The Impact of the Urban Neighborhood Environment on Marijuana Trajectories During Emerging Adulthood

Alcohol and Cannabis Use in the Context of Violence Experiences and Traditional Masculinity Attitudes Among Black Emerging Adult Men in Baltimore, Maryland

Cannabis and alcohol use can be coping mechanisms for young Black men who have experienced violence. Less is known about cannabis and alcohol use among men with cumulative violence experiences, including intimate partner violence (IPV). The purpose of this study was to describe alcohol and cannabis use in the context of violence experiences and traditional masculinity attitudes. Black men ages 18 to 24 (N = 100) were recruited from community centers serving disconnected youth in Baltimore, MD. They completed cross-sectional surveys and a subsample participated in a total of three focus groups (n = 17). Cumulative violence was a composite variable comprising experiences of IPV, child abuse, witnessing family violence, and neighborhood violence. Cannabis and alcohol use and violence experiences were summarized using descriptive statistics. Focus group data were managed in a software program and thematically analyzed among three team members. Most participants reported cannabis use (61%) and two or more cumulative violence experiences (70%), with a smaller percentage reporting frequent binge drinking (15%). Two themes described cannabis and alcohol use motivations: (a) Coping and (b) Social connectedness. "That's my escape for real" described a participant coping with experiences of trauma and violence. "It's a social thing" described participant use that facilitated and enhanced peer social connectedness in the context of collective trauma. A Baltimore-based sample of young Black men reported multiple forms of violence. Alcohol and cannabis helped men cope with experiences of trauma and violence and enhance social connections. Black men's cumulative experiences of violence should be considered when addressing alcohol and cannabis use.

Attention-Deficit/Hyperactivity Disorder and Subsequent Trauma Exposure: The Mediating Role of Deviant Peer Affiliation

Individuals with ADHD symptoms are at an increased risk of lifetime trauma exposure. However, research has yet to fully examine whether symptoms of ADHD function as a temporal risk factor for experiencing trauma and specific mechanisms that may explain the association between symptoms of ADHD and trauma exposure. Two constructs that may account for the relation between ADHD symptoms and trauma are deviant peer association and neighborhood disadvantage. The present study sought to 1) elucidate the temporal nature of ADHD symptoms and exposure to trauma and 2) examine whether peer deviancy and/or neighborhood disadvantage mediate the relation between childhood ADHD symptoms and subsequent trauma exposure across a 20-year longitudinal cohort study. Participants (N = 616) were predominantly Black/African American (86%; Male n = 389) from an urban school district. Using structural equation modeling, total trauma exposures during young adulthood (Years 17-20) were regressed on parent- and teacher-rated ADHD symptoms in Grade 1 (Year 1). A significant indirect path from ADHD symptoms to trauma exposure through deviant peer affiliation (Year 16) indicated that having childhood ADHD symptoms predicted deviant peer affiliation 16 years later, which in turn predicted greater exposures to traumatic events during young adulthood, controlling for neighborhood disadvantage. Neighborhood disadvantage was not a significant mediator when accounting for peer deviancy. Taken together, findings contribute to a limited body of research that utilizes a prospective design to examine the association between childhood ADHD symptoms and trauma exposure in young adulthood among Black/African American youth. Potential targets for intervention are proposed.

Perceived neighborhood disorder as a moderator of the relationship between marijuana use and disinhibition in a sample of emerging adult African American females

Disinhibition is associated with myriad risk-taking behaviors and adverse outcomes. Both marijuana use and poor neighborhood conditions have been associated with disinhibition. However, the extent to which neighborhood disorder interacts with marijuana use to influence disinhibition has not been studied, extensively. A better understanding of these relationships has implications for designing more effective tailored place-based interventions that aim to reduce risk taking behaviors and related adverse social and health outcomes associated with marijuana use. Thus, the purpose of this study was to examine the interactive effects of perceived neighborhood disorder and marijuana use on disinhibition. The sample included 120 African American female residents of disadvantaged neighborhoods (Mage = 23.6 ± 3.46). We employed hierarchical linear regression analysis to examine the interactive effects of marijuana use and perceived neighborhood disorder on disinhibition, while controlling for age and education. The interaction term was marginally significant (b = 5.66; t(109) = 1.72, p = .08). Next, the conditional effects were explored. Results indicated the association of marijuana use with disinhibition was stronger for females in the higher neighborhood disorder group, compared to those in the lower neighborhood disorder group (10.40 and 4.51, respectively). Our findings support the need for more research on the potential of neighborhood disorder to amplify the effects of marijuana use on disinhibition and related neurobehavioral traits. The identification of contextual moderators and high-risk sub-groups will aid in the design of more tailored place-based interventions that aim to reduce risk-taking behavior among those most vulnerable.

Family-Focused Prevention and Early Intervention of Substance Use in Pediatric Primary Care Settings

Prevention of substance misuse and substance use disorders is a national public health priority. The home environment can represent risk or protective factors for development of substance misuse. Children in homes with caregiver substance use are biologically, developmentally, interpersonally, and environmentally vulnerable to substance misuse and associated consequences, making it necessary for substance use prevention to focus on families early. Children and families who are minoritized, marginalized, and disenfranchised experience disproportionate consequences of substance use, through experiences of poverty, racism, trauma, and the built environment. Strengthening protective factors in early childhood by improving the health of caregivers and supporting the caregiver-child relationship can have enduring benefits over the life course. Pediatric primary care practices are an important setting for adopting a family-focused approach to prevention and early intervention of substance use. By engaging families early, identifying substance use in the family and household, recognizing the intersection of social needs and substance use, providing culturally tailored, trauma-informed, evidence-based care, and advising and supporting families on ways to minimize substance-related harm, pediatric care providers can play an important role in preventing substance use and substance-related consequences to children and families. Pediatric care providers are ideally suited to deliver prevention messages in a nonstigmatizing manner and serve as a conduit to evidence-based, family-focused intervention programs.

Mexican-origin parent and child reported neighborhood factors and youth substance use

Background

Structural oppression affects health behaviors through residence in suboptimal neighborhoods and exposure to community violence. Youth and parents report perceptions of neighborhood factors that can affect youth substance use behaviors. Given that Latinx youth report higher levels of perceived community violence than other racial and ethnic groups, it is imperative to examine how youth- and parent-perceived neighborhood-level factors may relate to youth substance use.

Methods

Data were collected using clinical interviews with family triads (fathers, mothers, and youth) and parent-child dyads (father or mother and youth) enrolled in the Seguimos Avanzando study of 344 Mexican-origin families in Indiana. Neighborhood measures, including perceptions of exposure to violence, neighborhood characteristics, and neighborhood collective efficacy, were included in parent and youth surveys. Self-report measures for past year alcohol and drug use were included in the youth survey only. T-tests were conducted to estimate differences in neighborhood reports among the sample triads. A series of linear regression models were used to estimate the associations between youth-, mother-, and father-reported perceptions of neighborhood factors and youth substance use.

Results

Preliminary results indicate that fathers reported higher levels of exposure to violence than mothers [t(163) = 2.33, p = 0.02] and youth [t(173) = 3.61, p < 0.001]. Youth reported lower negative neighborhood characteristics than mothers [t(329) = 6.43, p < 0.001] and fathers [t(169) = 3.73, p < 0.001]. Youth reported significantly better neighborhood collective efficacy than mothers [t(296) = 3.14, p = 0.002], but not statistically different from fathers. Results from the primary analysis showed that youth exposure to violence was positively associated with youth substance use (b = 0.24, SE = 0.06, p < 0.0001), but the youth's neighborhood characteristics and collective efficacy were not significantly associated with youth substance use. None of the parent-reported neighborhood variables were associated with youth substance use.

Conclusion

The discrepant findings between parent and youth reports of perceived neighborhood characteristics and substance use have important implications for researchers and community stakeholders, and for developing targeted interventions and prevention strategies. Our study highlights the need to address youth experience of community violence and to prioritize creating safe and inclusive neighborhood environments. Potential strategies include improving community resources, strengthening social support networks, promoting open communication about neighborhood risks, and fostering collaborative efforts to address substance use behaviors.

"What Do You Consider Use?" Perspectives of Black Youth on Cannabis Use

PURPOSE

Adolescent health surveillance systems are critical for understanding patterns of cannabis use; however, their limitations underscore the need for studies that generate new insights, particularly from individuals who are most impacted by negative outcomes. Our objectives were to learn about youths' cannabis use and their perceptions of their peers' cannabis use; their perspectives about trajectories of cannabis use over time and factors that influence trajectories; and perceived risks and benefits associated with cannabis use.

METHODS

A group model building approach was used to gather data about cannabis use from a sample of urban, Black youth. Information about participants' cannabis use was assessed on eligibility screener, enrollment survey, and through structured activities over the course of four group model building workshops.

RESULTS

Participants [(n = 20) mean age 18; 35% male and 95% Black] exclusively used the terms weed and blunts for cannabis. Youth who consume peers' blunts would not characterize themselves as cannabis users. Collectively, youth estimated the majority of Baltimore youth used cannabis by age 16 and that most used daily. Youth described cannabis as more beneficial than harmful. There were no gender differences in prevalence of use, but there were gender dynamics to shared use.

DISCUSSION

Participatory research with urban, Black youth suggests youths' perceptions are misaligned with the ways that researchers conceptualize cannabis use. To better understand the scope of youth cannabis use and its harms, it is critical to leverage input from youth with lived experience to ensure survey tools adequately capture the way youth see themselves using cannabis.

How Neighborhood Characteristics Influence Neighborhood Crimes: A Bayesian Hierarchical Spatial Analysis

Urban crimes are a severe threat to livable and sustainable urban environments. Many studies have investigated the patterns, causes, and strategies for curbing the occurrence of urban crimes. It is found that neighborhood socioeconomic status, physical environment, and ethnic composition all might play a role in the occurrence of urban crimes. Inspired by the recent interest in exploring urban crime patterns with spatial data analysis techniques and the development of Bayesian hierarchical analytical approaches, we attempt to explore the inherently intricate relationships between urban assaultive violent crimes and the neighborhood socioeconomic status, physical environment, and ethnic composition in Paterson, NJ, using census data of the American Community Survey, alcohol and tobacco sales outlet data, and abandoned property listing data from 2013. Analyses are set at the census block group level. Urban crime data are obtained from the Paterson Police Department. Instead of examining relationships at a global level with both non-spatial and spatial analyses, we examine in depth the potential locally varying relationships at the local level through a Bayesian hierarchical spatially varying coefficient model. At both the global and local analysis levels, it is found that median household income is decisively negatively related to urban crime occurrence. Percentage of African Americans and Hispanics, number of tobacco sales outlets, and number of abandoned properties are all positively related with urban crimes. At the local level of analysis, however, the different factors have varying influence on crime occurrence throughout the city of Paterson, with median household income having the broadest influence across the city. The practice of applying a Bayesian hierarchical spatial analysis framework to understand urban crime occurrence and urban neighborhood characteristics enables urban planners, stakeholders, and public safety officials to engage in more active and targeted crime-reduction strategies.

Racial and Ethnic Differences in Cannabis Use and Cannabis Use Disorder: Implications for Researchers

PURPOSE

Heavy and prolonged use of cannabis is associated with several adverse health, legal and social consequences. Although cannabis use impacts all U.S. racial/ethnic groups, studies have revealed racial/ethnic disparities in the initiation, prevalence, prevention and treatment of cannabis use and Cannabis Use Disorder (CUD). This review provides an overview of recent studies on cannabis and CUD by race/ethnicity and a discussion of implications for cannabis researchers.

FINDINGS

The majority of studies focused on cannabis use and CUD among African American/Black individuals, with the smallest number of studies found among Native Hawaiians/Pacific Islanders. The limited number of studies highlight unique risk and protective factors for each racial/ethnic group, such as gender, mental health status, polysubstance use and cultural identity.

SUMMARY

Future cannabis studies should aim to provide a deeper foundational understanding of factors that promote the initiation, maintenance, prevention and treatment of cannabis use and CUD among racial/ethnic groups. Cannabis studies should be unique to each racial/ethnic group and move beyond racial comparisons.

Associations of cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults in Washington State

BACKGROUND

This study examined associations of local cannabis retail outlet availability and neighborhood disadvantage with cannabis use and related risk factors among young adults.

METHODS

Data were from annual cross-sectional surveys administered from 2015 to 2019 to individuals ages 18-25 residing in Washington State (N = 10,009). As outcomes, this study assessed self-reported cannabis use at different margins/frequencies (any past year, at least monthly, at least weekly, at least daily) and perceived ease of access to cannabis and acceptability of cannabis use in the community. Cannabis retail outlet availability was defined as the presence of at least one retail outlet within a 1-kilometer road network buffer of one's residence. Sensitivity analyses explored four other spatial metrics to define outlet availability (any outlet within 0.5-km, 2-km, and the census tract; and census tract density per 1000 residents). Census tract level disadvantage was a composite of five US census variables.

RESULTS

Adjusting for individual- and area-level covariates, living within 1-kilometer of at least one cannabis retail outlet was statistically significantly associated with any past year and at least monthly cannabis use as well as high perceived access to cannabis. Results using a 2-km buffer and census tract-level metrics for retail outlet availability showed similar findings. Neighborhood disadvantage was statistically significantly associated with at least weekly and at least daily cannabis use and with greater perceived acceptability of cannabis use.

CONCLUSIONS

Results may have implications for regulatory and prevention strategies to reduce the population burden of cannabis use and related harms.

Geographic ecological momentary assessment methods to examine spatio-temporal exposures associated with marijuana use among young adults: A pilot study

BACKGROUND

This study demonstrates the use of geographic ecological momentary assessment (GEMA) methods among young adult marijuana users.

METHOD

Participants were 14 current marijuana users ages 21-27 living in Greater Seattle, Washington. They completed brief surveys four times per day for 14 consecutive days, including measures of marijuana use and desire to use. They also carried a GPS data logger that tracked their spatial movements over time.

RESULTS

Participants completed 80.1% of possible EMA surveys. Using the GPS data, we calculated daily number of exposures to (i.e., within 100-m of) marijuana retail outlets (mean = 3.9 times per day; SD = 4.4) and time spent per day in high poverty census tracts (mean = 7.3 h per day in high poverty census tracts; SD = 5.1).

CONCLUSIONS

GEMA may be a promising approach for studying the role spatio-temporal factors play in marijuana use and related factors.

Understanding caregiver acceptance of screening for family substance use in pediatric clinics serving economically disadvantaged children

Background: Children of parents with substance use disorders are at greater risk for mental and physical health co-morbidities. Despite guidelines, pediatricians rarely screen for substance use in the family/household, citing fear of offending parents. The objectives of this study were to examine (1) caregiver acceptance of pediatricians screening for family/household substance use during well-child visits, (2) prevalence of family/household substance use, and (3) the association between family/household substance use and trust in their child's pediatrician. Methods: This cross-sectional study surveyed adult caregivers presenting a child for medical care at two urban pediatric outpatient clinics using a brief anonymous computer-based survey. The primary outcome measured the acceptability of pediatrician screening for family/household substance use. Substance use and concerns about use in the family/household were also assessed. Results: Adult caregivers (n = 271) surveyed were mean age 35 years, 73% mothers, 90% African American, and 85% on Medicaid. Over half (51%) of caregivers reported substance use by someone in the family/household, most commonly cigarettes (38%), followed by alcohol (19%) and marijuana (10%). Sixty-one percent of caregivers who reported family substance use expressed concern about the use of this substance. The majority (87%) agreed it is appropriate for pediatricians to ask caregivers about family/household substance use. No differences were found between caregivers who did and did not report substance use in their family/household. Caregivers with concerning substance use in their family/household were less likely to trust their pediatrician [OR = 0.21, 95%CI: 0.05, 0.85] Conclusions: Caregivers endorsed acceptance of universal screening for substance use, including illicit substances, and substance use disorders in the family/household during well-child visits. Pediatricians are trusted professionals with expertise in communicating with parents to maximize the health of their patients; assessing family history of substance use and substance use disorders is a natural extension of their role.

Local variation in cannabis use patterns among young adults in the San Francisco Bay Area

This study evaluated whether neighborhood-level disorder, social cohesion, and perceived safety, were associated with days of cannabis use in the prior month in a representative sample of young adults in Alameda and San Francisco Counties in California (N = 1272). We used multiscale geographically weighted regression, modeled by county, to measure associations between cannabis use days and neighborhood attributes, adjusting for sociodemographic characteristics and self-rated health. Positive associations were found between number of cannabis use days and neighborhood disorder, and greater perceived safety. Higher levels of social cohesion predicted fewer cannabis use days. Racial/ethnic, sex and, socioeconomic compositions of participants residing in areas with significant neighborhood-level associations varied substantially, suggesting that risk factors for young adult cannabis use may be highly localized. Public health efforts in cannabis education and intervention should be tailored to fit the culture and composition of local neighborhoods.

Trajectories of cannabis use and risk for opioid misuse in a young adult urban cohort

BACKGROUND

Although much of the attention surrounding the opioid epidemic has focused on rural and suburban Whites and prescription opioids, heroin overdoses among urban Blacks are on the rise. While some argue that legalization of cannabis will combat the epidemic, there are concerns it ignores the shift in the epidemic and could increase vulnerability to opioid misuse. The goal of this study is to examine the association between cannabis use from adolescence to young adulthood with opioid misuse in a primarily urban Black cohort.

METHODS

Data are from a study of 580 youth (87 % Black and 71 % low SES) residing in Baltimore City followed from ages 6-26. Cannabis trajectories were identified between ages 14-26 using group-based trajectory modeling. Logistic regressions were conducted to examine the impact of trajectories on opioid misuse in young adulthood adjusting for individual, neighborhood and peer factors. Opioid misuse was defined as using heroin or narcotics or painkillers without a prescription between ages 19-26.

RESULTS

Four cannabis trajectories were identified: Low/Non-Users (59.7 %), Adolescent Onset Limited (19.5 %), Young Adult Onset (10.8 %), and Adolescent Onset Chronic (10.0 %). Adolescent Onset Chronic cannabis users had the highest rate of opioid misuse (44.8 %) followed by Adolescent Onset Limited (18.8 %), Young Adult Onset (14.8 %) and Low/Non-Users (8.3 %). Prevalences were significantly higher for Adolescent Onset groups relative to Low/Non-Users even after adjustment for individual, neighborhood and peer factors.

CONCLUSIONS

Adolescent onset cannabis use is associated with opioid misuse in young adulthood among urban Blacks even after adjustment for socioecological factors associated with opioid misuse.

Polygenic and environmental influences on the course of African Americans' alcohol use from early adolescence through young adulthood

The study examined (a) whether alcohol use subgroups could be identified among African Americans assessed from adolescence through early adulthood, and (b) whether subgroup membership was associated with the interaction between internalizing symptoms and antisocial behavior polygenic risk scores (PRSs) and environmental characteristics (i.e., parental monitoring, community disadvantage). Participants (N = 436) were initially recruited for an elementary school-based prevention trial in a Mid-Atlantic city. Youths reported on the frequency of their past year alcohol use from ages 14-26. DNA was obtained from participants at age 21. Internalizing symptoms and antisocial behavior PRSs were created based on a genome-wide association study (GWAS) conducted by Benke et al. (2014) and Tielbeek et al. (2017), respectively. Parental monitoring and community disadvantage were assessed at age 12. Four classes of past year alcohol use were identified: (a) early-onset, increasing; (b) late-onset, moderate use; (c) low steady; and (d) early-onset, decreasing. In high community disadvantaged settings, participants with a higher internalizing symptoms PRS were more likely to be in the early-onset, decreasing class than the low steady class. When exposed to elevated community disadvantage, participants with a higher antisocial behavior PRS were more likely to be in the early-onset, increasing class than the early-onset, decreasing and late-onset, moderate use classes.

Neighbourhood disadvantage and depressive symptoms among adolescents followed into emerging adulthood

BACKGROUND

Residents of disadvantaged neighbourhoods report higher levels of depressive symptoms; however, few studies have employed prospective designs during adolescence, when depression tends to emerge. We examined associations of neighbourhood social fragmentation, income inequality and median household income with depressive symptoms in a nationally representative survey of adolescents.

METHODS

The NEXT Generation Health Study enrolled 10th-grade students from 81 US high schools in the 2009-2010 school year. Depressive symptoms were assessed with the Modified Depression Scale (wave 1) and the paediatric Patient-Reported Outcome Measurement Information System (waves 2-6). Neighbourhood characteristics at waves 1, 3, 4, and 5 were measured at the census tract level using geolinked data from the American Community Survey 5-year estimates. We used linear mixed models to relate neighbourhood disadvantage to depressive symptoms controlling for neighbourhood and individual sociodemographic factors.

RESULTS

None of the models demonstrated evidence for associations of social fragmentation, income inequality or median household income with depressive symptoms.

CONCLUSION

Despite the prospective design, repeated measures and nationally representative sample, we detected no association between neighbourhood disadvantage and depressive symptoms. This association may not exist or may be too small to detect in a geographically dispersed sample. Given the public health significance of neighbourhood effects, future research should examine the developmental timing of neighbourhood effects across a wider range of ages than in the current sample, consider both objective and subjective measures of neighbourhood conditions, and use spatially informative techniques that account for conditions of nearby neighbourhoods.