Adolescents' future orientation and nonmedical use of prescription drugs

Protective Factors Against Vaping and Other Tobacco Use

BACKGROUND AND OBJECTIVES

Vaping has gained popularity among adolescents despite negative health consequences. Few studies have focused on factors that may protect against vaping. We sought to determine if future orientation, parental monitoring, school connectedness, and social support are associated with decreased risk of vaping and other forms of tobacco use.

METHODS

Data were obtained via anonymous school-based health behavior surveys among ninth- through 12th-graders in Pittsburgh, PA (n = 2487). Protective factors were assessed through validated Likert scale instruments. The primary outcome was recent (past 30-day) vaping. Additional outcomes included other forms of tobacco use and intention to quit tobacco products. Poisson regression models examined associations between protective factors and vaping and tobacco use outcomes.

RESULTS

Mean age was 15.7 years, 1446 (58.1%) respondents were female, and 671 youth (27.0%) reported recent vaping. Positive future orientation and high parental monitoring were associated with significantly lower prevalence of recent vaping (adjusted prevalence ratio: 0.84 [95% confidence interval: 0.73-0.97] and adjusted prevalence ratio: 0.73 [95% confidence interval: 0.62-0.85], respectively). There were no significant relationships between social support or school connectedness and vaping. All 4 protective factors were inversely associated with other forms of tobacco use. No factors were significantly associated with intent to quit tobacco products.

CONCLUSIONS

Findings reveal significant inverse associations between future orientation, parental monitoring, and vaping but no relationship between protective factors and intent to quit tobacco products. Developing interventions to foster protective factors in youth and their parental supports may inform primary prevention efforts to reduce vaping and other tobacco use.

The Role of Future Orientation and Self-determination on American Indian Adolescents' Intentions to Use Alcohol and Marijuana

Substance use (SU) rates among American Indian (AI) adolescents have been greater than national rates for decades, with little progress made on reducing them. Reasons for this may include lack of evidence on which to base effective interventions, the uniqueness of this population, and the overall lack of attention that this population has received in reducing socioeconomic and health disparities. Moreover, there has been limited focus on understanding how positive individual characteristics may serve as protective factors for AI adolescents. Using data from 379 AI youth living on or near four northern plains reservations, the current study examines the relationship between future orientation (FO) and self-determination (SD) and intentions to use alcohol and marijuana, with negative consequences of SU for future goals and autonomy evaluated as potential mediators. SEM models were estimated for alcohol use and marijuana use intentions, with two separate models for each dependent variable-one assessing the direct and indirect effects of FO via perceived consequences for future goals and the other assessing the effects of SD via perceived consequences for autonomy. All models displayed good fit, but the pattern of significant effects varied by substance, by construct (FO vs. SD), and by gender. Findings suggested that SD, and more proximally, perceived consequences of use for autonomy, may be particularly useful promotive factors to target SU prevention in AI adolescents. Culturally congruent interventions designed to promote SD and autonomous motivations to abstain may be particularly impactful within a young AI adolescent population, as early adolescence represents a critical period of development for personal autonomy and identity.

Risk and protective factors predicting prescription drug misuse in a sample of Puerto Rican students

The present study was directed at examining a model of risk, and protective factors for prescription drug misuse in a representative sample of 8,079 students enrolled in 130 randomly selected middle and high schools in Puerto Rico. Based on the available empirical literature that was examined, depressed mood, availability of illegal drugs, sensation-seeking behavior, social learning, peer's drug use as risk factors, and positive outlook of the future as protective factors for prescription drug misuse youths. The Puerto Rico Survey of Youth Risk Behaviors Questionnaire (SYRB-PR) was administered to all participants, and all the experimental measures of the risk and protective factors were obtained from this instrument. The results show that the best predictors of drug misuse among Puerto Rican students were those related to the social learning at their homes, followed by sensation seeking, peer use of drugs, accessibility of drugs, and depressed mood. A positive outlook of the future was not a significant predictor of less prescription drug misuse. These results can serve as explorative and provide recommendations for future research on prescription drug misuse among Hispanics and possibly all youths in the U.S.

Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol

BACKGROUND

Self-regulation (SR), or the capacity to control one's thoughts, emotions, and behaviors in order to achieve a desired goal, shapes health outcomes through many pathways, including supporting adherence to medical treatment regimens. Type 1 Diabetes (T1D) is one specific condition that requires SR to ensure adherence to daily treatment regimens that can be arduous and effortful (e.g., monitoring blood glucose). Adolescents, in particular, have poor adherence to T1D treatment regimens, yet it is essential that they assume increased responsibility for managing their T1D as they approach young adulthood. Adolescence is also a time of rapid changes in SR capacity and thus a compelling period for intervention. Promoting SR among adolescents with T1D may thus be a novel method to improve treatment regimen adherence. The current study tests a behavioral intervention to enhance SR among adolescents with T1D. SR and T1D medical regimen adherence will be examined as primary and secondary outcomes, respectively.

METHODS

We will use a randomized control trial design to test the impact of a behavioral intervention on three SR targets: Executive Functioning (EF), Emotion Regulation (ER), and Future Orientation (FO); and T1D medical regimen adherence. Adolescents with T1D (n = 94) will be recruited from pediatric endocrinology clinics and randomly assigned to treatment or control group. The behavioral intervention consists of working memory training (to enhance EF), biofeedback and relaxation training (to enhance ER), and episodic future thinking training (to enhance FO) across an 8-week period. SR and treatment regimen adherence will be assessed at pre- and post-test using multiple methods (behavioral tasks, diabetes device downloads, self- and parent-report). We will use an intent-to-treat framework using generalized linear mixed models to test our hypotheses that: 1) the treatment group will demonstrate greater improvements in SR than the control group, and 2) the treatment group will demonstrate better treatment regimen adherence outcomes than the control group.

DISCUSSION

If successful, SR-focused behavioral interventions could improve health outcomes among adolescents with T1D and have transdiagnostic implications across multiple chronic conditions requiring treatment regimen adherence.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03688919; registered September 28, 2018.

Feasibility and acceptability of a future-oriented empowerment program to prevent substance use and school dropout among school-disengaged youth

OBJECTIVE

To evaluate the feasibility and acceptability of a health promotion program to prevent school dropout and substance use among middle school-aged youth who display early warning signs of school disengagement.

INTERVENTION

Youth Empowerment Solutions for Positive Futures (YES-PF), an intensive, theoretically driven, 5-week summer enrichment program, aims to prevent school dropout and substance use by promoting youth empowerment, school engagement, and future orientation.

DESIGN AND SAMPLE

Using a pre-post-intervention design, we test feasibility and acceptability with 6th and 7th grade students (n = 43) who exhibited early warning signs for school disengagement (e.g., chronic absenteeism) in two school districts.

MEASURES

Program evaluation components included: (a) program session forms completed by facilitators; (b) post-program interviews with facilitators; (c) post-intervention program evaluation surveys with youth; (d) attendance; and (e) baseline and post-intervention surveys with youth to assess behavioral and psychosocial outcomes.

RESULTS

Facilitators routinely delivered core component lesson activities. Acceptability and program satisfaction were evidenced in strong program attendance by youth. Youth participants reported higher levels of leadership efficacy (p < .05) and a greater sense of control over their lives and potential problems (p < .01).

CONCLUSIONS

YES-PF was feasible and acceptable to school personnel and youth. Program refinement, based on implementation findings, is discussed.

Educational attainment and prescription drug misuse: The importance of push and pull factors for dropping out

PURPOSE

Young adults who do not complete high school are at increased risk for substance use and offending behavior. A limitation of this research is that dropouts are often treated as a homogeneous group, which ignores the various push (e.g., academic failure or disciplinary problems) and pull (e.g., family responsibility or economic need) factors for leaving school.

METHODS

The current study relies on multiple years of data from the National Survey on Drug Use and Health (2009-2014) and examines several dependent variables, including prevalence of prescription drug misuse, frequent prescription drug misuse, and prescription drug-related substance use disorder symptoms. We assess the importance of push and pull factors for dropping out, and compare dropouts to respondents who completed school.

RESULTS

Multivariable logistic regression analyses produce two important findings. First, push factors increase the risk of various types of prescription drug misuse compared to pull factors. Additionally, respondents who attend college are at a decreased risk for various types of prescription opioid and sedative/tranquilizer misuse and disorder.

DISCUSSION

The current research identifies important differences in prescription drug misuse and disorders among dropouts based on the reason they left school. Additionally, college attendance appears to be a strong protective factor.

Adolescent Risk Behavior: Differentiating Reasoned And Reactive Risk-taking

Although explanatory models of adolescent risk behavior have predominantly focused on adolescents' limited ability to self-regulate impulsive and/or reward-driven behavior (reactive risk behavior), recent arguments suggest that a significant proportion of adolescent risk behavior may actually be strategic and planned in advance (reasoned risk behavior). The present study evaluates hypothesized predictors of reasoned versus reactive risk behavior using self-reported and neurocognitive task data from a large, diverse adolescent sample (N = 1266 participants; N = 3894 risk behaviors). Participants' mean age was 16.5 years (SD = 1.1); 56.9% were female, 61.9% White, 17.1% Black, 7.0% Hispanic, and 14.1% other race/ethnicity; 40% were in 10th grade, 60% in 12th grade. As hypothesized, reasoned risk behavior (compared to reactive risk behavior) was associated with higher levels of sensation seeking, better working memory, greater future orientation, and perceiving risk behavior to be more beneficial than risky. These results support the distinction between reasoned and reactive risk behavior as meaningful subtypes of adolescent risk behavior and challenge prevailing frameworks that attribute adolescent risk behavior primarily to poor response inhibition.

Consideration of future consequences as a moderator of the willingness-behavior relationship for young adult marijuana use and consequences

The Prototype Willingness Model is a dual-processing (i.e., intentional and socially reactive) health-risk behavior model. The socially reactive path includes behavioral willingness, descriptive normative perceptions, and favorable images of individuals who engage in health-risk behavior (prototype favorability) as important predictors of health behaviors. Individual differences (such as consideration of future consequences) may potentiate the effects of behavioral willingness on health-risk outcomes, such as marijuana use. Given limited research investigating marijuana use and the Prototype Willingness Model, the goals of the current study were: 1) examine consideration of future consequences and Prototype Willingness Model social reaction pathway variables in relation to behavioral willingness to use marijuana longitudinally; and 2) determine if consideration of future consequences moderated the behavioral willingness-marijuana use relation prospectively. Young adults (N = 769) from a larger longitudinal study completed baseline and 3 follow-up assessments (Months 3, 4, 5). Behavioral willingness was positively related to a higher likelihood of use, more days having used marijuana, and more consequences prospectively, over and above baseline use. Consideration of future consequences moderated the association between behavioral willingness and hours high in a typical week. These findings support the willingness-behavior association of the Prototype Willingness Model and preliminarily demonstrate consideration of future consequences' differential impact on behavioral willingness-future marijuana use relation. Intervention and prevention implications are discussed.

Factors that Differentiate Prescription Stimulant Misusers from those At-Risk for Misuse: Expectancies, Perceived Safety, and Diversion

BACKGROUND

The nonmedical use of prescription stimulants (NMUPS) is one of the most prevalent illicit behaviors on college campuses. While numerous risk factors for NMUPS have been identified, it is unknown how nonusing students who meet several risk factors for NMUPS differ from those who have used, which may inform intervention efforts. We expected that users would evidence greater cognitive enhancement and anxiety/arousal expectancies and intentions to use, and lower guilt/dependence expectancies, perceptions of NMUPS-related harm, and academic self-efficacy.

METHODS

Between 2014 and 2016, students (N = 121; 65% female) at two demographically dissimilar colleges in the Northeastern and Midwestern United States who reported lifetime NMUPS or endorsed two or more NMUPS risk factors (i.e., recent marijuana use, recent binge drinking, grade point average <3.5, Greek-life involvement, male gender) reported on their prescription stimulant expectancies; academic self-efficacy; perceived harm of NMUPS; lifetime NMUPS; and intentions for NMUPS in the next six months.

RESULTS

A MANCOVA showed that at-risk nonusers had lower cognitive expectancies, higher guilt/dependence expectancies, and higher anxiety/arousal expectancies compared to users. ANCOVAs and Chi-square tests showed that nonusers also perceived NMUPS to be more harmful and were less likely to divert their medication if prescribed. The groups did not differ on academic self-efficacy or total number of risk factors endorsed. However, recent marijuana use was more prevalent in users.

CONCLUSIONS

Targeted preventive interventions for NMUPS should focus on students who are using marijuana and should aim to maintain lower positive and higher negative stimulant expectancies and reaffirm potential NMUPS-related harms.