Trying to Fit a Square Peg in a Round Hole? Testing the Robustness of Maltreatment Measurement Models for Youth

Research on maltreatment exposure often demonstrates mixed findings and a potential explanation for this may be the measurement of maltreatment. One approach for addressing measurement concerns, which also accounts for maltreatment's multidimensional nature, is the use of a measurement or latent model. However, there is minimal evidence on the generalizability of this approach across populations of youth. This study examined measurement invariance of a one-factor maltreatment model across two samples of youth exposed to maltreatment using case file data from the SPARK and LONGSCAN datasets (N = 1286). Results showed that only partial metric invariance could be established for the one-factor model between SPARK and LONGSCAN subsamples, and neglect and emotional abuse indicators tended to show low factor loadings. Findings highlight the need to consider how potential differences in documentation and maltreatment rates influence model performance and the need for research on which maltreatment characteristics may best capture youths' experiences.

Youth Reported Perpetrators of Victimization Within a Foster Care Sample

Maltreatment type, severity, and chronicity are predictors of poor youth outcomes, yet youth reported perpetrators of abuse have gone largely unstudied. Little is known about variation in perpetration across youth characteristics (e.g., age, gender, placement type) and abuse features. This study aims to describe youth reported perpetrators of victimization within a foster care sample. 503 youth in foster care (ages 8-21 years) reported on experiences of physical, sexual, and psychological abuse. Follow up questions assessed abuse frequency and perpetrators. Mann-Whitney U Tests were used to compare central tendency differences in number of perpetrators reported across youth characteristics and victimization features. Biological caregivers were commonly endorsed perpetrators of physical and psychological abuse, though youth also reported high levels of peer victimization. For sexual abuse, non-related adults were commonly reported perpetrators, however, youth reported higher levels of victimization from peers. Older youth and youth residing in residential care reported higher numbers of perpetrators; girls reported more perpetrators of psychological and sexual abuse as compared to boys. Abuse severity, chronicity, and number of perpetrators were positively associated, and number of perpetrators differed across abuse severity levels. Perpetrator count and type may be important features of victimization experiences, particularly for youth in foster care.

Feasibility, usability, and acceptability of MobileCoach-Teen: A smartphone app-based preventative intervention for risky adolescent drinking behavior

BACKGROUND

Older adolescence (ages 15-18) is a critical period for experimentation with substance use, especially alcohol. Adolescent drinking poses hazards to physical and mental health, amplifies risk associated with other activities typically initiated during this life stage (e.g., driving, sexual activity), and is associated with adverse outcomes in adolescence and adulthood. Existing preventative interventions are expensive and have questionable long-term efficacy. Digital interventions may represent an accessible and personalized approach to providing preventative intervention content to youth.

METHODS

This study recruited 29 adolescents aged 16-18 (M = 17.24, SD = 0.74) for a pilot feasibility trial of the MobileCoach-Teen (MC-Teen) smartphone app-based intervention. The study team randomized participants to receive either the alcohol intervention (MC-Teen) or attention control pseudo-intervention (MC-Fit). MC-Teen participants received 12 weeks of content adapted from a prior Swiss-based trial of a preventative alcohol intervention. Participants provided qualitative and quantitative feedback at baseline, via six biweekly surveys during and post-intervention.

RESULTS

Both groups rated the application as easy to download (M = 4.31, SD = 0.93; 5-point Likert). All participants completed the baseline survey in less than the estimated time of 10 min (M = 7:42, SD = 2:15) and rated the survey as easy to complete (M = 4.69, SD = 0.60; 5-point Likert). MC-Teen participants favorably assessed application user experience, message user experience, and digital working alliance with application. Qualitative themes included a desire for increased rate/amount and diversity of content, greater representation via coach options, user interface/user experience improvements, and additional features.

CONCLUSION

The MC-Teen intervention is feasible and acceptable based on a pilot feasibility trial with a sample of U.S. adolescents.

A qualitative analysis of adolescents' perspectives on peer and influencer alcohol-related posts on social media

INTRODUCTION

Adolescent exposure to alcohol-related content on social media is common and associated with alcohol use and perceived norms; however, little is known about how exposure differs by the source of the content (e.g., peer or 'influencer'). The purpose of this study was to utilise qualitative methods to compare adolescent perspectives on peer- versus influencer-generated alcohol content on social media.

METHODS

Nine virtual semi-structured focus groups were conducted with adolescents (aged 15-19 years), following a general script aimed at ascertaining adolescent comparative perspectives on peer and influencer alcohol-related media content and the contexts in which it occurs.

RESULTS

Five main themes emerged: (i) although both influencers and peers post predominantly positively-valenced alcohol content online, adolescents perceived some differences between these posts; (ii) adolescents perceived their peers to be more cautious and strategic when posting about alcohol than influencers are; (iii) the decision to engage with peer or influencer alcohol-related posts is influenced by a number of factors; (iv) both peer and influencer posts were perceived to send the message that drinking is acceptable, normal or cool; and (v) adolescents believed they are more likely to be influenced by peers' alcohol posts than influencers' alcohol posts, with some exceptions.

DISCUSSION AND CONCLUSIONS

Future studies should aim to further understand the unique attributes and circumstances in which exposure to peer and influencer alcohol-related posts impact adolescent alcohol-related cognitions and behaviours. This knowledge will inform prevention and intervention efforts, such as media literacy training and media-specific parenting practices.

A social network analysis of perpetrators of child maltreatment reported by youth in foster care

OBJECTIVE

Prior research on child maltreatment has focused on distinct features of maltreatment (type, severity, chronicity) important for youth outcomes, yet perpetrators of child maltreatment reported by youth have gone largely unstudied. The present study examines connections between perpetrators, the total number and type of perpetrators reported, and the frequency at which each type of perpetrator was reported across 24 relationship types to provide a foundation for future research seeking to provide comprehensive measurement of perpetrator profiles.

METHODS

Data from 503 youth in foster care (8-21 years old) were collected through the Studying Pathways to Adjustment and Resilience in Kids (SPARK) Project. Youth reported on their history of physical, sexual, and psychological maltreatment. Social Network Analysis (SNA) was used to visualize links between perpetrators within maltreatment type and paired samples t-tests were used to compare differences between network edge weights.

RESULTS

Full sample SNA results were highly interconnected and variable across maltreatment types. Biological parents and peers were the most common perpetrators of physical and psychological abuse with peers and non-family adults being most common for sexual abuse. Family and community member groupings were most distinct in the physical and psychological abuse networks whereas in the sexual abuse network, ties between perpetrators were more equidistant.

CONCLUSIONS

Differences exist in perpetrator profiles across maltreatment types, adding a layer of complexity to how maltreatment experiences are captured, and variability in profiles might provide insight to differing youth outcomes. Understanding individual youth perpetrator profiles could be used to inform foster care placements and reduce the risk of revictimization.

Adolescents' perceptions of alcohol portrayals in the media and their impact on cognitions and behaviors

OBJECTIVE

Exposure to alcohol in the media is pervasive and may influence adolescents' perceptions and use of alcohol. The purpose of this study was to better understand how adolescents perceive alcohol-related content in both entertainment and social media, with a focus on the valence of portrayals (i.e., positive, negative) and impacts on cognitions and behaviors.

METHOD

Participants were 40 high school students (60% female). Nine focus groups were conducted via videoconferencing, stratified by grade (9th/10th, 11th/12th) and gender. Transcripts were analyzed via template-style thematic analyses to identify themes.

RESULTS

Six themes were developed, including (a) some portrayals of alcohol may increase likelihood of using alcohol, (b) some portrayals of alcohol in the media can discourage drinking, (c) sometimes truly negative consequences of alcohol are portrayed positively or downplayed, (d) media portrayals of alcohol are perceived to be based in reality but are at times exaggerated, (e) adolescent and adult alcohol use is portrayed differently in entertainment media, and (f) the extent to which adolescents are influenced by the media may depend on their preexisting attitudes, beliefs, and education.

CONCLUSIONS

Adolescents have awareness of media portrayals of alcohol, both positive and negative, and their associated impacts. Findings highlight the need for much more work to understand the conditions under which, and for whom, exposure to different types of positive portrayals of alcohol in the media translate into positive expectancies about alcohol or drinking motives. Such work may ultimately inform intervention targets to reduce early initiation and/or risky drinking among adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived social support: Measurement differences in youth residing in the community versus youth residing in foster care

BACKGROUND

Social support is commonly examined as a protective factor for children with a history of child maltreatment, and it has been measured by self-report via the Social Support Scale for Children (SSSC). Although the SSSC has established adequate reliability and validity in community and clinical samples, its psychometric properties have yet to be assessed in a sample of foster care youth.

OBJECTIVE

This study provided a psychometric comparison of the SSSC in youth residing in foster care with youth residing in the community.

PARTICIPANTS AND SETTING

Participants were two, comparable samples of 214 youth participants residing in foster care and 163 youth participants from the community between the ages of 8-12 years.

METHODS

Community participants were recruited from local middle schools, and an age-matched comparison sample from a larger study on youth in foster care was utilized for comparison. Youth self-reported across measures and provided demographic information. Confirmatory factor analysis was utilized to determine measurement model fit to the data, and invariance testing was conducted to compare measurement models across the samples.

RESULTS

Differences between samples in the factor structure and item distribution of the SSSC emerged. Specifically, the community sample provided adequate fit to the original four-factor model (friend, classmate, teacher, parent) of the SSSC, whereas the foster sample required a three-factor model (combined friend and classmate constructs). The newly defined three-factor model provided significant associations with youth behavioral and emotional outcomes.

CONCLUSIONS

Youth in foster care may perceive social support across sources differently from youth residing in the community.

A latent class analysis of physical, emotional, and sexual abuse history among suicidal inpatients

OBJECTIVE

Physical, emotional, and sexual abuse are subtypes of childhood abuse that may persist into adulthood. This study applied latent class analysis to describe the pattern of co-occurrence of these three abuse subtypes during childhood and adulthood and examined latent class differences in psychosocial characteristics and three types of suicide attempt history (aborted, interrupted, and actual).

METHODS

Data were drawn from a high-risk sample of 115 military service members and adult beneficiaries who were psychiatrically hospitalized following a suicide-related crisis.

RESULTS

Three latent classes were identified: Multiple and Persistent Abuse (Class One: 29.6%), Childhood Physical and Persistent Emotional Abuse (Class Two: 27.0%), and Minimal Abuse (Class Three: 43.5%). Females were more likely than males to report a history of Multiple and Persistent Abuse. After controlling for gender, the Multiple and Persistent Abuse Class had higher scores of depressive symptoms and hazardous drinking, poorer sleep quality, and increased social stress than the Minimal Abuse Class. Moreover, the Multiple and Persistent Abuse Class was associated with increased likelihood of lifetime interrupted suicide attempt (Odds Ratio [OR] = 3.81, 95% CI = 1.20, 12.07) and actual suicide attempt (OR = 3.65, 95% CI = 1.23, 10.85), and had the greatest number of total actual suicide attempt (1.82 times on average).

CONCLUSION

Co-occurrence of multiple subtypes of abuse across development is associated with higher psychosocial risk and history of suicide attempt. The assessment of specific subtypes of abuse and their timing may inform case conceptualization and the management of suicide risk among psychiatric inpatients.

Profiles of Parenting in the Digital Age: Associations With Adolescent Alcohol and Marijuana Use

OBJECTIVE

This study assessed parental communication and behavior related to children's Internet and social media usage to delineate profiles of parenting regarding these newer forms of media and associated those profiles with youth alcohol and marijuana use.

METHOD

Using data from 748 adolescents (mean age = 15.8, 52% female, 25% non-White) and their parents, latent class analysis was performed to identify classes based on items concerning device ownership, monitoring, and communication of online activities. The associations between class membership and ever use of alcohol and marijuana were then tested, controlling for screen time, general parenting, substance availability, and deviance.

RESULTS

We identified five classes: high media parenting (23%), low media parenting (20%), moderate media parenting with limited device access (11%), moderate media parenting with high device access (25%), and low monitoring but high communication about online activities (21%). Probability of class membership was differentially associated with contemporaneous and 1-year prospective alcohol and marijuana use. The low-device-access class had the highest percentage of abstainers at both time points. The lowest rate of abstaining was associated with membership in the high-device-access class but moderate levels of monitoring. Membership in the low media parenting class was associated with use of both substances.

CONCLUSIONS

This study provides a novel exploration of media parenting, an important construct in the context of increased access to personalized media devices that allow for streaming of mature media content related to substance use.

Academic Functioning of Youth in Foster Care: The Influence of Unique Sources of Social Support

Youth in foster care often experience more difficulty in school compared to their non-foster care peers. Difficulties exist across domains of academic functioning, including both performance (e.g., low grades) and behavioral health (e.g., high externalizing concerns) in school. One factor that has shown to be associated with positive academic functioning in the general population but remains to be comprehensively examined among youth in foster care is social support. This includes examining specific sources of support for youth in foster care and taking into consideration the context of the frequent placement disruptions many children in foster care experience. This study sought to determine which sources of social support are associated with academic functioning for youth in foster care by examining child-report of social support from parents, teachers, friends, and classmates in relation to school grades and teacher-reported behavioral health outcomes. Information on each source of social support was obtained from the self-report of 257 youth in foster care, and information on placement characteristics were obtained from child welfare casefiles. Teachers provided information on youth's behavioral health in school, and academic grades were obtained from school records. Results suggested that youth reported teacher social support, as compared to parent, friend, or classmate social support, was most influential for both performance and behavioral health in school. Findings highlight the need for additional research on the important role of teachers for promoting academic success amongst youth in foster care, as well as the importance of placement changes in relation to academic functioning.

Exposure to Television Alcohol Brand Appearances as Predictor of Adolescent Brand Affiliation and Drinking Behaviors

Adolescence and the transition to adulthood is an important developmental stage in the emergence of health risk behaviors, specifically underage alcohol use. Adolescents consume a tremendous amount of screened media (primarily streamed television), and media depictions of behaviors is prospectively linked to youth initiation of behaviors. With the arrival of streamed media technology, alcohol advertising can be nested within television content. This study describes alcohol brand depictions in television and evaluates impact of exposure to such depictions on adolescent drinking outcomes. A national sample of 2012 adolescents (M_age = 17.07; SD = 1.60 years, range 15-20; 50.70% female) reported on television viewership, alcohol brand affiliation, and drinking behavior, with follow-up one year later. Ten series (that remain relevant to youth today) across television ratings from a single television season were content coded for presence/salience of alcohol brand appearances. Adjusting for covariates (e.g., peer/parent drinking, youth sensation seeking, movie alcohol brand exposure), higher exposure to brand appearances in the television shows was associated with youth drinking. Aspirational and usual brand to drink corresponded to television alcohol brand prominence, and television brand exposure was independently associated with drinking initiation and hazardous drinking.

Internet Alcohol Marketing Recall and Drinking in Underage Adolescents

OBJECTIVE

Evidence suggests that adolescents are exposed to alcohol marketing in digital media. We aimed to assess recall of Internet alcohol marketing and its association with underage drinking.

METHODS

New England adolescents age 12 to 17 years (N = 202) were recruited from a pediatric clinic. Subjects completed an online survey assessing: 1) general simple recall of Internet alcohol marketing and 2) image-prompted recall of specific Internet alcohol marketing channels (display ads, commercials, brand websites, and brand social media pages). Cross-sectional associations between recall (simple and image-prompted) and ever-drinking were each assessed in regression analysis adjusting for age, gender, race, parent education, ever-smoking, media use, sensation-seeking, peer/parent drinking, parent monitoring/responsiveness, and parent Internet monitoring.

RESULTS

In this sample (Mage = 14.5 years; 55% female; 89% white; high parent education), 20% reported ever-drinking and 87% recalled Internet alcohol marketing. Of the latter, 67% recalled display ads, 67% Internet commercials, 5% websites, and 5% social media pages. In logistic regression, higher simple Internet alcohol advertising recall was independently associated with higher odds of ever-drinking for simple (adjusted odds ratio: 2.66 [1.04,6.83]) but not for image-prompted recall.

CONCLUSIONS

Despite controlling for potential confounders, simple recall of Internet alcohol marketing was significantly associated with underage drinking whereas image-prompted recall was significant only in bivariate analysis, likely due to small sample and a more limited range of specific channels assessed than those accessed by adolescents. Further longitudinal studies using image-prompted recall and capturing a broader range of internet platforms could be used to better understand adolescent engagement with alcohol marketing and guide policy and prevention efforts.

Aspirational Brand Choice and Underage Alcohol Use

OBJECTIVE

Marketing aims to foster brand allegiance, and alcohol is a heavily marketed commodity. We hypothesize that exposed youth who are able to identify an aspirational alcohol brand will be at higher risk for underage drinking.

METHOD

U.S. youth ages 15-20 (N = 2,012; 51% female) were surveyed twice in 2011-2013. Aspirational brand was assessed by asking, "If you could drink any brand you want, what is the name of the brand of alcohol you would choose?" Multivariable logistic regression tested associations between having an aspirational brand at baseline and onset of ever, binge (≥6 drinks/occasion), and hazardous drinking (Alcohol Use Disorders Identification Test-Consumption ≥ 4).

RESULTS

Baseline ever, binge, and hazardous drinking prevalence was 55%, 26%, and 19%, respectively; 47% reported having an aspirational brand, of whom 20% were nondrinkers. Top five reported brands were Budweiser, Smirnoff, Corona, Jack Daniels, and Bacardi, all heavily advertised brands. Older age, male gender, sensation seeking, and peer/parent drinking were associated with having an aspirational brand. After we controlled for these confounders, having an aspirational brand was independently associated cross-sectionally with greater risk of ever, binge, and hazardous drinking (adjusted odds ratio = 4.47, 95% CI [3.33, 6.00], 4.84 [3.41, 6.86], and 5.46 [3.63, 8.23], respectively) and longitudinally with initiation of binge and hazardous drinking (1.80 [1.19, 2.73] and 2.02 [1.33, 3.06], respectively).

CONCLUSIONS

Having an aspirational alcohol brand is both common and independently associated with subsequent underage alcohol use and misuse. Further studies examining how youth interact with and are affected by branded advertising are critical to guide development of effective education and policy interventions.

Emerging Trends in Cannabis Administration Among Adolescent Cannabis Users

PURPOSE

The legal landscape of cannabis availability and use in the United States is rapidly changing. As the heterogeneity of cannabis products and methods of use increases, more information is needed on how these changes affect use, especially in vulnerable populations such as youth.

METHODS

A national sample of adolescents aged 14-18 years (N = 2,630) were recruited online through advertisements displayed on Facebook and Instagram to complete a survey on cannabis. The survey assessed patterns of edible use, vaping, and smoking cannabis, and the associations among these administration routes and use of other substances.

RESULTS

The most frequent and consistent route of cannabis use was smoking (99% lifetime), with substantial numbers reporting vaping (44% lifetime) and edible use (61% lifetime). The majority of those who had experimented with multiple routes of cannabis administration continued to prefer smoking, and the most common pattern of initiation was smoking, followed by edibles and then vaping. In addition to cannabis use, adolescents reported high rates of nicotine use and substantial use of other substances. Adolescents who used more cannabis administration routes tended to also report higher frequency of other substances tried.

CONCLUSIONS

Additional work is needed to determine whether the observed adolescent cannabis administration patterns are similar across different samples and sampling methods as well as how these trends change over time with extended exposure to new products and methods. The combined knowledge gained via diverse sampling strategies will have important implications for the development of regulatory policy and prevention and intervention efforts.

Media/Marketing Influences on Adolescent and Young Adult Substance Abuse

PURPOSE OF REVIEW

We describe the state of research on substance use portrayals in marketing and media, considering exposure to tobacco, alcohol, e-cigarette, and marijuana content. Putative mechanisms are offered, and recommendations made for effective prevention strategies for mitigating the influence of these portrayals.

RECENT FINDINGS

There is consistent evidence that adolescents and young adults are highly exposed to substance use portrayals and that these portrayals are associated with subsequent substance use. Exposure via new media (social networking sites, brand websites) has risen rapidly. Social norms and cognitions appear to at least partially account for the effects of portrayals on youth substance use.

SUMMARY

Digital media has surpassed traditional marketing, which is concerning because youth have on-demand access to content and are active consumers of digital media. Developmentally appropriate media literacy interventions that include a parenting component and target multiple substances and media domains are recommended.

Media/Marketing Influences on Adolescent and Young Adult Substance Abuse

PURPOSE OF REVIEW

We describe the state of research on substance use portrayals in marketing and media, considering exposure to tobacco, alcohol, e-cigarette, and marijuana content. Putative mechanisms are offered, and recommendations made for effective prevention strategies for mitigating the influence of these portrayals.

RECENT FINDINGS

There is consistent evidence that adolescents and young adults are highly exposed to substance use portrayals and that these portrayals are associated with subsequent substance use. Exposure via new media (social networking sites, brand websites) has risen rapidly. Social norms and cognitions appear to at least partially account for the effects of portrayals on youth substance use.

SUMMARY

Digital media has surpassed traditional marketing, which is concerning because youth have on-demand access to content and are active consumers of digital media. Developmentally appropriate media literacy interventions that include a parenting component and target multiple substances and media domains are recommended.

Maltreatment, Coping, and Substance Use in Youth in Foster Care: Examination of Moderation Models

Child maltreatment is associated with negative outcomes such as substance use (SU). This study tested relations among maltreatment history, coping behavior, and SU behavior in youth residing in foster care. Participants were 210 youth ( M_age = 12.71 years; SD = 2.95) in foster care who completed self-report measures through an audio computer-assisted self-interview program. Using a structural equation modeling framework and latent measurement constructs, positive associations were identified between maltreatment at baseline and coping behavior outcomes as well as SU behavior outcome approximately 4.5 months later. Specifically, greater severity and chronicity of maltreatment was associated with greater SU behavior as well as indirect action, prosocial, and asocial coping behavior. Maltreatment was not significantly related to direct action coping behavior. In moderation tests, only asocial coping provided a significant interaction effect for SU behavior outcomes; SU behavior did not moderate pathways between maltreatment and coping behavior. For youth in foster care, the coping approach may be varied and relate differentially to SU behavior outcomes, with asocial approaches to coping acting as a buffer for the maltreatment/SU relation. Additionally, SU remains an important target for intervention and prevention in youth residing in foster care.

Coping styles in youth exposed to maltreatment: Longitudinal patterns reported by youth in foster care

Coping styles in youth living in foster care with a history of maltreatment were examined to determine the nature and stability of self-reported coping behavior over time. Participants included 542 (time 1), 377 (time 2), and 299 (time 3) youth ages 8-22 years (M=13.28years, SD=3.04). Using the Behavioral Inventory of Strategic Control, a dimensional, continuous measure of coping, across four possible coping styles endorsed in reference to specific potentially stressful situations, the results indicated that direct action coping was the most frequently endorsed or preferred style for more than 50% of the sample at each time point. A number of youth endorsed using more than one coping style, indicating some flexibility in the approach to coping when problems occur. Although most youth endorsed a preferred style, coping style endorsed did vary somewhat over time. The coping style endorsed also varied depending on the type of problem referenced, but no statistically significant differences were noted across situations, including social, academic, general, and foster-specific situations. Effects for age were also examined and the results indicated no significant differences across the age range for type of coping most commonly endorsed. The present study is the first large-scale, longitudinal assessment of coping styles in youth in foster care and the results suggest that coping is not a simple, categorical-only construct and the implications for the endorsement of the direct approach for youth in foster care along with the other findings are discussed.

Adolescent smoking experimentation as a predictor of daily cigarette smoking

OBJECTIVE

The utility of studying substance use during early adolescence depends on how well indicies of lower-level experimentation predict the development of substance use problems. We examined associations between experimental cigarette use at T1, recanting of use 8 months later (T2), and daily smoking at 2 years (T4).

METHODS

Longitudinal telephone survey of 6522 US youth aged 10-14, examining lifetime cigarette smoking (none, just puffing, 1-19, 20-100, >100) and recanting (i.e., reporting lifetime use at T1, denying ever using at T2) as predictors of T4 daily smoking using multivariable logistic regression. Covariates included sociodemographics, friend/family smoking, school performance, and personality characteristics.

RESULTS

The sample was 51% male, 18% Black, 17% Hispanic, with 70% retained at T2. At T1, 407 (8.9%) adolescents reported some smoking, of whom 85 (20.9%) recanted at T2. At T4, 970 reported any smoking, of whom 88 (9.1%) were daily smokers. Any T1 experimentation identified two-thirds of T4 daily smokers (sensitivity=66.7%) with a false positive rate of 7.8%. T1 lifetime smoking categories were associated with the following adjusted odds ratios for T4 daily smoking (vs. never smokers): 2.7 for recanters (95% confidence interval 0.82, 8.5), 3.5 for few puffs (1.7, 7.0), 9.6 for 1-19 cigarettes (4.1, 22.3), 3.8 for 20-100 cigarettes (1.0, 14.3), and 30.1 for >100 cigarettes (8.1, 111).

CONCLUSIONS

In this sample experimentation with cigarettes predicted future daily smoking with high utility. The findings provide a rationale for monitoring and reporting any experimentation cigarettes as a tobacco surveillance outcome.

Validation of commercial business lists as a proxy for licensed alcohol outlets

Background

Studies of retail alcohol outlets are restricted to regions due to lack of U.S. national data. Commercial business lists (BL) offer a possible solution, but no data exists to determine if BLs could serve as an adequate proxy for license data. This paper compares geospatial measures of alcohol outlets derived from a commercial BL with license data for a large US state.

Methods

We validated BL data as a measure of off-premise alcohol outlet density and proximity compared to license data for 5528 randomly selected California residential addresses. We calculated three proximity measures (Euclidean distance, road network travel time and distance) and two density measures (kernel density estimation and the count within a 2-mile radius) for each dataset. The data was acquired in 2015 and processed and analyzed in 2015 and 2016.

Results

Correlations and reliabilities between density (correlation 0.98; Cronbach’s α 0.97–0.99) and proximity (correlations 0.77–0.86; α 0.87–0.92) measures were high. For proximity, BL data matched license in 55–57% of addresses, overstated distance in 19%, and understated in 24–26%.

Conclusions

BL data can serve as a reliable proxy for licensed alcohol outlets, thus extending the work that can be performed in studies on associations between retail alcohol outlets and drinking outcomes.

The blind men and the elephant: Identification of a latent maltreatment construct for youth in foster care

Child maltreatment is a major public health concern due to its impact on developmental trajectories and consequences across mental and physical health outcomes. Operationalization of child maltreatment has been complicated, as research has used simple dichotomous counts to identification of latent class profiles. This study examines a latent measurement model assessed within foster youth inclusive of indicators of maltreatment chronicity and severity across four maltreatment types: physical, sexual, and psychological abuse, and neglect. Participants were 500 foster youth with a mean age of 12.99 years (SD=2.95years). Youth completed survey questions through a confidential audio computer-assisted self-interview program. A two-factor model with latent constructs of chronicity and severity of maltreatment revealed excellent fit across fit indices; however, the latent constructs were correlated 0.972. A one-factor model also demonstrated excellent model fit to the data (χ² (16, n=500)=28.087, p=0.031, RMSEA (0.012-0.062)=0.039, TLI=0.990, CFI=0.994, SRMR=0.025) with a nonsignificant chi-square difference test comparing the one- and two-factor models. Invariance tests across age, gender, and placement type also were conducted with recommendations provided. Results suggest a single-factor latent model of maltreatment severity and chronicity can be attained. Thus, the maltreatment experiences reported by foster youth, though varied and complex, were captured in a model that may prove useful in later predictions of outcome behaviors. Appropriate identification of both the chronicity and severity of maltreatment inclusive of the range of maltreatment types remains a high priority for future research.

Associations Between Maltreatment History and Severity of Substance Use Behavior in Youth in Foster Care

Substance use (SU) in youth remains a significant public health concern and a risk factor for morbidity and mortality in adolescents. The present study offers examination of the association between severity and chronicity of maltreatment history and SU in youth in foster care. Two hundred and ten (48% female) foster youth with a mean age of 12.71 years ( SD = 2.95 years) completed surveys using an audio-computer-assisted self-interview program. Results revealed 31% of participants reported past-year SU, and substance users had a mean CRAFFT score of 3.43 ( SD = 1.90). Reported age of SU onset was 11.08 years ( SD = 2.21 years). The SU measurement model demonstrated excellent fit in this sample. Accounting for both youth age and youth placement type, the structural model with maltreatment predicting SU severity demonstrated strong model fit with a significant path between maltreatment and SU. Youth in residential facilities and older youth had higher rates of use than those residing in traditional foster home environments and younger youth. Findings provide additional support for the link between maltreatment experiences and SU severity in foster youth and suggest the need for screening and intervention services appropriate for this high-risk population.

Industry Television Ratings for Violence, Sex, and Substance Use

OBJECTIVE

To examine whether the industry-run television (TV) Parental Guidelines discriminate on violence, sexual behavior, alcohol use, and smoking in TV shows, to assess their usefulness for parents.

METHODS

Seventeen TV shows (323 episodes and 9214 episode minutes) across several TV show rating categories (TVY7, TVPG, TV14, and TVMA) were evaluated. We content-coded the episodes, recording seconds of each risk behavior, and we rated the salience of violence in each one. Multilevel models were used to test for associations between TV rating categories and prevalence of risk behaviors across and within episodes or salience of violence.

RESULTS

Every show had at least 1 risk behavior. Violence was pervasive, occurring in 70% of episodes overall and for 2.3 seconds per episode minute. Alcohol was also common (58% of shows, 2.3 seconds per minute), followed by sex (53% of episodes, 0.26 seconds per minute), and smoking (31% of shows, 0.54 seconds per minute). TV Parental Guidelines did not discriminate prevalence estimates of TV episode violence. Although TV-Y7 shows had significantly less substance use, other categories were poor at discriminating substance use, which was as common in TV-14 as TV-MA shows. Sex and gory violence were the only behaviors demonstrating a graded increase in prevalence and salience for older-child rating categories.

CONCLUSIONS

TV Parental Guidelines ratings were ineffective in discriminating shows for 3 out of 4 behaviors studied. Even in shows rated for children as young as 7 years, violence was prevalent, prominent, and salient. TV ratings were most effective for identification of sexual behavior and gory violence.

Associations Between Physical and Relational Forms of Peer Aggression and Victimization and Risk for Substance Use Among Elementary School-Age Youth

This study examined associations between physical and relational forms of aggression and victimization and risk for willingness to engage in substance use and actual use in a sample of 231 (50% Male) 2nd thru 4th grade students (Mean age = 8.3 years). Physical aggression was more strongly associated with risk for substance use outcomes than physical victimization. Neither relational aggression nor victimization were linked to risk for substance use. Specifically targeting physical aggression for the prevention of early substance use among elementary school-age youth appears to be warranted.

Child Maltreatment, Trauma, and Physical Health Outcomes: The Role of Abuse Type and Placement Moves on Health Conditions and Service Use for Youth in Foster Care

OBJECTIVE

The purpose of the study was to investigate the relations between abuse types, non-maltreatment-related trauma, and health service utilization in a sample of youth in foster care with and without chronic medical conditions.

METHOD

A total of 213 youth, aged 8-21 years, provided self-report of general trauma and abuse exposure. Medicaid claims for each child were collected from official state databases.

RESULTS

Exposure to sexual abuse, neglect, or general trauma but not exposure to physical abuse or psychological abuse increased the rates of medical visits, while only general trauma increased medical hospitalizations. 

CONCLUSIONS

Trauma types are not equally predictive of health care utilization for youth with chronic health conditions.

Do communication and social interaction skills differ across youth diagnosed with autism spectrum disorder, attention-deficit/hyperactivity disorder, or dual diagnosis?

Given the well-documented symptom overlap between Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD), careful evaluation of potential differentiation and overlap is critical for accurate diagnostic decisions. Although research has considered the use of symptom checklists and parent/teacher report questionnaires for symptom differentiation, standardized observational methods, typically utilized in the context of ASD evaluation, have received less attention. The present study examined the continuum of communication and social interaction impairment for youth diagnosed with ASD and ADHD, as indexed by the Autism Diagnostic Observation Schedule (ADOS). Participants were 209 youth ages 3 to 18 years with ASD, ADHD, Dual Diagnosis (ASD+ADHD) or No Diagnosis. Differences across diagnostic groups were observed for mean communication and social interaction total scores on the ADOS, with the highest scores (i.e., greater impairment) observed for the ASD group and lowest scores for the ADHD and No Diagnosis groups. Results provide the first evidence for use of the ADOS for distinguishing youth who have ADHD alone versus ASD alone or co-occurring ASD+ADHD. Findings are discussed in light of implications for clinical practice and future research.

Longitudinal Assessment of Self-Harm Statements of Youth in Foster Care: Rates, Reporters, and Related Factors

Self-harm in youth is a risk factor related to mental health and future morbidity, yet, relatively little is known about the rates and course of self-harm in youth residing in foster care. This study examined self-harm talk in foster youth based on caregiver and child report for 135 children between the ages of 8- and 11-years old. Longitudinal data on course of self-harm talk from both youth and caregivers also are provided. Caregivers identified that 24% of youth participants had disclosed a desire to die or to hurt themselves. Youth self-report revealed that 21% of children indicated a desire for self-harm, and rates of self-harm from both reporters decreased over time. While overall rates were similar across reporters, findings show discrepancies between youth self-report and caregiver report within individuals. Also, caregivers for youth in residential facilities were more likely to report youth self-harm talk than caregivers from foster home settings.

Hope as a Moderator of the Associations between Common Risk Factors and Frequency of Substance Use among Latino Adolescents

Ample research suggests that delinquency, depressive symptoms, and peer substance use are common risk factors associated with adolescent substance use. However, the factors that may help to buffer the deleterious effects of these risk factors on adolescent substance use, such as hope, have yet to be examined. The current study evaluated hope as a moderator of the associations between these common risk factors and frequency of substance use (alcohol, tobacco, and marijuana) in a sample of Latino high school students (Mage = 16.14years, SD = 1.30; 55% female). Findings indicated that the influence of delinquency on frequency of tobacco and marijuana use depended on levels of hope, with delinquency only positively associated with frequency of use when levels of hope were low. Additionally, hope moderated the association between depressive symptoms and alcohol use, such that depressive symptoms were only positively associated with frequency of alcohol use when levels of hope were low. Results and their implications for intervention are reviewed.

A Safety Awareness Program for Women With Diverse Disabilities

Women with diverse disabilities ( N = 213), recruited through 10 centers for independent living (CILs), were randomly assigned to either a personal safety awareness program or usual care. The 8-week program, led by CIL staff, was designed to increase safety awareness, abuse and safety knowledge, safety skills, safety self-efficacy, social support, and safety promoting behaviors. All participants completed pre-, post-, and 6-month follow-up questionnaires. Results revealed that participation in a brief safety awareness program may improve safety protective factors among women with disabilities who vary widely in their experience with abuse. The program holds promise for enhancing safety among women with disabilities.

Untangling the relative contribution of maltreatment severity and frequency to type of behavioral outcome in foster youth

Within maltreatment research, type, frequency, and severity of abuse are often confounded and not always specifically documented. The result is samples that are often heterogeneous in regard to maltreatment experience, and the role of the different components of maltreatment in predicting outcome is unclear. The purpose of the present study was to identify and test the potential unique role of type, frequency, and severity of maltreatment to elucidate each variable's role in predicting outcome behavior. Data from 309 youth in foster care (ages 8-22) and their caregivers were collected using the Modified Maltreatment Classification System and the Behavioral Assessment System for Children, 2nd Edition (BASC2), to measure maltreatment exposure and behavioral outcome respectively. A measurement model of the BASC2 was completed to determine model fit within the sample data. A second confirmatory factor analysis (CFA) was completed to determine the unique contributions of frequency and severity of maltreatment across four types of abuse to externalizing, internalizing, and adaptive behavior. The result of the CFA determined good fit of the BASC2 to the sample data after a few modifications. The result of the second CFA indicated that the paths from severity to externalizing behavior and adaptive behavior (reverse loading) were significant. Paths from frequency of abuse were not predictive of behavioral outcome. Maltreatment is a complex construct and researchers are encouraged to examine components of abuse that may be differentially related to outcome behavior for youth. Untangling the multifaceted nature of abuse is important and may have implications for identifying specific outcomes for youth exposed to maltreatment.

Using Multiple Informants to Assess Child Maltreatment: Concordance Between Case File and Youth Self-Report

To understand the psychosocial implications of child maltreatment, methods used to document prevalence must be clear. Yet, rates of maltreatment found in child self-report are generally inconsistent with data found in case files from state social service agencies. Although self-reports and case file reports of abuse disagree on occurrence of specific events, it is unclear if reporters agree when overall categories of abuse are considered. This study investigated differences between case file and youth report of abuse by examining four types of abuse: physical, sexual, neglect, and psychological, in a within-subjects design using a sample of 97 youth in foster care aged 8 to 22. Case files were coded for the presence of any indication of each type of abuse. Self-report of abuse was also assessed for any indication of each type of abuse. Results indicated that, overall, youth reported more physical and psychological abuse, and younger youth reported more sexual abuse than documented in their file. Implications for research and service provision for maltreated youth are discussed.

Strategies for Longitudinal Research with Youth in Foster Care: A Demonstration of Methods, Barriers, and Innovations

Longitudinal research on youth in foster care is important, but often challenging to accomplish. To assist the field, a thorough description of the development of the SPARK (Studying Pathways to Adjustment and Resilience in Kids) project, a longitudinal research project on the mechanisms of resilience for foster youth and their caregivers, is presented. Authors explain the difficult task for researchers in accessing youth in foster care and suggest strategies for success. Recruitment approaches for foster youth and their families are also provided along with examples of effective techniques. Data collection concerns are discussed, and the authors provide recommendations for researchers to consider when asking youth sensitive questions. Finally, data collection on academic information from teachers and how the SPARK project works with the academic community to gain information on school functioning for youth in the project is described. Suggestions for methodology utilized in future research along with examples of innovative adjustments to typical research procedures are provided as guidance for how research on maltreated youth can be conducted.

Screening adolescents for substance use-related high-risk sexual behaviors

PURPOSE

This analysis was undertaken to determine whether adolescents who screened positive for high-risk substance use with the CRAFFT questions were also more likely to engage in risky sexual behaviors than their peers, and to determine the test-retest reliability of a substance use-related sexual risk behaviors inventory.

METHODS

Clinic patients 12-18 years old completed a multi-part questionnaire that included eight demographic items, the CRAFFT substance use screen, and a 14-item scale assessing sexual behaviors associated with substance use. Participants were invited to return 1 week later to complete an identical assessment battery.

RESULTS

Of the 305 study participants, 49 (16.1%) had a positive CRAFFT screen result (score of 2 or greater, indicating high risk for substance abuse/dependence) and 101 (33.9%) reported sexual contact during the past 90 days. After controlling for gender, age, race/ethnicity, and number of parents in household, adolescents with a positive CRAFFT screen had significantly greater odds of having sexual contact after using alcohol or other drugs, of having a sexual partner who used alcohol or other drugs, of having sex without a condom, and of having multiple sexual partners within the past year, compared to their CRAFFT negative peers. The substance use-related sexual risk behaviors inventory has acceptable test-retest reliability, and the 10 frequency questions have scale-like properties with acceptable internal consistency (standardized Cronbach's alpha=.79).

CONCLUSION

Clinicians should pay special attention to counseling CRAFFT-positive adolescents regarding use of condoms and the risks associated with sexual activity with multiple partners, while intoxicated, or with an intoxicated partner.

Alcohol use and religiousness/spirituality among adolescents

BACKGROUND

Previous studies indicate that religiousness is associated with lower levels of substance use among adolescents, but less is known about the relationship between spirituality and substance use. The objective of this study was to determine the association between adolescents' use of alcohol and specific aspects of religiousness and spirituality.

METHODS

Twelve- to 18-year-old patients coming for routine medical care at three primary care sites completed a modified Brief Multidimensional Measure of Religiousness/Spirituality; the Spiritual Connectedness Scale; and a past-90-days alcohol use Timeline Followback calendar. We used multiple logistic regression analysis to assess the association between each religiousness/spirituality measure and odds of any past-90-days alcohol use, controlling for age, gender, race/ethnicity, and clinic site. Timeline Followback data were dichotomized to indicate any past-90-days alcohol use and religiousness/spirituality scale scores were z-transformed for analysis.

RESULTS

Participants (n = 305) were 67% female, 74% Hispanic or black, and 45% from two-parent families. Mean +/- SD age was 16.0 +/- 1.8 years. Approximately 1/3 (34%) reported past-90-day alcohol use. After controlling for demographics and clinic site, Religiousness/Spirituality scales that were not significantly associated with alcohol use included: Commitment (OR = 0.81, 95% CI 0.36, 1.79), Organizational Religiousness (OR = 0.83, 95% CI 0.64, 1.07), Private Religious Practices (OR = 0.94, 95% CI 0.80, 1.10), and Religious and Spiritual Coping--Negative (OR = 1.07, 95% CI 0.91, 1.23). All of these are measures of religiousness, except for Religious and Spiritual Coping--Negative. Scales that were significantly and negatively associated with alcohol use included: Forgiveness (OR = 0.55, 95% CI 0.42-0.73), Religious and Spiritual Coping--Positive (OR = 0.67, 95% CI 0.51-0.84), Daily Spiritual Experiences (OR = 0.67, 95% CI 0.54-0.84), and Belief (OR = 0.76, 95% CI 0.68-0.83), which are all measures of spirituality. In a multivariable model that included all significant measures, however, only Forgiveness remained as a significant negative correlate of alcohol use (OR = 0.56, 95% CI 0.41, 0.74).

CONCLUSIONS

Forgiveness is associated with a lowered risk of drinking during adolescence.