Early Substance Use and Subsequent DUI in Adolescents

Individual and social-environmental factors among young drivers informing decisions to ride with an impaired driver and drive impaired: A sequential mixed methods assessment

OBJECTIVE

To contextually examine facilitators of young driver decisions to ride with an impaired driver (RWI) or drive while impaired (DWI).

METHODS

Data were from the NIH's NEXT Generation Health Study (NEXT), a 7-year longitudinal nationally representative study with a U.S. probability cohort of 10th graders starting in 2009-2010. Using a multistage sequential explanatory mixed methods approach, we conducted latent class analysis (n = 2,783) to identify RWI/DWI trajectories from adolescence to young adulthood (Stage-1). We then conducted in-depth qualitative interviews with purposively sampled young adults (N = 105, 26.30 ± 0.43 y/o) from four identified RWI/DWI trajectory classes (Stage-2): 31 Abstainers (consistently low probability), 33 Escalators (low-to-high probability), 14 Decliners (high-to-low probability), and 27 Persisters (consistently high probability). In Stage-2, the qualitative interview guide was informed by Stage-1 findings and Ecodevelopmental Theory. Using directed content analysis, we applied inductive and deductive theory-grounded codes to interview transcripts. With data immersion, reflexivity, and team dialogue, we derived themes from the code, "Facilitators of RWI and/or DWI". Demographics and validated measures of resiliency, health-related quality of life, Timeline Follow Back for alcohol and marijuana, and recent engagement in RWI/DWI were collected during the interviews.

RESULTS

Based on the interview transcripts, five themes emerged around RWI/DWI facilitators during and after high school: (1) beliefs about alcohol/drug effects; (2) trust of others; (3) trust of self; (4) parental disapproval; and (5) transportation factors. Participants who RWI confidently placed their trust in their assessment of the driver's impairment and their own in the context of close relationships. Those who DWI described desire to maintain simple/easy vehicle access while avoiding tickets/towing. The joint display of the quantitative and qualitative data is presented.

CONCLUSIONS

Notable misperceptions exist about how alcohol/drugs impact driving in the RWI/DWI context, particularly regarding the subtle signs of impairment. Youth commonly relied on their own assessment of impairment before driving themselves or riding with a potentially impaired driver, sometimes to avoid parental disapproval. Some engage in RWI/DWI to avoid discord with parents. DWI may relate to needing easy/immediate vehicle access. Pragmatic remedy considerations could include educating youth and young drivers about impairment, enhancing safe public transportation, and expanding ride-share programing.

Characteristics associated with blindness or visual impairment within the adolescent demographic: a national cohort analysis

BACKGROUND

Psychosocial metrics associated with self-reported blindness or visual impairment for adolescents in the National Survey of Drug Use and Health (NSDUH) have not been fully characterized. This retrospective cohort analysis of the latest NSDUH aimed to determine novel characteristics associated with self-reported visual loss among adolescents in the United States.

METHODS

Data from the NSDUH2020, a publicly available, federally validated database, were analyzed. Self-reported severe visual impairment or blindness was defined as being truly blind or having serious difficulty seeing even when wearing corrective lenses (s-rSVI). Inclusion criteria were all cases of s-rSVI in adolescents aged 12-17 years. NSDUH weights were used to accommodate complex survey design, nonresponse rates, and population variance. Weighted percentages, asymptotic two-sided Rao-Scott χ2 analyses, and multivariable logistic regression were performed. Statistical significance was considered reached at P < 0.05.

RESULTS

A total of 5,667 adolescents aged 12-17 years were surveyed, and s-rSVI occurred in 236 cases (weighted percentage, 3.48%). Within our final multivariable risk model, characteristics associated with increased odds of s-rSVI were female sex, Asian and Latino race/ethnicity (relative to non-Hispanic White), and self-reported serious difficulty hearing and concentrating (all P < 0.05).

CONCLUSIONS

This national retrospective cohort analysis highlights risk factors associated with s-rSVI for adolescents within the 2020 NSDUH. Clinicians and policymakers should consider at-risk demographics for s-rSVI during development and enhancement of screening programs, population health initiatives, and healthcare policy issues.

Randomized controlled trial of motivational interviewing for alcohol and cannabis use within a predominantly Hispanic adolescent sample

Hispanic youth represent one of the fastest-growing minority groups. Yet, we know little about Hispanic adolescents' response to empirically-supported interventions for adolescent addiction, including motivational interviewing (MI). This randomized controlled trial (RCT) compared MI to an active educational treatment for adolescent alcohol and cannabis use (alcohol and cannabis education; ACE). Adolescents who regularly use substances (N = 448; n = 347 Hispanic; n = 101 non-Hispanic white; ages 13-18) were randomized to two 1-hr individual sessions of MI or ACE. We examined 6-month outcomes and mechanisms of change across Hispanic and non-Hispanic white youth. Treatment response was comparable across ethnicities (Hispanic vs. non-Hispanic white youth). Additionally, adolescents in the MI condition showed greater reductions in alcohol use compared to those in ACE, with support for motivation and self-efficacy as mechanisms of treatment response. Direct effects of MI on cannabis use were not observed; however, a significant indirect effect of motivation was observed for reductions in cannabis use. Data support the efficacy of MI in reducing adolescent alcohol use, through the vehicle of enhanced motivation and self-efficacy. While consistent treatment response was observed for adolescent alcohol use across ethnicities (Hispanic vs. non-Hispanic white), further exploration into potential underexplored mechanisms of Hispanic adolescents' treatment response is requisite to strengthening prevention and intervention programming for Hispanic adolescents' cannabis use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adolescents' Frequency of Alcohol Use and Problems from Alcohol Abuse: Integrating Dating Partners with Parent and Peer Influences

Despite the centrality of dating relationships for teens, it is unclear whether the influence of romantic partners' alcohol use on adolescents' under-age drinking is distinct from the influence of peers and parents. To address this gap, this study used longitudinal data from a population-based sample of 825 adolescents (49% male, 51% female), ages 12 to 19. Adolescents completed a survey using laptops for privacy, and a parent completed a survey separately. Ordinary least squares and logistic regression models assessed alcohol use frequency and alcohol problems and included dating partners' drinking, adolescents' prior drinking, peers' drinking, parents' substance use, parental monitoring, and sociodemographic background characteristics. Alcohol use frequency and alcohol problems were influenced by dating partners' alcohol use and dating partners' influence was stronger on older adolescents and male adolescents. The study results are useful for public health messaging and prevention efforts by demonstrating the influence of parents, peers, and dating partners on teens' alcohol use.

Risk Factors Associated With Driving After Cannabis Use Among Canadian Young Adults

This study identifid the most prominent risk factors associated with driving after cannabis use (DACU). 1,126 Canadian drivers (17–35 years old) who have used cannabis in the past 12 months completed an online questionnaire about sociodemographic information, substance use habits, cannabis effect expectancies, driving behaviours and peers’ behaviours and attitudes concerning DACU. A hierarchical logistic regression allowed identifying variables that were associated with DACU. Income (CA$30,000–CA$69,000), weekly-to-daily cannabis use, higher level of cannabis-related problems, expectation that cannabis facilitates social interactions, drunk driving, belief that DACU is safe, general risky driving behaviours, having a few friends who had DACU and injunctive norms predicted past 12-month DACU. Older age, holding negative expectations concerning cannabis, driving aggressively and perceived accessibility of public transportation decreased the probability of DACU. With restricted resources, programmes will be more efficient by targeting Canadian young adults most inclined to DACU by focussing on these risk factors.

Screening and Brief Advice to Reduce Adolescents' Risk of Riding With Substance-Using Drivers

OBJECTIVE

Alcohol- and drug-related car crashes are a leading cause of death for adolescents in the United States. This analysis tested the effects of a computer-facilitated Screening and Brief Advice (cSBA) system for primary care on adolescents' reports of driving after drinking or drug use (driving) and riding with substance-using drivers (riding).

METHOD

Twelve- to 18-year-old patients (N = 2,096) at nine New England pediatric offices completed assessments only during the initial 18-month treatment-as-usual (TAU) phase. Subsequently, the 18-month cSBA intervention phase began with a 1-hour provider training and implementation of the cSBA system at all sites. cSBA included a notebook-computer with self-administered screener, immediate scoring and feedback, and 10 pages of scientific information and true-life stories illustrating substance-related harms. Providers received screening results, "talking points" for 2 to 3 minutes of counseling, and a Contract for Life handout. Logistic regression with generalized estimating equations generated adjusted relative risk ratios (aRRR) for past-90-day driving and riding risk at 3- and 12-month follow-ups, controlling for significant covariates.

RESULTS

We found no significant effects on driving outcomes. At 3 months, cSBA youth were less likely than TAU to report riding with a drinking driver (aRRR = 0.70, 95% CI [0.49, 1.00]), and less likely to report riding with a driver who had used cannabis or other drugs (aRRR = 0.46, 95% CI [0.29, 0.74]). The effect was even greater (aRRR = 0.34, 95% CI [0.16, 0.71]) for riding with drinking drivers who were adult family members. All effects dissipated by 12-month follow-up.

CONCLUSIONS

Screening and pediatrician brief advice shows promise for reducing adolescents' risk of riding with substance-using drivers.

Associations between driving under the influence or riding with an impaired driver and future substance use among adolescents

Objective: Risky driving behaviors among adolescents, such as riding with a drinking or impaired driver (RWID) or driving while under the influence (DUI) of alcohol or drugs, are significant public health concerns. Few studies have examined associations of RWID and DUI with future substance use and problems after controlling for baseline substance use. Given that the DUI/RWDD event may be a teachable moment to prevent future consequences (e.g., when injured or arrested), it is important to understand how this risk behavior relates to subsequent use and problems. This study therefore examined characteristics of adolescents who reported DUI and RWID and assessed their risk of future alcohol and marijuana use and consequences 6 months later. Methods: Participants were 668 adolescents aged 12 to 18 (inclusive) recruited at 1 of 4 primary care clinics in Pittsburgh and Los Angeles as part of a larger randomized controlled trial. They completed surveys about their health behaviors at baseline and 6 months after baseline. We examined baseline characteristics of adolescents who reported DUI and RWID and then assessed whether past-year DUI and RWID at baseline were associated with alcohol and marijuana use and consequences 6 months after baseline. Results: Fifty-eight percent of participants were female, 56% were Hispanic, 23% were Black, 14% were White, 7% were multiethnic or other, and the average age was 16 years (SD = 1.9). At baseline, participants who reported RWID or DUI were more likely to be older, report past-year use of alcohol and marijuana, and more likely to have an alcohol use disorder or cannabis use disorder versus those who did not report RWID or DUI, respectively. At 6-month follow-up and after controlling for baseline demographics and baseline alcohol use, RWID was associated with more frequent drinking episodes in the past 3 months and greater number of drinks in the past month when they drank heavily. DUI at baseline was associated with more frequent heavy drinking episodes and alcohol and marijuana consequences 6 months later. Conclusions: RWID and DUI are significantly associated with greater alcohol and marijuana use over time. This study highlights that teens may be at higher risk for problem substance use in the future even if they ride with someone who is impaired. Prevention and intervention efforts for adolescents need to address both driving under the influence and riding with an impaired driver to prevent downstream consequences.

To Educate or To Incarcerate: Factors in Disproportionality in School Discipline

The school-to-prison pipeline describes the process by which school suspension/expulsion may push adolescents into the justice system disproportionately based on race/ethnicity, socioeconomic status, and gender. The current study moves the field forward by analyzing a survey of a diverse sample of 2,539 students in 10^th to 12^th grade in Southern California to examine how demographic, individual, and family factors contribute to disparities in office referral and suspension/expulsion. African Americans, boys, and students whose parents had less education were more likely to be suspended/expelled. Higher levels of student academic preparation for class, hours spent on homework, and academic aspiration were associated with less school discipline. Findings suggest that helping students engage in school may be protective against disproportionate school discipline.

Alcohol mixed with energy drinks: Associations with risky drinking and functioning in high school

BACKGROUND

Mixing alcohol with energy drinks is associated with heavier drinking and related problems among college students. However, little is known about how high school drinkers who mix alcohol with energy drinks (AmED) compare to those who do not (AwoED). This study compares high school AmED and AwoED users on their alcohol use during middle and high school, as well as key domains of functioning in high school.

METHODS

Two surveys were conducted three years apart in adolescents initially recruited from 16 middle schools in Southern California. The analytic sample consists of 696 past month drinkers. Multivariable models compared AmED and AwoED users on alcohol use, mental health, social functioning, academic orientation, delinquency and other substance use at age 17, and on their alcohol use and related cognitions at age 14.

RESULTS

AmED was reported by 13% of past month drinkers. AmED and AwoED users did not differ on alcohol use or cognitions in middle school, but AmED users drank more often, more heavily, and reported more negative consequences in high school. AmED users were also more likely to report poor grades, delinquent behavior, substance use-related unsafe driving, public intoxication, and drug use than AwoED users in high school. Group differences were not found on mental health, social functioning, or academic aspirations.

CONCLUSIONS

AmED use is common among high school drinkers. The higher risk behavioral profile of these young AmED users, which includes drug use and substance use-related unsafe driving, is a significant cause for concern and warrants further attention.