Socioeconomic inequalities and Black/White disparities in US cocaine-involved overdose mortality risk

Purpose

This study examined whether socioeconomic inequalities account for Black/White disparities in: (a) the prevalence of potential risk factors for overdose among adults using cocaine; and (b) national mortality rates for cocaine-involved overdose.

Methods

Data from 2162 Non-Hispanic (NH) Black or White adults (26 +) who reported past-year cocaine use in the 2015–2019 National Survey of Drug Use and Health were analyzed to obtain predicted probabilities of potential overdose risk factors by race and sex, using marginal effects via regression analyses, adjusting for age and socioeconomic indicators. Next, National Center for Health Statistics data (for 47,184 NH Black or White adults [26 +] who died of cocaine-involved overdose between 2015 and 2019) were used to calculate cocaine-involved overdose mortality rates by race and sex across age and educational levels.

Results

Several potential overdose vulnerabilities were disproportionately observed among NH Black adults who reported past-year cocaine use: poor/fair overall health; cocaine use disorder; more days of cocaine use yearly; hypertension (for women); and arrests (for men). Adjusting for age and socioeconomic indicators attenuated or eliminated many of these racial differences, although predicted days of cocaine use per year (for men) and cocaine use disorder (for women) remained higher in NH Black than White adults. Cocaine-involved overdose mortality rates were highest in the lowest educational strata of both races; nonetheless, Black/White disparities were observed even at the highest level of education, especially for adults ages 50 + .

Conclusion

Age and socioeconomic characteristics may account for some, yet not all, of Black/White disparities in vulnerability to cocaine-involved overdose.

     

Prevalence and correlates of truancy in the US: Results from a national sample

Truancy has been a persistent problem in the United States for more than 100 years. Although truancy is commonly reported as a risk factor for substance use, delinquency, dropout, and a host of other negative outcomes for youth, there has been surprisingly little empirical investigation into understanding the causes and correlates of truancy using large, nationally representative samples. Using the adolescent sample (N = 17,482) of the 2009 National Survey on Drug Use and Health (NSDUH), this study presents the prevalence of truancy and examines individual, school engagement, parental, and behavioral correlates of truancy. Overall, 11% of adolescents between the ages of 12–17 reported skipping school in the past 30 days. Results from multinomial logistic regression models indicate skipping school was robustly associated with an increased probability of reporting externalizing behaviors, less parental involvement, and engagement and lower grades in school. Implications for theory, prevention, and policy are discussed.     

Adolescent Experiences of Clinician–Patient HIV/STI Communication in Primary Care

Effective clinician–patient communication is linked to positive patient health outcomes in adults, yet the research on adolescent populations remains limited. We describe adolescent experiences of clinician–patient HIV/STI communication through qualitative interviews with predominantly African-American adolescent women from a youth-centered primary care clinic. Participants described acknowledging clinicians are professionals, the importance of confidentiality to foster clinician–adolescent communication, and calling for clinician-initiated HIV/STI communication. Adolescents expressed the necessity for clinicians to engage youth in these challenging conversations through an open and understanding approach. Additionally, adolescents described experiences of perceived judgment and uncomfortableness from clinicians, and non-disclosure of HIV/STI risk behaviors to their clinician. Findings underscore the adolescents’ desire to engage in HIV/STI communication with healthcare providers, while highlighting important strategies for clinicians. Results can inform health communication research and practice, and the development of interventions aimed at increasing clinician–adolescent HIV/STI communication.     

A Typology of Substance Use Among Pregnant Teens in the United States

Objectives Previous research suggests that, in general, youth who become pregnant during their teenage years tend to report elevated levels of substance use prior to conception and substantial reductions in use during pregnancy. While such studies provide insight into aggregate patterns of adolescent substance use in relation to pregnancy, they may have the unintended effect of masking the behavioral heterogeneity of pregnant teens. Methods The present study employs data from a large, population-based study of adolescents in the United States. We employ latent class analysis to identify subgroups of pregnant adolescents (ages 12–17; n = 810) on the basis of variables measuring the past 12-month and past 30-day use of an extensive array of substances. Results Results revealed a four class solution. Classes were identified as Class 1: Abstainers (n = 344, 42.47 %), Class 2: Drinkers (n = 303, 37.41 %), Class 3: Alcohol and Cannabis Users (n = 77, 9.51 %), and Class 4: Polydrug Users (n = 86, 10.62 %). The Abstainers class had the highest proportion of Hispanic youth (34.3 %) as well as the highest proportion of youth residing in households earning less than $20,000 per year (44.2 %). The Polydrug Users class had the highest proportion of youth who were in late adolescence (75.58 %), non-Hispanic white (54.65 %), high-income (13.95 %), and in their first trimester of pregnancy (58.33 %). Conclusions for Practice Findings point to an important degree of heterogeneity among pregnant teens and may have implications for the development of interventions designed for youth exhibiting disconcerting patterns of substance use prior to pregnancy.     

Understanding tobacco use among urban African American adolescents living in public housing communities: a test of problem behavior theory

This study was guided by Jessor and Jessor's problem behavior theory (PBT) to test the relative effects of personality, perceived environment and behavior system variables on urban teen tobacco use. A sample of 518 urban African American youth residing in public housing communities in three large U.S. cities was utilized. Our results provide partial support for PBT in this study. Personality system variables (i.e., positive attitudes toward tobacco use, and depressive affect, cause and outcome indicators) and behavior system variables (i.e., delinquent behaviors) significantly predicted adolescent tobacco use. Depressive effect and cause indicators were stronger than depressive outcome indicators in predicting the extent of tobacco use. Additionally, age positively moderated the impact of positive attitudes about tobacco use on the extent of adolescent tobacco use. However, perceived environment system variables (e.g., exposure to delinquent peers) did not predict such use. This study suggests that PBT may aid in understanding adolescent tobacco use. Implications for practice and future inquiry are discussed.     

Substance use among bi/multiracial youth in the United States: Profiles of psychosocial risk and protection

Background: Bi/multiracial youth face higher risk of engaging in substance use than most monoracial youth. Objectives: This study contrasts the prevalence of substance use among bi/multiracial youth with that of youth from other racial/ethnic groups, and identifies distinct profiles of bi/multiracial youth by examining their substance use risk. Methods: Using data from the National Survey on Drug Use and Health (collected between 2002 and 2014), we analyze data for 9,339 bi/multiracial youth ages 12–17 living in the United States. Analyses use multinomial regression and latent class analysis. Results: With few exceptions, bi/multiracial youth in general report higher levels of tobacco, alcohol, marijuana, and other illicit drug use compared to other youth of color. Bi/multiracial youth also report higher levels of marijuana use compared to non-Hispanic white adolescents. However, latent class modeling also revealed that a majority (54%) of bi/multiracial youth experience high levels of psychosocial protection (i.e., strong antidrug views and elevated parental engagement) and low levels of psychosocial risk (i.e., low peer substance use, school-related problems, and social-environmental risk), and report very low levels of substance use. Substance use was found to be particularly elevated among a minority of bi/multiracial youth (28%) reporting elevated psychosocial risk and low levels of protection. Bi/multiracial youth characterized by both elevated psychosocial risk and elevated psychosocial protection (22%) reported significantly elevated substance use as well. Conclusions: While bi/multiracial youth in general exhibit elevated levels of substance use, substantial heterogeneity exists among this rapidly-growing demographic.     

The immigrant paradox: immigrants are less antisocial than native-born Americans

Social Psychiatry and Psychiatric Epidemiology - Although recent research on crime and violence among immigrants suggests a paradox—where immigrants are more socially disadvantaged yet less...     

Faculty education in addiction training (FEAT): Evaluating an online training program for multidisciplinary health professions educators

Abstract

Background: Many health professionals lack adequate training needed to effectively address alcohol and other drug (AOD)-related problems. Building upon our previously successful in-person faculty training programs, we designed and pilot tested the brief online Faculty Education in Addiction Training (FEAT) Program for social work and internal medicine residency faculty. The present study examines baseline and post-FEAT Program AOD knowledge and teaching confidence and preparedness among faculty participants. Methods: The FEAT Program curriculum included didactic videos, online engagement with content experts, recommended readings, and a live virtual classroom experience. Participants completed self-assessments of knowledge and teaching confidence and preparedness pre- and post-FEAT program. Results: In this pilot test, thirty faculty completed the FEAT program: 15 social work and 15 internal medical residency program faculty. Both groups showed significant improvement (p?<?0.001) in overall AOD-related knowledge with medium-to-large effects (Cohen’s d?=?1.83 [social work], 0.72 [medicine]). Both groups showed significant increases in teaching confidence (p?<?0.001) for all items with large effects (Cohen’s d values range from 1.08 to 1.92) and significant increases and large effects for all teaching preparedness items for social work (at least p?<?0.01 | Cohen’s d range = 1.03–1.56) and internal medical residency faculty (p?<?0.001 | Cohen’s d range = 1.08–1.69). Conclusions: Multidisciplinary health professions educators’ AOD knowledge and teaching confidence and preparedness can be improved by participation in a brief online program designed to circumvent the logistical and fiscal challenges presented by in-person programs.     

A confirmatory approach to understanding the four-factor structure of the Adolescent Drinking Index: Evidence for a brief version

The purpose of this study was to examine the psychometric properties of the original version of the Adolescent Drinking Index (ADI), and to examine the fit of a series of confirmatory factor analysis models to arrive at an abbreviated version that can be easily administered in settings with limited time for assessment. These aims were examined in a sample of 740 adolescents (M_age = 15.26; 58.5% males) who completed the ADI during an emergency department visit. Results suggested that the four-domain design did not fit the data adequately. Results, however, demonstrated good fit for an 8-item adapted version with a four-factor structure: interpersonal, social, psychological, and physical indicators. This abbreviated version was also associated with outcomes such as hangover, alcohol withdrawal, and substance use. Findings from this study provide support for the use of an abbreviated version of the ADI for screening adolescents and referring them to appropriate interventions.     

Dropping out of school and chronic disease in the United States

Aim

Despite links between education and health, it is unclear to what extent dropping out of school is associated with major chronic health conditions.

Subjects and Methods

Data from the 2006–2010 United States National Survey on Drug Use and Health (NSDUH) was employed and examined associations between dropping out of school and major chronic health conditions among individuals 18 years or older (N?=?189,896).

Results

Analyses show that dropout status is associated with increased odds of reporting a major chronic health condition; however, the effect is stronger for Whites and African-Americans than Hispanics.

Conclusions

Study findings suggest that one important strategy to prevent and reduce health disparities is increased education in general including high school completion. Policies and practices that reduce dropout may in turn impact the prevalence of chronic disease.