Early-onset prescription drug misuse in Indiana youth

BACKGROUND

Based on 2018 national estimates, approximately 5-10% of youth between the ages of 12-17 report past year prescription drug misuse (PDM) in the United States. PDM among adolescents is associated with negative health outcomes and risk behaviors. The current study examined both the prevalence of PDM among diverse groups of adolescents and the association of alcohol and cigarette use with early PDM.

METHODS

Data came from the cross-sectional state-based 2018 Indiana Youth Survey of students from grades 6-12, ranging in age from 10 to 17 years (n = 80,926). Lifetime PDM, alcohol, and cigarettes were assessed by self-report, including ages at first use. A series of analyses were conducted separately for non-Hispanic Black, non-Hispanic White, and Hispanic students. We estimated the prevalence of PDM. Likelihood of PDM was estimated using the Kaplan-Meier survivor function. Cox proportional hazards regression models estimated age at first PDM from ages at first use of alcohol and cigarettes.

RESULTS

Three percent of non-Hispanic Black, 4% of non-Hispanic White, and 5% of Hispanic students reported PDM. Onset of smoking was associated with first PDM across adolescence for all groups. Onset of drinking was associated with first PDM among Hispanic students across adolescence. For Non-Hispanic Black and Non-Hispanic White students, likelihood of PDM was most pronounced during very early adolescence.

CONCLUSIONS

Onset of alcohol and cigarette use were associated with of PDM among Indiana youth, suggesting that interventions aimed at preventing early smoking and drinking may also reduce PDM among youth.

The relationship between racial discrimination and substance use: Does locus of control help explain risk?

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The racial discrimination, locus of control, substance use pathway was tested.

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The sample was comprised of racial/ethnic minority adults.

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Indirect effects were found for chance and powerful others external locus of control.

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Internal locus of control was not found to be a significant mediator.

Introduction

Exposure to racial discrimination has been consistently linked with risk for substance use. However, outside of externalizing and affect-based factors, few other mechanisms have been examined. One potential candidate is locus of control, a learning processes that involves the degree to which one attributes rewards as resulting from their own control (internal locus of control) versus outside control (external locus of control). There is evidence that exposure to stressors is associated with locus of control, with a separate body of literature linking locus of control with substance use. Thus, it is plausible that locus of control may be a mechanism underlying the relationship between racial discrimination and substance use.

Methods

The current study investigated this pathway among 503 racial/ethnic minority adults aged 18–35 who completed an online questionnaire including measures on racial discrimination related stress, locus of control, and substance use.

Results

Results indicated a significant indirect effect between racial discrimination related stress, two external domains of locus of control (i.e., powerful others and chance), and substance use. A significant indirect effect was not found for internal locus of control.

Conclusion

These findings expand our understanding on potential mechanisms that underlie the racial discrimination-substance use risk pathway among racial/ethnic minority adults, which may in turn provide important targets for substance use intervention programming.

Examining the effects of implicit and explicit racial identity on psychological distress and substance use among Black young adults

Racial identity is an aspect of self-concept that is important to the mental and behavioral health of Black individuals. Yet, much of the current research on racial identity is based on self-report measures which may impact findings due to reporting biases. One way to alleviate some of the measurement concerns is to use implicit measures to assess racial identity. The purpose of the present study was to examine whether an implicit assessment of racial identity, specifically racial centrality, provided a unique contribution to the understanding of risk for psychological distress and substance use among Black young adults above potential effects observed from an explicit measurement of racial identity. Additionally, the potential moderating effect of implicit racial identity, controlling for explicit racial identity, on the association between racial discrimination and these health outcomes was also examined. One hundred and forty-seven Black young adults participated in this study. Contrary to our hypothesis, there was no significant main effect of implicit racial centrality on depressive symptoms or substance use after accounting for explicit racial centrality. However, after controlling for explicit racial centrality, a significant moderating effect of implicit racial centrality on the relationship between racial discrimination and substance use was observed. Although support for all of our hypotheses was not definitively found, our findings can be added to this emerging area of study. Additionally, potential explanations for the findings are provided that can be used to inform future research in this area to better understand the utility of assessing for implicit racial identity among Black young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Alliances to disseminate addiction prevention and treatment (ADAPT): A statewide learning health system to reduce substance use among justice-involved youth in rural communities

BACKGROUND

Youth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the continuum of the cascade include identification of treatment need, referral to services, and treatment engagement. To address gaps in care for YJS, we will (1) implement a learning health system (LHS) to develop, or improve upon, alliances between juvenile justice (JJ) agencies and community mental health centers (CMHC) and (2) present local cascade data during continuous quality improvement cycles within the LHS alliances.

METHODS/DESIGN

ADAPT is a hybrid Type II effectiveness implementation trial. We will collaborate with JJ and CMHCs in eight Indiana counties. Application of the EPIS (exploration, preparation, implementation, and sustainment) framework will guide the implementation of the LHS alliances. The study team will review local cascade data quarterly with the alliances to identify gaps along the continuum. The study will collect self-report survey measures longitudinally at each site regarding readiness for change, implementation climate, organizational leadership, and program sustainability. The study will use the Stages of Implementation Completion (SIC) tool to assess the process of implementation across interventions. Additionally, the study team will conduct focus groups and qualitative interviews with JJ and CMHC personnel across the intervention period to assess for impact.

DISCUSSION

Findings have the potential to increase SUD need identification, referral to services, and treatment for YJS.

Collective ethnic-racial identity and health outcomes among African American youth: Examination of promotive and protective effects

OBJECTIVES

Racial discrimination is associated with numerous negative health outcomes, including increased risk for depression and anxiety symptoms and substance use. Positive affect toward of one's ethnic or racial group (i.e., ethnic-racial identity affirmation) has been shown to buffer the negative effects of racial discrimination on health outcomes. The extent to which one believes his or her group is valued by others (i.e., positive collective ethnic-racial identity) has also been proposed to be protective. However, to date a limited body of research has examined the moderating effect of collective ethnic-racial identity on health, and among available studies, findings are mixed.

METHOD

African American youth (N = 612; 58.2% female, M grade = 8) completed measures on experiences of discrimination, mood symptoms, substance use, ethnic-racial identity affirmation, and collective ethnic-racial identity (assessed using the Collective Self-Esteem Scale).

RESULTS

Controlling for demographic variables and affirmation, a significant main effect was found for collective ethnic-racial identity, such that believing that others viewed your group positively was associated with better health outcomes among African American youth. However, collective ethnic-racial identity was not found to buffer the effects of discrimination on health outcomes.

CONCLUSIONS

These findings highlight the importance of examining collective ethnic-racial identity and the promotive effect it can have on health outcomes for African Americans. More research is needed to better understand if there are health outcomes in which collective ethnic-racial identity may also mitigate risk as a consequence of racial discrimination. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Peer victimization and substance use: Understanding the indirect effect of depressive symptomatology across gender

OBJECTIVE

Peer victimization in school is common, with emerging literature suggesting that it may also increase risk for substance abuse. Yet, little is known about the underlying mechanisms within this risk pathway. The objective of this study is to use a prospective 3-wave design to examine the mediating role of depressive symptomatology on the relationship between peer victimization and substance use, as well as examine if the pathway varies based on gender.

METHOD

801 youth between 6th and 12th grade completed surveys across three years, which included measures on school peer victimization, depression symptomatology and substance use. Models tested the mediational pathway between victimization, depressive symptoms, and substance use. Models were stratified by gender.

RESULTS

Controlling for grade and the effect of each variable across waves, a significant indirect effect of peer victimization on substance use through depressive symptoms was found for females, with a non-significant indirect effect for males.

CONCLUSION

Results suggest that female youth who are victimized by peers engage in substance use behaviors, at least in part, due to increases in depressive symptoms. Given its effect on depression, female victims may therefore benefit from coping skills training that targets emotion regulation and distress tolerance skills in order to combat increased risk for substance use behaviors as a coping response to their victimization. Further research is warranted to better understand the risk pathway for male youth who also experience peer victimization.

Pathway of protection: Ethnic identity, self-esteem, and substance use among multiracial youth

Fifty percent of adolescents have tried an illicit drug and 70% have tried alcohol by the end of high school, with even higher rates among multiracial youth. Ethnic identity is a protective factor against substance use for minority groups. However, little is known about the mechanisms that facilitate its protective effects, and even less is known about this relationship for multiracial youth. The purpose of the present study was to examine the protective effect of ethnic identity on substance use and to determine whether this relationship operated indirectly through self-esteem, a strong predictor of substance use for among adolescent populations. Participants included 468 multiracial youth in grades six through 12 (53% female). The results found that ethnic identity was indeed related to substance use, partially through changes in self-esteem. Findings from this study contribute to our understanding and development of models of risk and protection for an understudied population.

A longitudinal test of impulsivity and depression pathways to early binge eating onset

OBJECTIVE

The very early engagement in bulimic behaviors, such as binge eating, may be influenced by factors that dispose individuals to impulsive action as well as by factors that dispose individuals to depressive symptomatology. Using a longitudinal design, we conducted the first test of the simultaneous operation of both risk factors as children transition from elementary to middle school.

METHOD

In a sample of 1,906 children, we assessed risk for impulsive action (negative urgency, which is the tendency to act rashly when distressed, and eating expectancies, which are learned anticipations that eating will alleviate negative mood) and risk for depression (negative affect and depressive symptomatology) and binge eating behavior at three time points using a longitudinal design: the end of fifth grade (last year of elementary school: T0), the beginning of sixth grade (first year of middle school: T1), and the end of sixth grade (T2).

RESULTS

Both the impulsive action and depression pathways predicted very early engagement in binge eating: each accounted for variance beyond the other. Mediation tests found that T1 eating expectancies mediated the predictive influence of T0 negative urgency on T2 binge eating (z = 2.45, p < .01) and that T1 depressive symptoms mediated the influence of T0 negative affect on T2 binge eating (z = 2.04, p < .05).

DISCUSSION

In children, elevated levels of both negative urgency and negative affect predict early binge eating. This finding has important clinical implications because there are different interventions for the two different risk processes.