Risk factors for substance use among youth experiencing homelessness

Abstract

Background: Youth experiencing homelessness are at high risk for frequent substance use. This study examines individual, interpersonal, and contextual factors associated with substance use among such youth, age 13–24. Methods: Data were collected through computer-assisted structured interviews with participants (N?=?474) recruited at service agencies in Los Angeles. Results: Youth had experienced over two years of homelessness on average. Almost a third used substances frequently; significant risk factors included delinquency, sensation seeking, and ongoing homelessness. Time spent in clubs and organizations was protective. Conclusions: Providing housing and services to curb delinquency may help protect youth from becoming frequent substance users.     

North American Indigenous adolescent substance use

Objectives

To investigate growth in problem drinking and monthly marijuana use among North American Indigenous adolescents from the upper Midwest and Canada.

Methods

Panel data from a community-based participatory research project includes responses from 619 adolescents residing on or near 7 different reservations/reserves. All respondents were members of the same Indigenous cultural group.

Results

Rates of problem drinking and monthly marijuana use increased steadily across the adolescent years, with fastest growth occurring in early adolescence (before age 15). In general, female participants reported higher rates of substance use prior to age 15; however, male reports of use surpassed those of females in later adolescence.

Conclusions

Results of this study highlight the importance of early adolescent substance use prevention efforts and the possible utility of gender responsive programming.     

Predicting high-risk versus higher-risk substance use during late adolescence from early adolescent risk factors using latent class analysis

Much of the existing risk factor literature focuses on identifying predictors of low levels of substance use versus higher-levels of substance use. In this article, we explore more nuanced patterns of alcohol, tobacco and other drug (ATOD) use during late adolescence. Our aims were to: (1) identify subgroups of youth with qualitatively different patterns of ATOD use and (2) explore whether membership among qualitatively distinct, high-risk classes could be predicted based on early adolescent risk factors. Data came from a selected subsample of the National Longitudinal Survey of Youth (n?=?1689). Predictors were measured when youth were about 12 years old; ATOD use was assessed when youth were aged 17 years. Results showed that adolescent ATOD use is not a homogenous behavior. Four distinct classes of adolescent ATOD users were derived. Each class had a qualitatively distinct and discriminable pattern of ATOD use. Ecological predictors were shown to differentiate between latent classes, with peer factors playing a particularly important role in differentiating between high-risk and higher-risk users. Implications for prevention and limitations are discussed.     

Predicting adolescent substance use: the effects of depressed mood and positive expectancies

This study examined whether sixth-graders' depressed mood and positive substance use expectancies predicted increases over the next two years in students' lifetime and 30-day cigarette, alcohol, and marijuana use, and whether sixth graders' positive substance use expectancies moderated the relationship between baseline depressed mood and changes over the next two years in the use of these substances. Study data came from a randomized controlled trial of Project ALERT, a school-based substance use prevention program, in which students from 34 schools completed self-report surveys as sixth (n=5782), seventh (n=5065), and eighth graders (n=4940). Primary analyses were performed using Hierarchical Nonlinear Modeling. Over time, there were significant effects of baseline positive expectancies on each of the six measures of substance use. Baseline depressed mood predicted increases over time only for lifetime use of cigarettes and alcohol, and for 30-day alcohol use. Positive expectancies significantly moderated the effects of adolescent depressed mood only on lifetime marijuana use. Although depressed mood predicted substance use for half of our variables, our results suggest that positive expectancies are a more consistent predictor of adolescent substance use, and that they may moderate the effects of depressed mood on marijuana, but not cigarette or alcohol, use. Substance use prevention programs may benefit from addressing adolescents' perceptions about the positive consequences of drug use.     

Risk profiles among adolescent nonmedical opioid users in the United States

Although prior research has provided data on nonmedical use of opioids in adolescents, studies examining the heterogeneity of risk are limited. The present study extends prior research by deepening the understanding of adolescent nonmedical opioid use by specifying empirically meaningful profiles of risk. Using data on adolescent non-medical opioid users (N=1783) from the 2008 US National Survey on Drug Use and Health (NSDUH), latent class analysis and multinomial logistic regression were employed to identify latent classes and determine the effects of covariates on class membership. Four latent classes provided the best fit to the data. Classes consisted of a low risk class (33.7%), a high delinquency/low substance use class (17.8%), a high substance use/low delinquency class (34.2%), and finally a high risk class (14.3%) characterized by high levels of both substance use and delinquent behavior. Study findings advance the understanding of adolescent nonmedical opioid use by specifying distinct latent classes. Results suggest that intervention efforts can fruitfully target a number of risk domains especially programs that enhance effective parenting and supervision.     

Assessing adolescent substance use: A critique of current measurement instruments

A variety of instruments are currently available to screen for and assess adolescent substance abuse and aid in planning appropriate interventions. Assessment pratices in treatment facilities for adolescents have tended to rely on the use of unstandardized, local measures or on measures developed for adults with unknown reliability and validity for adolescents. This review is designed to serve as a resource for health professionals regarding the issues involved in assessing adolescent substance involvement and the types of instruments that are available for use. Conceptual issues relevant to the evaluation of adolescent substance use are discussed. Then, standardized, adolescent-specific assessment tools are briefly summarized, including screening questionnaires, comprehensive instruments, and several other substance-related instruments.     

Cost-effectiveness analysis of four interventions for adolescents with a substance use disorder

Alcohol, tobacco, and illicit drug use among adolescents in the United States continues to be a serious public health challenge. A variety of outpatient treatments for adolescent substance use disorders have been developed and evaluated. Although no specific treatment modality is effective in all settings, a number of promising adolescent interventions have emerged. As policy makers try to prioritize which programs to fund with limited public resources, the need for systematic economic evaluations of these programs is critical. The present study attempted a cost-effectiveness analysis of four interventions, including family-based, individual, and group cognitive behavioral approaches, for adolescents with a substance use disorder. The results indicated that treatment costs varied substantially across the four interventions. Moreover, family therapy showed significantly better substance use outcome compared to group treatment at the 4-month assessment, but group treatment was similar to the other interventions for substance use outcome at the 7-month assessment and for delinquency outcome at both the 4- and 7-month assessments. These findings over a relatively short follow-up period suggest that the least expensive intervention (group) was the most cost-effective. However, this study encountered numerous data and methodological challenges in trying to supplement a completed clinical trial with an economic evaluation. These challenges are explained and recommendations are proposed to guide future economic evaluations in this area.     

Risk/protective factors associated with substance use among runaway/homeless youth utilizing emergency shelter services nationwide.

Rates of alcohol, tobacco, and marijuana use among runaway/homeless youth are substantially higher than found among American high school students. To understand the risk and protective factors associated with substance use, this study (1) assessed cigarette, alcohol, and marijuana use among a national sample of runaway/homeless youth, (2) identified risk/protective factors associated with lifetime substance use, and (3) examined risk/protective factors associated with six month frequency of substance use. Unduplicated cases (n = 11,841) from the 1997 Runaway/ Homeless Youth Management Information System (RHY MIS) were analyzed. Results showed that substance use levels are greater than previously reported for this population. Predictors of cigarette, alcohol, and marijuana use and frequency were predominately individual youth risk factors and demographics rather than family risk factors. Providers in emergency youth shelters are in a prime position to assess substance use behaviors, as well as the associated risk factors. Provision of appropriate screening and referral to other services is essential to meet the needs of these youth.     

The comparative effectiveness of outpatient treatment for adolescent substance abuse: A meta-analysis

Meta-analysis was used to synthesize research on the effects of outpatient treatment on substance use outcomes for adolescents with substance use disorders. An extensive literature search located 45 eligible experimental or quasi-experimental studies reporting 73 treatment–comparison group pairs, with many of the comparison groups also receiving some treatment. The first analysis examined 250 effect sizes for the substance use outcomes of adolescents receiving different types of treatment relative to the respective comparison groups. As a category, family therapy programs were found to be more effective than their comparison conditions, whereas no treatment programs were less effective. However, not all treatment types were compared with each other in the available research, making it difficult to assess the comparative effectiveness of the different treatments. To provide a more differentiated picture of the relative improvement in substance use outcomes for different treatments, a second analysis examined 311 pre–post effect sizes measuring changes in substance use for adolescents in the separate treatment and comparison arms of the studies. The adolescents in almost all types of treatment showed reductions in substance use. The greatest improvements were found for family therapy and mixed and group counseling. Longer treatment duration was associated with smaller improvements, but other treatment characteristics and participant characteristics had little relationship to the pre–post changes in substance use. Based on these findings family therapy is the treatment with the strongest evidence of comparative effectiveness, although most types of treatment appear to be beneficial in helping adolescents reduce their substance use.     

Opportunities to use drugs and the transition to drug use among adolescents from Caracas,Venezuela

Few studies have examined exposure to drug use and the lag between exposure and use. This paper estimates prevalence of opportunity to use a substance, for use, and for use given an opportunity to use among a sample of Venezuelan adolescents. Several covariates on the opportunity to use and the transition to use are also examined. Findings show that lifetime prevalence of substance use among Venezuelan adolescents increases dramatically and more closely resembles rates among US and European samples when having had an opportunity to use was taken into account. A majority of youth who transitioned to use did so the same year exposure occurred, and females had a shorter time difference compared to males. Covariates primarily predicted exposure rather than having used after controlling for exposure, and their effects varied by substance. Implications for prevention efforts are discussed.     

Perceived parental support and adolescent motivation for substance use change: a preliminary investigation

Background: The benefits of motivation to change may be enhanced depending on environmental factors, such as perceived parental support.

Objective: We propose a quadrant model of perceived parental support and adolescent motivation with the following four possibilities: High perceived parent support/Low adolescent motivation; High perceived parent support/High adolescent motivation; Low perceived parent support/Low adolescent motivation; Low perceived parent support/High adolescent motivation. The purpose of this study was to examine the outcomes of each quadrant within a randomized clinical trial of adolescent substance use treatment.

Method: Data for these analyzes were from the DATOS-A study. We used chi-square and one-way ANOVA tests to examine differences between the four quadrants on demographic factors, treatment engagement, and substance use treatment outcomes.

Results: We found that participants in Quadrant 2 (high perceived parent support/high adolescent motivation) were the most likely to report that treatment was important (x²?=?34.34 (6), p?F(3, 248.46)?=?9.99, p?Conclusions: We found preliminary support of our conceptualization of perceived parental support and adolescent motivation, as adolescents in Quadrant 2 had higher treatment importance, and adolescents in Quadrant 3 reported the most severe substance use outcomes.     

Acculturation and substance use in a Mexican American college student sample

Although the association between acculturation and substance use among Latino groups is important, it is often understudied, especially within specific Latino groups living in geographically distinct communities, such as the Mexican American population in South Texas. The researchers of this study aimed to better understand the effect of acculturation on substance use and alcohol dependence in a Mexican American college student population. This survey study investigated the correlation between acculturation and substance use and dependence by using the Vancouver Index of Acculturation (VIA), items related to substance use (nicotine, marijuana, and cocaine) in a Mexican American college student sample (N = 1,494), and the Short Alcohol Dependence Data Questionnaire (SADD; N = 715). The study was conducted in the Texas–Mexico border region. The results suggest that higher levels of acculturation do not predict increased drug use or alcohol dependence in the Mexican American college students. However, acculturation was found to be associated with lower use of cocaine and marijuana. The discussion examines commonalities and differences in drug use and dependence. Specifically, acculturation seems to have an inverse relationship to substance use and may serve as a protective factor to licit and illicit drug use among Mexican American college students.     

Adolescent initiation of licit and illicit substance use: Impact of intrauterine exposures and post-natal exposure to violence

Whether intrauterine exposures to alcohol, tobacco, marijuana, or cocaine predispose offspring to substance use in adolescence has not been established. We followed a sample of 149 primarily African American/African Caribbean, urban adolescents, recruited at term birth, until age 16 to investigate intrauterine cocaine exposure (IUCE). We found that in Kaplan-Meier analyses higher levels of IUCE were associated with a greater likelihood of initiation of any substance (licit or illicit), as well as marijuana and alcohol specifically. Adolescent initiation of other illicit drugs and cigarettes were analyzed only in the “any” summary variable since they were used too infrequently to analyze as individual outcomes. In Cox proportional hazard models controlling for intrauterine exposure to alcohol, tobacco, and marijuana and demographic and post-natal covariates, those who experienced heavier IUCE had a greater likelihood of initiation of any substance, and those with lighter intrauterine marijuana exposure had a greater likelihood of initiation of any substance as well as of marijuana specifically. Time-dependent higher levels of exposure to violence between ages of 8 and 16 were also robustly associated with initiation of any licit or illicit substance, and of marijuana, and alcohol particularly.     

When you see it,let it be: Urgency,mindfulness and adolescent substance use

The emotion-based domains of impulsivity, positive and negative urgency, are facets that have garnered attention due to their associations with substance use, and mindfulness based strategies have shown promise in reducing substance use in adults. The aim of the current study was to examine relations among urgency, mindfulness, and substance use in adolescence. Cross-sectional data were collected from students (N = 1,051) at a large, private high school in the Pacific Northwest. Both positive and negative urgency were uniquely associated with greater likelihood of lifetime and current alcohol use; only positive urgency predicted lifetime marijuana use. Mindfulness was associated with a lower likelihood of lifetime alcohol or marijuana use. Interactions between urgency and mindfulness were not supported. Our findings highlight the need to explore relations among baseline mindfulness, skills based mindfulness, and personality in adolescent alcohol and other drug use.     

Do parents and school matter? Protective factors for adolescent substance use

Protective factors may promote successful development by neutralizing the effects of negative risk factors. This paper is focused on possible protective factors of adolescent substance in a sample of high school students (N = 881) in Szeged, Hungary. Data were collected in 2008. Self-administered questionnaires were applied that measured smoking, binge drinking, marijuana use and parental and school-related protective factors. Multiple regression analysis revealed that parental monitoring was a universal protective factor for adolescents. Acceptance and respect of parents' values may serve as a protection against binge drinking among adolescents. High academic achievement was a predictor of smoking and binge drinking, talking about problems with teachers and being happy with school were predictors of marijuana use. Future research is needed to clarify the altered role of parent–child relationship in adolescents' substance use.     

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.     

Sibling popularity: A moderator of sibling influence for adolescent substance use

Sibling substance use is a known correlate of adolescent substance use. Yet, not all siblings are equally influential. Sibling influence has been found to vary by age gap, sex and birth order. Little research, however, has investigated whether siblings' peer context is also a source of variation. The present study tested whether more popular siblings were more influential for adolescent use of cigarettes, alcohol and marijuana. Data were obtained from sibling pairs in the National Longitudinal Study of Adolescent Health. Findings indicate that older siblings have more influence on younger sibling marijuana use when they have more friends. These findings contribute to prior work examining which siblings are more influential and highlight the need to consider siblings as part of a greater peer context.     

Motivational Interviewing for adolescent substance use: A review of the literature

Motivational Interviewing (MI) is a widely-used approach for addressing adolescent substance use. Recent meta-analytic findings show small but consistent effect sizes. However, differences in intervention format and intervention design, as well as possible mediators of change, have never been reviewed. This review of the literature summarizes the most up-to-date MI interventions with adolescents, looks at differences between intervention format and design, and discusses possible theory-based mechanisms of change. Of the 39 studies included in this review, 67% reported statistically significant improved substance use outcomes. Chi square results show no significant difference between interventions using feedback or not, or interventions combined with other treatment versus MI alone. The need for systematic investigation in theory-based mechanisms of change is presented.