Homies with aspirations and positive peer network ties: associations with reduced frequent substance use among gang-affiliated Latino youth

When a pandemic and epidemic collide: Lessons learned about how system barriers can interrupt implementation of addiction research

Background

Telehealth technologies are now featured more prominently in addiction treatment services than prior to the COVID-19 pandemic, but system barriers should be carefully considered for the successful implementation of innovative remote solutions for medication management and recovery coaching support for people with opioid use disorder (OUD).

Method

The Centers for Disease Control and Prevention funded a telehealth trial prior to the COVID-19 pandemic with a multi-institution team who attempted to implement an innovative protocol during the height of the pandemic in 2020 in Tampa, Florida. The study evaluated the effectiveness of a mobile device application, called MySafeRx, which integrated remote motivational recovery coaching with daily supervised dosing from secure pill dispensers via videoconference, on medication adherence during buprenorphine treatment. This paper provides a participant case example followed by a reflective evaluation of how the pandemic amplified both an existing research-to-practice gap and clinical system barriers during the implementation of telehealth clinical research intervention for patients with OUD.

Findings

Implementation challenges arose from academic institutional requirements, boundaries and role identity, clinical staff burnout and lack of buy-in, rigid clinical protocols, and limited clinical resources, which hampered recruitment and intervention engagement.

Conclusions

As the urgency for feasible and effective telehealth solutions continues to rise in response to the growing numbers of opioid-related deaths, the scientific community may use these lessons learned to re-envision the relationship between intervention implementation and the role of clinical research toward mitigating the opioid overdose epidemic.

Adolescent Peers and Prevention: Network Patterns of Sexual Violence Attitudes and Bystander Actions

Peer sexual violence is a significant social problem that affects adolescents and can lead to negative mental health and developmental consequences. Peers are a significant source of influence for adolescent behavior. For example, recent studies show training teens to be bystanders can be an effective prevention strategy to reduce peer violence and harassment. Peers can also promote risky behaviors including substance use and violence. The current study examined how sexual violence-specific risk and protective attitudes (e.g., denial of peer sexual violence and positive peer prevention norms) and behaviors (alcohol use and bystander actions to prevent peer sexual violence) clustered within peer networks cross-sectionally and over time. Participants were 1,499 7th-10th graders who took surveys during an academic year and who reported having opportunity to take action as bystanders to peer sexual violence. Participants took surveys 6 months apart online in schools. Questions included nomination of best friends to capture information about peer networks. Social network analyses indicated that there was weak but significant clustering of positive prevention attitudes such as bystander denial and marginal clustering on reactive bystander behaviors to address sexual assault. For comparison, alcohol use and academic grades were analyzed and found to also cluster in networks in these data. These findings suggest that for early adolescents, peer bystander training may be influential for some key bystander attitudes and reactive sexual violence prevention behaviors as individual behaviors are not independent of those of their friends.

Positive deviance in health and medical research on individual level outcomes - a review of methodology

BACKGROUND

Positive deviance as a methodology is increasing in application yet there is high variability in how this approach is applied in health services research.

METHODS

We conducted a scoping review of the literature for positive deviance applied to health outcomes informed by PRISMA-ScR. We searched the literature from 1945 to 2020, including articles on positive deviance or positive outliers, and restricted to examining individual rather than organizational outcomes. We analyzed the methodology applied including the process of identifying deviants, the use of control groups, and the degree of community engagement.

RESULTS

Our initial search identified 1140 manuscripts; we included 104 papers describing 98 studies, 11 topical and one miscellaneous category. Most studies used objective measures of health or survey-based responses to identify deviants from a sub-set of the population at risk. The use of controls was less common in some topics (hospital infections), whereas controls were universally applied in other topics (malnutrition). The degree of community engagement varied widely.

CONCLUSIONS

Positive deviance would benefit from improvements in reporting and standardized approaches to defining deviance. Studies could be improved through clarified definitions of deviance/risk, explicit descriptions of community engagement, and more consistent use of controls.

Child maltreatment and protective assets in the development of internalising and externalising problems: A study of youth offenders

INTRODUCTION

An emerging trend in child maltreatment research focuses on identifying protective assets that contribute to youth resilience. Extending the trend, this study examines not just whether but also how protective assets in various domains (e.g., the individual, family, and schools) are associated with internalising and externalising problems among youth offenders, which is a population that typically reports a high prevalence of child maltreatment experiences.

METHODS

This study used the baseline data of 790 youth offenders (85% male) aged between 12 and 19 years old from the EPYC project, a national longitudinal study in Singapore. Structural equation modelling was conducted to test the direct effects and interactive effects of protective assets and child maltreatment on internalising and externalising problems.

RESULTS

For direct effects, maltreated youth offenders reported higher levels of internalising and externalising problems than their non-maltreated counterparts. Higher levels of peer assets were directly related to lower levels of externalising, but not internalising problems. For interactive effects, overall protective assets, school/work assets and internal assets had significant buffering effects against physical/emotional abuse on externalising problems, whereas peer assets showed significant buffering effects against sexual abuse on internalising problems.

CONCLUSION

An overall level of protective assets, as well as assets from specific domains (peer, school/work, and internal assets) could provide protective effects on problematic behaviours among youth offenders. Interventions seeking to address youth internalising and externalising problems should focus on reducing child maltreatment incidence and enhancing protective assets within these domains.

Substance Use Profiles Among Gang-Involved Youth: Social Ecology Implications for Service Approaches

Substance use is a frequently cited health risk behavior in the youth gang literature, yet little is known about how substance use patterns vary among gang-involved youth or the social ecological factors that contribute to potential variation. Developing relevant and effective service approaches will require an understanding of this variation and the malleable factors that are likely to promote or inhibit particular patterns of use. Using latent class analysis, we identified four substance use classes within a school-based sample of gang-involved youth (n = 2,770): Non-Users (38%), Past Users (15%), Casual Users (27%), and Frequent Multi-Users (21%). These classes were distinguished by substance type, frequency of use, and source of access. Demographic and substance use-specific ecological factors across the family, peer, school, and neighborhood contexts were found to significantly differentiate these classes. Specifically, acceptance of use by parents, friends, and neighbors, along with a lack of family rules and high accessibility in the neighborhood, significantly differentiated use patterns. Findings highlight the need for service approaches that are responsive to the unique needs of individuals and their environments. Implications for practice are discussed, including the potential utility of applying a harm reduction service framework to address youth gang substance use.

Improving Social Norms and Actions to Prevent Sexual and Intimate Partner Violence: A Pilot Study of the Impact of Green Dot Community on Youth

Sexual violence (SV) and intimate partner violence (IPV), which often co-occur with bullying, are serious public health issues underscoring the need for primary prevention. The purpose of this study was to examine the impact of a community-building SV and IPV prevention program, Green Dot Community, on adolescents' perceptions of community social norms and their propensity to intervene as helpful actionists using two independent data sources. Green Dot Community takes place in towns and aims to influence all town members to prevent SV and IPV by addressing protective factors (i.e., collective efficacy, positive prevention social norms, and bystander helping, or actionism). In the current study, one town received Green Dot Community (the prevention-enhanced town), and two towns received prevention as usual (i.e., awareness and fundraising events by local IPV and SV advocacy centers). The program was evaluated using a two-part method: (a) A cross-sectional sample of high school students from three rural communities provided assessment of protective factors at two time points (Time 1, N = 1,187; Time 2, N = 877) and (b) Youth Risk Behavior Survey data from the state Department of Health were gathered before and after program implementation (Time 1, N=2,034; Time 2, N=2,017) to assess victimization rates. Youth in the prevention-enhanced town reported higher collective efficacy and more positive social norms specific to helping in situations of SV and IPV over time but did not differ on bystander behaviors or on victimization rates. Community-based prevention initiatives may be helpful in changing community norms to prevent SV/IPV.

Longitudinal pathway from violence exposure to firearm carriage among adolescents: The role of future expectation

INTRODUCTION

Exposure to violence is a risk factor for firearm carriage. Youth exposed to violence also have difficulty envisioning positive future outcomes (e.g., educational outcomes), which can increase the likelihood of firearm carriage over time. Researchers, however, have not yet examined whether changes in exposure to violence over time can influence the developmental trajectories of firearm carriage. To address this gap, we (1) examined the longitudinal association between exposure to violence and firearm carriage (grades 9 to 12) and then (2) examined whether changes in future expectations mediated this longitudinal association.

METHOD

The longitudinal association between exposure to violence and firearm carriage through future expectations was examined among 850 adolescents from the Flint Adolescent Study. Participants were recruited from four high schools in a midwestern city in the United States. Parallel latent growth models and latent growth mediation models were estimated.

RESULTS

A positive association was observed between the rate of change in exposure to violence and firearm carriage. Exposure to violence also indirectly increased the risk for firearm carriage over time by decreasing future expectation in the 9th grade.

CONCLUSIONS

Our results support the idea that helping youth develop positive attitude about educational success may help reduce firearm carriage. Increasing positive expectations about future may help prevent firearm carriage within the context of violence exposure.

Prospective Associations Among Youth Assets and Alcohol, Tobacco, and Other Drug Use in a Hispanic Youth Population

This study’s purpose was to determine whether specific youth assets (conceptualized as influencing health behavior at the individual, family, or community level) were prospectively associated with reduced alcohol, tobacco, and other drug use (ATD) in a sample of Hispanic youth. A longitudinal community-based study was conducted with five waves of data collected annually over 4 years. Participants were Hispanic youth (14.1 years old; 53% female) and their parents ( N = 306 youth/parent pairs). Generalized linear mixed models were used to determine the prospective influence of 17 youth assets on ATD over five waves of data. Results indicated that Hispanic youth with three of seven individual-level assets (e.g., educational aspirations), any of four family-level assets (e.g., family communication), or with one of six community-level assets (e.g., positive peer role models) were significantly less likely to engage in ATD. The results suggest that assets protect Hispanic youth from ATD and that family-level assets may be particularly important.

Multiple Marginality and the Variation in Delinquency and Substance use Among Adolescent Gang Members

BACKGROUND

Gang membership is a significant contributor to delinquency and violent victimization among adolescents. Yet, there is considerable variability in the extent to which gang members engage in delinquency and substance use, and previous research suggests factors beyond the individual level are important to consider.

OBJECTIVES

Using the multiple marginality framework, this study examines the factors related to the family, school, and neighborhood contexts that may contribute to delinquency and substance use among current gang members.

METHODS

Between 2013 and 2015, we conducted quantitative surveys with 449 self-identified gang members between the ages of 14 and 19 years old in Milwaukee, Wisconsin. Surveys included measures to assess delinquency, substance use, parental involvement, educational attainment, drug distribution, and police involvement. We ran simple and multiple regressions to assess the relationship between family, school, and neighborhood factors and delinquency and substance use.

RESULTS

Regression analyses revealed several significant predictors of delinquency and substance use among adolescent gang members including parental substance use and incarceration, school safety, police contact, and neighborhood disorder.

CONCLUSIONS

Family and school factors are likely important protective factors against delinquency and substance use among gang members. Interventions at the family and community level may be particularly important in reducing poor health and social outcomes for adolescent gang members.

Neighborhood disorder, peer network health, and substance use among young urban adolescents

BACKGROUND

The current study investigated the moderating effect of peer networks on neighborhood disorder's association with substance use in a sample of primarily African American urban adolescents.

METHODS

A convenience sample of 248 adolescents was recruited from urban health care settings and followed for two years, assessing psychological, social, and geographic risk and protective characteristics. A subset of 106 substance using participants were used for the analyses. A moderation model was tested to determine if the influence of neighborhood disorder (percent vacant housing, assault index, percent single parent headed households, percent home owner occupied, percent below poverty line) on substance use was moderated by peer network health (sum of peer risk and protective behaviors).

RESULTS

Evidence for hypothesized peer network moderation was supported. A latent growth model found that peer network health is most strongly associated with lower baseline substance use for young adolescents residing in more disordered neighborhoods. Over the course of two years (ages approximately 14-16) this protective effect declines, and the decline is stronger for more disordered neighborhoods.

CONCLUSIONS

Understanding the longitudinal moderating effects of peer networks within high-risk urban settings is important to the development and testing of contextually sensitive peer-based interventions.

RESULTS

suggest that targeting the potential protective qualities of peer networks may be a promising approach for interventions seeking to reduce substance use, particularly among younger urban adolescents living in high-risk neighborhoods.

Cell phone-based ecological momentary assessment of substance use context for Latino youth in outpatient treatment: Who, what, when and where

BACKGROUND

Relationships between alcohol, marijuana and other drug (AOD) use and contextual factors have mostly been established through retrospective self-report. Given the embeddedness of cell phones in adolescents' daily activities, cell phone-based ecological momentary assessment (CEMA) provides an opportunity to better understand AOD use in youth and how cell phones can be used to self-monitor and deliver interventions. We use CEMA to examine AOD use in Latino youth who have been especially understudied.

METHODS

Twenty-eight mostly Latino youth (ages 13-18) in outpatient substance abuse treatment recorded AOD use, contextual factors, cravings, and affect through once-daily CEMA over one month periods. Random-effects logistic regression was used to compare contextual factors between periods of AOD use and non-use.

RESULTS

The most frequent contextual factors reported during AOD use were being with close friends and "hanging out" as the primary activity. During AOD use compared to non-use, youth were more likely to be with close friends (OR=4.76; p<0.01), around users (OR=17.69; p<0.01), and at a friend's house (OR=5.97; p<0.01). Alcohol use was more frequently reported at night (63% vs 34%) and on weekends relative to other substances (64% vs 49%). Strong cravings were more frequently reported on AOD-use days (OR=7.34; p<0.01). Types of positive and negative affect were reported with similar frequencies, regardless of AOD use.

CONCLUSIONS

Reporting on social context, location, day and time of day, and cravings all show promise in developing cell phone-based interventions triggered by contextual data.