Preventing Substance Use in American Indian Youth: The Case for Social Support and Community Connections

Aims: This study explored the relationship between social support, community connections, self-esteem, and culture on misuse in American Indian youth. Methods: The study team developed a culturally-responsive 16-question survey for American Indian youth ages 12–20 living in six American Indian communities in the Great Plains Region of the United States. The study was grounded in primary socialization theory and variables were explored using regression models. Results: A total of 565 American Indian youth completed the participant survey between January 2016 and August 2017. The present study found that community connections were negatively associated with marijuana use in American Indian youth. Higher community connection scores were associated with higher social support and self-esteem scores. Conclusions: Tribally-led prevention initiatives can fill an important socio-behavioral prevention gap by facilitating social support opportunities for American Indian youth who may not have adequate support from immediate family or friends.     

Alcohol Use Severity Among Adult Hispanic Immigrants: Examining the Roles of Family Cohesion,Social Support,and Gender

Background: This study examined (a) the direct association of family cohesion on alcohol use severity among adult Hispanic immigrants; (b) the indirect association of family cohesion on alcohol use severity via social support; and (c) if gender moderates the direct and indirect associations between family cohesion and alcohol use severity. Method: Mediation and moderation analyses were conducted on a cross-sectional sample of 411 (men = 222, women = 189) participants from Miami-Dade, Florida. Results: Findings indicate that higher family cohesion was directly associated with higher social support and lower alcohol use severity. Higher social support was also directly associated with lower alcohol use severity. Additionally, family cohesion had an indirect association with alcohol use severity via social support. Moderation analyses indicated that gender moderated the direct association between family cohesion and alcohol use severity, but did not moderate the indirect association. Conclusions: Some potential clinical implications may be that strengthening family cohesion may enhance levels of social support, and in turn, lower alcohol use severity among adult Hispanic immigrants. Furthermore, strengthening family cohesion may be especially beneficial to men in efforts to lower levels of alcohol use severity.     

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.     

Investigating Social Support and Network Relationships in Substance Use Disorder Recovery

Background: Social support and characteristics of one's social network have been shown to be beneficial for abstinence and substance use disorder recovery. The current study explores how specific sources of social support relate to general feelings of social support and abstinence-specific self-efficacy. Methods: Data were collected from 31 of 33 individuals residing in 5 recovery houses. Participants were asked to complete social support and social network measures, along with measures assessing abstinence from substance use, abstinence self-efficacy, and involvement in 12-step groups. Results: A significant positive relationship was found between general social support and abstinence-specific self-efficacy. General social support was also significantly associated with the specific social support measures of sense of community and Alcoholics Anonymous (AA) affiliation. Social network size predicted abstinence-related factors such as AA affiliation and perceived stress. Conclusions: These results provide insight regarding individual feelings of social support and abstinence-specific self-efficacy by showing that one's social network-level characteristics are related to one's perceptions of social support. We also found preliminary evidence that individual Oxford Houses influence one's feelings of social support.     

Emergency Department Visits in a Cohort of Persons with Substance Use: Incorporating the Role of Social Networks

Background: Frequent emergency department (ED) visits often suggest inappropriate use for low acuity needs and multiple comorbidities, including substance use disorders. Objective: This study examines associations of individuals and their social networks with high frequency ED use among persons reporting substance use. Methods: Information was obtained from interview responses from the first 6-month follow-up visit of a longitudinal. Prevalence ratios for the outcome of high frequency ED visits (≥2 in 6 months) were determined with a generalized linear model, log link, Poisson distribution and robust standard errors. Results: Of 653 participants, 131 (20%) had ≥2 ED visits. In multivariable analysis, greater likelihood of high frequency ED visits over 6 months was associated with being homeless (PR: 1.58; 95% CI: 1.19, 2.10), taking ≥3 medications (PR: 1.58; 95% CI: 1.19, 2.10) and having had a hospitalization over the same period (PR: 4.33; 95% CI: 3.26, 7.56). Among social network factors, lower likelihood of high frequency visits was associated with each increasing year of mean alter age (PR: 0.98; 95% CI: 0.6, 0.99) and greater likelihood with having received health-related informational support from ≥2 alters (PR: 1.62; 95% CI: 1.04, 2.53). Conclusions/Importance: Social network factors may play an important role in ED use. Interventions to promote health behaviors through social influence may be helpful in reducing high frequency ED visits.     

Substance Use Among Young Adolescents in HIV-Affected Families: Resiliency,Peer Deviance,and Family Functioning

This study examines the association of risk and protective factors with substance use among 77 early adolescents (11–15 years old) with an HIV-infected parent who were interviewed in 2000–2001 in the South Bronx, a HIV high-prevalence area of New York City. The subjects were 49% female, 53% African American, and 30% Hispanic; mean age was 13 years old. A face-to-face interview was used to administer a battery of instruments representing community, family, peer, and resiliency factors. Forty percent reported ever using tobacco, alcohol or drugs; 71% were aware of their parent's HIV seropositivity. An age-adjusted path analytic model was constructed which showed : 1) family functioning predicted resiliency (a composite measure of psychological adjustment and personal competencies); 2) positive community factors and resiliency predicted less affiliation with deviant peers; and 3) poorer family functioning and affiliation with deviant peers predicted substance use. These results underscore the need for interventions that address social influence factors among vulnerable early adolescents with HIV-positive parents.     

Same-Sex Friendship,School Gender Composition,and Substance Use: A Social Network Study of 50 European Schools

Background: Other-sex friendship (girls with boy friends, boys with girl friends) has been associated with substance use, but how the gender composition of schools influences substance use has not been known. Objectives: We analyzed the influence of other-sex friendship on substance use and took into account the proportion of each gender group at the schools, and hypothesized that other-sex friendship is associated with higher levels of substance use and that schools with a majority of males have higher levels of use than female-majority schools. Methods: In 2013, a social network survey was carried out in six European cities. In each city, schools were selected and 11,015 adolescents (aged 14-16) were recruited (participation rate = 79.4%). We collected data on smoking, binge drinking, cannabis use, and peer group composition. Results: Other-sex friendship was associated with smoking, binge drinking, and cannabis use for girls and with smoking for boys. Substance use was more frequent in schools with a majority of males. Conclusions/Importance: Adolescent girls are best protected from substance use if they are in gender-balanced schools, but in same-sex friendship. This offers new perspectives on gender mixing at school. In schools with a majority of boys, more attention should be paid to girls, and gender-specific health promotion programs should be implemented. This European study is the first to take into account both individual (other-sex friendship) and contextual (gender composition of schools) gender interactions. It confirms previous studies on other-sex friendship, while shedding light on the influence of gender-normative contexts on substance use.     

Gender Differences in the Impact of Social Support on Crack Use Among African Americans

This article examines the influence of social support on crack use in a sample of 435 African American out-of-treatment crack users recruited through street outreach in Raleigh, North Carolina, between 2000 and 2002. Multivariate regression models indicated that social support was not a strong influence on crack use. For women, no social support variables predicted crack use, whereas for men, having a non-using partner was negatively associated with crack use. Findings indicate that existing social support is not strongly linked to drug use among African Americans, but African American men may be positively influenced by non-using sexual partners. Limitations of the sample and data are discussed. Further research is needed on the influence of social support for African American drug-using populations.     

Substance Use in Healthcare Workers: Importance of Stress Perception,Smoking Temptation,Social Support,and Humor

Background: Research indicates healthcare workers' personal substance use may affect quality of care. Investigating factors that correlate with coping through substance use may provide insight into improving quality care. Objectives: This study aims to examine potential correlates of coping through substance use among healthcare workers, with a particular focus on humor, social support, stress perception, and smoking temptation. Method: Participants, recruited from healthcare facilities, anonymously completed a 30-minute questionnaire of psychometrically valid measurements. Results: In a sample of primarily female (75.7%), age 20–39 (74.8%), floor staff (i.e., doctors, nurses, technicians/assistants; 61.2%), perceived stress [β = .036, t(98) = 2.55, p = .012], smoking temptation [β = .036, t(98) = 2.21, p = .030], and coping through humor [β = .163, t(98) = 2.033, p = .045] were significant correlates of the coping through substance use, with all relationships positively co-varying. Social support at work did not predict coping through substance use [β = ?.032, t(98) = ?.814, p > .05]. Furthermore, negative affect/situation smoking temptation was associated with increased coping through substance use [β = .246, t(99) = 2.859, p = .005] and habit/craving temptation was associated with decreased coping through substance use [β = ?.260, t(99) = ?2.201, p = .030; however, positive affect/social temptation was not [β = .054, t(99) = ?.553, p > .05]. Conclusions/Importance: These findings suggest that coping with humor may relate to coping through substance use, while social support at work is either unrelated to coping through substance use in this sample or may not be adequately assessed with the measure used. Consistent with the literature, negative affect/situation was associated with increased coping through substance use. However, habit/craving was negatively predictive. Further research should explore the variables related to coping through substance use among healthcare workers.     

Adverse Events and Substance Use Among Female Adolescent Offenders: Effects of Coping and Family Support

This study examined a stress-coping model for substance use among female adolescents (N == 305, 69%% African American) involved in the Mississippi juvenile justice system. Participants were interviewed in , regarding exposure to adverse and traumatic events, and they completed self-administered measures of social support from relatives, coping strategies, and questions on frequency of alcohol and other drug use. Results from nested regression models revealed that stressors are associated with drug, but not alcohol use. The use of supportive kinship ties and religion to cope were protective factors. The implications and limitations of the study are discussed.     

Neighborhood,School, and Family Effects on the Frequency of Alcohol Use Among Toronto Youth

This study examines the effect of neighborhood, school, and family indicators on adolescent drinking. The Toronto Drugs, Alcohol, and Violence International (DAVI) data were collected in 2001–2002. The sample was stratified both by region (city vs. outskirts) and by the socio-economic status of the schools. Two schools from each stratum were randomly selected and 910 students completed the survey. The survey contains extensive measures of substance use, violence, and mental health. The study uses cluster analysis and multinomial logits to examine the variation in the effect of schools, family, and demographic indicators on alcohol use across neighborhood contexts. Study implications and suggestions for future research are included. The study was partially funded by NIDA grant #R01-DA11691–01A1.     

Correlates of Substance Use Abstinence and Non-Abstinence Among High School Seniors: Results From the 2014 Monitoring the Future Survey

Several risk and protective factors are influential in predicting who uses or abstains from illicit substances during the high school years. The 2014 national cohort data from the Monitoring the Future survey shows the demographics, psychosocial factors, and attitudes regarding substance use that predict abstention by twelfth-graders (versus those who report any lifetime use of any illicit drugs). Being older, having a higher rate of sensation-seeking behaviors, perceiving drugs as easy to obtain, and participation of some social activities were associated with a lower rate of abstention. In contrast, being optimistic, involvement in school activities, perceiving drug and alcohol use as high risk, believing their peers disapprove of substance use, and personally disapproving of substance use were associated with greater abstention from lifetime substance use. A similar model including negative attitudes and experiences (nonuse-related) with marijuana was associated with a greater likelihood to abstain from substances. We examine possible explanations and prevention implications of these findings and discuss the role of abstention in post-high school substance use risks.     

The Role of Gender in the Association Between Child Maltreatment and Substance Use Behavior: A Systematic Review of Longitudinal Research from 1995 to 2011

This systematic review analyzes the role of gender in the association between childhood maltreatment and substance use outcomes, among longitudinal papers published between 1995 and 2011. Ten papers examined gender as a moderating variable. Results on gender differences were mixed. When studies that found no gender effects were compared with studies that did identify gender effects, differences in measurement, sample composition, and developmental timing of outcomes were identified. This review also examines how gender effects are assessed. Implications and limitations of these findings are discussed. Areas for future research are identified.     

Prevalence of Substance Use among Lesbian,Gay, Bisexual,and Transgender Youth in Military Families: Findings from the California Healthy Kids Survey

Background: In addition to the challenges associated with military life, lesbian, gay, bisexual, and transgender (LGBT) youth in military families may face stressors associated with having a stigmatized sexual orientation and/or gender identity or expression, placing them at risk of substance use. To the authors' knowledge, this is the first study exploring substance use outcomes among LGBT youth in military families. Objectives: This study assessed the role of military connection, LGB identity, and transgender identity on lifetime and past 30-day substance use. Methods: This study is a secondary data analysis of the 2013–2015 California Healthy Kids Survey (CHKS). The study's participants (n = 634,978) were students attending middle and high schools in nearly all school districts in California. The study outcomes were lifetime and past 30-day cigarette, alcohol, tobacco, and marijuana use. Chi-square tests of associations (including cross-tabulations) and multivariate logistic regressions were conducted to address the study aims. Results: Multivariate logistic regression results indicated that military connection, LGB identity, and transgender identity were significantly associated with an increased odd of lifetime and past 30-day substance use. Compared to military non-transgender youth, military transgender youth had an increased likelihood of past 30-day cigarette use and past 30-day alcohol use. In addition, military LGB youth were 3.62 times as likely as military non-LGB youth to report past 30-day cigarette use. Conclusions/Importance: This study provides researchers with knowledge about the behavioral health of LGBT youth in military families, a vulnerable subgroup within the military-connected youth population, thus informing substance use prevention programs.     

Exploring Survey Participation,Data Combination,and Research Validity in a Substance Use Study: An Application of Hierarchical Linear Modeling

A sound decision regarding combination of datasets is critical for research validity. Data were collected between 1996 and 2000 via a 99-item survey of substance use behaviors. Two groups of 7th–12th grade students in predominately White communities are compared: 166,578 students from 193 communities with high survey participation and 41,259 students from 65 communities with lower participation. Hierarchical logistic models are used to explore whether the two datasets may be combined for further study of community-level substance use effects. “Scenario analysis” is introduced. Results suggest the datasets may reasonably be combined. Limitations and further research are discussed.     

Alcohol-Impaired Driving: The Influence of Adverse Rearing Environments,Alcohol, Cannabis Use,and the Moderating Role of Anxiety

Background: The rate of alcohol-impaired driving (AID) increases during the college years and students who have reported adverse rearing environments appear to be at increased risk for the development of alcohol and drug use behaviors. Alcohol and cannabis are the most commonly used drugs by college students, and these substances are particularly predictive of substance-impaired driving. Objectives: The present study aimed to investigate whether adverse rearing environment experiences and level of alcohol and cannabis use are related to the frequency of alcohol-impaired driving and whether anxiety might buffer or accelerate this effect. Methods: Data regarding adversity, drug use, anxiety, and AID were obtained from 1,265 students annually, from first to final year of college, over four waves (Mean Age at wave 1 = 18.5 years). Results: Structural equation modeling supported associations among childhood adversity, alcohol, cannabis, and anxiety symptoms. A significant mediation effect was found such that adversity was predictive of AID via alcohol use and cannabis use. Among men, anxiety symptoms accelerated the path from increased cannabis use and decelerated the path from increased alcohol use to AID frequency. Conclusions/Importance: Childhood adversity is a developmental risk precursor to drug use and AID, whereas anxiety might serve a risk or protective factor to AID, contingent on the drug used.     

Strategies to Resist Drug Offers Among Urban American Indian Youth of the Southwest: An Enumeration,Classification, and Analysis by Substance and Offeror

This study explores the drug resistance strategies of urban American Indian adolescents when they encounter people offering them alcohol, cigarettes, and marijuana. Data were collected in 2005 from 11 female and 9 male adolescents who self-identified as American Indian and attended two urban middle schools in the southwestern United States. In two focus groups—one at each school site—the youth described their reactions to 25 hypothetical substance offer scenarios drawn from real-life narratives of similar youth. Qualitative analysis of their 552 responses to the scenarios generated 14 categories. Half of the responses were strategies reported most often by nonnative youth (refuse, explain, leave, and avoid). Using ecodevelopmental theory, the responses were analyzed for indications of culturally specific ways of resisting substance offers, such as variation by specific substance and relationship to the person offering. Study limitations are noted along with suggestive implications for future research on culturally appropriate prevention approaches for urban American Indian youth.