Is the Association between Neighborhood Drug Prevalence and Marijuana use Independent of Peer Drug and Alcohol Norms? Results from a Household Survey of Urban Youth

Perceived neighborhood disorder as a moderator of the relationship between marijuana use and disinhibition in a sample of emerging adult African American females

Disinhibition is associated with myriad risk-taking behaviors and adverse outcomes. Both marijuana use and poor neighborhood conditions have been associated with disinhibition. However, the extent to which neighborhood disorder interacts with marijuana use to influence disinhibition has not been studied, extensively. A better understanding of these relationships has implications for designing more effective tailored place-based interventions that aim to reduce risk taking behaviors and related adverse social and health outcomes associated with marijuana use. Thus, the purpose of this study was to examine the interactive effects of perceived neighborhood disorder and marijuana use on disinhibition. The sample included 120 African American female residents of disadvantaged neighborhoods (Mage = 23.6 ± 3.46). We employed hierarchical linear regression analysis to examine the interactive effects of marijuana use and perceived neighborhood disorder on disinhibition, while controlling for age and education. The interaction term was marginally significant (b = 5.66; t(109) = 1.72, p = .08). Next, the conditional effects were explored. Results indicated the association of marijuana use with disinhibition was stronger for females in the higher neighborhood disorder group, compared to those in the lower neighborhood disorder group (10.40 and 4.51, respectively). Our findings support the need for more research on the potential of neighborhood disorder to amplify the effects of marijuana use on disinhibition and related neurobehavioral traits. The identification of contextual moderators and high-risk sub-groups will aid in the design of more tailored place-based interventions that aim to reduce risk-taking behavior among those most vulnerable.

Adolescent Development in Context: A Decade Review of Neighborhood and Activity Space Research

Over the last decade, two lines of inquiry have emerged from earlier investigations of adolescent neighborhood effects. First, researchers began incorporating space-time geography to study adolescent development within activity spaces or routine activity locations and settings. Second, cultural-developmental researchers implicated neighborhood settings in cultural development, to capture neighborhood effects on competencies and processes that are salient or normative for minoritized youth. We review the decade's studies on adolescent externalizing, internalizing, academic achievement, health, and cultural development within neighborhoods and activity spaces. We offer recommendations supporting decompartmentalization of cultural-developmental and activity space scholarship to advance the science of adolescent development in context.

Predictors of Early-Onset Cannabis Use in Adolescence and Risks for Substance Use Disorder Symptoms in Young Adulthood

Early detection of risks for substance use disorders is essential to lifelong health and well-being for some youth. Very early-onset use is proposed as an indicator of risk for substance use disorders, but risk and protective factors related to early-onset use have not been identified. The current study compared risk and protective factors that distinguish early- and late-onset cannabis users from abstainers using data collected from a large community sample. The study also examined onset-group differences in participants’ reports of substance use disorder symptoms a decade later. Heavy episodic drinking (early-onset: OR = 7.29 CI = [1.60, 33.19]) and engagement with peers involved in deviant behaviors (early-onset: OR = 2.50 CI = [1.50, 4.13]) are risk factors for early-onset cannabis use. Protective factors, including parent monitoring (early-onset: OR = 0.73 CI = [0.58, 0.93]), engagement with peers involved in positive behaviors (early-onset: OR = 0.54 CI = [0.39, 0.76]), school engagement (early-onset: OR = 0.83 CI = [0.72, 0.96]), and academic grades (early-onset: OR = 0.37 CI = [0.21, 0.65]) also predicted early versus later onset-group differences. Early age of onset may be distinctly related to risk and protective factors previously associated with risks for substance use in all adolescents.

Longitudinal Effects of Peer, School, and Parenting Contexts on Substance Use Initiation in Middle Adolescence

Purpose: Preventing substance use initiation (SUI) can reduce negative consequences associated with adult substance use disorder. The role of involvement with deviant peers, school connectedness, and parenting quality on SUI was investigated among a community sample (N = 387).Method: PROCESS tested whether three parenting quality factors (Parental Knowledge and Affective Relationships, Parental Control, and Parental Communication and Involvement) served as moderators of two different mediation pathways (involvement with deviant peers and school connectedness) on three SUI outcomes (alcohol, cigarettes, and marijuana).Results: Involvement with deviant peers mediated the relation between school connectedness and substance use. Low school connectedness predicted high deviant peer affiliation, which, in turn, predicted high SUI. School connectedness did not mediate involvement with deviant peers and substance use. Parenting quality factors were not significant moderators.Conclusion: Supporting adolescents who lack strong school connections may help prevent involvement with deviant peers, which, in turn, may prevent SUI.

Perceptions and behaviors related to noncommunicable diseases in Palau: a qualitative study

The increasing burden of noncommunicable diseases (NCDs) is a major public health concern in Palau. This study aims to identify social and psychological factors related to NCDs among Palauan people using a qualitative approach. We conducted eight key informant interviews and eight focus group discussions, which were audio-recorded, transcribed and translated into English. Ideas of the respondents were extracted and labeled, and the labels were analyzed using an inductive multistage approach referred to as qualitative content analysis. Three themes emerged: (1) home education, (2) traditional local community, and (3) modernization and westernization of lifestyle. Respondents believed that the influence of the family on lifestyle was significant, but that disciplining children at home had become difficult. They considered that the traditional lifestyle was mostly healthy, and were reluctant to abandon certain unhealthy customs, such as serving abundant food to guests as a sign of fraternity. They also thought that they overate because of their stressful modernized lifestyle. This is the first qualitative study to analyze perception and behavior of the Palauan people in relation to NCDs. We found that the increase in NCDs was related to two concurrent trends: preserving certain traditional customs unfavorable to good health, and abandoning time-consuming healthy traditional lifestyle to adopt a modernized one. We also found that Palauan people were not confident in their ability to prevent NCDs. Therefore, health promotion activities should be designed to empower people to make positive changes.

Neighborhood, Peer, and Parental Influences on Minor and Major Substance Use of Latino and Black Adolescents

Self-report survey data were collected from 797 adolescents (47.2% Latino, 52.8% Black) in North Carolina. Path analyses were conducted to examine relationships between youth perceptions of maternal and paternal monitoring, neighborhood crime/drugs, friends’ delinquency, peer victimization, minor substance use, and major substance use. After establishing a good fitting model, multigroup models were conducted for Blacks vs. Latinos. The results indicated perceived maternal monitoring (and paternal monitoring for Latinos) was directly related to decreased exposure to neighborhood crime/drugs and friends’ delinquency. For Latinos and Blacks, maternal and paternal monitoring were directly related to gateway substance use, and indirectly related to major substance use through gateway substance use. Additionally, friends’ delinquency and peer victimization were directly related to gateway and major substance use for Blacks and Latinos. Thus, exposure to neighborhood crime/drugs was indirectly related to substance use through friends’ delinquency and peer victimization.

Perceived neighborhood disorder and frequency of marijuana use among emerging adult African American females

Emerging adult African American females are at increased risk for cannabis use disorders. Ecological models suggest that African Americans' increased risk for substance use disorders and associated adverse outcomes may result from chronic exposure to contextual disadvantages, such as living in economically deprived and disorganized communities. However levels of vulnerability for developing cannabis use disorders vary, even among residents of disadvantaged neighborhoods. Therefore, studies focused on within group differences are necessary. This study examined the relationship between frequency of marijuana use and perceived neighborhood disorder. The sample included 117 African American emerging adult females (M_age = 23.6 ± 3.4). After providing informed consent, participants completed a semi-structured interview that included the Neighborhood Environment Scale and a self-report measure of marijuana use. Additionally, participants provided a urine sample that was tested for the presence of psychoactive drugs. 46% tested positive for marijuana and 45% reported using marijuana in the past 30 days. 27% reported frequent/heavy use. Results from multinomial logistic regression analysis indicated a significant relationship between perceived neighborhood disorder and heavy marijuana use (AOR = 3.3; 95% CI = 1.06 - 10.29). Findings suggest African American emerging adult female residents of economically disadvantaged neighborhoods who appraise their environments as disorganized may be at heighten risk for problematic marijuana use and should be targeted for intervention. Moreover, the findings support the need for multi-systems interventions. As policy makers consider the legalization of marijuana, it is important that differences in marijuana use behaviors and negative outcomes across groups and contexts are taken into consideration.

Causal Mediation Analysis With Observational Data: Considerations and Illustration Examining Mechanisms Linking Neighborhood Poverty to Adolescent Substance Use

Understanding the mediation mechanisms by which an exposure or intervention affects an outcome can provide a look into what has been called a "black box" of many epidemiologic associations, thereby providing further evidence of a relationship and possible points of intervention. Rapid methodologic developments in mediation analyses mean that there are a growing number of approaches for researchers to consider, each with its own set of assumptions, advantages, and disadvantages. This has understandably resulted in some confusion among applied researchers. Here, we provide a brief overview of the mediation methods available and discuss points for consideration when choosing a method. We provide an in-depth explication of 2 of the many potential estimators for illustrative purposes: the Baron and Kenny mediation approach, because it is the most commonly used, and a recently developed approach for estimating stochastic direct and indirect effects, because it relies on far fewer assumptions. We illustrate the decision process and analytical procedure by estimating potential school- and peer-based mechanisms linking neighborhood poverty to adolescent substance use in the National Comorbidity Survey Adolescent Supplement.

Mediation of Neighborhood Effects on Adolescent Substance Use by the School and Peer Environments

BACKGROUND

Evidence suggests that aspects of the neighborhood environment may influence risk of problematic drug use among adolescents. Our objective was to examine mediating roles of aspects of the school and peer environments on the effect of receiving a Section 8 housing voucher and using it to move out of public housing on adolescent substance use outcomes.

METHODS

We used data from the Moving to Opportunity (MTO) experiment that randomized receipt of a Section 8 housing voucher. Hypothesized mediators included school climate, safety, peer drug use, and participation in an after-school sport or club. We applied a doubly robust, semiparametric estimator to longitudinal MTO data to estimate stochastic direct and indirect effects of randomization on cigarette use, marijuana use, and problematic drug use. Stochastic direct and indirect effects differ from natural direct and indirect effects in that they do not require assuming no posttreatment confounder of the mediator-outcome relationship. Such an assumption would be at odds with any causal model that reflects an intervention affecting a mediator and outcome through adherence to treatment assignment.

RESULTS

Having friends who use drugs and involvement in after-school sports or clubs partially mediated the effect of housing voucher receipt on adolescent substance use (e.g., stochastic indirect effect 0.45% [95% confidence interval: 0.12%, 0.79%] for having friends who use drugs and 0.04% [95% confidence interval: -0.02%, 0.10%] for involvement in after-school sports or clubs mediating the relationship between housing voucher receipt and marijuana use among boys). However, these mediating effects were small, contributing only fractions of a percent to the effect of voucher receipt on probability of substance use. No school environment variables were mediators.

CONCLUSIONS

Measured school- and peer-environment variables played little role in mediating the effect of housing voucher receipt on subsequent adolescent substance use.

Marihuana y drogas ilícitas en jóvenes mexicanos: Factores de riesgo y protección asociados a la edad de inicio del consumo

Objetivo: Determinar factores de riesgo y protección asociados a la edad de inicio del consumo de mariguana y drogas ilícitas en jóvenes mexicanos. Método: Se analizaron datos de 40,366 jóvenes participantes de la Encuesta de Cohesión Social para la Prevención de la Violencia y la Delincuencia (ECOPRED). Las variables asociadas con la edad de inicio del consumo de mariguana y otras drogas ilícitas fueron determinadas mediante dos modelos de riesgos proporcionales. Resultados: La edad mediana de inicio en consumo de drogas ilícitas osciló entre los 15 y 18 años, mientras que en consumo de marihuana fue de 17 años. En ambos modelos, tener un par consumidor de marihuana fue el factor más fuertemente asociado al inicio de consumo. Discusión: La edad de inicio de consumo revelada en el presente estudio resultó similar a aquella propuesta en investigaciones previas. A pesar de las diferencias de factores en cada modelo, tener un par consumidor de marihuana y el consumo previo de tabaco (variable moderadora) resultaron los factores más fuertemente asociados en ambos modelos.

The association of unemployment from age 21 to 33 with substance use disorder symptoms at age 39: The role of childhood neighborhood characteristics

BACKGROUND

This study examined whether duration of unemployment from ages 21 to 33 was associated with symptoms of alcohol use disorder, nicotine dependence disorder, and cannabis use disorder at age 39, after accounting for childhood and early adult involvement in substance use and other indicators of psychopathology. Analyses also investigated whether dimensions of perceived neighborhood characteristics during childhood and adolescence contributed to the link between unemployment and substance use disorder symptoms during adulthood. Potential gender differences were examined.

METHOD

Using life-course calendar data from a prospective longitudinal study (N=677), participants' unemployment history was measured from ages 21 to 33. General childhood and substance use-specific neighborhood characteristics were assessed at ages 10-18.

RESULTS

Findings from negative binomial regression models showed that duration of unemployment was associated with higher levels of alcohol use disorder and nicotine dependence symptoms, after adjusting for earlier involvement in substance use. Substance use-specific neighborhood factors during childhood were associated with symptoms of nicotine dependence and cannabis use disorder. Findings also suggest that the detrimental impact of unemployment on nicotine dependence symptoms was possibly stronger for women.

CONCLUSIONS

Findings suggest that unemployment may be an important risk factor for alcohol use disorder and nicotine dependence symptoms, indicating that public health efforts providing strategies to cope with unemployment, particularly for women who experience chronic unemployment, may be promising. Additionally, substance use-specific neighborhood characteristics during childhood should be considered as part of a prevention strategy to ameliorate adult nicotine and cannabis use problems.

Parents, Peers, Perceived Risk of Harm, and the Neighborhood: Contextualizing Key Influences on Adolescent Substance Use

Recent research has affirmed the need to examine contextual influences on adolescent substance use in a multilevel framework. This study examined the role of neighborhood opportunities for substance use in promoting adolescent substance use. Data came from two components of the Project on Human Development in Chicago Neighborhoods: the Longitudinal Cohort Study, consisting of interviews with youth and their primary caregivers across three waves of data with an average span of 4.5 years; and a Community Survey of neighborhood residents. Analysis used an Item-Response Theory-based statistical approach on 6556 substance use item responses from 1639 youth (49.0 % female) within 80 neighborhoods to assess the extent to which neighborhood opportunities for substance use had direct and indirect effects on adolescent substance use. Neither direct nor mediated effects of neighborhood opportunities for substance use on adolescent substance use were detected. But, analyses revealed moderating effects such that higher levels of neighborhood opportunities for substance use: (1) amplified the detrimental effects of parental substance use and peer substance use on youth substance use; and (2) attenuated the protective effect of adolescents' perceived harm of substance use on adolescent substance use. The results suggest that the ways in which neighborhood characteristics impact adolescent behavior are nuanced. Rather than impact individual-level outcomes directly, neighborhood context may be particularly relevant by conditioning the effects of salient individual-level risk and protective factors for substance use.

The Geography of Normative Climates: An Application to Adolescent Substance Use

The existing research on risk factors for adolescent substance use highlights the importance of peers' direct influence on risky behaviors, yet two key limitations persist. First, there is considerably less attention to the ways in which peers shape overall (e.g., school-level) normative climates of attitudes and expectations about substance use, and, second, the role of the broader geographic contexts in which these climates are embedded is essentially neglected. In light of shifting trends in geographic differences in adolescent substance use, the current study uses data from the 2007 Nebraska Risk and Protective Factor Student Survey (n = 26,647; 80 % non-Hispanic White; 51 % female) to (a) explore whether geographic context shapes the character (permissiveness) and consistency (homogeneity) of normative climates and (b) examine the consequences (effects) of such climates on adolescent substance use risk across the rural-urban continuum. Normative climates are a consistent predictor of substance use, yet the geographic context in which schools are located matters for both the nature and influence of these climates, and the patterns differ between normative climates about alcohol and marijuana. These findings illustrate that school normative climates do indeed matter for substance use behavior, and the ways in which they do depend on their broader, geographic context. Thus, future research on youth's substance use should be attuned to these more nuanced distinctions.