Association of contextual factors with drug use and binge drinking among White, Native American, and Mixed-Race adolescents in the general population

Negative Affect and Drinking among Indigenous Youth: Disaggregating Within- and Between-Person Effects

Negative affect (depression/anxiety) and alcohol use among Indigenous youth in Canada remain a concern for many communities. Disparate rates of these struggles are understood to be a potential outcome of colonization and subsequent intergenerational trauma experienced by individuals, families, and communities. Using a longitudinal design, we examined change in alcohol use and negative affect, and reciprocal associations, among a group of Indigenous adolescents. Indigenous youth (N = 117; 50% male; Mage=12.46-16.28; grades 6-10) from a remote First Nation in northern Quebec completed annual self-reported assessments on negative affect (depression/anxiety) and alcohol use. A Latent Curve Model with Structured Residuals (LCM-SR) was used to distinguish between- and within-person associations of negative affect and alcohol use. Growth models did not support change in depression/anxiety, but reports of drinking increased linearly. At the between-person level, girls reported higher initial levels of depression/anxiety and drinking; depression/anxiety were not associated with drinking. At the within-person level, drinking prospectively predicted increases in depression/anxiety but depression/anxiety did not prospectively predict drinking. When Indigenous adolescents reported drinking more alcohol than usual at one wave of assessment, they reported higher levels of negative affect than expected (given their average levels of depression/anxiety) at the following assessment. Our findings suggest that when Indigenous youth present for treatment reporting alcohol use, they should also be screened for negative affect (depression/anxiety). Conversely, if an Indigenous adolescent presents for treatment reporting negative affect, they should also be screened for alcohol use.

Race/ethnic differences in the association of anxiety, depression, and discrimination with subsequent nicotine and cannabis use among young adults: A prospective longitudinal study

INTRODUCTION

The shifting patterns in nicotine and cannabis use among young adults is taking place at a time when there is also increased reports of psychosocial stressors such as anxiety, depression, and everyday discrimination. Although race/ethnicity has been found to moderate the impact of psychosocial stressors, there is limited research examining the association of anxiety, depression, and discrimination with patterns of nicotine and/or cannabis product use among diverse young adults.

METHODS

Data were from a longitudinal study of 2478 US young adults surveyed between 2019 and 2021. General estimating equation models were used to examine associations of self-reported psychological symptoms (depression, anxiety) and social stressors (discrimination) with substance use (any nicotine and cannabis product use; nicotine and cannabis vaping).

RESULTS

Young adults from different racial/ethnic groups differed significantly in their depression and discrimination scores with young adults of color having higher mean scores. Overall, higher depression and everyday discrimination score was associated with increased odds of past 6-month use of any nicotine/tobacco and cannabis products. Higher generalized anxiety score increased odds of any nicotine/tobacco and dual nicotine and cannabis product use. Higher everyday discrimination score was associated with increased odds nicotine and cannabis vaping overall. Stratified models showed variation in associations among different racial/ethnic groups.

CONCLUSIONS

Psychosocial stressors are associated with increased substance use odds among young adults. However, these stressors have a differential impact on substance use odds among young adults from different racial/ethnic contexts.

Alcohol use in multiracial American youth compared with monoracial youth: A meta-analysis

BACKGROUND AND AIMS

Although multiracial people comprise the fastest growing population in the United States, multiracial youth are nearly invisible in alcohol research. This meta-analysis synthesized the youth alcohol literature to estimate the magnitude of difference in alcohol use as a function of multiracial status.

DESIGN AND MEASUREMENTS

Empirical studies reporting multiracial and monoracial comparisons in youth (aged 10-24 years) alcohol use were identified through a systematic literature search. A random-effects meta-analysis was conducted using 85 effect sizes extracted from 16 studies assessing life-time, past-year, past-month and binge alcohol use.

SETTING AND PARTICIPANTS

A total of n=1 555 635 youth were assessed in the United States.

FINDINGS

Multiracial youth are suggested to be more likely to endorse life-time alcohol use than Asian youth [number of studies (k) = 3; odds ratio (OR) = 1.81, 95% confidence interval (CI) = 1.01, 3.24; p = 0.04], with significant between-study heterogeneity (Q = 8.42; p < 0.001; I2  = 76%) in effect size comparisons. Multiracial youth are suggested to be more likely to endorse past-month alcohol use than Black (k = 6; OR = 1.54, 95% CI = 1.38, 1.71; p < 0.001) and Asian (k = 4; OR = 2.09, 95% CI = 1.52, 2.88; p < 0.001) youth, but less likely than White (k = 6; OR = 0.87, 95% CI = 0.84, 0.91; p < 0.001) youth, with significant between-study heterogeneity for Black youth (Q = 11.94; p = 0.03; I2  = 58%) in effect size comparisons. Lastly, multiracial youth are suggested to be more likely to endorse binge alcohol use than Black (k = 4; OR = 1.98, 95% CI = 1.62, 2.44; p < 0.001) and Asian (k = 4; OR = 2.82, 95% CI = 2.28, 3.48; p < 0.001) youth, but less likely than White (k = 5; OR = 0.75, 95% CI = 0.70, 0.81; p < 0.001) and American Indian/Alaska Native (k = 3; OR = 0.78, 95% CI = 0.71, 0.85; p < 0.001) youth, with significant between-study heterogeneity among Black (Q = 23.99; p < 0.001; I2  = 87%) and Asian (Q = 17.76; p < 0.001; I2  = 83%) youth in effect size comparisons.

CONCLUSIONS

In the United States, multiracial youth report distinct alcohol use patterns compared with monoracial youth and may be at elevated alcohol use risk compared with Black and Asian youth.

Cultural and Psychosocial Correlates of co-use among Black-White Biracial Adults

INTRODUCTION

Biracial individuals, a subset of the fastest growing population segment in the United States, frequently experience conflict with ethnic identity, according to marginality theory. Ethnic identity is associated with perceived discrimination and self-esteem, and each of these factors is associated with alcohol and marijuana use. Some research suggests that Black-White biracial individuals have specific challenges with ethnic identity, discrimination, and self-esteem, as well as have disproportionate rates of alcohol and marijuana use separately. Co-use of these substances is linked to more risk behaviors and greater quantity/frequency of use compared to singular use of alcohol or marijuana. However, research examining these cultural and psychosocial factors as correlates of recent co-use among Black-White biracial individuals is limited.

METHOD

The current study examined past-year cultural (i.e., ethnic identity, perceived discrimination) and psychosocial (i.e., age, gender, self-esteem) factors associated with past 30-day co-use (i.e., alcohol, marijuana) among a sample of 195 biracial (Black-White) adults recruited and surveyed via MTurk. We analyzed data using a hierarchical logistic regression.

RESULTS

Results of the final step of logistic regression indicate increases in perceived discrimination were significantly associated with a 1.06 times greater likelihood in 30-day co-use (95% CI [1.002, 1.10]; p = .002). Further, co-use is more common among women than men (OR = 0.50, 95% CI [0.25, 0.98]; p = .04).

CONCLUSIONS

Findings indicate discrimination experienced among Black-White biracial adults is the most culturally relevant correlate of recent co-use in this study, of the factors measured given the framework. As such, substance use treatment with this population may focus on experiences of and coping with discrimination. Since women were also at greater risk for co-use, gender-specific treatments may be beneficial for this population. The article also discussed other culturally relevant treatment considerations.

Adolescent binge drinking in the West of Ireland: associated risk and protective factors

BACKGROUND

Alcohol is a leading cause of morbidity and mortality worldwide. Adolescence is when alcohol use typically begins. Harmful patterns of alcohol consumption, such as binge drinking, may emerge during adolescence and become established. This study aimed to examine potential risk and protective factors for binge drinking among 15-16-year-old adolescents in the West of Ireland.

METHODS

This was a cross-sectional secondary analysis of 4473 participants from the Planet Youth 2020 Survey. The outcome was ever binge drinking, defined as ever consumption of five or more drinks in a two-hour period or less. Independent variables were selected a priori following review of peer-reviewed literature and were grouped as individual, parents and family, peer group, school, leisure time and local community factors. Statistical analysis was completed using SPSS version 27. Differences in medians and means for continuous variables were examined using the Mann-Whitney U test and Independent Samples t-test respectively. Multivariable logistic regression was used to examine independent associations between potential risk and protective factors and ever binge drinking. A p-value of < 0.05 was deemed statistically significant.

RESULTS

The prevalence of ever binge drinking was 34.1%. Self-rated 'bad/very bad' mental health (adjusted Odds Ratio (aOR) 1.61, 95% CI 1.26-2.06, p < 0.001), current cigarette use (aOR 4.06, 95% CI 3.01-5.47, p < 0.001) and current cannabis use (aOR 2.79, 95% CI 1.80-4.31, p < 0.001) increased odds of ever binge drinking. Parental supervision (aOR 0.80, 95% CI 0.73-0.88, p < 0.001) and negative parental reaction to adolescent drunkenness (aOR 0.51, 95% CI 0.42-0.61, p < 0.001) reduced odds of ever binge drinking. Getting alcohol from parents increased odds of ever binge drinking (aOR 1.79, 95% CI 1.42-2.25, p < 0.001). Adolescents with friends who drink alcohol had almost five times higher odds of ever binge drinking (aOR 4.59, 95% CI 2.65-7.94, p < 0.001). Participating in team/club sports also increased odds of ever binge drinking (aOR 1.30, 95% CI 1.07-1.57, p = 0.008 for 1-4 times/week, aOR 1.52, 95% CI 1.07-2.16, p = 0.020 for ≥ 5 times/week).

CONCLUSION

This study identifies individual and social environment factors associated with adolescent binge drinking in the West of Ireland. This can inform intersectoral action to protect adolescents from alcohol-related harm.

The intersection of neighborhood and race in urban adolescent health risk behaviors

AIMS

Racial variability in associations of neighborhood socioeconomic disadvantage and neighborhood disorder with adolescent health risk behaviors remains under-researched, which this study examined over 1 year among racially diverse adolescents.

METHODS

High school students (N = 345; 18% Asian, 44% Black, 16% Multiracial, 22% White) completed surveys assessing neighborhood socioeconomic disadvantage and neighborhood disorder, and health risk behaviors (lifetime alcohol, cannabis, and cigarette use, number of sexual partners) at baseline (Year 1) and 1-year follow-up (Year 2).

RESULTS

Asian, Black, and Multiracial adolescents were more likely to endorse health risk behaviors in Year 2 compared to White adolescents living in similarly disadvantaged neighborhoods at Year 1. Associations of neighborhood disorder with health risk behavior did not differ by race.

CONCLUSION

Neighborhood socioeconomic disadvantage (but not neighborhood disorder) may predispose Asian, Black, and Multiracial adolescents to health risk behaviors. Findings may inform interventions to address racial disparities in adolescent health risk behaviors.

The association between early onset of alcohol, smokeless tobacco and marijuana use with adult binge drinking in United States

Binge drinking is a deadly pattern of excessive alcohol use that is associated with multiple diseases in the United States. To date, little is known about the associations between the early onset of substance use and other factors with the severity of adult binge drinking. The 2018 National Survey on Drug Use and Health data was used to identify binge drinking (binary and in number of days in the past month). Age at onset was categorized into four groups as 1-12, 13-14, 15-17, or beyond 18. Weighted multivariate logistic regression and Poisson regression analyses were performed to examine the associations between early onset of alcohol, smokeless tobacco, and marijuana use with binge drinking. The severity of binge drinking was statistically significantly associated with substance use (4.15 days in a month), early onset of alcohol, smokeless tobacco, and marijuana use (2.15-4.93 days, all p-values < 0.0001), after accounting for the covariates. Past year substance use disorder is strongly associated with binge drinking. The severity of adult binge drinking is significantly associated with early onset of substance use including alcohol, smokeless tobacco, and marijuana. Continued efforts are warranted to improve substance use prevention and treatment tailored for adolescents and youths to prevent development of adult binge drinking.

Extreme Binge Drinking During Adolescence: Associations With Subsequent Substance Use Disorders in American Indian and Mexican American Young Adults

OBJECTIVE

This study collected retrospective data on adolescent binge drinking (ABD) (5 drinks for boys, 4 for girls per occasion at least once per month) and/or extreme adolescent binge drinking (EABD) (10 or more drinks per occasion at least once per month) and tested for associations with demographic and diagnostics variables including alcohol and other substance use disorders (AUD/SUD).

METHODS

Cross-sectional data were collected from young adult (age 18-30 yrs) American Indians (AI) (n = 534) and Mexican Americans (MA) (n = 704) using a semi-structured diagnostic instrument.

RESULTS

Thirty percent (30%) of the sample reported ABD and 21% reported EABD. Those having had monthly ABD were more likely to be AI and have less education; those having had EABD were more likely to be AI, male, younger, have less education and lower economic status compared to participants without ABD. ABD/EABD was associated with higher impulsivity, a family history of AUD, and lower level of response to alcohol (ORs = 1.0-2.0), as well as with adult AUD (ORs = 3.7-48), other substance use disorders (ORs = 3.5-9), and conduct disorder/ antisocial personality disorder (ORs = 2.0-2.6), but not with anxiety/depression. Monthly EABD further increased the odds of AUD/SUD.

CONCLUSIONS

Although binge drinking was more common in AI compared to MA, there were little effects of race in individual risk factor analyses. Monthly ABD and EABD were common among these AI/MA as adolescents, and, as with other ethnic groups, these drinking patterns resulted in highly significant increases in the odds of developing alcohol and other substance use disorders in young adulthood.

Weekly Drinking and Binge Drinking Mediate the Association Between Drinking Location and Sexual Coercion

It has been well documented that alcohol use is a risk factor for sexual assault. However, few studies have examined how alcohol use is associated with sexual coercion experiences. Furthermore, off-campus parties and bars are drinking locations where alcohol use is high among college students. It is important to determine other risk factors, such as the drinking location, that may affect alcohol use and sexual coercion. The current study examined whether alcohol use (drinks per week and binge drinking) mediated the association between drinking location frequency (off-campus party and bar/restaurant) and experiencing sexual coercion in the past 30 days. Participants were N = 295 young adult (M_age = 21.17 years, SD = 2.70) undergraduate women who reported drinking at least once in the past 30 days and completed an online survey. Results revealed that 88 (29.8%) participants experienced sexual coercion in the past 30 days. Participants who experienced sexual coercion in the past 30 days reported greater drinks per week, were more likely to binge drink, and reported drinking more frequently at off-campus parties than those who had not experienced sexual coercion. Drinks per week significantly mediated the relationship between drinking location frequency (off-campus party and bar/restaurant) and sexual coercion. Specifically, more frequent drinking at off-campus parties and bars/restaurants was associated with greater drinks per week, which in turn was related to experiencing sexual coercion in the past 30 days. Binge drinking significantly mediated the association between frequency of drinking at a bar/restaurant and sexual coercion, but not off-campus drinking frequency. Findings suggest that college student alcohol interventions that target harm reduction should consider including information about how the drinking location may intersect with alcohol use to increase risk for sexual coercion.

Predicting adolescent alcohol and other drug problems using electronic health records data

IMPORTANCE

Alcohol and other drug (AOD) use problems may cause significant burden on affected adolescents and their families, yet treatment providers often do not identify these problems early enough.

OBJECTIVE

To develop, and internally and externally validate a multivariable prediction model of adolescent AOD problems using child- and maternal-level predictors before age 12, and child-level predictors between ages 12 to 18, as recorded in the electronic health records (EHR).

DESIGN

A retrospective cohort study conducted time-to-event analyses using Cox proportional hazards models.

SETTING AND PARTICIPANTS

41,172 children born between 1997 and 2000 at four health plans (Kaiser Permanente Hawaii, KPHI; Kaiser Permanente Northern California, KPNC; Geisinger Clinic, GC; and Henry Ford Health System, HFHS) who had continuous membership since birth and linkable maternal records in the health plan.

OUTCOMES

AOD use problems between ages 12 to 18, defined as either: 1) having a contact with the AOD treatment program or 2) receiving a non-tobacco AOD diagnosis in an inpatient or outpatient encounter.

EXPOSURES

Candidate predictor variables include demographics, socioeconomic status, and clinical diagnoses of the children and the mothers.

RESULTS

Overall, 1400 (3.4%) adolescents had an AOD disorder between ages 12 to 18; the median follow-up time post-age 12 was 5.3 years. The research team developed two final prediction models: a "baseline" model of 10 child-level and 7 maternal-level predictors before age 12, and a more comprehensive "time-varying" model, which incorporated child risk factors after age 12 as time-varying covariates in addition to the baseline model predictors. Model performance evaluation showed good discrimination performance of the models, with the concordance index improved for the time-varying model, especially for prediction of AOD events in late adolescence.

CONCLUSIONS AND RELEVANCE

This study identified a number of child and maternal characteristics and diagnoses routinely available in EHR data as predictive of risk for developing AOD problems in adolescence. Further, we found that risk of developing problems varies significantly by the timing and persistence of the risk factors. Findings may have potential clinical implications for prevention and identification of adolescent AOD problems, but more research is needed, especially across additional health systems.

The role of the parent-child relationship in fostering resilience in American Indian/Alaskan Native children

Resilience is a key characteristic to study in families, particularly those who have experienced significant systemic risk factors. While much resilience research focuses on ethnic and cultural minorities, little research focuses specifically on American Indian/Alaskan Native (AI/AN) families. The parent-child relationship has been demonstrated to be a key characteristic in families, and this relationship may also serve as a protective factor for AI/AN families. Positive parent-child relationships are consistently linked to positive child outcomes, and parental psychological symptoms are linked with child psychological symptoms in non-Native families. These associations warrant further examination among AI/AN families. We hypothesized that the parent-child relationship would moderate the link between parent distress (i.e., depressive and anxious symptoms) and child internalizing problems in a sample of 57 AI/AN parents of children 3-5 years of age. As expected, the parent-child relationship moderated the associations between parent anxiety symptoms and child internalizing symptoms, and between parent depressive symptoms and child internalizing symptoms. Furthermore, the strength of the parent-child relationship buffered the effects of parent distress on child internalizing symptoms. Results highlight the potentially protective role of strong parent-child relationships in AI/AN families.

Ethnic Identity, Perceived Discrimination, Substance Use and Misuse among Black-White Biracial Adults

Background: Multiracial groups are projected to be the fastest growing segment of the U.S. population, more than tripling in size over the next four decades. Marginality Theory suggests that biracial individuals, a subgroup of multiracial, may experience heightened conflict with their ethnic identity due to having to negotiate between two distinct cultures. Research shows that changes in ethnic identity is associated with perceived discrimination, and both are associated with marijuana and alcohol use among multiracial groups. These relationships are sometimes stronger among multiracial individuals than monoracial. Limited research exists among specific biracial groups, such as Black-White biracial individuals, despite unique complexities related to ethnic identity. Research conducted among Black-White biracial individuals is often limited to youth samples and shows disproportionate rates of substance use. Objectives: Given the population increase and disparate substance use outcomes among Black-White biracial youth, it is essential to extend substance use and misuse research to Black-White biracial adults to see if similar disparities exist. The present study examined the direct effect of biracial ethnic identity on marijuana use and alcohol misuse, and indirect effects of perceived discrimination to these relationships among a sample of Black-White biracial adults (n = 195) using a 46-item self-report survey administered online via MTurk. Results: Results revealed that while ethnic identity alone was not associated with marijuana use or alcohol misuse, there were significant indirect relationships between ethnic identity, marijuana use, and alcohol misuse through perceived discrimination. Conclusions/Importance: Findings suggest that substance use interventions should seek to address coping with perceived discrimination among this population.

Delta Event-Related Oscillations Are Related to a History of Extreme Binge Drinking in Adolescence and Lifetime Suicide Risk

Alcohol exposure typically begins in adolescence, and heavy binge drinking is associated with health risk behaviors. Event-related oscillations (EROs) may represent sensitive biomarkers or endophenotypes for early alcohol exposure as well as other risk behaviors such as suicidal thoughts and actions. In this study, young adults (age 18–30 years) of American Indian (AI) (n = 479) and Mexican American (MA) (n = 705) ancestry were clinically assessed, and EROs were generated to happy, sad and neutral faces. Extreme adolescent binge drinking (10+ drinks) was common (20%) in this population of AI/MA and associated with a significantly increased risk of a lifetime history of suicidal acts (SA, suicide attempts, deaths) but not suicidal thoughts (ST, ideation, plans). ST were reported among MA participants, whereas SA were more common among AI young adults. Extreme adolescent binge drinking was also associated with errors in detection of sad and neutral faces, increases in delta ERO energy, and decreases in phase locking (PL), particularly in parietal areas. A lifetime history of ST was associated with increases in delta ERO energy and PL, whereas SA were associated with decreases in both. These studies suggest that ERO measures may represent important potential biomarkers of adolescent extreme binge drinking and risk for suicidal behaviors.

Phase locking of event-related oscillations is decreased in both young adult humans and rats with a history of adolescent alcohol exposure

Alcohol exposure typically begins in adolescence, and frequent binge drinking has been associated with health risk behaviors including alcohol use disorders (AUDs). Few studies have documented the effects of a history of adolescent binge drinking on neurophysiological consequences in young adulthood. Synchrony of phase (phase locking (PL)) of event-related oscillations (EROs) within and between different brain areas reflects communication exchange between neural networks and is a sensitive measure of adolescent development in both rats and humans, and thus may be a good translational measure of the potential harmful effects of alcohol exposure during adolescence. In this study, EROs were collected from 1041 young adults of Mexican American and American Indian ancestry (age 18-30 years) with and without a history of adolescent binge drinking (five drinks for boys and four for girls per occasion at least once per month) and in 74 young adult rats with and without a history of 5 weeks of adolescent alcohol vapor exposure. PL of theta and beta frequencies between frontal and parietal cortex were estimated using an auditory-oddball paradigm in the rats and a visual facial expression paradigm in the humans. Significantly lower PL between frontal and parietal cortices in the theta frequencies was seen in both the humans and the rats with a history of adolescent alcohol exposure as compared with their controls. These findings suggest that alcohol exposure during adolescence may result in decreases in synchrony between cortical neuronal networks, suggesting a developmental delay, in young adult humans and in rats.

“Mixed” Drinking Motivations: A Comparison of Majority, Multiracial, and Minority College Students

Social exclusion is associated with substance use, but the specific link between majority and minority racial group membership and substance use is unknown. We examined how social exclusion among racial majority (White), Multiracial, and racial minority (Native American, Latino, Asian, and Black) college students relates to self-reported alcohol use and motivations. Using the AlcoholEdu for College™ survey, Study 1a reports five factors related to motives for initiating or inhibiting alcohol use. Study 1b analyzes majority, Multiracial, and minority college students’ comparative endorsement of these motivations. Study 2 compares these factors with established belonging scales using a separate undergraduate sample. White, Multiracial, Native American, and Latino students displayed the highest proportion of problematic alcohol use. White students endorsed belonging-based drinking motivations, while Multiracial and Asian students endorsed motivations similar to both majority and minority groups. Native American, Latino, and Black students endorsed abstaining motivations more than other groups.

Overt Perceived Discrimination and Racial Microaggressions and their Association with Health Risk Behaviors among a Sample of Urban American Indian/Alaska Native Adolescents

BACKGROUND

Urban American Indian/Alaska Native (AI/AN) adolescents are an understudied population in the USA who are at risk for a variety of health problems. Perceived discrimination (PD), including both overt PD and racial microaggressions (RMA), is known to adversely affect health. However, studies analyzing associations between overt PD and RMA and various health behaviors are limited.

METHODS

This study measured past-year alcohol use, heavy drinking, marijuana use, commercialized tobacco use, consequences experienced from alcohol and marijuana use in the past 3 months, mental and physical health status, AI/AN traditional activity participation, and overt PD and RMA among 182 urban AI/AN adolescents in California. To assess the association between overt PD and RMAs and health outcomes, we conducted either logistic regression (for dichotomous outcomes: past-year alcohol use, past-year heavy drinking, past-year marijuana use, consequences of alcohol and marijuana use, commercialized tobacco use) or linear regression (for continuous outcomes: mental and physical health, AI/AN traditional practices).

RESULTS

In contrast to our hypotheses, overt PD and RMA were not significantly associated with substance use or mental or physical health among this sample of urban AI/AN adolescents. After adjusting for age and gender, overt PD and RMA were only correlated with past-year cigarette use and alcohol-related consequences experienced in the past 3 months.

CONCLUSION

Potential factors that may play a role in decreasing effects of overt PD and RMA among urban AI/AN adolescents are discussed, including participation in AI/AN traditional practices and community engagement.

A history of binge drinking during adolescence is associated with poorer sleep quality in young adult Mexican Americans and American Indians

RATIONALE

Binge drinking during adolescence is common, and adolescents and young adults with alcohol problems may also have sleep difficulties. However, few studies have documented the effects of a history of adolescent binge drinking on sleep in young adulthood in high-risk minority populations.

OBJECTIVES

To quantify sleep disturbance, as indexed by the Pittsburgh Sleep Quality Index (PSQI), in a sample of young adult Mexican American and American Indian men and women (18-30 years, n = 800) with and without a history of alcohol binge drinking during adolescence, controlling for age, gender, and race.

RESULTS

Gender was found to affect PSQI responses with females reporting waking up at night, having more bad dreams, and later habitual bedtimes than males, and males reporting more problems with breathing and snoring. Increasing age was associated with snoring or coughing, less hours spent in bed, and later evening bedtimes. Race also influenced the PSQI with American Indians reporting longer sleep latencies and sleep durations, more hours spent in bed, and more trouble with coughing and snoring than Mexican Americans, and Mexican Americans reporting later bedtimes. A history of adolescent regular binge drinking was associated with longer sleep latencies, more problems with breathing, bad dreams, and an overall higher PSQI total score, when controlling for age, race, and gender.

CONCLUSIONS

This report suggests, like what has been found in young adults in general population samples, that binge drinking during adolescence is associated with deleterious consequences on sleep quality in young adulthood in these high-risk and understudied ethnic groups.

Group Psychotherapy in Specialty Clinics for Substance Use Disorder Treatment:The Challenge of Ethnoracially Diverse Clients

Minimal research has explored how clinicians address race and ethnicity considerations in the context of group psychotherapy within substance use disorder (SUD) specialty treatment settings. This article is an exploratory qualitative study in an effort to narrow this gap, using data from semi-structured interviews with 13 group clinicians at three outpatient SUD specialty clinics in the United States. Results are drawn from the portion of coded material pertaining to ethnoracial considerations. A predominant theme from the interviews was the importance of individualized care in terms of "meeting clients where they are at." However, minimal attention appears to have been given to addressing clients' demographic diversity. Overall, ethnoracial considerations were minimally addressed in groups, with clinicians framing such primarily in terms of "cultural" factors relevant to clinics' treatment philosophies. Moreover, limited attention was reportedly given to acknowledgment of social inequities faced by ethnoracial minority clients (e.g., racial discrimination), even though a few clinicians reported concern that minority clients were less engaged in treatment. Clinical implications of these findings and recommendations for future research are discussed.

Exploration of Pathways to Binge Drinking Among American Indian Adolescents

Binge drinking is a serious public health problem among American Indian adolescents, yet few theoretical models specific to this population and type of problematic drinking have been tested. The White Mountain Apache Tribe has begun surveillance of binge drinking and a related line of research to inform tailored prevention efforts. The goal of this paper is to use structural equation modeling to understand the relationships between different individual, family, peer, and cultural factors that predict or protect against binge drinking behavior among Apache adolescents ages 10-19 years old. A cross-sectional case-control study was completed with N = 68 Apache adolescents who required medical attention due to a recent binge event (past 90 days) and N = 55 controls with no lifetime history of binge drinking. The hypothesized model was estimated with Mplus using the WLSMV robust least squares estimator. In the final model, stressful life events were related to family functioning and peer relationships. In turn, family functioning affected peer relationships and adolescent impulsivity, which were both associated with greater risk of binge drinking. The path between peer relationships and having engaged in binge drinking was statistically significant for those expressing lower cultural identity, but not for those reporting higher cultural identity. Findings suggest preventive interventions should emphasize teaching coping skills to manage life stressors and handle impulsivity, strengthening families, and changing peer dynamics with social network-based approaches as well as social skill training. The model highlights the potentially important role of culture in strengthening positive peer relationships to reduce binge drinking risk.

Similarities in the Etiology of Alcohol Use Among Native American and Non-Native Young Women

OBJECTIVE

This study examined social-and individual-level factors associated with alcohol use among young women and tested whether differences exist between Native American and non-Native young women.

METHOD

School-based surveys were conducted among 952 young women (ages 14-19) attending four high schools within the tribal jurisdictional service area of the Cherokee Nation in northeastern Oklahoma. Structural equation modeling using Mplus was used to assess the direct and indirect effects of social-and individual-level factors on subsequent alcohol use among Native and non-Native young women.

RESULTS

We found no differences in the level of risk and protective factors among Native and non-Native young women. Among Native and non-Native young women, alcohol access, parental communication, and best friends' alcohol use had statistically significant direct and/or indirect effects on alcohol use. Indirect effects were mediated through alcohol expectancies and norms. A history of alcohol problems by an adult in the household and depression were not retained as independent risk factors in either model.

CONCLUSIONS

We found more similarities than differences in level of and relations to alcohol use among social and individual risk and protective factors between Native American and non-Native young women from northeastern Oklahoma. The results provide support for universal prevention strategies, suggesting the importance of increasing perceptions that it is difficult to obtain alcohol and increasing parent-child communication.

Other- and Self-Directed Forms of Violence and Their Relationship With Number of Substance Use Disorder Criteria Among Youth Ages 12-17: Results From the National Survey on Drug Use and Health

OBJECTIVE

The purpose of this study was to examine the associations between the number of substance use disorder (SUD) criteria as listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and other- and self-directed forms of violence among youth ages 12-17 in the general population.

METHOD

Data were obtained from the National Survey on Drug Use and Health pooled across survey years 2008-2013, with a combined sample of 108,560 respondents ages 12-17. Violence categories defined by suicide attempt (self-directed) and attacking someone with the intent for serious injury (other-directed) were categorized as follows: none, self-directed only, other-directed only, and combined self-/other-directed. Multinomial logistic regression estimated odds ratios of the increased number of criteria for alcohol, marijuana, and other illicit drug use, and nicotine dependence for each violence category, by controlling for sociodemographics and criminal justice involvement.

RESULTS

The multivariable model indicates that increased number of SUD criteria confers significantly higher odds for each violence category versus no violence. For combined violence versus self-directed violence, male gender, non-Hispanic Black and mixed race (with non-Hispanic White as referent), nicotine dependence, increased number of alcohol use disorder criteria, and other drug use disorder criteria have significantly higher odds, whereas Native Hawaiian/Pacific Islander and age have significantly lower odds. For combined violence versus other-directed violence, non-Hispanic mixed race and the increased number of other drug use disorder criteria have significantly higher odds, whereas male gender, non-Hispanic Black and Native Hawaiian/Pacific Islander, and Hispanic have significantly lower odds.

CONCLUSIONS

The identification of the combined self-/other-directed violence in the general population provides additional support for clinical studies that established associations between self- and other-directed violent behaviors. Prevention and treatment programs need to address both instances of violence and suicidality.

Review: Genetic and environmental risk factors for alcohol use disorders in American Indians and Alaskan Natives

BACKGROUND AND OBJECTIVES

Genetic and environmental predictors for alcohol use disorder (AUD) are both important in the general population. As a group, American Indian and Alaskan Native individuals (AI/AN) are at increased risk for alcohol-related morbidity /mortality, early onset problem drinking and AUD.

METHODS

Alcohol consumption behaviors amongst AI/AN tribes, environmental stressors and genetic studies in AI/AN and European-ancestry individuals are reviewed followed by an analysis of unique difficulties for undertaking research with AI/AN.

RESULTS

Some AI/AN tribes have high rates of childhood trauma that predict psychopathology including AUD. The deleterious effects of historical trauma and forced placement in boarding schools cross generations to the present day. There are scanty numbers of genetic studies of AUD in AI/AN and these derive from only a few tribes. However, it is important to note that the results are largely similar to findings in European-ancestry individuals indicating that AI/AN do not have increased genetic risk for AUD. Conducting AI/AN genetic studies has been challenging, in part because of tribe disillusionment and mistrust over past experiences and unique hurdles in getting consent from tribes, each a sovereign nation. However, it is encouraging that a new way forward has been established-community-based participatory research with tangible health benefits and a focus on strength-based approaches.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Given the high prevalence of AUD in many AI/AN tribes and limited knowledge about genetic risk-resilience factors, it is important for our understanding of prevention and treatment that AI/AN research progresses and that more tribes are represented. (Am J Addict 2017;26:461-468).

Similarities and differences in alcohol trajectories: Testing the catch-up effect among biracial black subgroups

Using National Longitudinal Study of Adolescent and Adult Health (Add Health) data, we examine the alcohol-use trajectories of monoracial Black youth and biracial Black-White, Black-Hispanic, and Black-American Indian youth to assess how their trajectories differ from the alcohol-use trajectories of White youth over time. The sample consists of 9421 adolescents and young adults who self-identified as White, Black, Black-American Indian, Black-Hispanic, or Black-White. Study hypotheses are tested using latent growth curve modeling. Results indicate that a catch-up effect exists, but only for Black-American Indians whose alcohol-use rates approach the higher rates of Whites at age 29. Black-American Indians face particularly high risk of problematic drinking over the life course. Additional research is needed to understand causal factors of alcohol-use among biracial individuals particularly Black-American Indians who may be at higher risk for alcohol misuse.

Substance Use Profiles of Urban American Indian Adolescents: A Latent Class Analysis

A growing majority of American Indian adolescents now live in cities and are at high risk of early and problematic substance use and its negative health effects.

OBJECTIVE

This study used latent class analysis to empirically derive heterogeneous patterns of substance use among urban American Indian adolescents, examined demographic correlates of the resulting latent classes, and tested for differences among the latent classes in other risk behavior and prosocial outcomes.

METHOD

The study employed a representative sample of 8th, 10th, and 12th grade American Indian adolescents (n = 2,407) in public or charter schools in metropolitan areas of Arizona in 2012. Latent class analysis examined eight types of last 30 day substance use.

RESULTS

Four latent classes emerged: a large group of "nonusers" (69%); a substantial minority using alcohol, tobacco, and/or marijuana [ATM] (17%); a smaller group of polysubstance users consuming, alcohol, tobacco, marijuana, other illicit drugs, and prescription or OTC drugs in combination (6%); and a "not alcohol" group reporting combinations of tobacco, marijuana, and prescription drug use, but rarely alcohol use (4%). The latent classes varied by age and grade level, but not by other demographic characteristics, and aligned in highly consistent patterns on other non-substance use outcomes. Polysubstance users reported the most problematic and nonusers the least problematic outcomes, with ATM and "not alcohol" users in the middle.

CONCLUSIONS

Urban AI adolescent substance use occurs in three somewhat distinctive patterns of combinations of recent alcohol and drug consumption, covarying in systematic ways with other problematic risk behaviors and attitudes.

Risk and protective factors for heavy binge alcohol use among American Indian adolescents utilizing emergency health services

BACKGROUND

American Indian (AI) adolescents are disproportionately burdened by alcohol abuse and heavy binge use, often leading to problematic drinking in adulthood. However, many AI communities also have large proportions of adults who abstain from alcohol.

OBJECTIVE

To understand these concurrent and divergent patterns, we explored the relationship between risk and protective factors for heavy binge alcohol use among a reservation-based sample of AI adolescents.

METHODS

Factors at individual, peer, family, and cultural/community levels were examined using a cross-sectional case-control study design. Cases were adolescents with recent heavy binge alcohol use that resulted in necessary medical care. Controls had no lifetime history of heavy binge alcohol use. 68 cases and 55 controls were recruited from emergency health services visits. Participants were 50% male; average age 15.4 years old, range 10 to 19. Independent variables were explored using logistic regression; those statistically significant were combined into a larger multivariate model.

RESULTS

Exploratory analyses showed adolescents who were aggressive, impulsive, had deviant peers, poor family functioning or more people living at home were at greater risk for heavy binge alcohol use. Protective factors included attending school, family closeness, residential stability, social problem-solving skills, having traditional AI values and practices, and strong ethnic identity. Confirmatory analysis concluded that school attendance and residential stability reduce the probability of heavy binge alcohol use, even among those already at low risk.

CONCLUSIONS

Findings deepen the understanding of AI adolescent heavy binge alcohol use and inform adolescent intervention development fostering trajectories to low-risk drinking and abstinence.

Predicting the Onset of Alcohol Use and the Development of Alcohol Use Disorder Among Indigenous Adolescents

Empirical efforts to identify the predictors of drinking behavior among North American Indigenous adolescents are relatively limited. Using longitudinal data, this study considers perceived discrimination, positive drinker prototypes, and peer drinking behavior as risk factors for the onset of alcohol use and development of an alcohol use disorder among 674 Indigenous adolescents as they progressed from early to late adolescence (M age at baseline = 11.11, SD = 0.83). Results showed that positive drinker prototypes and associations with peers who drink increased the risk for the onset of drinking, while perceived discrimination and associations with peers who drink increased the risk for the development of an alcohol use disorder. The theoretical and practical implications of our results are discussed.

Variations in parental monitoring and predictions of adolescent prescription opioid and stimulant misuse

OBJECTIVE

This study examined relations between adolescents' family structures, social ties, and drug-related attitudes, and their misuse of prescription opioids and stimulants. Different relationships were anticipated for the substances based on prior research highlighting varying motivations for their use.

METHOD

Based on an earlier model of adolescent substance misuse, two path analytic models were tested using data from 12 to 17 year olds in the 2012 U.S. National Survey on Drug Use and Health (NSDUH: N=17,399).

RESULTS

Female respondents reported higher levels of parental warmth, as did youth from wealthier families. Greater parental monitoring was reported by adolescents from wealthier and intact families. Parental monitoring and warmth predicted adolescents' social ties and individual differences associated with drug use, and both variables predicted prescription opioid and stimulant misuse. Contrary to previous research, for adolescents aged 12 to 14, high levels of parental monitoring, while positively associated with attitudes and social ties, also predicted higher rates of prescription stimulant misuse when combined with low levels of parental warmth. Results were cross-validated with data from the 2011 NSDUH.

CONCLUSIONS

Analyses highlighted the importance of understanding and differentiating the underlying factors associated with adolescent prescription stimulant and opioid misuse, and the role of parental behaviors in prevention.

Associations between a history of binge drinking during adolescence and self-reported responses to alcohol in young adult Native and Mexican Americans

BACKGROUND

Binge drinking during adolescence is common and may predict increased drinking in young adulthood and enhanced risk of alcohol dependence. Variation in level of response to the hedonic and adverse effects of alcohol is in part an inherited factor that may also influence its use, abuse, and dependence. This study investigated, in young adults, whether an association could be demonstrated between variation in self-reported responses to alcohol and a history of binge drinking during adolescence.

METHODS

Young adult (18 to 30 years, n = 790) Native Americans and Mexican Americans were recruited from the community and completed a structured diagnostic interview. Response to alcohol was indexed using the expectation version of the Subjective High Assessment Scale (SHAS-E). An adolescent history of regular binge drinking was defined as drinking 5 or more drinks for boys and 4 or more drinks for girls per drinking occasion at least once a month during their highest drinking period prior to the age of 18.

RESULTS

An adolescent history of regular binge drinking was found to be associated with a lower level of self-reported responses to the negative aspects of alcohol intoxication (feeling terrible) as well as to the overall level of intoxication, but not to the positive impressions of intoxication (feeling great) on the SHAS-E. A history of regular adolescent binge drinking was also correlated with less feelings of the "terrible" and "total" effects of alcohol, as indexed by the SHAS-E, in a linear regression model that included several diagnostic and demographic variables such as a history of conduct disorder and current levels of drinking.

CONCLUSIONS

These data suggest that a history of adolescent binge drinking is associated with a reduction in the self-reported level of intoxication in young adulthood, a factor that could theoretically lead to increased risk of alcohol dependence.

Trajectories of substance use among young American Indian adolescents: patterns and predictors

Substance use often begins earlier among American Indians compared to the rest of the United States, a troubling reality that puts Native youth at risk for escalating and problematic use. We need to understand more fully patterns of emergent substance use among young American Indian adolescents, risk factors associated with escalating use trajectories, and protective factors that can be parlayed into robust prevention strategies. We used growth mixture modeling with longitudinal data from middle-school students on a Northern Plains reservation (Wave 1 N = 381, M age at baseline = 12.77, 45.6% female) to identify subgroups exhibiting different trajectories of cigarette, alcohol, and marijuana use. We explored how both risk (e.g., exposure to stressful events, deviant peers) and protective (e.g., positive parent-child relationships, cultural identity) factors were related to these trajectories. For all substances, most youth showed trajectories characterized by low rates of substance use (nonuser classes), but many also showed patterns characterized by high and/or escalating use. Across substances, exposure to stress, early puberty, and deviant peer relationships were associated with the more problematic patterns, while strong relationships with parents and prosocial peers were associated with nonuser classes. Our measures of emergent cultural identity were generally unrelated to substance use trajectory classes among these young adolescents. The findings point to the importance of early substance use prevention programs for American Indian youth that attenuate the impact of exposure to stressful events, redirect peer relationships, and foster positive parent influences. They also point to the need to explore more fully how cultural influences can be captured.

Purple drank prevalence and characteristics of misusers of codeine cough syrup mixtures

A mixture of codeine cough syrup with alcohol and/or a soft drink known as "purple drank" has gained media attention in recent years as a drug associated with professional athletes and southern rap music. The existing research on purple drank consumption has primarily utilized samples of African Americans residing in the Houston, Texas area. This is the first scholarly study of purple drank use outside of the Houston, Texas area among a general population of young adults, and indicates that purple drank use is not limited to African American males. The findings depict higher odds of the use of purple drank among other racial and ethnic groups, males, and homosexual, bisexual, and transgender college students from urban areas.

The Role of Intrapersonal Factors on Alcohol and Drug Use Among Latinos With Physical Disabilities

Persons with disabilities are disproportionately impacted by alcohol and drug use. Social work best practice approaches require an understanding of the effects of intrapersonal factors on alcohol and drug use, yet the theoretical and empirical literature remain underdeveloped, especially among ethnic minority populations. We sought to obtain a detailed description of the role of intrapersonal factors, including perceptions and life experiences, on alcohol and drug use among Latinos with physical disabilities. We employed community-based participatory research in conjunction with photovoice. A total of 17 focus group interviews were completed. Three rounds of photography and focus group interviews occurred with a total of 28 participants who participated in each round. Data analyses followed the tenets of descriptive phenomenology. Results highlight intrapersonal risk and protective factors to inform social work practice and work toward developing and evaluating alcohol and drug use preventive interventions for this overlooked and vulnerable population.