Adolescent Girls in Out-of-Home Care: Associations Between Substance Use and Sexual Risk Behavior

ABSTRACT

Substance use and sexual risk behaviors continue to be major concerns for today's youths, and are particularly problematic for those who have been placed in out-of-home care settings. The purpose of this study was to explore these associations in a sample of 120 girls placed in a residential treatment setting and attending an on-site school in a major metropolitan area in the Midwest. A modified Youth Risk Behavior Survey (YRBS) was administered including questions relating to the youths' foster care or adjudicated status. The substance use variables targeted were alcohol and drug use. The sexual risk behavior variables were age of onset of first sexual intercourse, virginity status, contraceptive use, age of first sexual partner, and experience with ever having been forced to have sex. Results indicate that earlier onset and greater frequency of substance use were both correlated with number of sexual partners. Frequency of substance use was a significant and consistent contributor. Age of sexual partner was an inconsistent contributor, and history of forced sexual activity was not a contributor. Implications for policy and practice are offered to enhance the health and well-being of this unique population.     

Adolescent Sexual Behaviors at Varying Levels of Substance Use Frequency

Combining substance use and sex compounds the risk of contracting sexually transmitted diseases, including HIV. However, the association between substance use and sexual behaviors may vary by substance and sexual behavior. The current study sought to examine the relationship between alcohol and marijuana use frequency and specific sexual behaviors. The International Longitudinal Survey of Adolescent Health was administered to 1432 youths in one middle school and one high school in Minnesota. Results from logistic regression analyses indicated a relationship between alcohol and marijuana use and being sexually active. However, only marijuana use was associated with having multiple partners. To aid researchers in designing more effective HIV prevention interventions, future research should focus on understanding the differential effects of alcohol and marijuana on sexual behaviors.     

Sexual Minority Disparities in Substance Use Willingness Among Youth

Background: Disparities in substance use have been observed in sexual minority youth, but less is known about willingness to use substances, an important precursor to actual use. Objective: The goal of this study was to examine willingness to use cigarettes, alcohol, and marijuana among sexual minority youth compared to their non-sexual minority counterparts using both cross-sectional and longitudinal data. Methods: The present study drew on two waves (Times 1 and 2; 6 months apart) of data collected during high school as part of a prospective study of substance use initiation and progression in Rhode Island. At Time 1, participants (N = 443) ranged in age from 15 to 20 years (M age = 16.7 years, 26.6% sexual minority, 59.5% female, 72.0% White). Participants self-reported their sexual identity and attraction, lifetime use of alcohol, cigarettes and marijuana, and cigarette, alcohol, and marijuana use willingness (i.e., if offered by a best friend or group of friends). Results: In cross-sectional multivariate regression models, sexual minority youth were more likely to report willingness to use cigarettes (p <.05) and marijuana (p <.01) compared to their non-sexual minority counterparts. Longitudinal multivariate regression models revealed that sexual minorities were only significantly more likely to report cigarette willingness at Time 2 compared to their non-sexual minority counterparts (p <.01). There were no significant differences in alcohol use willingness in multivariable cross-sectional or longitudinal models by sexual minority status. Conclusions: Sexual minority youth reported more willingness than non-sexual minority youth to use substances offered by peers; however, longitudinal analyses revealed that peers appear to play a role only in willingness to smoke cigarettes for these youth, and thus peer influence may be a contributing factor in explaining tobacco-related disparities among sexual minority youth. Given that stigma and peer groups may a particular risk factor for tobacco among sexual minority youth, our findings highlight the importance of prevention programs such as social marketing approaches that correct social norms, reduce stigma, and provide refusal-skills training to reduce tobacco-related disparities among sexual minorities.     

Classifying Clinically Referred Adolescent Substance Abusers by Level of Externalizing and Internalizing Symptoms

ABSTRACT

Adolescent substance abusers demonstrate numerous emotional and behavioral difficulties in conjunction with drug problems. In this study, 236 clinically referred substance abusing adolescents were grouped on level of self-reported and parent-reported internalizing and externalizing symptoms and compared on important variables. Three groups emerged: Externalizers, Exclusive Substance Abusers, and Mixed (adolescents with both internalizing and externalizing symptoms). Exclusive Substance Abusers showed a general pattern of more positive functioning than adolescents in the other groups. This study reveals that clinically referred adolescent substance abusers can be meaningfully distinguished on levels of externalizing and internalizing problems, and that family characteristics differentiate these groups.     

Trauma,Delinquency, and Substance Use: Co-Occurring Problems for Adolescent Girls in the Juvenile Justice System

Girls in the juvenile justice system are known to have high rates of co-occurring childhood abuse, trauma, and substance abuse. Girls with this constellation of problems are at high risk for serious adverse outcomes, including problems with drug dependence and abuse. The relationship among childhood sexual abuse, childhood physical abuse, other types of childhood trauma, and rates of substance use during adolescence were examined for girls in the juvenile justice system. As expected, childhood sexual abuse was significantly related to girls' substance use during adolescence. In contrast to prior research, no link was found between physical abuse, lifetime trauma, and substance use. Limitations and future directions are discussed.     

The Application of Minority Stress Theory to Marijuana Use Among Sexual Minority Adolescents

Previous research indicates that lesbian, gay, and bisexual (LGB) adolescents are at increased risk for substance use, including heightened rates of marijuana use. Minority stress theory suggests that difficult social situations create a state of chronic stress that leads to poor health outcomes for LGB adults; however, the applicability of this model has not been well explored in relation to substance use among LGB adolescents. The current study is a secondary analysis of the OutProud survey, conducted in 2000. The original study used purposive sampling to collect data from 1,911 LGB adolescents (age 12–17) across the United States, and represents the largest known study to explore experiences specific to identifying as LGB, such as homophobia and gay-related victimization. We used structural equation modeling (SEM) to explore the feasibility of applying a minority stress framework to understand marijuana use in this population. The final structural model for marijuana use in the LGB adolescent sample displayed excellent fit and modest explanatory power for marijuana use. Two of the five factors, community connectedness and internalized homophobia, were significantly (p < .05) associated with marijuana use. Findings suggest that minority stress theory may be appropriately applied to marijuana use in this population; however, better measurement of minority stress concepts for LGB adolescents is needed.     

Trajectories of Adolescent Alcohol Use: The Effect of Individual and Social Risk Factors by Race

This study examined racial differences across African-American, Hispanic, and White participants in the impact that individual and social risk factors have on drinking behavior trajectories. Data from the National Longitudinal Study of Adolescent Health from seventh through ninth graders (N = 4,372) were used. Participants reported on frequency of drinking across the four waves and risk factors at Wave 1. Growth mixture modeling revealed four trajectories for alcohol use that included Abstainers, Early Starters, Late Starters, and De-Escalators. Social and individual indicators of risk were differently predictive of group membership to the problematic drinking trajectories. Differences across racial groups suggested that a lack of future orientation may be a salient risk factor for African-American and Hispanic youths' alcohol use, and peer alcohol use may be a salient risk factor for White youths' alcohol use. The findings of this study suggest that there may be individual differences in risk factors that provide insight for prevention efforts.     

Substance Use Among Sexual Minority Collegiate Athletes: A National Study

Background: The empirical research examining substance use among sexual minority collegiate athletes is sparse. Problematically, this group may be at a greater risk of substance use due to their marginalized status within the context of sport. Objectives: We examined different types of substance use during the past 30 days, and diagnosis of substance use disorders during the past 12 months, among sexual minority collegiate athletes. Methods: This study uses data from college students for the fall semester between 2008 and 2012 from the American College Health Association-National College Health Assessment. Results: Sexual minority collegiate athletes had greater odds of past 30-day cigarette use, past 30-day alcohol use, past 30-day marijuana use, and indicating being diagnosed or treated for a substance use disorder during the past 12 months when compared to either heterosexual collegiate athletes or heterosexual nonathletes, but had similar odds on these outcomes when compared to sexual minority nonathletes. Sexual minority collegiate athletes also had greater odds of binge drinking during the past 2 weeks when compared to either heterosexual nonathletes or sexual minority nonathletes, but had similar odds on this outcome when compared to heterosexual collegiate athletes. Additional analyses by gender reveal that male sexual minority athletes are at the greatest risk of being diagnosed or treated for a substance use disorder. Conclusions: Possible explanations as to why sexual minority collegiate athletes (particularly males) may be at a greater risk of substance use disorders could include the difficulty of trying to maintain an athletic identity within a social environment that is traditionally homophobic.     

Alcohol and Cigarette Free: Examining Social Influences on Substance Use Abstinence among Black Non-Latina and Latina Urban Adolescent Girls

Increases in substance use prevalence among girls, as well as a lack of research conducted with urban girls of color, highlight the importance of understanding both predictors and outcomes of substance use abstinence (SUA) within this population. This study addresses gaps in SUA research through a longitudinal investigation conducted with urban black non-Latina and Latina girls (N = 597) as they transitioned through junior high school. Multivariate logistic regressions found social influences (i.e., friend/family use, drug access) to be significantly associated with girls’ SUA, although differential associations were found by race/ethnicity. SUA was also associated with positive adjustment and wellness by ninth grade. Implications for gender-specific prevention programming are discussed.     

Individualism-Collectivism,Social Self-Control and Adolescent Substance Use and Risky Sexual Behavior

Individualism and collectivism are cultural syndromes that have been associated with adolescent problem behavior in studies conducted in the U.S. and Southeast Asia. However, research investigating the mechanisms of how cultural orientation impacts health risk behaviors has been limited. This study tested a new model explaining the relationship between cultural orientation (i.e., individualism, collectivism) and adolescent problem behavior (i.e., substance use and risky sex) in terms of interpersonal self-regulation (i.e., social self-control). As such, the study is rooted in theories of the role of culture in developing self-regulation. Participants were high school students (N = 716) from the Bashkirtostan Republic of the Russian Federation. Adolescents from the Russian Federation tend to show high prevalence of cigarette smoking and binge drinking. People of the Russian Federation in general are traditionally collectivist in orientation, although increased globalization and post-Soviet capitalism may indicate high individualist values in younger generation Russians. Using path analysis we found that in addition to having direct effects, higher individualism indirectly affected substance use and risky sexual behavior through social self-control and negative life events. Higher collectivism was found to have a direct protective effect on risky sexual behavior and a direct effect on social self-control. However, collectivism was not found to have indirect effects on substance use or risky sexual behavior. Higher individualism appears to function as a risk factor for adolescent problem behavior and this relationship may be mediated by lower social self-control. Culturally-tailored prevention programs utilizing the individualism-collectivism framework may benefit from addressing social self-control.     

Brief Intervention for Truant Youth Sexual Risk Behavior and Marijuana Use

Substance use and sexual risk behaviors are common among adolescents, but research has focused attention on alcohol use. Much less is known about the relationship of marijuana use and sexual risk behavior among high-risk, especially truant, youths. We report interim findings from a NIDA-funded experimental, brief intervention (BI) study involving truant youths and their parents/guardians. Longitudinal data were analyzed to study (1) the relationships between the youths' marijuana use and sexual risk behavior and (2) the effects of a substance use BI on their marijuana use and sexual risk behavior. A growth model analysis for parallel processes was conducted to study relationships between marijuana use and sexual risk behavior, and to assess the overall BI effect on linear and quadratic trends in subgroups of youth differing in their sexual risk behavior and marijuana use. Implications of the results for future research and service delivery are considered.     

Alcohol Use Severity and Sexual Risk Behavior Among Female Substance Users

Background: Substance use has been identified as one of the leading factors related to HIV transmission in the United States. The association of problematic drinking with sexual risk behavior puts individuals at greater risk for HIV transmission. This may be of particular concern for women given that approximately 66% of new HIV infections occurring through heterosexual transmission are female. Objectives: To investigate alcohol use severity and sexual risk behavior among females who use heavy, illicit drugs. Methods: Female substances users (N = 251; M_age = 31.90, SD = 7.67; 63.7% Black) self-reported past month alcohol use and lifetime sexual risk behaviors with both casual and steady sex partners. Results: Problematic alcohol users were more likely to use noninjection drugs and less likely to use injection drugs than abstainers and more likely than moderate alcohol users to use alcohol before/during sex with a steady partner. White problematic alcohol users were less likely to use injection drugs before/during sex with a steady partner than abstainers. Black problematic alcohol users were more likely to use non-injection and alcohol than moderate alcohol users before/during sex with steady partners. Conclusions: The current study extends the existing literature by taking a closer look at the role of alcohol use severity in sexual risk taking behavior of Black and White female substance users, a particularly vulnerable group for HIV transmission.     

Elevated Substance Use Among Lesbian and Bisexual Women: Possible Explanations and Intervention Implications for an Urgent Public Health Concern

Potential explanations for the elevated rates of substance use among lesbian and bisexual women relative to heterosexual women are provided by focusing on substance use differences among lesbian and bisexual women. The three explanations include butch versus femme (i.e., gender atypicality) differences in substance use, lesbian versus bisexual disparities in substance use, and disparities associated with socializing in substance-using settings, such as bars. Implications for interventions to reduce substance use and abuse among lesbian and bisexual women are addressed.     

Association of Family Background with Adolescent Smoking and Regular Use of Illicit Substances Among Underage Psychiatric In-Patients

ABSTRACT

This study investigated whether adolescent's family type was associated with regular smoking or the use of illicit substances (cannabis or hard drugs) among underage adolescent psychiatric in-patients. The sample consisted of 471 adolescents aged 12–17 years admitted to psychiatric hospital between April 2001 and March 2006 at Oulu University Hospital, Finland. The information on family factors and substance use was based on the Schedule for Affective Disorder and Schizophrenia for School-Age Children, Present and Lifetime interview and the European modification of the Addiction Severity Index questionnaire. Compared to adolescent boys from two-parent families, those from child welfare placement were more likely to regularly use both cannabis (odds ratio [OR] = 4.4; 95% confidence interval [CI] = 1.4–13.7; P = .012) and hard drugs (OR = 8.4; 95% CI = 1.7–42.1; P = .01). Among girls, no association was found between family type and the use of illicit substances. Two-parent or foster family units may protect adolescents from involvement with illicit substances. In clinical adolescent psychiatric practice more attention should be paid to family interventions and parental support.     

Emotion Regulation Outcomes and Preliminary Feasibility Evidence From a Mindfulness Intervention for Adolescent Substance Use

Based on the evidence that emotion regulation difficulties underpin many mental health struggles during adolescence, including substance use disorders (SUDs), we focused on distress tolerance as a particularly salient mechanism of action for bolstering emotion regulation outcomes for adolescents in early SUD recovery. Mindfulness-based interventions are effective in improving distress tolerance through teaching skills to reduce individuals’ perceived stress or feelings of crisis and increasing a sense of agency and self-regulatory efficacy. The aim of the present study was to improve emotion regulation outcomes in the student body of a recovery high school (N = 27) through six weeks of mindfulness intervention content delivered in a small-group format. Thus, we tested feasibility through recruitment and retention rates and examined preliminary efficacy outcomes from two, randomized mindfulness intervention conditions, and used a comparison group of students without an SUD diagnosis (N = 29) sampled from the community. Results indicate significant post-intervention impacts on recovery students’ depression symptomology and on two separate measures of impulsivity (t(22) = 2.358, p?<?.05; t(20)?=?2.358, p?<?.05; t(17)?=?3.979, p?<?.01, respectively), although no significant differences between intervention condition were noted. Findings from the current study echo similar studies with comparable samples. Implications for the dosage and approach of group-format mindfulness interventions for adolescent samples are discussed.     

Person-Environment Interactions and Adolescent Substance Use: The Role of Sensation Seeking and Perceived Neighborhood Risk

ABSTRACT

Aims: This longitudinal study investigated person-environment interactions and adolescent substance use by examining whether, and if so how, early temperamental quality of sensation seeking interacted with current neighborhood characteristics to shape underage smoking, drinking, and marijuana use. Sample: Participants consisted of a community-representative sample of 352 adolescents. Methods: Early temperament was assessed when adolescents were between seven and 13 years of age, and current neighborhood characteristics (as perceived by participants and their mothers) and current adolescent substance use (self-reported smoking, drinking, and marijuana use in the past 30 days) were assessed approximately three years later. Results: The results from a zero-inflated negative binomial (ZINB) regression revealed a potent negative effect of the perceived neighborhood risk, such that riskier neighborhoods were associated with both a greater probability for any substance use among adolescents, and a greater frequency of substance use among those who were engaging in these behaviors. High sensation seeking was a risk factor only for frequency of substance use among adolescent extant users, but not for the likelihood of any use. In addition, a significant interaction between sensation seeking and neighborhood risk revealed that adolescent sensation seekers engaged in smoking, drinking, and marijuana use primarily under conditions of elevated neighborhood risk and increased opportunity for such behaviors. Conclusion: Underage substance use was affected by synergistic effects between personal and community risk factors.     

Validity of Adolescent Self-Report of Substance Use

The validity of self-report of substance use was examined in 367 adolescents referred for a substance use assessment between 1996 and 2000. Referrals came from a wide variety of sources, including pediatricians, the courts, and social services, as well as their parents. Average age of the sample was 15, 52% were male, and 82% were Caucasian. Adolescents were first asked about the details of their substance use by a clinician using a structured interview with established reliability and validity (Adolescent Drug and Alcohol Diagnosis). They were subsequently asked to provide a urine sample, a requirement they were unaware of when being interviewed about their substance use. If the urine sample was deemed valid by the laboratory technician, it was analyzed by means of fluorescence polarization immunoassay and paper chromatography. If positive screens were obtained for any substance, the sample was subjected to gas chromatography/mass spectrometry for confirmation and quantification. Biochemical test results were compared to self-report. Overall, 28% (96/338) of the self-reports were not corroborated by urinalysis. In adolescents who reported nonuse of a substance, 26% (56/219) had a positive urinalysis. More surprisingly, 34% (40/119) of adolescents reporting substance use in the urinalysis detection window had a negative urinalysis. The present study found self-report of substance use in adolescents to only have fair validity. It is recommended that biochemical corroboration be routinely used for this population.     

Adolescent Substance Use and Sensation-Seeking on Sexual Behaviors Among Young Adults from Continuation High Schools

Background: Youth from continuation high schools report greater substance use and sensation-seeking than youth from regular high schools, yet their long-term consequences on age at sexual onset and the number of sexual partners are unknown. Objective: To examine substance use, sensation-seeking and sexual behaviors by gender and race/ethnicity and the effects of substance use and sensation-seeking in adolescence on age at sexual initiation and numbers of sexual partners by young adulthood. Methods: Baseline and 4-year follow-up data on youth from 14 continuation high schools in Southern California who participated in a drug abuse prevention intervention were analyzed. Structural equation modeling assessed whether or not substance use or sensation-seeking in adolescence predicted age at sexual onset and numbers of sexual partners by young adulthood. Results: Latinos had lower sensation-seeking and frequency of substance use and a later age at sexual onset than non-Latinos. Males were more likely than females to have multiple lifetime and recent sexual partners. The effects of adolescent substance use on the number of sexual partners by young adulthood were mediated fully by their age at sexual initiation. Sensation-seeking had no direct or indirect effects on sexual behaviors. Conclusions/Importance: Factors leading to and actual sexual risk behaviors among youth from continuation high schools vary by race/ethnicity and gender. Targeting these antecedent factors by race/ethnicity and gender may improve prevention efforts.     

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.     

Risk Factors for Different Dimensions of Adolescent Drug Use

ABSTRACT

The purpose of this investigation is to analyse which risk factors in the family, school and peer domains have an effect on the use of different types of drugs (alcohol, tobacco and narcotics) and on frequencies of drug use. Another question to be addressed is whether the number of risk factors present also has an effect on the different dimensions of drug use. A total of 467 students aged 14–15 (234 boys and 233 girls) were included in the study and a series of multivariate logistic regressions were estimated. The results show that the effects of family disruption, conflict in the family, parental monitoring, academic performance, time spent with friends and peer deviance differ significantly across the various dimensions of drug use studied. Parental monitoring, time spent with friends and peer deviance showed themselves to be the most important risk factors across these various dimensions. The number of risk factors present was also found to have an effect on drug use.