Preventing growth in amphetamine use: long-term effects of the Midwestern Prevention Project (MPP) from early adolescence to early adulthood

A scoping review of social determinants of health's impact on substance use disorders over the life course

BACKGROUND

Substance use is a public crisis in the U.S. Substance use can be understood as a series of events in the life course, from initiation to mortality. Social Determinants of Health (SDoH) have increasingly been recognized as essential contributors to individuals' health. This scoping review aims to examine available evidence of SDoH impact on the life course of substance use disorder (SUD).

METHODS

This study identified peer-reviewed articles that reported longitudinal studies with SDoH factors as independent variables and substance use and disorders as dependent variables from PubMed, Embase, and Web of Science. The reported associations between SDoH and substance use stages over the life course were narratively and graphically summarized.

RESULTS

Among the 50 studies identified, ten revealed parental monitoring/support and early childhood education as protective factors, while negative peer influences and neighborhood instability were risk factors of substance use initiation. Nineteen articles reported factors associated with escalation in substance use, including unemployment, neighborhood vulnerability, negative peer influence, violence/trauma, and criminal justice system (CJS) involvement. Ten articles suggested that employment, social support, urban living, and low-barrier medication treatment facilitated treatment participation, while stigma and CJS involvement had negative impact on treatment trajectory. Social support and employment could foster progress in recovery and CJS involvement and unstable housing deterred recovery. Four studies suggested that unemployment, unstable housing, CJS involvement, and lack of social support were associated with overdose and mortality.

CONCLUSIONS

This review underscores the influence of social networks and early life experiences on the life course of SUD. Future SDoH research should investigate overdose and mortality and the impact of broader upstream SDoH on SUD. Interventions addressing these social factors are needed to mitigate their detrimental effects on the trajectories of SUD over the life course.

PROJECT STAR (Midwestern Prevention Project): Overview

The program designed to prevent substance use should be planned in multiple dimensions. One of these programs is Project Star. This study aims to evaluate the studies on the Project Star and identify the strengths and weaknesses of the program. For this purpose, the keywords "Project Star" and "Midwestern Prevention Project" were scanned from databases. The results of these studies were evaluated by giving a summary of the studies included in the study. As a result, the strengths of Project Star are that it is multidimensional, focuses on early development periods, includes the individual's ecological environment, and reduces substance use in later development periods, and not having an internet-based version. This situation has been identified as its weaknesses since its situation in other societies is unknown due to its cost and limited international applications.

Applying the PROSPER prevention delivery system with middle schools: Emerging adulthood effects on substance misuse and conduct problem behaviors through 14 years past baseline

This study evaluated emerging adult effects of the PROmoting School‐Community‐University Partnerships to Enhance Resilience (PROSPER) universal prevention delivery system implemented in middle schools. Twenty‐eight rural school districts were randomized to intervention and control conditions, with 1985 nineteen‐year‐old participants (90.6% White, 54.1% female) evaluated through age 25. Intent‐to‐treat, multi‐level, point‐in‐time analyses of covariance and growth analyses were conducted. Outcomes were assessed with self‐report measures of substance misuse (lifetime, current, frequency) and conduct problem behaviors. Analyses showed very limited point‐in‐time effects; there were growth pattern effects on measures of illicit drugs, non‐prescribed drugs, cigarettes, and drug problems. When risk moderation was observed, it favored higher‐risk participants. These emerging adult effects concerning slower growth of lifetime misuse combine with more robust adolescent stage findings to support PROSPER’s public health value.

PROSPER delivery of universal preventive interventions with young adolescents: long-term effects on emerging adult substance misuse and associated risk behaviors

BACKGROUND

Substance misuse and associated health-risking behaviors are prevalent in emerging adulthood. There is a knowledge gap concerning the post-high school effects of community-based delivery systems for universal preventive interventions implemented during young adolescence. This study reports effects of the PROSPER delivery system through age 19, 7.5 years past baseline.

METHODS

A cohort sequential design included 28 public school districts randomly assigned to the PROSPER partnership delivery system or usual-programming conditions. PROSPER community teams implemented a family-focused intervention in 6th grade and a school-based intervention in 7th grade. Outcomes for the age 19, post-high school report included lifetime, current, and frequency of substance misuse, as well as antisocial and health-risking sexual behaviors. Intent-to-treat, multi-level analyses of covariance of point-in-time outcomes were conducted, along with analyses of risk-related moderation of intervention effects.

RESULTS

Results showed emerging adults from PROSPER communities reported significantly lower substance misuse across a range of types of substances, with relative reduction rates of up to 41.0%. No significant findings were observed for associated antisocial and health-risking sexual behavior indices; or for lifetime rates of sexually transmitted infections. Risk-related moderation effects were non-significant, suggesting generally comparable outcomes across higher- and lower-risk subgroups of emerging adults.

CONCLUSIONS

The PROSPER delivery system for brief universal preventive interventions has potential for public health impact by reducing long-term substance misuse, with positive results extending beyond high school.

Systematic review of universal school-based 'resilience' interventions targeting adolescent tobacco, alcohol or illicit substance use: A meta-analysis

Universal school-based interventions that address adolescent 'resilience' may represent a means of reducing adolescent substance use, however previous systematic reviews have not examined the effectiveness of such an intervention approach. A systematic review was undertaken to 1) assess whether universal school-based 'resilience' interventions are effective in reducing the prevalence of tobacco, alcohol or illicit substance use by adolescents, and 2) describe such effectiveness per intervention characteristic subgroups. Eligible studies were peer-reviewed reports (1994-2015) of randomised controlled trials including participants aged 5-18years that reported adolescent tobacco, alcohol or illicit substance use, and implemented a universal school-based 'resilience' intervention (i.e. those addressing both individual (e.g. self-esteem) and environmental (e.g. school connectedness) protective factors of resilience). Trial effects for binary outcomes were synthesised via meta-analyses and effect sizes reported as odds ratios. Subgroup (by intervention type, prevention approach, setting, intervention duration, follow-up length) and sensitivity analyses (excluding studies at high risk of bias) were conducted. Nineteen eligible studies were identified from 16,619 records (tobacco: n=15, alcohol: n=17, illicit: n=11). An overall intervention effect was found for binary measures of illicit substance use (n=10; OR: 0.78, 95%CI: 0.6-0.93, p=0.007,Tau²=0.0, I²=0%), but not tobacco or alcohol use. A similar result was found when studies assessed as high risk of bias were excluded. Overall intervention effects were evident for illicit substance use within multiple intervention characteristic subgroups, but not tobacco and alcohol. Such results support the implementation of universal school-based interventions that address 'resilience' protective factors to reduce adolescent illicit substance use, however suggest alternate approaches are required for tobacco and alcohol use. PROSPERO registration: CRD42014004906.

The Effectiveness of Family Interventions in Preventing Adolescent Illicit Drug Use: A Systematic Review and Meta-analysis of Randomized Controlled Trials

In order to quantify the effectiveness of family interventions in preventing and reducing adolescent illicit drug use, we conducted a systematic review and meta-analysis of randomized controlled trials. We searched the Cochrane Database of Systematic Reviews, Educational Research Information Centre (ERIC), MEDLINE, Embase, and PsycINFO for studies published between 1995 and 2013. Results were described separately for different outcomes (marijuana vs. other illicit drugs) and intervention types (universal, selective, and indicated prevention). Meta-analyses were performed when data were sufficient (e.g., marijuana and other illicit drug initiation in universal samples), using random effect models. Otherwise, we provided narrative reviews (e.g., regarding selective and indicated prevention). Thirty-nine papers describing 22 RCTs were eligible for inclusion. Universal family interventions targeting parent-child dyads are likely to be effective in preventing (OR 0.72; 95 % CI 0.56, 0.94) and reducing adolescent marijuana use, but not in preventing other illicit drugs (OR 0.90; 95 % CI 0.60, 1.34). Among high-risk groups, there is no clear evidence for the effectiveness of family interventions in preventing and reducing illicit drug use and drug disorders. The three small RCTs among substance-(ab)using adolescents gave some indication that programs might reduce the frequency of illicit drug use. Family interventions targeting parent-child dyads are likely to be effective in preventing and reducing adolescent marijuana use in general populations, but no evidence for other illicit drug use was found. We underline the need to strengthen the evidence base with more trials, especially among at-risk populations.

Prospective associations between bilingualism and executive function in Latino children: sustained effects while controlling for biculturalism

The study purpose was to test 1-year prospective associations between English-Spanish bilingualism and executive function in 5th to 6th grade students while controlling for biculturalism. Participants included 182 US Latino students (50 % female). Self-report surveys assessed biculturalism, bilingualism, and executive function (i.e., working memory, organizational skills, inhibitory control, and emotional control, as well as a summary executive function score). General linear model regressions demonstrated that bilingualism significantly predicted the summary executive function score as well as working memory such that bilingual proficiency was positively related to executive function. Results are the first to demonstrate (a) prospective associations between bilingualism to executive function while controlling for the potential third variable of biculturalism, and (b) a principal role for working memory in this relationship. Since executive function is associated with a host of health outcomes, one implication of study findings is that bilingualism may have an indirect protective influence on youth development.

Drug Use Trajectories After a Randomized Controlled Trial of MTFC: Associations with Partner Drug Use

Trajectories of drug use were examined in a sample of women with prior juvenile-justice system involvement. One hundred fifty-three young women who participated in a randomized controlled trial of Multidimensional Treatment Foster Care (MTFC) in adolescence were assessed on five occasions over a 24-month period in young adulthood (mean age = 22.29 years at T1). Participants assigned to the MTFC condition during adolescence reported greater decreases in drug use than girls assigned to the treatment as usual (TAU) condition. Partner drug use was significantly associated with women's concurrent drug use, although participants in the MTFC condition were more resilient to partner drug use than in the TAU condition. Implications for drug use prevention and intervention programs during adolescence are discussed.

Mentoring adolescents to prevent drug and alcohol use

BACKGROUND

Many adolescents receive mentoring. There is no systematic review if mentoring prevents alcohol and drug use.

OBJECTIVES

Assess effectiveness of mentoring to prevent adolescent alcohol/drug use.

SEARCH METHODS

Cochrane CENTRAL (issue 4), MEDLINE (1950-to July 2011), EMBASE (1980-to July 2011), 5 other electronic and 11 Grey literature electronic databases, 10 websites, reference lists, experts in addictions and mentoring.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of mentoring in adolescents to prevent alcohol/drug use.

DATA COLLECTION AND ANALYSIS

We identified 2,113 abstracts, independently assessed 233 full-text articles, 4 RCTs met inclusion criteria. Two reviewers independently extracted data and assessed risks of bias. We contacted investigators for missing information.

MAIN RESULTS

We identified 4 RCTs (1,194 adolescents). No RCT reported enough detail to assess whether a strong randomisation method was used or allocation was concealed. Blinding was not possible as the intervention was mentoring. Three RCTs provided complete data. No selective reporting.Three RCTs provided evidence about mentoring and preventing alcohol use. We pooled two RCTs (RR for mentoring compared to no intervention = 0.71 (95% CI = 0.57 to 0.90, P value = 0.005). A third RCT found no significant differences.Three RCTs provided evidence about mentoring and preventing drug use, but could not be pooled. One found significantly less use of "illegal" drugs," one did not, and one assessed only marijuana use and found no significant differences.One RCT measured "substance use" without separating alcohol and drugs, and found no difference for mentoring.

AUTHORS' CONCLUSIONS

All four RCTs were in the US, and included "deprived" and mostly minority adolescents. Participants were young (in two studies age 12, and in two others 9-16). All students at baseline were non-users of alcohol and drugs. Two RCTs found mentoring reduced the rate of initiation of alcohol, and one of drug usage. The ability of the interventions to be effective was limited by the low rates of commencing alcohol and drug use during the intervention period in two studies (the use of marijuana in one study increased to 1% in the experimental and to 1.6% in the control group, and in another study drug usage rose to 6% in the experimental and 11% in the control group). However, in a third study there was scope for the intervention to have an effect as alcohol use rose to 19% in the experimental and 27% in the control group. The studies assessed structured programmes and not informal mentors.