This randomized feasibility trial aimed to 1) assess methodology for a subsequent efficacy trial and 2) examine the usability and acceptability of Project BETTER's hybrid technology-delivered educational intervention for pregnant people receiving medication for opioid use disorder within a perinatal addiction treatment clinic. Participants were randomized to the technology-delivered educational intervention or standard practice control (brochure). Project BETTER's intervention offers three modules (pregnancy-to-postpartum transition, Neonatal Opioid Withdrawal Syndrome, child welfare interactions) via Computerized Intervention Authoring System (CIAS 3.0). Inclusion criteria were: ≥18 years of age, <34 weeks pregnant, currently receiving medication for opioid use disorder (MOUD), and had engaged in care ≤10 weeks during their current pregnancy. Study visits included an online survey, brief interview, and medical record review. Mean perceived helpfulness scores were compared by study condition using independent samples t-test. The screening process identified 49 potential participants, n=31 (63%) of whom were recruited. Twenty-nine participants were randomized (intervention: n=16, control: n=13). Participants (n=29) were reproductive age [M = 30.0 years (SD = 4.4)], 66% white and 31% Black with a median estimated gestational age of 24 weeks. Most participants (69%) received buprenorphine. Study completion rate was 83%. Most participants completed study components remotely. Among participants in the intervention group, 56% completed at least one module. Participants perceived the intervention to be as helpful as the brochure (intervention: 5.28 ± 0.98, control: 5.39 ± 0.56, p=0.387) and highly acceptable. With protocol modifications, scale up to a larger clinical trial is feasible and acceptable to pregnant people receiving MOUD.
Beginning in adolescence, lesbian, gay, and bisexual (LGB) individuals exhibit higher levels of problem alcohol use relative to heterosexual populations. Based in minority stress theory, psychological mediation frameworks of LGB psychopathology typically serve as explanatory models of these disparities, suggesting that LGB identity-related stressors lead to social and affect-related mechanisms that proximally influence alcohol use disorder risk. While stress and its psychological consequences are considered universal risk factors, minority stress research has yet to be synthesized with theory and evidence from general adolescent studies of alcohol use. This is needed to translate and refine minority stress theory to the developmental context of emerging use, and to determine plausible targets for prevention and early intervention of alcohol-related health risk. Here, I compare theories from LGB and general youth populations articulating psychological mechanisms linking stress with the development of problem drinking behaviors. I then review studies examining these mechanisms in the prediction of LGB alcohol behaviors in youth. Finally, incorporating multidisciplinary findings, I highlight understudied areas of inquiry in a developmental pathway model of sexual minority alcohol use and disorder that may guide future alcohol research involving LGB youth. This review demonstrated that while studies have focused primarily on negative affect-based mechanisms of alcohol risk, few have examined stress-related changes in positive affect, social contexts, and interactions among these pathways. Studies addressing a confluence of these mechanisms of risk over time are critically needed to better inform etiology, prevention, and intervention of problem alcohol use among younger LGB populations.
Using results from the 2017 Nevada Youth Risk Behavior Survey, this research aims to understand factors associated with driving under the influence of alcohol (DUIA), marijuana (DUIM), and both alcohol and marijuana (DUIB) among students who reported they drove and used alcohol and/or marijuana recently. DUIM was the most prevalent behavior (16.4%), followed by DUIB (9.3%) and DUIA (4.9%). Weighted multinomial logistic regression analysis showed more risk and protective factors were associated with DUIB than DUIM and DUIA. To decrease motor vehicle crashes among adolescents, interventions should address modifiable factors for driving under the influence of both alcohol and marijuana.
The aim of this study was to examine trends in cannabis use among Spanish students from 2006 to 2018 by sex, age, and sex and age combined. Data showed a global decrease both in a lifetime and frequent cannabis use between 2006 and 2018 but four-year comparisons revealed more variability within the specific sex-age groups. No change was found in lifetime use between 2014 and 2018 for all groups. The results emphasize the need for ongoing monitoring of trends in cannabis use and the importance of implementing preventive measures to avoid a change in tendency and to work with high-risk groups, especially 17-18-old boys.
Previous studies and reports of drug abuse cases in China indicate that college students' perceptions and attitudes toward illegal drugs may have been greatly impacted by the changing social surroundings. However, little work has been done to assess empirically their willingness and perceptions of using drugs. This paper, therefore, focuses on examining the intention of college students' drug using and its influential factors. It draws upon the framework of the theory of planned behavior (TPB) which contains three constructs to predict intentions of a certain behavior, namely attitude, social norm and perceived control. Additionally, it explored whether prevention education may exert an influence on drug use intention. A survey was conducted among college students from 20 universities in Beijing with a self-report questionnaire. A total of 1,425 valid questionnaires were collected. The results show that only 2.3% of the respondents reported they had intentions of using illegal drugs. Other main findings include that attitudes (measured by knowledge on drugs and harm perception) is a significant protective factor of college students' drug use intention, while social norms (measured by invitation of others) and perceived control (weighted by visibility of drugs on campus) are the risk factors. The usability of the TPB has been generally testified in this paper, whereas the result on several items showed different feedbacks than prior studies. The study reveals significant correlations between drug use intention and prevention programs of specific organizers and forms. Based on these findings, possible explanations and policy recommendations are provided.
The purpose of this research is to compare serum cotinine cutoffs for nicotine/tobacco exposure and self-reported tobacco use in adolescents. National Health and Nutrition Survey, 2015-18, cotinine levels and tobacco questions were analyzed for frequencies; bivariate and logistic regression analyses. With serum cotinine as the gold standard, self-report of current smoking detected 40.5% who had tobacco/nicotine exposure cotinine levels (sensitivity = 40.5%). Self-report of current smoking and/or e-cigarette use detected 60.0% who had tobacco/nicotine exposure cotinine levels (sensitivity = 60.0%). In this nationally representative study, caution should be considered in relying upon adolescent self-reported cigarette use, and self-reported cigarette and/or e-cigarette use.
This study examines substance use, emotional/behavioral symptoms and sexual risk among first-time offending, court-involved, non-incarcerated (FTO-CINI) youth. Youth and caregivers (N=423) completed tablet-based assessments. By time of first justice contact (average 14.5 years old), 49% used substances, 40% were sexually active and 33% reported both. Youth with co-occurring substance use and sexual risk had more emotional/behavioral symptoms; youth with delinquent offenses and females had greater co-occurring risk. Time of first offense is a critical period to intervene upon high rates of mental health need for those with co-occurring substance use and sexual risk to prevent poor health and legal outcomes.
Introduction:The majority of epidemiologic research on adolescent non-medical anabolic-androgenic steroid (AAS) use was conducted in the 1990s and early 2000s, indicating a need to update evidence for the modern era. We aim to understand the prevalence of AAS use among US adolescents and assess associations between AAS use, sports participation, other drug use, and injection drug use (IDU).Methods:Using data from the 2017 National Youth Risk Behavior Survey, we estimated the prevalence of AAS use and tested for associations between AAS use, sports participation, and drug use, overall and by sex.Results:The prevalence of AAS use was 2.98%. The prevalence among boys (3.46%) was higher than among girls (2.41%). AAS use was high among youth with lifetime heroin use (64.41%) and IDU (64.42%). There was no association between AAS and team sport participation (p=0.61).Conclusions:Our results indicate that adolescent AAS use is an aspect of polysubstance use rather than a substance used solely for performance enhancement in sports. Research with adolescents should be mindful of the overlap of heroin and AAS use among youth with IDU.
Existing research on opioid misuse and child outcomes is scattered across subfields and nascent compared to scholarship regarding consequences for adults. This scoping review synthesizes studies examining postnatal consequences of parent opioid misuse for children. Findings from 52 studies showed a descriptive connection between parental opioid misuse and a range of adverse child outcomes including accidental poisonings, psychopathology, and child welfare system contact. It was unclear if connections between opioid misuse and child outcomes were due to opioids specifically or to related risk factors. Studies comparing opioids to other substances were inconclusive and few studies measured potential parenting mechanisms that may explain the association between opioid misuse and child outcomes.
Among adolescents (ages 12-17) and young adults (ages 18-25) enrolled in Medicaid or the Children's Health Insurance Program (CHIP), 0.5% of adolescents had opioid use disorder (OUD), 3.0% had other risky opioid use, 3.4% had another substance use disorder, and 21.6% used other substances without disorder. Compared to adolescents, the prevalence of OUD and other risky opioid use was about 3 and 2 times higher among young adult enrollees, among whom 1.6% had OUD and 5.8% had other risky opioid use. Among young adults, 8.6% had another SUD and 61.8% used other substances without disorder. Prevalence of OUD or other risky opioid use was substantially higher among Medicaid-enrolled youth with other substance use or health risk factors including more than double among those with fair or poor health, more than 3 times higher among those with heavy alcohol use, and more than 1.5 times higher among those with a major depressive episode. Results underscore the need to take a whole person approach to addressing risks for OUD.
Abstract Adolescents’ substance use disorders (SUD) and adolescents’ internet use disorders (IUD) have adverse health impacts on adolescents. For example, adolescents’ SUD adverse outcomes have included psychiatric disorders, criminal involvement, school truancy, unintended pregnancy, sexually transmitted infections, and physical health problems. Researchers have indicated that some of adolescents’ IUD adverse outcomes are depression, social withdrawal, anxiety, loneliness, decreased sleep, decreased physical activity, poor preparation for college, impaired self-esteem, increased risk for suicide, insecurity, and substance use disorders. Surprisingly, little research attention has been given to the impact of adolescents’ IUD on adolescents’ SUD. The purpose of this article is to describe the impact of adolescents’ IUD on adolescents’ SUD, to discuss the impact of adolescents’ IUD and adolescents’ SUD on gender, and to present research that suggests there is a need for home-based ecological treatments for adolescent females with SUD and IUD. Lessons learned will be presented after each of the aforementioned areas.
Abstract Chronic cannabis use among adolescents is associated with many adverse health effects. One group of adolescents at the highest risk for chronic use are those involved in the juvenile justice system. While cannabis use disorder (CUD) screening tools have recently become briefer, ideally a single-item measure could be used to efficiently identify those who likely meet the criteria for CUD. These analyses aimed to determine whether a cut score, based on the frequency of cannabis use in the past year, could predict whether participants met the criteria for CUD among a sample of juvenile detainees (n = 189). DSM-IV diagnostic criteria for CUD were mapped onto current DSM-V criteria to determine a diagnosis. Two CUD severity cut scores were explored: (1) a cut score that distinguished those with no CUD or mild CUD from those who have a moderate or severe CUD, and (2) a cut score that distinguishes those with no, mild, or moderate CUD from those who have severe CUD. t-Tests revealed significant differences in the number of cannabis use days in the past year by both sets of CUD comparison categories. When predicting none/mild vs. moderate/severe CUD, the optimal cut score was found to be ≥24 cannabis use days; for no/mild/moderate vs. severe CUD, the optimal cut score was ≥57 days. Hierarchical regression demonstrated the addition of cannabis use days provided significant incremental validity beyond the proportion of friends who use substances when predicting diagnostic symptom count. This 1-item cannabis screener is an effective tool to quickly determine the need for further assessment of CUD.
This study uses the Cebu Longitudinal Health and Nutrition Survey (CLHNS) data set and Cox proportional hazards models to determine whether factors relating to mothers' status and autonomy, as well as other parenting and socioeconomic/sociodemographic variables, are associated with the early onset of children's risky behaviors, namely smoking and drinking alcohol. We find that the women empowerment variables, especially those that have direct bearing on the mother-child relationship, have a significant effect in delaying or hastening the onset of risky behavior. Those factors that compete for the time spent in parenting, such as the mother working, hastens their children's initiation into these risky habits. On the other hand, mothers' involvement in household decision-making delays smoking in females.
Abstract This study assessed the moderating effects of school facilitating conditions (school opportunities for prosocial involvement, school commitment, academic grades, and truancy) on adolescent marijuana use within the context of the Theory of Planned Behavior (TPB). Utilizing a large statewide surveillance study of adolescent risk and protective factors (N = 217,276), Structural Equation Modeling was used to examine the extent to which TPB constructs (behavioral beliefs, normative beliefs, control beliefs, and behavioral intention) predicted adolescent marijuana use. Results revealed the TPB model provided adequate fit to the data (χ 2(127) = 58,042, p < 0.01, CFI = 0.95, TLI = 0.94, RMSEA = 0.04), with strong and significant pathways in the directions expected. TPB constructs explained approximately 60% of the variance in intention and 34% of reported marijuana use over the past 30-days; revealing an unexplained intention-behavior gap. To explore this gap, we examined the role of school facilitating conditions on the relationship between intention and marijuana use. After controlling for related TPB constructs, moderation tests of this pathway revealed higher levels of school opportunities for prosocial involvement and school commitment significantly reduced the relationship between intention and marijuana use. Poor academic grades and higher levels of truancy strengthened the relationship between intention and marijuana use. These findings indicate school facilitating conditions may play an important role in adolescent decision-making regarding marijuana use. Greater attention to these conditions may address the intention-behavior gap and enhance the effectiveness of school-based drug prevention programming.
This study examined whether behavioral dysregulation moderated associations between individual contextual factors (i.e. psychological control, peer delinquency, peer victimization, and negative life events) and the past 30-day frequency of specific substance use (i.e. tobacco, alcohol, marijuana, e-cigarettes, and prescription drugs) in a sample of recently detained youth. Patterns of associations varied among substances, with peer delinquency being the contextual risk factor most robustly associated with the frequency of various substances. Behavioral dysregulation did not moderate these associations, with the exception of psychological control; psychological control was only positively associated with prescription drug use when levels of behavioral dysregulation were low.
Abstract Societal factors influencing adolescent alcohol initiation and use are not well documented in Tanzania. The goal of this qualitative study was to explore the structural and environmental factors influencing adolescent alcohol uptake and use in urban Tanzania. 177 adolescents aged 15–19 from varying socioeconomic backgrounds participated in 16 participatory groups (separated by sex and in-school/out-of-school status) at sites in four different locations in Dar es Salaam, Tanzania. Participatory methods were used, including listing and ranking activities, and photovoice, exploring adolescent’s perceptions around youth alcohol use, and recommendations for structural interventions to prevent or reduce adolescent alcohol uptake and use. Themes included: (1) “idle time” shapes adolescent alcohol use in urban Tanzania; (2) societal influences shape the locations where adolescents consume or purchase alcohol; and, (3) adolescents’ recommendations about structural approaches for reducing their idle time and vulnerability to alcohol use. Our findings highlight the need for programs and policies aimed at reducing youth idle time as an approach to reducing alcohol use, such as increasing opportunities for employment, extracurricular activities, and entertainment, particularly for adolescent boys in urban Tanzania, given their increased vulnerability to the uptake and use of alcohol.
Background Opioids and cocaine are the leading drugs for fatal drug intoxication (FDI). Manner of death may be accidental (i.e., unintentional); suicide (i.e., intentional), or undetermined. Difficulties of the medical examiner (ME) in confirming the manner of death by a standard investigation may result in underreporting of intentional FDI thus limiting efforts to identify, reduce, and prevent it. Objective Examine the rate of youth intentional and undetermined FDI and address the need for closing the gap in the determination of intentional FDI among youths by the addition of a psychological autopsy. Method Two hundred ninety-three (293) consecutive FDI case files from the State of Connecticut Office of the Chief Medical Examiner were reviewed. The case files were those of youths, 10 to 25 years of age, who died between January 1, 2016, and December 31, 2018. Results The annual intentional FDI rates among this group were between 3% and 5%. Undetermined manner of death rates were between 0% and 5% percent, while the remaining cases was reported as accidental. A majority of the FDI cases involved youths 20 to 25.11 years old, while a small percentage were among those ages 15 to 19.11 and none for 10 to 14.11. Male-to-female ratio was approximately 2:1 in all categories of FDI. Conclusion These low rates of intentional FDI among youths support the arguments regarding limitations in the procedures employed by a ME to determine intent. There is a need for an individual-level study of a multipronged approach to identify modifiable acute high-risk circumstances for intentional FDI, including a psychological autopsy.
Background Friends play an important role in cigarette and cannabis usage during adolescence. However, family is also a factor insofar as it can expose an adolescent to the development of consumption, or protect them from it. Experimentation with, and consumption of, these substances comes about within a specific relationship configuration: that of a somewhat conflictual relationship between young people and their parents. Methods The study was conducted in the Paris area (France) among 15-18-year-olds enrolled at school, with whom we conducted 93 biographical interviews (representing 483 person-years of retrospective observation). Results The consumption of cigarettes or cannabis is influenced by relationships with peers and meet-ups with friends (especially at weekends), as well as within the protective school environment. The relationship between adolescent consumption and parental attitude is two-way; consumption can be considered as much a cause of conflict as it is a consequence. Conclusions First, a product-based approach (tobacco or cannabis) is less fruitful than an approach of entry to addiction by life events. Secondly, analysis of both parent-adolescent conflicts and outings with friends seem to be powerful levers of action in preventing take-up of cigarettes and cannabis.Keypoints In the course of adolescence, behaviors in the consumption of cigarettes or cannabis connect with the relational context in which young people evolve at school community level The product-based approach (tobacco or cannabis) is less effective than an approach through analysis of both the conflicts and the nature of peer group meet-ups Analysis of parent-adolescent conflicts and control of meet-ups seem to be powerful levers of action for prevention of embarking on the use of products The Ageven grid for the description of life events is an innovative tool used to analyses a situation within the community as well as for the development of primary prevention
Introduction Adolescent female tobacco users are more likely to have a depression disorder relative to tobacco using adolescent males. Less is known about how sex interacts with depression within the context of text-messaged delivered randomized controlled trials addressing tobacco use. Understanding the variation of treatment response based on sex and depression symptomatology would inform targeted, personalized adolescent tobacco use treatments. Methods To address this issue, a secondary data analysis was conducted from a text message-delivered clinical trial targeting 198 tobacco-using adolescents. The sample was 53% female and 91% African American with a mean age of 16.2. A three-way moderation analysis was used to determine if the treatment's effect on tobacco use was moderated by depressive symptoms, which in turn, was moderated by sex. Results The analyses demonstrated that female adolescents were significantly more sensitive to the effects of depressive symptoms compared to male adolescents, such that those with elevated depressive symptoms did no better than controls on past 30-day tobacco use. However, for those females with fewer depressive symptoms, the treatment was effective in significantly reducing tobacco use. For males, treatment effects were not dependent on depressive symptoms. Conclusions These findings contribute to the clinical science on treatment response to text-delivered adolescent tobacco use interventions. Results support the need to provided targeted, individualized tobacco treatment that concurrently addresses depression for female adolescents.
