community environments.     

The influence of high school dropout on substance use among African American youth

The role of high school dropout in the onset and rapid escalation of substance use was investigated with 1,762 African American youth participating in the 1990 and 1992 follow-ups of the National Educational Longitudinal Study of 1988 (NELS:88). In 1990, all youth were students; most were in the 10th grade and approximately 16 years old. Path analysis models were used to examine dropout's unique contribution to substance use and its mediational effect on the association of prior problem behavior with later substance use. Compared with students, dropout youth were 1.6 times more likely to smoke cigarettes and 1.3 times more likely to smoke marijuana. Partial mediational effects emerged for problem behavior and use of cigarettes and marijuana.