Pathways from Early Childhood Adversity to Later Adult Drug Use and Psychological Distress: A Prospective Study of a Cohort of African Americans

Measurement invariance of the Perceived Stress Scale across race, sex, and time, and differential impacts on cocaine use treatment outcomes

INTRODUCTION

To understand the influence of phenotypic characteristics, such as stress, on substance use treatment outcomes, measures must function equivalently across groups to allow for interpretable comparisons of effects. The present study evaluated measurement invariance of the Perceived Stress Scale (PSS) across race, sex, and time, examined its association with cocaine use disorder (CUD) treatment outcomes, and tested whether associations were moderated by race and/or sex.

METHODS

Data from four clinical trials evaluating behavioral and/or pharmacological treatments for cocaine use were combined providing a total sample of 302 participants with DSM-IV cocaine abuse/dependence (57.6 % Black, 42.4 % White, 43.7 % females, Mage = 40.22 years, SD = 9.26).

RESULTS

Factor analyses support a two-factor model (i.e., general stress, self-efficacy to cope with stressors) that demonstrated configural, metric, and scalar invariance across race and sex and configural and metric invariance across time. End-of-treatment stress and coping were both related to treatment outcomes, but not treatment retention. Interactions between baseline and end-of-treatment stress and coping self-efficacy with race and sex predicting treatment retention and outcomes were not significant.

CONCLUSIONS

Results support the utility of the PSS to examine between-group differences among individuals with CUD and suggest that sociodemographic groups differ in the extent to which stress and self-efficacy to cope influence treatment outcomes.

Family history of substance problems among African Americans: Associations with drug use, drug use disorder, and prescription drug misuse

A family history of substance problems is a well-known risk factor for substance use and use disorders; however, much of this research has been conducted in studies with predominantly White subjects. The aim of this study was to examine the associations between family history density of substance problems and drug use, risk for drug use disorder, and prescription drug misuse in a sample of African American adults. Results indicate that family history density of substance problems increased the risk for all drug outcomes in the full sample. However, when subgroup analyses by gender were conducted, family history was not a risk factor among men for prescription drug misuse.

Substance use trajectories among emerging adult Black men: Risk factors and consequences

INTRODUCTION

Young, Black American men experience greater social, legal and economic consequences of substance use compared with White men for comparable levels of consumption. The development of tailored interventions requires prospective information on their substance use patterns, risk factors and consequences. We identified longitudinal substance use profiles and examined their links to childhood adversity, racial discrimination and young adult problem substance use and mental health.

METHODS

Emerging adult Black men (n = 504, mean age = 20.26, SD = 1.08) provided fours waves of data between January 2012 and March 2021. We conducted a parallel process latent class growth analysis for three substances to explore conjoint longitudinal use patterns and investigated the risk factors and consequences of each pattern.

RESULTS

Three trajectory classes emerged: non-using (n = 201, 39.9%), cannabis using (n = 202, 40.1%) and poly-substance using (n = 101, 20%) groups. Threat-based childhood adversity and racial discrimination were associated with higher odds of being members of cannabis or poly-substance groups than non-using group. Deprivation-based adversity was associated with higher odds for membership in poly-substance than non-using group. At Wave 4, elevated depressive symptoms were more prevalent among poly-substance compared with cannabis using group.

DISCUSSION AND CONCLUSIONS

Heterogeneous substance use patterns emerged among Black American men and each pattern has distinct risk factors and outcomes in young adulthood. For prevention, more attention is needed for cannabis use patterns and psychosocial adversities that are unique to Black population.

Cohort Profile: The Woodlawn Study

The Woodlawn Study is an epidemiologically- defined community cohort study of 1242 Black Americans (51% female and 49% male), who were in first grade in 1966-67 in Woodlawn, a neighborhood of Chicago, Illinois. The study comprises extensive interview data over the life course including self-, mother-, and/or teacher-reported assessments at ages 6, 16, 32, 42, and 62 (in progress), administrative records (i.e., education, crime, and death records), and census data. These data cover a wide range of focal areas across the life course, including family environment, socioeconomic indicators, education, social integration (e.g., marriage, community engagement, religious involvement) and social support, employment, racial discrimination, substance use, crime/victimization, and mental and physical health, including mortality. Over the past 50 years, Woodlawn research has mapped cumulative disadvantage, substance use, and criminal offending and has identified key risk and protective factors of adversity, resilience, and success across the full life course. In turn, these findings have informed life course theory and policy for a population that experiences significant criminal and health disparities.

"It was Just Good to Have an Outlet for Other Parents to Talk to": Feasibility and Acceptability of Integrating Mental Health and Wellness Services into Predominantly Black Early Childhood Education Centers During the COVID-19 Pandemic

Racial disparities in mental health care access and quality are associated with higher levels of unmet need for Black parents and families, a population disproportionately affected by the COVID-19 pandemic. Integrating services within early childhood education centers may increase mental health care access for Black families with young children. The current study examined the feasibility, acceptability, and perceived impact of an integrated program offering mental health care for parents, children, and dyads during the pandemic. Black parents (N = 61) completed measures of program satisfaction and perceived benefits of participation, and 47 parents also participated in focus groups further assessing perceptions of the program. Results demonstrated high levels of satisfaction and perceived benefit of the program for parents and children. Themes generated through analysis included: social support, creating a safe space, prioritizing self-care, and sharing parenting strategies. Parents' feedback provides preliminary feasibility and acceptability for the integrated mental health program.

Associations Between Family Factors, Social Integration, and Suicidal Ideation Across the Life Course of an Urban African American Cohort

Suicide is a problem on the rise but not studied extensively among African Americans. It is critical to identify risk factors for suicidal ideation to reduce risk. This study examines whether family and social factors over the life course predict suicidal ideation among African American adults in midlife. We conducted multiple logistic regression analyses on data from a longitudinal cohort of African Americans first assessed in childhood to identify associations with suicidal ideation in midlife (ages 33-42). Findings suggested living without one's mother in childhood (vs. living with mother alone; aOR = 3.69, p = .017) and parental rule-setting in adolescence (aOR = 0.79, p = .047) were associated with suicidal ideation. Having a lifetime drug disorder (aOR = 2.19, p = .046) or major depression by young adulthood (aOR = 3.58, p < .001) was also associated with an increased risk of suicidal ideation. Findings highlight the importance of intervention for children in mother-absent homes for improving mental health outcomes. Family interventions that promote parental rule-setting and addressing drug problems and depressive symptoms early in the life course offer an area for intervention to reduce suicide over the long term.

Patient characteristics and treatment utilization in fatal stimulant-involved overdoses in the United States Veterans Health Administration

BACKGROUND AND AIMS

This study aimed to (1) describe trends in stimulant-alone and stimulant and other substance use overdose deaths from 2012 to 2018 and (2) measure patient and service use characteristics across stimulant-related overdose death profiles.

DESIGN

Retrospective cohort study of patients who died from stimulant-involved overdose between annual years 2012 and 2018.

SETTING

United States Veterans Health Administration (VHA). A total of 3631 patients died from stimulant-involved overdose, as identified through the National Death Index.

MEASUREMENTS

Stimulant-involved overdose deaths were categorized by stimulant type (cocaine or methamphetamine/other) and other substance co-involvement. Cause of death data were linked to patient characteristics, including demographic and treatment use preceding overdose from VHA administrative data. We examined trends over time and compared treatment use factors between the following mutually exclusive overdose profiles: cocaine alone, methamphetamine alone, cocaine + opioid, methamphetamine + opioid, any stimulant + other substance and cocaine + methamphetamine.

FINDINGS

The rate of overdose death was 3.06 times higher in 2018 than 2012, with increases across all toxicology profiles. Compared with cocaine-involved overdoses, methamphetamine-involved overdoses were less likely in people who were older [adjusted odds ratio (aOR) = 0.22, 95% confidence interval (CI) = 0.06-0.87 aged 65+ versus 18-29] and more likely among those who lived in rural areas (aOR = 2.73, 95% CI = 1.43-5.23). People who died from stimulant + opioid overdoses had lower odds of a stimulant use disorder diagnosis compared with stimulant alone deaths (cocaine: aOR = 0.55, 95% CI = 0.41-0.75, methamphetamine: aOR = 0.44, 95% CI = 0.29-0.68).

CONCLUSIONS

The rate of deaths among US Veterans from stimulant-related overdose was three times higher in 2018 than 2012. Key differences in characteristics of patients across overdose toxicology profiles, such as geographic location and health-care use, point to distinct treatment needs based on stimulant use type.

Family Structure and History of Childhood Trauma: Associations With Risk-Taking Behavior Among Adolescents in Swaziland

Introduction: Risk-taking and self-harm behavior among adolescent are a global challenge. This study explored family structure and history of childhood trauma and their association with risk-taking and self-harm behaviors among adolescents in Swaziland. Methods: Using a cross-sectional design, a sample of 470 male and female adolescents were sampled through simple random sampling from selected high schools in Swaziland. They completed a questionnaire assessing family structure, history of childhood trauma, and risk-taking and self-harm behaviors. Analysis of variance and t-test were used to analyze the results. Results: The findings revealed that family structure significantly influence risk-taking and self-harm behavior among adolescents [F(2, 247) = 5.481; P < 0.004] those from child-headed and single-parent households reported higher risk-taking and self-harm behaviors. The results also revealed adolescents history of childhood trauma to be more risk-takers than those without history of childhood trauma t(468) = 3.409, p < 0.001. Discussion: Study results suggest that family structure and history of childhood trauma have significant association with adolescents' risk-taking and self-harm behaviors.

Cocaine use and overdose mortality in the United States: Evidence from two national data sources, 2002-2018

BACKGROUND

Cocaine-involved overdose mortality has recently risen in the United States (US), yet it is unclear to what extent patterns in cocaine-involved overdose mortality parallel patterns in cocaine use. This study: examined time trends (2002-2018) in past-year cocaine use and cocaine-involved overdose mortality in the US; and compared demographics and drug involvement of adults who reported past-year cocaine use versus adults who died of a cocaine-involved overdose.

METHODS

Data from two sources were utilized: (1) the National Survey on Drug Use and Health (n = 1,334 adults self-reporting cocaine use in 2018); and (2) the Multiple Cause of Death dataset of the National Center for Health Statistics (N = 14,630 adults who died of a cocaine-involved overdose in 2018). The study examined prevalence of past-year cocaine use, mortality rates for cocaine-involved overdose, 2002-2018 trends, demographic characteristics, and involvement of other drugs.

RESULTS

Results of Joinpoint Regression indicated that the prevalence of past-year cocaine use increased after 2011, with an annual percent change of 5.13, while age-adjusted cocaine-involved overdose mortality rates escalated after 2012, with an annual percent change of 26.54. In 2018, prevalence of past-year cocaine use did not significantly differ (p = 0.09) by racial/ethnic group, yet Non-Hispanic Blacks had an age-adjusted cocaine-involved overdose mortality rate more than double the rate in Non-Hispanic Whites and significantly higher (p < 0.001) than in any other group.

CONCLUSIONS

While the prevalence of cocaine use has increased modestly, cocaine-involved overdose mortality has risen dramatically. Cocaine-involved overdose mortality is disproportionately affecting individuals who are Black, older, or with lower educational attainment.

Assessing the effectiveness of a pediatrician-led newborn parenting class on maternal newborn-care knowledge, confidence and anxiety: A quasi-randomized controlled trial

BACKGROUND

The postpartum hospital stay is a unique opportunity for clinicians to educate parents on the importance of promoting early child development. Pediatricians are well-positioned to address both medical and developmental concerns during critical periods of development, yet very few parenting interventions are led by pediatricians.

AIMS

To assess the impact of a novel one-hour long pediatrician-led Newborn Class on maternal knowledge, confidence, and anxiety.

METHODS

We conducted a quasi-randomized controlled trial to evaluate the effectiveness of the Newborn Class. First-time mothers who delivered a full-term singleton vaginally with no major complications and attended the class were recruited. Mothers who expressed a desire to attend the class but were discharged before a class was offered served as controls.

OUTCOME MEASURES

Maternal self-perceived parental confidence and anxiety were measured using standardized scales [Karitane Parenting Confidence Scale (KPCS) and State-Trait Anxiety Inventory for Adults (STAI-AD)]. Knowledge on newborn care was assessed using a novel scale.

RESULTS

A total of 84 participants (intervention n = 36, control n = 48) were included in the study. Mothers who attended the class showed significantly higher levels of knowledge compared to the control group (Knowledge test, Two-tailed t-test, mean [SD], 8.08 [1.06] vs 6.78 [1.25]; P<0.001) as well as significantly higher parenting confidence levels (KPCS, Two-tailed t-test, mean [SD], 39.31 [3.88] vs 35.20 [3.99]; P<0.001). No change was observed in the overall level of anxiety (STAI-AD, Two-tailed t-test, mean [SD], 35.50 [8.73] vs 38.5 [9.53]; P=0.164).

CONCLUSIONS

A short pediatrician-led parenting intervention may be an effective tool in improving maternal confidence and newborn care knowledge. Given the importance of the newborn period in establishing healthy developmental trajectories, there is a crucial need for cost- and time-effective intervention that can be widely implemented to promote parental knowledge and confidence with the ultimate goal of fostering healthy development in children.

Gender, Maltreatment and Psychiatric Symptoms among Adolescents in Outpatient Substance Abuse Treatment

Childhood maltreatment experiences are risk factors for externalizing and internalizing symptoms, as well as substance abuse problems during adolescence. In the present study, we administered structured interviews to 394 adolescents receiving outpatient substance abuse treatment services (280 males; M _years=16.33; SD _years=1.15). K-means cluster analysis was used to examine: (a) the co-patterning of childhood maltreatment experiences and past-year externalizing symptoms (for drug and alcohol abuse and dependence, conduct disorder); (b) between-cluster differences in serious internalizing problems (for past-year anxiety and depression symptoms and current distress); and (c) gender differences in these relations. Both similarities and differences were identified in maltreatment-externalizing behavior patterns and relations with serious internalizing problems across gender groups. Childhood maltreatment and subsequent psychopathology have implications for the adaptation and delivery of substance abuse treatment services to boys and girls to improve their engagement and treatment outcomes.

Looking homeward with the life course: Early origins of adult dwelling satisfaction?

The long-term influence of childhood economic and social exposures on adult health and well-being is well-known. Most childhood circumstances transpire in or near the home, yet research has largely neglected how early exposures shape people's experience of their residential context in adulthood. To help address this gap, we use retrospective longitudinal data from the Midlife Development in the United States (MIDUS) study. Drawing on a life course framework, we test the potential mediating roles of adult social, economic, and mental health processes. Results suggest that childhood parental warmth and maltreatment have an enduring influence on people's satisfaction with their adult home, while there is little indication that childhood economic conditions shape adult dwelling satisfaction. Analyses of average controlled direct effects suggest that the effects of childhood parental warmth are mediated slightly by adult socioeconomic attainment and psychological adjustment but especially by supportive family relationships during adulthood. This pattern is consistent with an attachment-based interpretation of the importance of childhood conditions for adult relationships as well as home satisfaction. Taken together, our results suggest that parent-child bonds cast a long shadow over how people experience their residential context decades later, through a diffuse, multifaceted set of intervening pathways.

A preliminary study of early childhood parenting and adult past month drug use risk in low-income African American women

PURPOSE

This preliminary study was designed to assess the feasibility of examining early childhood parenting factors and their relationship with adult past month drug use among low-income African American women.

METHODS

A cross-sectional survey of 156 low-income African American women was conducted. Measures included the childhood parental bonding scale, frequency of exposure to corporal punishment (CP) in childhood, The Drug Abuse Screening Test (DAST) and The Differentiation of Self Scale. Structural equation modeling (SEM) was used to assess the relationship between the primary predictors, latent parental bonding and corporal punishment exposure, with past month drug use. The intermediary construct, emotional reactivity, was also included in the SEM model to test mechanisms of mediation.

RESULTS

There was a significant main effect for maternal care on lower emotional reactivity patterns in adulthood. There was also a significant main effect for frequent CP on higher emotional reactivity patterns in adulthood. The relationship between both parenting measures and drug use were mediated by emotional reactivity.

CONCLUSION

Childhood maternal factors are a strong predictor of adult past month drug use, and this may be accounted for, in part, by the influence that parenting patterns in childhood have on adult emotional reactivity patterns. These observations should be examined in a longitudinal study to determine the stability of our observation that CP in childhood, even when controlling for positive maternal bonding patterns, influences emotional reactivity patterns that predispose an individual to negative coping strategies, such as drug use, in adulthood, among low-income African American women.

Identifying Distinct Latent Classes of Adverse Childhood Experiences Among US Children and Their Relationship with Childhood Internalizing Disorders

This study aimed to determine the relationship between latent classes of adverse childhood experience (ACEs) and internalizing disorders (anxiety and depression) among US children. The 2016 National Survey of Children's Health data for children aged 6-17 was used. Latent class analysis was performed to identify distinct sub-types of ACE exposures and survey-weighted logistic regression models were employed to determine whether these classes were associated with any or comorbid childhood internalizing disorders, after controlling for meaningful covariates. Four latent classes were identified: income hardship, divorce, mental health or substance abuse exposure, and high ACEs overall. Children in three of the four classes were significantly more likely to have any childhood internalizing disorder when compared to children reporting no ACEs, while children in all classes were significantly more likely to have a comorbid history of anxiety and depression. Thus, children exposed to ACEs should receive necessary mental health screenings and treatments.

Comparing Mental Health across Distinct Groups of Users of Psychedelics, MDMA, Psychostimulants, and Cannabis

Differences in mental health (MH) of users of distinct psychoactive substances have been shown. Both substance use (SU) and MH in users are influenced by stressful life events. This study compared MH parameters in distinct groups of substance users and evaluated the impact of stress factors on these outcomes. Data stem from the longitudinal Swiss Cohort Study on Substance Use Risk Factors (C-SURF) involving 4,475 young adult men. Distinct groups were created for the past 12 months' use of psychedelics, MDMA, psychostimulants, and cannabis. MH measurements (depressive symptoms, overall MH, perceived stress, life satisfaction) were used as outcome variables, while indicators of past family functioning and stressful life events served as covariates. The MH of psychedelics users was not significantly different from the no-drug-use group, whereas poorer MH was found in the other SU groups. Observed effects were influenced by the tested stress factors. The absence of association between use of psychedelics and worsening of MH deserves further investigation in male and female samples. Stressful life experiences must be considered when assessing the MH of users of illicit substances. These findings suggest that some men practice SU as self-medication to cope with life adversity.

From childhood adversity to problem behaviors: Role of psychological and structural social integration

BACKGROUND

Childhood adversity (CA) is associated with problem behaviors in adolescence, but the mediators, that is, those factors that help build resilience and prevent some children who experience CA from engaging in problem behaviors, await more exploration, including social integration. The aim of this study was to identify the association between CA and adolescent problem behaviors, and to further examine the mediating role of social integration distinctly as psychological and structural integration.

METHODS

Data used were from the Taiwan Education Panel Survey, a core panel of 4,261 students (age 13) surveyed in 2001 and followed for three more waves until age 18. For psychological integration, an average score was calculated to represent adolescents' feelings about their school. Structural integration was constructed using several items about adolescents' school and extracurricular activities. We used structural equation modeling with the diagonally weighted least squares method to examine the effect of CA on the primary outcome: adolescent problem behaviors via social integration.

RESULTS

The hypothesized structural equation model specifying the path from CA to adolescent problem behavior had good fit. Respondents with one CA were indirectly linked to problem behaviors via psychological but not structural integration (e.g. the level of participation in school and non-school activities). On mediation analysis, psychological integration significantly mediated the paths from one CA to all six problem behaviors (all P < 0.05).

CONCLUSION

The presence of only one CA was indirectly associated with problem behavior via psychological integration; two or more CA were not associated with significant paths to problem behaviors. The contribution of social integration is crucial to an adolescent's development from CA to problem behaviors. To form supportive social relationships to achieve better health, we suggest that those adolescents who have been exposed to CA should be helped to join more teams and take part in more activities, thereby increasing their opportunities for social interaction, and improving their communication skills.

The role of DNA methylation in the association between childhood adversity and cardiometabolic disease

Growing evidence suggests that adverse environmental stimuli, especially during sensitive periods in early life, may lead to cardiometabolic disease in later life. However, the underlying biological mechanisms remain a mystery. Recent studies inferred that epigenetic modifications are likely involved. We review recent studies, primarily focused on the findings from human studies, to indicate the role of DNA methylation in the associations between childhood adversity and cardiometabolic disease in adulthood. In particular, we focused on DNA methylation modifications in genes regulating the hypothalamus-pituitary-adrenal axis as well as the immune system.