The Role of Individual and Contextual Factors in Differentiating Substance Use Profiles among Adolescents

Background: Adolescent substance use is a significant public health concern due to its prevalence and associated negative consequences. Although many adolescents use substances, there is substantial heterogeneity in their use patterns. Identifying risk and protective factors that differentiate adolescents with different substance use profiles is important for preventing negative consequences for those at risk. Objective: This study identified distinct latent profiles of substance use by considering adolescents' involvement in multiple common and illicit substances as well as related problems and examined the extent to which individual and contextual factors in the family, peer, school, and neighborhood environments were related to adolescents' membership of substance use profiles. Method: Data came from 9,155 high school students (51% female; 74% European American) who completed electronic surveys in the 2009 Dane County Youth Assessment (DCYA). Latent class analysis (LCA) was conducted to identify profiles of adolescent substance involvement and related problems. Multinomial logistic regression was conducted to examine associations between individual and contextual factors and latent class membership. Results: LCA identified four distinct profiles of adolescent substance use characterized by both licit and illicit substance use and related problems: Abstainers (56.3%), Alcohol-only users (25.6%), Alcohol-cigarette-marijuana users (13.8%), and Problem polysubstance users (4.3%). Controlling for demographics, individual and contextual factors were associated with adolescents' likelihoods of membership in substance use profiles; notably, the associations varied to some extent across substance use profiles. Conclusions: Substance use is heterogeneous among adolescents. Effects of risk and protective factors on substance use vary depending on adolescents' substance use patterns.     

Substance Use and Sexual Orientation among East and Southeast Asian Adolescents in Canada

The purpose of this study was to examine the relationship between substance use and sexual orientation among Asian adolescents in Canada. We analyzed an East- and Southeast-Asian subsample of a province-wide, school-based survey (weighted N = 51,349). Compared to heterosexual adolescents of the same gender, gay, lesbian, bisexual, and mostly heterosexual adolescents were more likely to use alcohol, marijuana, or other illicit drugs. Particularly, sexual minority girls were at increased risk for substance use. The findings suggest the need for substance use prevention interventions that are sensitive to gender, sexual orientation, and culture.     

Clustering of Sex and Substance Use Behaviors in Adolescence

Background: Adolescents often experiment with substance use and sexual activity, which can impact upon their health and well-being, and establish harmful patterns of behavior which continue into adulthood. While substance use and participation in sexual behaviors often co-occur, few studies have examined whether these behaviors cluster in adolescence. Objective: To investigate clustering of sexual activity and substance use among youth in Northern Ireland. Method: Data from 875 young people (aged 16) who participated in the 2008 Northern Ireland Life and Times Survey were used to investigate clustering using the Odds/Expected ratio method. Gender differences in clustering were explored. Results: Alcohol consumption was the most prevalent risk behavior (75%), followed by cigarette smoking, sexual intercourse, illicit substance use, and solvent use the least prevalent. Over 40% of young people participated in multiple risk behaviors (2 or more). Several behavior combinations were statistically clustered, for most the reported prevalence was lower than expected, however, participation in all five risk behaviors occurred at a much higher rate than expected, particularly for male youth. Conclusions: While experimentation with risky behaviors is often considered developmentally appropriate in adolescence it is important to understand how young people experience these behaviors, and the potential for multiple risk exposures as a result of participation in substance use and sexual behaviors. These findings highlight the clustering of substance use and sexual behaviors, and indicate variations in vulnerability to participation in multiple risk behaviors by gender.     

The Relationship Between Hope and Adolescent Likelihood to Endorse Substance Use Behaviors in a Sample of Marginalized Youth

Background: Hopefulness has been associated with increased treatment retention and reduced substance abuse among adults, and may be a promising modifiable factor to leverage in substance abuse treatment settings. Few studies have assessed the relationship between hopefulness and substance use in adolescents, particularly those with high-risk backgrounds. Objective: We explored whether high hope is associated with less likelihood for engaging in a variety of substance use behaviors in a sample of marginalized adolescents. Methods: Using logistic regression, we assessed results from a cross-sectional anonymous youth behavior survey (n = 256 youth, ages 14 to 19). We recruited from local youth serving agencies (e.g., homeless shelters, group homes, short-term detention). Results: The sample was almost 60% male and two thirds African American. Unadjusted models showed youth with higher hope had a 50-58% (p = <.05) decreased odds of endorsing heavy episodic drinking, daily tobacco use, recent or lifetime marijuana use, and sex after using substances. Adjusted models showed a 52% decreased odds of lifetime marijuana use with higher hope, and a trend towards less sex after substance use (AOR 0.481; p = 0.065). No other substance use behaviors remained significantly associated with higher hope scores in adjusted models. Conclusions/Importance: Hopefulness may contribute to decreased likelihood of substance use in adolescents. Focusing on hope may be one modifiable target in a comprehensive primary or secondary substance use prevention program.     

Family Functioning and Parent Support Trajectories and Substance Use and Misuse among Minority Urban Adolescents: A Latent Class Growth Analysis

We sought to examine latent classes of family functioning and parent support trajectories during high school and whether these trajectories are associated with an increased risk of substance use and misuse among urban youth. A total of 850 adolescents (Mage = 15.1 years) were included in this study, assessed at baseline, 12-, 24-, and 36-months postbaseline, and completed self-report measures on past 30-day alcohol and marijuana use, binge drinking, and measures of family functioning and parent support. Latent class growth analysis revealed that trajectories of high family functioning and parent support are associated with a decreased risk of marijuana use. Findings may be helpful to inform family-based preventive interventions.     

Competitive Sport Involvement and Substance Use among Adolescents: A Nationwide Study

Background: The empirical research examining the impact of sports participation on alcohol and other drug use has produced mixed results. Part of this problem may be the result of how different types of sports participation create different experiences that shape certain types of behaviors that either facilitate or deter substance use. Objectives. We examined the association between different types of competitive sports participation and substance use among a nationally representative sample of adolescents. Methods: Two recent cross-sections from the Monitoring the Future were merged to capture a large subsection of adolescents who participate in either high-contact sports (football, wrestling, hockey, and lacrosse), semicontact sports (baseball, basketball, field hockey, and soccer), and noncontact sports (cross-country, gymnastics, swimming, tennis, track, and volleyball). Results: Multivariate analyses revealed that adolescents who participated in high-contact sports had higher odds of using substances during the past 30 days and initiating substance use at early ages. Further, adolescents who participated in noncontact sports had lower odds to indicate smoking cigarettes and marijuana during the past 30 days. Conclusions: Parents, educators, and policy makers need to consider that some sporting contexts may be a catalyst to engage in risky behaviors like substance use.     

The Influence of Acculturation on Substance Use Behaviors among Latina Sexual Minority Women: The Mediating Role of Discrimination

Background: A large body of work has demonstrated that sexual minority women have elevated rates of substance use morbidity, as compared with heterosexual women, and that this might be especially true for women of color. Objectives: This study examines the influence of acculturation and discrimination on substance use among Latina sexual minority women. Methods: Data were collected from 2007 to 2008 as part of a larger community-based survey in the greater Chicago area. Scales measured discrimination, acculturation, and substance use. Structural equation modeling validated scales and examined their relationships, which were further described via mediation analysis. Results: Increased acculturation leads to substance use and this relationship is partially mediated by discrimination (Sobel test = 2.10; p < .05). Conclusions/Importance: Implications of these findings and directions for future research are discussed. Funding was provided by several women's and public health organizations.     

A Comparison of Adolescents in Foster Care and Their Peers in High School: A Study of Substance Use Behaviors and Attitudes

ABSTRACT

While adolescents in foster care are known to be more at risk for substance abuse, existing studies have significant limitations in their methodology, making it challenging to gauge the extent of current use of drugs, tobacco, and alcohol compared with their same-age peers not in care. This article examined data collected from adolescents currently in foster care alongside their same-aged peers within the same high schools in California, in order to learn more about existing rates of and attitudes toward substance use. California is the most populous state in the country with the highest number of children in foster care. Data were drawn from 166,521 students who were both in and out of foster care and were currently in the ninth and eleventh grades; this sample was comprised of 165,815 non-foster youths and 706 students in foster care. The adolescents completed the 2012–2013 administration of the California Health Kids Survey (CHKS). This study provides a clearer picture of current substance usage, finding that California adolescents in care are more likely to use substances than their same-aged peers, even after controlling for their demographic background characteristics. It was also found that attitudes regarding potential harm in using substances (2.29 versus 2.11), difficulty in obtaining substances (3.17 versus 3.24), and negative attitudes toward substance users (1.93 versus 2.18) were stronger for youths in foster care compared to their peers with similar demographic backgrounds who are not in care. Suggestions for interventions are discussed.     

Associations between Sociodemographic Characteristics and Sexual Risk Behaviors among Methamphetamine-using Men who Have Sex with Men

Background: Methamphetamine-using men who have sex with men (MSM) exhibit elevated rates of HIV and STI prevalence, indicating increased engagement in sexual risk behaviors. Objectives: This analysis elucidates associations between participant sociodemographics (i.e., age, racial/ethnic identity, sexual identity, educational attainment, and HIV status) and sexual risk behaviors, particularly substance use before/during sex, and engagement in condomless anal intercourse (CAI) with casual, anonymous, and/or exchange male partners. Methods: From March 2014 through January 2016, 286 methamphetamine-using MSM enrolled in a technology-based study to reduce methamphetamine use and HIV sexual risk behaviors. A robustly estimated generalized structural equation model employing the negative binomial family and log link function (n = 282) tested the simultaneous associations between participant sociodemographics and engagement in HIV sexual risk behaviors. Results: Participants' racial/ethnic identity (χ²₍₆₎ = 43.5; p < 0.0001), HIV status (χ²₍₆₎ = 22.0; p = 0.0012), educational attainment level (χ²₍₆₎ = 13.8; p = 0.0322), and years of age (χ²₍₆₎ = 32.4; p < 0.0001) all influenced participants' engagement in substance use before/during sex and engagement in CAI. Methamphetamine (χ²₍₂₎ = 7.0; p = 0.0309) and marijuana (χ²₍₂₎ = 9.7; p = 0.0079) use before/during sex influenced participants' engagement in CAI with casual, anonymous, and exchange male partners. Conclusion: Results indicate the importance of intervention efforts focused on younger racial/ethnic minority MSM with fewer years of educational attainment, and provides evidence of the specific subpopulations of MSM at greatest risk of detrimental effects of illicit substance use.     

Parental Style as a Possible Mediator of the Relationship Between Religiosity and Substance Use in African-American Adolescents

Abstract

Objectives: In both the general adolescent literature and African-American adolescent substance use literature, several facets of family relationships have been identified as protective factors for adolescent substance use. Two such factors are religiosity and parental style. The relationship of these variables, however, may not be direct in relation to adolescent substance use. There are gaps in the knowledge base for African-American youths living in poverty that would benefit from further exploration.

Method: A sample of 2,317 African-American adolescents, living in metropolitan low-income areas and ranging in age from 9 to 19 years old, were surveyed. An exploratory analysis was performed to determine if parental style was a mediator variable for religion and substance use.

Results: The results suggest that parental style is a mediating variable. Results were significant for several parental style and religiosity variables.

Conclusions: The parent-adolescent relationship is an important factor influencing adolescent substance use. Also, the influence of religiosity appears to be a significant factor in this relationship. This relationship should also be targeted when considering any intervention for treating these adolescents. Further research should be conducted in this domain.     

The Comorbidity of Psychiatric and Substance Use Disorders Among Hispanic Adolescents

Objective: The comorbidity of psychiatric disorders and substance abuse disorders among adolescents and adults is well-documented in the literature. The current study investigates the relationship between psychiatric and substance use disorders in a sample of treatment-seeking Hispanic adolescents. Methods: The study uses baseline data (N = 190) from a randomized control trial testing the effectiveness of a family-based treatment for Hispanic adolescents with substance abuse disorder to examine the relationship between psychiatric disorders and substance use patterns at baseline, including types of substances used (both lifetime use and past-month use) and age at onset of substance use, controlling for age and gender. Results: Linear regression models were used to examine predictors of age at onset, while logistic regression models examined predictors of lifetime substance use. Significant findings predicting age at onset for marijuana and alcohol are discussed. In addition, psychiatric profiles were differentially associated with lifetime use of sedatives, stimulants, and hallucinogens, but not alcohol or marijuana. Conclusions: Findings from this study can be used to help inform the treatment of adolescents seeking mental health and substance use services.     

Mental Health and Substance Use Disorder Comorbidity among Methamphetamine-Using Men Who have Sex with Men

Men who have sex with men (MSM) exhibit elevated rates of mental health and substance use disorder relative to their non-MSM male counterparts. Methamphetamine use in particular has been associated with both neuronal damage and mental health disorders among MSM, and this study reports on the prevalence and comorbidity of DSM-5 mental health and substance use disorders in a sample of methamphetamine-using MSM. From March 2014 through January 2015, 286 methamphetamine-using MSM enrolled in a study to reduce methamphetamine use and sexual risk behaviors. At baseline, participants demonstrated high rates of current major depressive episode (35.8%), antisocial personality disorder (23.9%), suicide risk (23.2%), obsessive-compulsive disorder (23.2%), and social phobia (20.4%), as well as methamphetamine use disorder (89.1%), marijuana use disorder (41.0%), alcohol use disorder (39.6%), cocaine use disorder (30.9%), and inhalants use disorder (15.4%). Analyses revealed significant (p < 0.05) associations between methamphetamine use disorder severity and all listed mental health disorders, as well as between alcohol use disorder and all listed mental health disorders. Mental health disorder prevalence and substance use disorder severity were both elevated, and both methamphetamine and alcohol use disorder severity were associated with increased likelihood of comorbid mental health disorder.     

Substance Use,Sexual Identity,and Health Care Provider Use in Men Who Have Sex With Men

This article describes the association between substance use, sexual identity, and seeing a health care provider on a regular basis for 257 men who have sex with men (MSM). Data from in-person interviews were gathered from MSM who resided in Massachusetts between 2003 and 2007. A logistic regression analysis that controlled for demographic characteristics, health insurance status, HIV/AIDS status, drug use, and social support revealed that MSM who identified as heterosexual, compared with those who identified as gay or bisexual, were 60% less likely to access a health care provider on a regular basis. Further, the likelihood of seeing a provider regularly was 54% lower for MSM who had used illegal drugs in the past 30 days and 32% higher for MSM who had more social support. Study limitations and implications are discussed.     

The Dynamic Nature of Risk Factors for Substance Use Among Adolescents

ABSTRACT

Substance use is one of the major social problems facing youth today. The research on risk factors associated with onset and continuation of use is extensive. Typically, reviews of the literature categorize risk factors by environmental domain (i.e., family, peer relations, neighborhoods). This review extends this framework by examining studies that focus on the changing nature of risk factors for substance use among teenagers. The underlying assumption is that, especially during adolescence, these relations are dynamic and shift across time. Five time-related mechanisms are identified and used to describe the research. The article concludes with a discussion about the implications for future research.     

Sex Differences in Cortisol Level and Neurobehavioral Disinhibition in Children of Substance Abusers

SUMMARY

This investigation determined the extent to which cortisol level, an index of HPA axis activity, covaries with neurobehavioral disinhibition. The sample consisted of 369 boys and 91 girls who were assigned to either a high average risk (HAR) group or a low average risk (LAR) group based on the presence or absence of paternal substance use disorder (SUD). Neurobehavioral disinhibition was assessed using a combination of questionnaires and neuropsychological tests. Saliva was collected for cortisol determination during a mild stressor and again 35 minutes after the task. The results indicated that disinhibition was higher and cortisol level lower in boys compared to girls. Cortisol level was negatively correlated with severity of neurobehavioral disinhibition in girls, accounting for 24% of the variance. A similar trend was observed in the boys; however, the correlation did not attain statistical significance. Based on these findings, it is tentatively concluded that boys and girls differ with respect to biochemical indicators of stress reactivity underlying neurobehavioral disinhibition, a putative phenotype associated with the liability for SUD.     

Substance Use During Pregnancy and Postnatal Outcomes

Substance exposure in utero has been associated with physical birth defects and increased risk of regulatory and neuropsychological difficulties. The aims of this study were to describe women who use substances and are in treatment with respect to the type and number of substances used during pregnancy, as well as their background, and to examine the effect substance use has on gestational age, birth weight, and the development of neonatal abstinence syndrome at birth. A sample of 161 pregnant women and their 163 newborn children were included. The results indicate that the children whose mothers continued to use substances throughout their pregnancies were born at a lower gestational age (Chi-Square = 15.1(2), P < .01); children exposed to poly-substances in utero were more affected than those exposed to only alcohol and those with no substance exposure. The same children were more vulnerable to the development of neonatal abstinence syndrome at birth (Chi-Square = 51.7(2), P < .001). Newborns who were exposed primarily to alcohol in utero were at a significant risk of being born with low birth weight (Chi-Square = 8.8(2), P < .05) compared with those exposed to other types of substances. More than 50% of the mothers ceased using any substances (with the exception of tobacco) by birth, indicating that the treatment program did have an interventional effect on the mothers. The mothers’ ability to either cease or decrease the use of substances during pregnancy appears to have direct positive effect on their newborns.     

Prenatal Depression Effects on Pregnancy Feelings and Substance Use

ABSTRACT

Depressed (n = 110) and nondepressed (n = 104) mothers were given a set of self-report measures, including the CES-D (depression), the STAI (anxiety), the STAXI (anger), the Perinatal Anxieties and Attitudes Scale, a questionnaire on substance use and the Feelings About Pregnancy and Delivery Scale that was designed for this study and that includes scales on coping, support, intimacy, common knowledge of depression, and cultural effects on pregnancy. During the neonatal period, the depressed mothers scored higher on the depression, anger, and anxiety scales as well as the Perinatal Anxieties and Attitudes Scale. They also reported using more substances including cigarettes, caffeine, and medications (primarily antibiotics). Their scores on the Feelings About Pregnancy and Delivery Scale were lower including the coping, support, intimacy, and cultural effects scores. In addition, they reported having more stressful situations during pregnancy, being less happy when finding out they were pregnant and their significant other being less happy when finding out about the pregnancy. A regression analysis on maternal depression suggested that 28% of the variance was explained by low support scale scores, not co-sleeping with their infant and high caffeine intake.     

Relationship between Tobacco Use and Health-Related Quality of Life (HRQoL) among Clients in Substance Use Disorders Treatment

We examined relationships of smoking status and tobacco-related variables with health-related quality of life (HRQoL), a metric of disease burden, among clients in substance use disorders (SUDs) treatment. Participants (N = 2,068; 46.6% female) completed surveys reporting demographics, smoking status, and past-month days they experienced physical and/or mental health distress. Smokers (n = 1,596; 77.2% of sample) answered questions on tobacco-related variables. Multinomial regression models assessed relationships between tobacco-related variables (smoking status, nicotine dependence, menthol smoking, electronic-cigarette use, health concerns, and cost as reasons affecting reducing/quitting smoking, past and future quit attempts) with HRQol in four categories (good health, physical health distress, mental health distress, or both physical and mental health distress). Current smokers were more likely than former smokers to report frequent physical and mental health distress than good health (OR = 1.97, 95% CI = 1.16, 3.34), as were smokers with higher nicotine dependence (OR = 1.18, 95% CI = 1.03, 1.35). Smokers reporting both frequent physical and mental health distress were more sensitive to cigarettes’ cost (OR = 1.56, 95% CI = 1.06, 2.29), and less likely to use e-cigarettes (OR = 0.59, 95% CI = 0.38, 0.94). Findings of poor HRQoL among nicotine-dependent smokers with additional SUDs strengthen the imperative to provide smoking cessation interventions in addictions treatment.     

The Effects of Interventions to Prevent Substance Use Among Adolescents: A Systematic Review

The aim of this systematic review is to describe and evaluate the effects of interventions used for preventing or reducing substance use among adolescents under 18 years of age. Studies (N = 27) available in CINAHL and PubMed from 2007 to 2010 were included. Results showed that family-based interventions and combined interventions have significant outcomes for substance use among adolescents. Similarly, school-based interventions were effective in providing knowledge about substance use, which eventually reduced the substance use. Further research should be conducted in different cultures as well as on computer-based interventions targeting both genders.     

Deconstructing the Complexity of Substance Use among Young Men Who have Sex with Men (YMSM) by Optimizing the Role of Qualitative Strategies in a Mixed Methods Study

Qualitative data can be a powerful tool in developing interventions for substance use and other HIV-risk behaviors. Mixed methods design offers researchers the ability to obtain data that provides both breadth and depth to their research questions. However, the integration of qualitative data in mixed methods research has been limited. This paper describes the qualitative study design of the Healthy Young Men's Study, a longitudinal mixed method study with an ethnically diverse cohort of young men who have sex with men (YMSM) (N = 526) in Los Angeles. Integral to this discussion is how a mixed methods study can address common challenges such as sampling, representation and integration of both datasets.