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Pan EJ, Liu JC, Zha AC, Seballos SS, Falcone T, Phelan M, Weleff J. Adverse Childhood Experiences (ACEs) in Unhoused Children Increase Odds of Psychiatric Illness, Physical Illness, and Psychiatric Admission. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:363-372. [PMID: 38938936 PMCID: PMC11199423 DOI: 10.1007/s40653-023-00608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 06/29/2024]
Abstract
Unhoused children and adolescents have high rates of adverse childhood experiences (ACEs). The objective of this study was to characterize a large cohort of unhoused children and investigate rates of psychiatric diagnoses, medical diagnoses, and utilization of emergency department (ED) resources depending on the presence of additional documented ACEs. A retrospective cohort of all unhoused children who presented to the ED of a large Midwestern health system from January 2014 to July 2019 were included. Unhoused status was determined by address field or ICD-10 code for homelessness (Z59.0). Demographics and ED visits were extracted from the electronic health record. Past medical history, ACEs, chief complaint (CC), length of stay (LOS), imaging, and labs were extracted by chart review. T-tests, chi square tests, and Fisher's exact tests were completed for each sub-analysis. Unhoused children with at least one additional ACE had higher odds of the following psychiatric disorders: depression (OR = 5.2, 95% CI = 3.4- 7.9), anxiety (OR = 3.4, 95% CI = 32.1-5.5), behavioral disorder (OR = 7.2, 95% CI = 35.1- 10.4), psychoses (OR = 6.0, 1.9-18.4), bipolar disorder (OR = 19.8, 95% CI = 34.6-84.9), suicidal ideation (OR = 8.0, 95% CI = 34.8-13.4), post-traumatic stress disorder (OR = 10.1, 95% CI = 35.4-18.6), and attention deficit hyperactive disorder (OR = 4.1, 3.0-5.7). Patients with additional documented ACEs were also more likely to have a prior psychiatric admission (p < 0.001). Unhoused children and adolescents with exposure to additional documented ACEs are more likely to have some serious psychiatric and medical diagnoses compared to other unhoused children.
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Affiliation(s)
- Eric J. Pan
- Department of Psychiatry & Behavioral Neurosciences, Northwestern University, Chicago, IL USA
| | - Jessica C. Liu
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Alexander C. Zha
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH USA
| | - Spencer S. Seballos
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland, OH USA
| | - Tatiana Falcone
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH USA
| | - Michael Phelan
- Emergency Services Institute, Cleveland Clinic, Cleveland, OH USA
| | - Jeremy Weleff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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Schwebel FJ, Richards DK, Andersson C, Larimer ME. A Cross-Cultural Comparison of Negative Alcohol-Related Consequences in the United States and Sweden: Measurement Invariance of the Rutgers Alcohol Problem Index. Assessment 2024; 31:899-907. [PMID: 37694379 DOI: 10.1177/10731911231195834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Commensurate measures of alcohol-related consequences across countries and cultures are critical for addressing the global burden of hazardous alcohol use. The Rutgers Alcohol Problem Index (RAPI), developed and validated in the United States, is a popular measure of alcohol problems. This study examined measurement invariance of the RAPI across samples of U.S. and Swedish high school seniors. Latent mean differences in alcohol problems across countries and differences in associations between alcohol problems with alcohol use and protective behavioral strategies (PBS) were also examined. The RAPI was scalar invariant. Swedish students reported fewer problems than U.S. students (latent mean difference = -0.19, p = .047). In both samples, the RAPI was positively correlated with alcohol use frequency and quantity (ps < .001), and negatively correlated with PBS use (ps < .05). Overall, the RAPI demonstrated measurement invariance, and we found evidence for its validity across samples of U.S. and Swedish high school seniors.
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Macleod SL, MacRae P, Pimenta J. Children in street situations' access to healthcare: qualitative findings from the Street Child World Cup 2022. BMJ Paediatr Open 2023; 7:e002101. [PMID: 38142059 DOI: 10.1136/bmjpo-2023-002101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/22/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Children in street situations (those who live or work on the street) are known to face barriers in accessing healthcare. METHODS The study combined a remote survey with 33 adult non-governmental organisation (NGO) staff members, in-depth interviews with staff members of 11 NGOs and 4 formerly street-connected adult young leaders and a questionnaire with 30 street-connected children from 15 countries participating in the Street Child World Cup event in Qatar in 2022. Data were analysed using thematic analysis. RESULTS The participating children have strong connections with supportive organisations and do tend to seek adult assistance when they are ill or injured, refuting the assertion of adult participants and the literature that children in street situations only seek healthcare in emergencies. Some barriers that children in street situations face when seeking healthcare are likely shared by other disadvantaged groups, including the cost of care, long waiting times, the quality of public healthcare and discrimination based on socioeconomic status. Children in street situations may face further discrimination based on assumptions about their lives, their appearance or hygiene levels. Identity documents are highlighted in the literature as a major barrier but seemed less important to the participants. Both adult and child participants emphasised the need for an accompanying adult to find appropriate services and be treated. CONCLUSIONS This study highlights the important work of organisations supporting street-connected children to access healthcare both during and after their time working or living on the street. It concludes that while some of the barriers to accessing healthcare that children in street situations face are not specific to this group, the absence of an adult caregiver differentiates many street-connected children from other disadvantaged groups. This also signals differences among children in street situations, with those with connections to family or organisations having more support.
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Affiliation(s)
| | - Pia MacRae
- Consortium for Street Children, London, UK
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Rogers CJ, Forster M, Sussman S, Steinberg J, Barrington-Trimis JL, Grigsby TJ, Unger JB. The Impact of Childhood Trauma on Problematic Alcohol and Drug Use Trajectories and the Moderating Role of Social Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2829. [PMID: 36833526 PMCID: PMC9957226 DOI: 10.3390/ijerph20042829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Adverse childhood experiences (ACE) have a strong association with alcohol and drug use; however, more research is needed to identify protective factors for this association. The present study assesses the longitudinal impact of ACE on problematic alcohol and drug use and the potential moderating effect of perceived social support. Data (n = 1404) are from a sample of Hispanic youth surveyed in high school through young adulthood. Linear growth curve models assessed the effect of ACE and perceived social support over time on problematic alcohol and drug use. Results indicated youth with ACE (vs. those without ACE) report more problematic alcohol and drug use in adolescence and have increased rates into young adulthood. Additionally, findings suggest that social support in high school may moderate the effects of ACE on problematic use over time. Among youth with high levels of support, the association of ACE with problematic alcohol and drug use was diminished. Although ACE can have a persistent impact on problematic alcohol and drug use from adolescence into adulthood, high social support during adolescence may mitigate the negative effects of ACE, lowering early problematic alcohol and drug use, offering the potential for lasting benefits.
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Affiliation(s)
- Christopher J. Rogers
- Department of Health Sciences, California State University, Northridge, CA 91330, USA
| | - Myriam Forster
- Department of Health Sciences, California State University, Northridge, CA 91330, USA
| | - Steven Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Jane Steinberg
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Jessica L. Barrington-Trimis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
| | - Timothy J. Grigsby
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV 89154, USA
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90007, USA
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Wilson C, Parke S, VanDeusen TC, Millard H, Qayyum Z, Kim HJ. Systems of Care for Transitional-Age Youth With Severe Mental Illness. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20220527-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chassman S, Barman-Adhikari A, Hsu HT, Ferguson KM, Narendorf SC, Maria DS, Shelton J, Petering R, Bender K. Prevalence and Correlates of Illicit Substance Use Among Young Adults Experiencing Homelessness in Seven Cities Across the United States. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426211049355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Young adults experiencing homelessness (YAEH) engage in substantially higher substance use rates than housed young adults. This current study builds on previous research by investigating the prevalence of and salient correlates of illicit substance use across a seven-city sample. Methods This study used the Homeless Youth Risk and Resiliency Survey (HYRRS) dataset, n=1426 Young adults experiencing homelessness to study patterns and correlates of illicit substance use. Results Multivariate logistic regression analyses were used to assess correlates of substance use. Study site, age, gender identity, sexual orientation, history of suicidal ideation, use of specific substances, and trading sex for drugs were associated with five types of illicit substance use (ecstasy, cocaine, crack, methamphetamine, and injection drug use). Conclusion Findings indicate that substance use interventions for YAEH must be multifaceted, addressing illicit and multiple substance use, along with the myriad factors associated with substance use among this at-risk group.
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Affiliation(s)
| | | | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, MO, USA
| | | | - Sarah C. Narendorf
- Graduate College of Social Work, University of Houston, Houston, TX, USA
| | - Diane Santa Maria
- Department of Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jama Shelton
- Silberman School of Social Work at Hunter College, New York, NY, USA
| | | | - Kimberly Bender
- Graduate School of Social Work, University of Denver, Denver, CO, USA
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Santa Maria D, Lightfoot M, Nyamathi A, Businelle M, Paul M, Quadri Y, Padhye N, Jones J, Calvo Armijo M. A Nurse Case Management HIV Prevention Intervention (Come As You Are) for Youth Experiencing Homelessness: Protocol for a Randomized Wait-list Controlled Trial. JMIR Res Protoc 2021; 10:e26716. [PMID: 34018967 PMCID: PMC8178739 DOI: 10.2196/26716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/29/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Youth experiencing homelessness are more likely than housed youth to experience premature death, suicide, drug overdose, pregnancy, substance use, and mental illness. Yet while youth experiencing homelessness are 6 to 12 times more likely to become infected with HIV than housed youth, with HIV prevalence as high as 16%, many do not access the prevention services they need. Despite adversities, youth experiencing homelessness are interested in health promotion programs, can be recruited and retained in interventions and research studies, and demonstrate improved outcomes when programs are tailored and relevant to them. Objective The study aims to compare the efficacy of a nurse case management HIV prevention and care intervention, titled Come As You Are, with that of usual care among youth experiencing homelessness aged 16 to 25 years. Methods The study is designed as a 2-armed randomized wait-list controlled trial. Participants (n=450) will be recruited and followed up for 9 months after the intervention for a total study period of 12 months. Come As You Are combines nurse case management with a smartphone-based daily ecological momentary assessment to develop participant-driven HIV prevention behavioral goals that can be monitored in real-time. Youth in the city of Houston, Texas will be recruited from drop-in centers, shelters, street outreach programs, youth-serving organizations, and clinics. Results Institutional review board approval (Committee for the Protection of Human Subjects, University of Texas Health Science Center at Houston) was obtained in November 2018. The first participant was enrolled in November 2019. Data collection is ongoing. To date, 123 participants have consented to participate in the study, 89 have been enrolled, and 15 have completed their final follow-up. Conclusions There is a paucity of HIV prevention research regarding youth experiencing homelessness. Novel and scalable interventions that address the full continuum of behavioral and biomedical HIV prevention are needed. This study will determine whether a personalized and mobile HIV prevention approach can reduce HIV risk among a hard-to-reach, transient population of youth at high risk. International Registered Report Identifier (IRRID) DERR1-10.2196/26716
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Affiliation(s)
- Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies and UCSF Prevention Research Center, University of California San Francisco, San Francisco, CA, United States
| | - Adey Nyamathi
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, United States
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Mary Paul
- Baylor College of Medicine, Houston, TX, United States
| | - Yasmeen Quadri
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Nikhil Padhye
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Jones
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Margarita Calvo Armijo
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
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Haile K, Umer H, Ayano G, Fejo E, Fanta T. A qualitative exploration of substance misuse among homeless women in Addis Ababa, Ethiopia. BMC Psychiatry 2020; 20:204. [PMID: 32375717 PMCID: PMC7203867 DOI: 10.1186/s12888-020-02626-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/27/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Substance use among homeless people is higher compared to the general population. In some studies, reported rates of problematic drug use among the homeless vary, with estimates ranging from 25 to 70%. There is a common perception that substance abuse and homelessness are linked, but there is considerable debate about the direction of the relationship. Despite observations of high levels of substance use among the homeless population in Addis Ababa, there are limited studies to date conducted on the topic. This study aims to explore the factors associated with onset of substance use and its continued use, patterns of substance use and its social and health consequences among female residents of a shelter in Addis Ababa, Ethiopia. METHODS A qualitative study was conducted in 2019. In-depth interviews were conducted on 14 study participants who were selected purposively. The qualitative data analysis software QDA Miner 5.0.30 was used for data processing and analysis. RESULTS Four major thematic areas were identified and they comprised the categories under which sub-themes were identified and coded. The major segments or categories included the following: reasons for the onset of substance use after becoming homeless, experiences of substance use and reasons for continued use, the harms which resulted on them from substance use, and the means of obtaining supply of the substances. CONCLUSION Factors related to life on streets were strong reasons for onset of substance use, as well as for its continued use. Homeless women suffered untimely death, addiction, and ill health from use of substances; however, they gave priority to obtaining substances than any other thing, and used every means to grab a supply of the substances.
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Affiliation(s)
- Kibrom Haile
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
| | - Halima Umer
- Clinical Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Getinet Ayano
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Edao Fejo
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Tolesa Fanta
- Research and Training Department, St Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
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Hagen AEF, Battista SR, Couture ME, Pencer AH, Stewart SH. The Effects of Alcohol and Depressive Symptoms on Positive and Negative Post-Event Rumination in Social Anxiety. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10100-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Beharry MS, Christensen R. Homelessness in Pediatric Populations: Strategies for Prevention, Assistance, and Advocacy. Pediatr Clin North Am 2020; 67:357-372. [PMID: 32122565 DOI: 10.1016/j.pcl.2019.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent data indicate that homelessness among pediatric and adolescent populations is significantly higher than previous studies and point-in-time counts indicate. Pediatricians and other health care providers often see children and youth who are at risk of or are currently experiencing homelessness, but may not be aware of their status. This article summarizes current definitions of homelessness and data on common health issues for pediatric patients. Information on how to recognize and help those experiencing homelessness as well as areas for continued advocacy is shared.
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Affiliation(s)
- Meera S Beharry
- Adolescent Medicine, McLane Children's Medical Center, McLane Children's Specialty Clinic, Baylor Scott and White, 1901 SW H.K. Dodgen Loop, MS-CK-300, Building 300, Temple, TX 76502, USA; Texas A&M Health Science Center (Affiliate), Temple, TX, USA.
| | - Randal Christensen
- Randal Christensen Consulting, LLC, 2654 W Horizon Ridge Parkway Suite B5-113, Henderson, NV 89052, USA. https://twitter.com/AskMeWhyIHurt
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Park T, Thompson K, Wekerle C, Al-Hamdani M, Smith S, Hudson A, Goldstein A, Stewart SH. Posttraumatic Stress Symptoms and Coping Motives Mediate the Association Between Childhood Maltreatment and Alcohol Problems. J Trauma Stress 2019; 32:918-926. [PMID: 31742776 DOI: 10.1002/jts.22467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/15/2019] [Accepted: 03/26/2019] [Indexed: 11/12/2022]
Abstract
Childhood maltreatment is associated with increased risk of alcohol misuse. Posttraumatic stress symptoms (PTSS) and coping motives have both been identified, separately, as mediators of the relation between childhood maltreatment and alcohol misuse but have yet to be examined as serial mediators in a high-risk population. A total of 564 adolescents (53.7% female; M age = 15.9 years, SD = 1.1) in the care of child welfare services completed validated measures of childhood trauma, PTSS, drinking motives, and alcohol misuse across the first two waves (baseline and 6-month follow-up) of the Maltreatment and Adolescent Pathways (MAP) longitudinal study. Childhood maltreatment was associated with elevated PTSS, PTSS predicted higher coping motives, and coping motives were associated with higher levels of alcohol misuse, indirect effect (IE) = 0.03; 95% CI [0.00, 0.07]. Single mediator models with PTSS, IE = 0.03; 95% CI [-0.01, 0.05], and coping motives, IE = -0.02, 95% CI [-0.05, 0.03], as mediators were not statistically significant. The results suggest that PTSS and coping motives contribute sequentially to the association between childhood maltreatment and alcohol misuse and could thus both serve as intervention targets to prevent problem drinking in maltreated youth.
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Affiliation(s)
- Tristan Park
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kara Thompson
- Department of Psychology St. Francis University, Antigonish, Nova Scotia, Canada
| | - Christine Wekerle
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mohammed Al-Hamdani
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Savanah Smith
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Hudson
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Abby Goldstein
- Department of Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Sherry H Stewart
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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Shono Y, Ames SL, Edwards MC, Stacy AW. The Rutgers Alcohol Problem Index for Adolescent Alcohol and Drug Problems: A Comprehensive Modern Psychometric Study. J Stud Alcohol Drugs 2019. [PMID: 30079883 DOI: 10.15288/jsad.2018.79.658] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The Rutgers Alcohol Problem Index (RAPI) has been used extensively as a measure of alcohol-related problems experienced by adolescents and young adults. The present study aimed to comprehensively examine the psychometric profile and criterion-related validity of an 18-item RAPI adapted to measure negative consequences resulting from alcohol and other drug use in an at-risk adolescent population. METHOD Categorical confirmatory factor analysis and the graded response model were used for evaluations of the latent factor structure, item properties, test information, and item invariance across gender, age groups (middle vs. late adolescence), and drug use profiles (readily available drugs vs. other illicit drugs), as well as computation of the item response theory scale scores for each of 617 alternative high school students (44% female). RESULTS A reduced set of 16 RAPI items provided plausible evidence of unidimensionality and good measurement precision at a relatively wide range of the latent trait continuum. All but two items were invariant across the drug use profiles. The other illicit drug group had higher levels of the latent substance-related problems than the readily available drug group. Criterion-related validity was supported using a measure of past-year polysubstance use. CONCLUSIONS The RAPI can be effectively modified to measure negative consequences resulting from alcohol and other drug use and reflects a sufficiently wide range of the latent continuum of problem use.
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Affiliation(s)
- Yusuke Shono
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Susan L Ames
- School of Community and Global Health, Claremont Graduate University, Claremont, California
| | | | - Alan W Stacy
- School of Community and Global Health, Claremont Graduate University, Claremont, California
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Substance use off and on school grounds: A California statewide comparison between different groups of homeless students and nonhomeless students. Addict Behav 2019; 92:141-147. [PMID: 30640145 DOI: 10.1016/j.addbeh.2018.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 11/20/2022]
Abstract
About 1.3 million homeless students attend schools across the US, yet little is known about their substance use patterns, especially substance use on school grounds. The objectives of this study were to examine differences in substance use on and off school grounds between nonsheltered homeless, sheltered homeless, and nonhomeless public school students, and to examine the relationship between homelessness and substance use in school. Data were from a statewide representative sample from the California Healthy Kids Survey collected in 2011-2013, (n = 390,028). Bivariate and multivariate analyses were applied. Findings show that compared to nonhomeless students, homeless students, both sheltered and nonsheltered, reported higher rates of age at first time of use under the age of 10, and recent substance use, for an array of substances, indulging alcohol, cigarettes, marijuana and other illegal drugs. Additionally about 50% of nonsheltered homeless students, and 15% of sheltered homeless students reported having used substances in school in the past 30 days. Results from logistic regressions indicate that homelessness is associated with substance use in school. Particularly, nonsheltered homeless students were 17.41, 12.09, 11.36 and 17.59 times more likely to report smoking cigarettes, drinking alcohol, using marijuana and using other illegal drugs (respectively) in school in the past 30 days, compared to nonhomeless students. Sheltered homeless students were also more likely to use substances in school compared to nonhomeless students, but less likely compared to nonsheltered students. Findings highlight the need to develop differentiated school-based responses to each homeless subgroup and have conceptual, scientific and policy implications.
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Milburn NG, Stein JA, Lopez SA, Hilberg AM, Veprinsky A, Arnold EM, Desmond KA, Branson K, Lee A, Bath E, Amani B, Comulada WS. Trauma, Family Factors and the Mental Health of Homeless Adolescents. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:37-47. [PMID: 32318178 PMCID: PMC7163862 DOI: 10.1007/s40653-017-0157-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Family factors, such as poor family functioning and trauma, have been associated with negative outcomes for homeless adolescents. Further study is needed to better understand how family factors and trauma jointly relate to mental health problems and externalizing behaviors among homeless adolescents. Structural equation modeling was used to examine the influence of trauma (encompassing traumatic events experienced prior to, and after, becoming homeless) and family factors (poor family functioning and family conflict) on mental health problems and externalizing behaviors (substance use, delinquent behaviors, and sexual risk) among 201 homeless adolescents, ages 12 to 17 years. Trauma, poor family functioning, and family conflict significantly predicted greater mental health problems, delinquent behaviors, high-risk sexual behaviors and substance use. Overall, the findings suggest that family factors appear to be key to understanding mental health problems and externalizing behaviors among homeless adolescents. Implications, limitations and future directions are addressed.
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Affiliation(s)
- Norweeta G. Milburn
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA
| | - Judith A. Stein
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA USA
| | - Susana A. Lopez
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA
| | - Amanda M. Hilberg
- Department of Psychiatry and Behavioral Sciences, PGSP-Stanford PsyD Consortium, Palo Alto, CA USA
| | - Anna Veprinsky
- Department of Psychology, Old Dominion University, Norfolk, VA USA
| | - Elizabeth Mayfield Arnold
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Katherine A. Desmond
- Department of Public Policy, University of California at Los Angeles, Los Angeles, CA USA
| | - Katie Branson
- School of Nursing, University of California at Los Angeles, Los Angeles, CA USA
| | - Alex Lee
- School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Eraka Bath
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA
| | - Bita Amani
- College of Science and Health, Charles R. Drew University, Los Angeles, CA USA
| | - W. Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA
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Mochrie KD, Ellis JE, Whited MC. Does it Matter What We Drink? Beverage Type Preference Predicts Specific Alcohol-Related Negative Consequences Among College Students. Subst Use Misuse 2019; 54:899-907. [PMID: 30618337 DOI: 10.1080/10826084.2018.1549082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND College student substance use has been a problem for many years. In particular, heavy alcohol consumption can create issues with academics, social relationships, and overall functioning. Unitary measures of generic alcohol consumption (e.g., drinking frequency) are important predictors of alcohol-related negative consequences, but the small amount of specific-beverage research available suggests that assessing beverage type consumed may enhance prediction. OBJECTIVES The purpose of the present study was to expand knowledge of alcoholic beverage preference in relation to negative consequences and confirm the factor structure of the RAPI proposed by Martens et al. ( 2007 ) in a college student sample. METHODS In addition, the present study expanded current knowledge by assessing beverage preference type in relation to specific negative consequences on the RAPI. RESULTS Results replicated the three-factor structure originally found by Martens et al. ( 2007 ). Moreover, results found that individuals consuming shots of liquor or alcohol mixed with caffeine reported higher overall RAPI scores and higher scores on the Abuse/Dependence and Personal Consequences factors but not the Social Consequences factor than those consuming mixed drinks, beer, or wine. Conclusions/Importance: This research might inform discussions with incoming college freshman about not only alcohol consumption and negative consequences but the dangers of drinking specific types of alcohol beverages such as shots and/or alcohol mixed with caffeine.
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Affiliation(s)
- Kirk D Mochrie
- a Psychology , East Carolina University , Greenville , North Carolina , USA
| | - Jordan E Ellis
- a Psychology , East Carolina University , Greenville , North Carolina , USA
| | - Matthew C Whited
- a Psychology , East Carolina University , Greenville , North Carolina , USA
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Psychometric assessment of the marijuana adolescent problem inventory. Addict Behav 2018; 79:113-119. [PMID: 29288984 DOI: 10.1016/j.addbeh.2017.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 12/12/2017] [Indexed: 11/21/2022]
Abstract
Cannabis is one of the most commonly used psychoactive substances among adolescents in the United States. Adolescent cannabis use has multiple consequences including academic, health, and psychiatric problems. The Marijuana Adolescent Problem Inventory (MAPI) is a 23-item scale adapted from the Rutgers Alcohol Problem Index and used in the current literature to assess cannabis use problem severity. Psychometric testing for the MAPI has yet to be reported. The current investigation assessed the psychometric characteristics of the MAPI with cannabis-using adolescents (n=727) from school and outpatient settings who enrolled in five separate randomized clinical trials focused on treatment of substance use. Findings suggested that the MAPI is internally consistent and reliable. Factor structure analyses suggested that the MAPI measures one latent construct, with no differences in factor structure between the outpatient and school settings, supporting a one-factor model. External validity of the MAPI was also demonstrated as evidenced by significant relations with concurrent diagnosis of cannabis dependence and abuse, longitudinal frequency of cannabis use, and mean times used per day. Overall, this initial test of the psychometric characteristics of the MAPI suggests that it can be considered a reliable and valid measure of problems associated with cannabis use among adolescents. Future work is now needed to replicate these findings by testing the psychometric properties of the MAPI in more diverse samples and developing a short version to be used as a brief assessment tool.
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Santa Maria D, Padhye N, Yang Y, Gallardo K, Santos GM, Jung J, Businelle M. Drug use patterns and predictors among homeless youth: Results of an ecological momentary assessment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:551-560. [PMID: 29286835 DOI: 10.1080/00952990.2017.1407328] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Alcohol and drug use is associated with significant morbidity and mortality and is highly prevalent among homeless youth. Ecological Momentary Assessments (EMA) have been used to examine the effect of urges on drug use, though not among homeless youth. OBJECTIVES We assessed the patterns of drug use and the correlation between real-time contextual factors and drug use using EMA collected daily. We identified predictors of drug use among a sample of homeless youth 18-25 years old in Houston, Texas. METHODS Homeless youth (n = 66, 62% male) were recruited from a drop-in center between September 2015 and May 2016. We used generalized linear mixed models and cross-validation methods to determine the best predictive model of drug use. RESULTS The overall drug use was high: 61% and 32% of participants reported using drugs or alcohol at least one day, respectively. Marijuana and synthetic marijuana use (i.e., Kush, K2, incense packs) were reported most frequently; 86% and 13% of the total drug use EMAs, respectfully. Drug use urge was reported on 26% of days and was the highest on drug use days. Drug use was predicted by discrimination, pornography use, alcohol use, and urges for drugs, alcohol, and to steal. CONCLUSIONS EMA can be used to predict drug use among homeless youth. Drug use treatment among homeless youth should address the role of experiencing discrimination, pornography and alcohol use, and urge management strategies on drug use. Research is needed to determine if EMA informed just-in-time interventions targeting these predictors can reduce use.
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Affiliation(s)
- Diane Santa Maria
- a University of Texas Health Science Center , School of Nursing, Center for Nursing Research , Houston , TX , USA
| | - Nikhil Padhye
- a University of Texas Health Science Center , School of Nursing, Center for Nursing Research , Houston , TX , USA
| | - Yijiong Yang
- b University of Texas Health Science , Center School of Public Health , Houston , TX , USA
| | - Kathryn Gallardo
- b University of Texas Health Science , Center School of Public Health , Houston , TX , USA
| | - Glenn-Milo Santos
- c Department of Community Health Systems, University of California , San Francisco School of Nursing , San Francisco , CA , USA
| | | | - Michael Businelle
- e The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center , Oklahoma City , OK , USA
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Bowers A, Cleverley K, Di Clemente C, Henderson J. Transitional-aged youth perceptions of influential factors for substance-use change and treatment seeking. Patient Prefer Adherence 2017; 11:1939-1948. [PMID: 29200835 PMCID: PMC5703164 DOI: 10.2147/ppa.s145781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
There is an evident disparity between the number of youth who report experiencing problematic substance use and the number who seek treatment. To address this disparity, it is important to understand the reasons youth do and do not seek substance use treatment. Using qualitative data obtained from semistructured interviews with 31 youth aged 17-25 years presenting for treatment at a mental health hospital, the current study identifies themes in the factors that youth identify as having influenced them to seek or delay treatment. In alignment with self-determination theory, youth identified internal factors, such as wanting to better their academic, social, or financial situation, and external factors, such as familial pressure, as motivating them to seek treatment. Factors beyond those encompassed by self-determination theory were also revealed as having influenced youth decisions to seek treatment for substance abuse. These predominantly included structural factors, including satisfaction with previous treatment, accessibility of services, and availability of clinicians. These findings provide important insight for first-contact professionals and service providers looking to enhance youth motivation to seek and engage in treatment. Limitations and opportunities for future research are discussed.
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Affiliation(s)
- Anna Bowers
- Centre for Addiction and Mental Health
- University of Toronto, Toronto, ON, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health
- University of Toronto, Toronto, ON, Canada
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Guo X, Slesnick N. Reductions in Hard Drug Use Among Homeless Youth Receiving a Strength-Based Outreach Intervention: Comparing the Long-Term Effects of Shelter Linkage Versus Drop-in Center Linkage. Subst Use Misuse 2017; 52:905-915. [PMID: 28426359 DOI: 10.1080/10826084.2016.1267219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The current study sought to test hard drug use outcomes for youth receiving a strengths-based outreach and advocacy intervention that linked youth to either a shelter or a drop-in center. METHODS Homeless youth (14-24 years old) were engaged by research assistants (RAs) at soup kitchens, parks, libraries, and other locations that homeless youth were known to frequent. Youth were randomly assigned to receive six months of advocacy that focused on linking youth to a drop-in center (n = 40) or to a crisis shelter (n = 39). Follow-up assessments were conducted at 3, 6, and 9 months post-baseline. Hard drug use over time was the main outcome. Intervention condition and service connection were used as predictors for the baseline level and the slope of change in hard drug use over time. Data analysis was conducted with Bernoulli Hierarchical Generalized Linear Modeling in HLM7. RESULTS The current study found that those who were in the drop-in linkage condition exhibited a greater reduction in their odds of using hard drugs during the follow-up points than their counterparts in the shelter linkage condition. And finally, those who utilized services more often during the follow-ups were those who exhibited less hard drug use at baseline and less reduction in their odds of using hard drugs. CONCLUSIONS This study suggests that drop-in centers, which are often characterized by low-demand programming and few behavioral restrictions, are effective for addressing hard drug use among homeless youth.
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Affiliation(s)
- Xiamei Guo
- a Institute of Psychology, Xiamen University , Xiamen , China
| | - Natasha Slesnick
- b Department of Human Sciences , The Ohio State University , Columbus , Ohio , USA
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Angelone DJ, Marcantonio T, Melillo J. An Evaluation of Adolescent and Young Adult (Re)Victimization Experiences: Problematic Substance Use and Negative Consequences. Violence Against Women 2017; 24:586-602. [PMID: 29332494 DOI: 10.1177/1077801217710001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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The Prospective Association Between Sleep and Initiation of Substance Use in Young Adolescents. J Adolesc Health 2017; 60:154-160. [PMID: 27769761 PMCID: PMC5516896 DOI: 10.1016/j.jadohealth.2016.08.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE This study aimed to determine the unique utility of poor sleep health in predicting the onset of substance use in adolescents. METHODS Middle school students (N = 829, mean (M)age = 12.6 years, 52% female, 73% white) who participated in an ongoing prospective study of alcohol onset and progression completed a set of Web-based health behavior surveys over a 4-year period, with recruitment beginning in 2009. Surveys included assessments of alcohol, cigarette, and marijuana use as well as sleep duration, bedtime delay (from weekdays to weekends), and daytime sleepiness. Data were analyzed using discrete-time Cox Proportional hazard's regression. RESULTS Controlling for participant age at sleep assessment, gender, and internalizing and externalizing behaviors, shorter sleep duration and greater daytime sleepiness in year 1 were associated with increased odds of having had a full drink of alcohol, having engaged in heavy episodic drinking, and having experienced alcohol-related consequences by year 4. Shorter sleep duration was also associated with increased odds of marijuana use by year 4. No sleep parameter was uniquely associated with increased odds of cigarette use (first puff or first full cigarette). Effects were evident for both males and females. Age at sleep assessment did not moderate effects. CONCLUSIONS Sleep health is a prospective predictor of the onset of alcohol and marijuana use among adolescents. Increased efforts to prevent and intervene in sleep problems among adolescents are warranted.
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Wolitzky-Taylor K, McBeth J, Guillot CR, Stone MD, Kirkpatrick MG, Zvolensky MJ, Buckner JD, Leventhal AM. Transdiagnostic processes linking anxiety symptoms and substance use problems among adolescents. J Addict Dis 2016; 35:266-277. [PMID: 27431313 DOI: 10.1080/10550887.2016.1207969] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Numerous anxiety syndromes co-occur with substance use problems in adolescents, though the mechanisms underlying these comorbidities are not well understood. There are 3 transdiagnostic processes-anxiety sensitivity (fear of anxiety-related sensations), distress tolerance (capacity to withstand emotional distress), and negative urgency (propensity to respond impulsively to negative emotion)-that have been implicated in various anxiety and substance use problems. To examine whether anxiety sensitivity, distress tolerance, and negative urgency statistically mediated relations between symptoms of 3 different anxiety disorders (social anxiety, generalized anxiety, and panic disorders) and alcohol and cannabis use problems, cross-sectional analysis of high school students in Los Angeles (N = 3002) was assessed via paper and pencil questionnaires. When mediators were entered simultaneously, negative urgency accounted for a significant 33 to 85% of the covariance between anxiety symptomatology and substance use problems over and above the other trandiagnostic processes. This pattern was consistent across all 3 anxiety syndromes and both alcohol and cannabis problems. Anxiety sensitivity and distress tolerance did not account for positive associations between anxiety symptoms and substance use problems. Negative urgency may be an important mechanism underlying the relationship between various types of anxiety and substance use problems in adolescence, and thus represents a possible target for preventive interventions targeting adolescent anxiety and substance use.
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Affiliation(s)
| | - Julia McBeth
- b University of Southern California , Los Angeles , California , USA
| | - Casey R Guillot
- b University of Southern California , Los Angeles , California , USA
| | - Matthew D Stone
- b University of Southern California , Los Angeles , California , USA
| | | | | | - Julia D Buckner
- d Louisiana State University , Baton Rouge , Louisiana , USA
| | - Adam M Leventhal
- b University of Southern California , Los Angeles , California , USA
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Sulkowski ML. THE STUDENT HOMELESSNESS CRISIS AND THE ROLE OF SCHOOL PSYCHOLOGY: MISSED OPPORTUNITIES, ROOM FOR IMPROVEMENT, AND FUTURE DIRECTIONS. PSYCHOLOGY IN THE SCHOOLS 2016. [DOI: 10.1002/pits.21936] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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The structure of the UPPS-R-Child impulsivity scale and its relations with substance use outcomes among treatment-seeking adolescents. Drug Alcohol Depend 2016; 161:276-83. [PMID: 26905208 PMCID: PMC4799694 DOI: 10.1016/j.drugalcdep.2016.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/01/2016] [Accepted: 02/05/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND A youth version of the UPPS Impulsivity Scale (UPPS-R-C) was previously shown to predict drinking initiation among pre-adolescents. The goals of the current study were to confirm the structure of the UPPS-R-C using a sample of treatment-seeking adolescents and to examine the scales' relations with alcohol use, marijuana use, and problems related to substance use. METHOD Participants (N=120; ages 12-18; M=15.7) completed questionnaires at treatment intake. Confirmatory factor analysis (CFA) of the UPPS-R-C was conducted using a 5-factor model with factors corresponding to negative urgency, positive urgency, lack of perseverance, lack of premeditation, and sensation seeking. Relations between UPPS-R-C factors and binge drinking, marijuana use, and problems resulting from substance use were examined using path analysis. RESULTS CFA suggested the 5-factor model provided adequate fit to the data. The hypothesized path model was partially supported, positive urgency was associated with frequency of binge drinking, and both negative urgency and frequency of binge drinking was associated with problems due to substance use. Other hypothesized paths were not significant. Although not hypothesized, negative urgency was associated with frequency of marijuana use and lack of perseverance was associated with problems due to use. CONCLUSIONS Results suggest that the UPPS-R-C can be used with a treatment-seeking sample of adolescents. Furthermore, negative urgency, positive urgency, and lack of perseverance may be indicative of more severe substance use problems in a treatment setting.
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Serafini K, Shipley L, Stewart DG. Motivation and substance use outcomes among adolescents in a school-based intervention. Addict Behav 2016; 53:74-9. [PMID: 26458191 DOI: 10.1016/j.addbeh.2015.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 08/03/2015] [Accepted: 10/03/2015] [Indexed: 11/16/2022]
Abstract
The stages of change (Precontemplation, Contemplation, Preparation, Action, and Maintenance) have been well studied in adult populations. However, fewer studies have examined how the stages of change are related to adolescent substance use. Furthermore, there have been no studies that have examined how the stages of change relate to outcomes in a school-based intervention. To better capture adolescent motivation, we added an additional group to the Transtheoretical Model of Change, which we titled Coerced Action, to represent adolescents that made changes to their substance use despite low problem recognition (representing the internal motivation of Precontemplation and the change behaviors of the Action group). We then examined how the stages of change were related to a thorough assessment of substance use at baseline and corresponding treatment outcomes. Our sample consisted of 264 adolescents (mean age: 16.1, 44.5% Caucasian, 37.5% female) who participated in an 8-week, school-based Motivational Enhancement intervention. Results indicated significant group differences across the stages of change in substance use patterns (alcohol use, negative consequences, affective dysregulation), as well as treatment outcomes (alcohol use and negative consequences). For instance, adolescents in the Action group demonstrated more negative consequences at 16weeks follow-up than those in Precontemplation and Coerced Action, F(1, 3)=8.23, p<.001. The Coerced Action group reported the most alcohol use at 16weeks follow-up, although the finding was not significant when post-hoc tests were conducted. This study provides meaningful support for the assessment of motivation among adolescent substance users within school-based settings.
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Affiliation(s)
- Kelly Serafini
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States.
| | - Leandra Shipley
- VA Puget Sound Health Care System, Seattle, WA 98108, United States
| | - David G Stewart
- Seattle Pacific University, Department of Clinical Psychology, Seattle, WA 98119, United States
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Grigsby TJ, Forster M, Soto DW, Baezconde-Garbanati L, Unger JB. Problematic substance use among Hispanic adolescents and young adults: implications for prevention efforts. Subst Use Misuse 2014; 49:1025-38. [PMID: 24779502 PMCID: PMC4174412 DOI: 10.3109/10826084.2013.852585] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Using data collected between 2005 and 2012 from a longitudinal study of acculturation patterns and substance use among Hispanic youth in Southern California (N = 2722), we fit multivariate logistic regression models to estimate the association of type and frequency of drug use, friend and parent drug use, cultural orientation (measured by the ARSMA-II), and psychological distress (CES-D score) in 10th grade with problematic substance use (measured with the RAPI) in (i) 11th grade and (ii) young adulthood. We conclude that future intervention efforts with Hispanic adolescents and young adults should target polysubstance and problem users and emphasize inter-individual, structural, and cultural processes as they relate to problematic substance use.
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Affiliation(s)
- Timothy J. Grigsby
- Institute for Health Promotion and Disease Prevention, Keck School of Medicine, University of Southern California
| | - Myriam Forster
- Institute for Health Promotion and Disease Prevention, Keck School of Medicine, University of Southern California
| | - Daniel W. Soto
- Institute for Health Promotion and Disease Prevention, Keck School of Medicine, University of Southern California
| | - Lourdes Baezconde-Garbanati
- Institute for Health Promotion and Disease Prevention, Keck School of Medicine, University of Southern California
| | - Jennifer B. Unger
- Institute for Health Promotion and Disease Prevention, Keck School of Medicine, University of Southern California
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The health diagnoses of homeless adolescents: a systematic review of the literature. J Adolesc 2014; 37:531-42. [PMID: 24931556 DOI: 10.1016/j.adolescence.2014.04.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 03/17/2014] [Accepted: 04/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Homelessness during adolescence impacts negatively upon young people's physical and mental wellbeing. To be effective, programs aimed at addressing the health needs of this population must include knowledge of both the presenting and underlying acute and chronic conditions that characterise this high risk group of youth. METHODS We undertook a systematic review of the international literature for studies that used validated instruments and techniques to diagnose prevalence rates of physical and mental health disorders in homeless adolescents. RESULTS Twenty-one studies fulfilled the selection criteria. Of these, nine studies examined mental health diagnoses including depression, post-traumatic stress disorder, anxiety and substance abuse disorders. With one exception, the remaining twelve studies all related to sexually transmitted infections. CONCLUSION Homeless adolescents are diagnosed with widely varying rates of mental health disorders and high rates of sexually transmitted infection. Other likely chronic and acute physical conditions appear to be neglected in the published research.
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Grigsby TJ, Forster M, Baezconde-Garbanati L, Soto DW, Unger JB. Do adolescent drug use consequences predict externalizing and internalizing problems in emerging adulthood as well as traditional drug use measures in a Hispanic sample? Addict Behav 2014; 39:644-51. [PMID: 24345310 DOI: 10.1016/j.addbeh.2013.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 11/05/2013] [Accepted: 11/18/2013] [Indexed: 10/26/2022]
Abstract
The present study compares statistical models for three conceptualizations of drug use in 11th grade (past 30 day ever/never use, past 30 day frequency of drug use and past 30 day drug use consequences) with externalizing and internalizing problems in emerging adulthood when controlling for age, academic achievement and socioeconomic status in a Hispanic sample. Multivariate logistic regression models for the different drug use variables were compared when modeling weapon carrying, arrest, multiple lifetime sex partners, drug/alcohol use before sex and condom use in emerging adulthood. A multivariate linear regression model was used to model depression in emerging adulthood as a function of drug use measurement controlling for other covariates and depression in adolescence. Our findings suggest that any conceptualization of drug use will produce equitable results and model fit statistics when examining externalizing problems. However, when investigating internalizing problems, such as depression, lower frequency drug use-and not high frequency-was more strongly associated with depression whereas experiencing high levels of drug use consequences-and not low levels of consequences-was associated with depression in emerging adulthood despite similar model fit values. Variation between drug use and the experience of drug use consequences may lead to misspecification of "at-risk" subgroups of drug users. Implications and future directions are discussed.
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Testing the Conjoint Influence of Impulsivity and Drinking Restraint on Alcohol Use Consequences in College Student Drinkers. ADDICTIVE DISORDERS & THEIR TREATMENT 2013; 12:148-157. [PMID: 24078794 DOI: 10.1097/adt.0b013e31826ac3f4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Impulsivity and drinking restraint play a role in excessive drinking patterns and related negative consequences. Two domains of drinking restraint include preoccupation with thoughts of drinking (CEP) and attempts to control drinking (CBC), which differentially predict varying alcohol use outcomes in clinical and non-clinical samples. However, findings do not replicate across clinical, dependent samples and risky drinking young adults. This study examined the moderating role of dispositional impulsivity on the association between drinking restraint and alcohol consequences among college students to help clarify inconsistencies in the literature. METHODS Data were collected from a sample of college student drinkers (N = 393) on drinking behavior in the past 90 days, alcohol-related problems, dispositional impulsivity, and drinking restraint. RESULTS The association between CBC and alcohol consequences was significantly stronger for those higher than lower in dispositional impulsivity, after controlling for the effects of alcohol consumption. No such relationship was found for those high in trait temptation. CONCLUSIONS Alcohol consequences are greater among those who attempt to control their drinking and who act rashly and without consideration of future consequences; those who are high on trait temptation show no such relationship.
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McCarty CA, Wymbs BT, Mason WA, King KM, McCauley E, Baer J, Vander Stoep A. Early adolescent growth in depression and conduct problem symptoms as predictors of later substance use impairment. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2013; 41:1041-51. [PMID: 23624771 PMCID: PMC3758408 DOI: 10.1007/s10802-013-9752-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Most studies of adolescent substance use and psychological comorbidity have examined the contributions of conduct problems and depressive symptoms measured only at particular points-in-time. Yet, during adolescence, risk factors such as conduct problems and depression exist within a developmental context, and vary over time. Though internalizing and comorbid pathways to substance use have been theorized (Hussong et al. Psychology of Addictive Behaviors 25:390-404, 2011), the degree to which developmental increases in depressive symptoms and conduct problems elevate risk for substance use impairment among adolescents, in either an additive or potentially a synergistic fashion, is unclear. Using a school-based sample of 521 adolescents, we tested additive and synergistic influences of changes in depressive symptoms and conduct problems from 6th to 9th grade using parallel process growth curve modeling with latent interactions in the prediction of late adolescent (12th grade) substance use impairment, while examining gender as a moderator. We found that the interaction between growth in depression and conduct disorder symptoms uniquely predicted later substance use problems, in addition to main effects of each, across boys and girls. Results indicated that adolescents whose parents reported increases in both depression and conduct disorder symptoms from 6th to 9th grade reported the most substance use-related impairment in 12th grade. The current study demonstrates that patterns of depression and conduct problems (e.g., growth vs. decreasing) are likely more important than the static levels at any particular point-in-time in relation to substance use risk.
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Affiliation(s)
- Carolyn A McCarty
- Center for Child Health, Behavior, and Development, University of Washington and Seattle Children's Hospital, Seattle, WA 98145, USA.
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The Cross-Temporal Associations between Rumination Subtypes and Substance Use in Adolescence: Exploring the Moderating Role of Gender. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9373-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Drinking and Thinking: Alcohol Effects on Post-event Processing in Socially Anxious Individuals. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-013-9574-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Callous-unemotional traits as unique prospective risk factors for substance use in early adolescent boys and girls. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2012; 40:1099-110. [PMID: 22453863 DOI: 10.1007/s10802-012-9628-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Youth with elevated conduct disorder (CD) symptoms who also have callous-unemotional (CU) traits exhibit more antisocial behavior than youth without CU traits. However, evidence regarding whether CU traits increase risk of substance use over and above CD symptoms, and whether these associations differ for boys and girls, is scarce. Using the Developmental Pathways Project sample of 521 middle school students, we examined whether adolescent- and parent-reported CU traits measured in 6th grade prospectively predicted the onset and recurrence of substance use and use-related impairment by 9th grade. We also examined the degree to which CU traits uniquely predicted substance use and impairment over and above CD symptoms, as well as whether gender moderated these associations. Results indicated that adolescent-reported CU traits increased the likelihood of substance use and impairment onset and recurrence by 9th grade. Analyses revealed that CD symptoms accounted for prospective associations between adolescent-reported CU and substance use, but gender moderated these associations. Boys with elevated CU traits and CD symptoms were not more likely to report alcohol use onset or recurrence, but they were at highest risk of recurrent marijuana use, use of both alcohol and marijuana, and use-related impairment by 9th grade. Girls with low CU traits and high CD symptoms were most likely to report onset and recurrent use of alcohol, as well as recurrent marijuana use, use of both substances and impairment. Study findings highlight the importance of accounting for CD symptoms and gender when examining links between CU traits and substance use in early adolescence.
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Slesnick N, Guo X, Feng X. Change in parent- and child-reported internalizing and externalizing behaviors among substance abusing runaways: the effects of family and individual treatments. J Youth Adolesc 2012; 42:980-93. [PMID: 23054350 DOI: 10.1007/s10964-012-9826-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 09/21/2012] [Indexed: 11/28/2022]
Abstract
Shelter-recruited adolescents are known to have high rates of substance abuse and co-occurring internalizing and externalizing problem behaviors. Many studies have documented these mental health concerns, but only a small number of studies have tested interventions that may be useful for ameliorating these vulnerabilities. The current study compared three empirically supported psychotherapy interventions, Motivational Interviewing (MI), the Community Reinforcement Approach (CRA), and Ecologically-Based Family Therapy (EBFT) with 179 substance abusing runaway adolescents (47 % female, 74 % minority) and their primary caretaker recruited through a Midwestern runaway crisis shelter. Examining both child and primary caretaker reports, each treatment was associated with significant reductions in internalizing and externalizing behaviors to 24 months post-baseline. However, the trajectory of change differed among the treatments. Adolescents receiving MI showed a quicker reduction in internalizing and externalizing behaviors but also a quicker increase in these behaviors compared to adolescents receiving EBFT, who continued to evidence improvements to 24 months. The findings provide support for continued evaluation of these treatments for use with this vulnerable population of adolescents.
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Affiliation(s)
- Natasha Slesnick
- Department of Human Development and Family Science, The Ohio State University, 1787 Neil Ave, Columbus, OH 43210, USA.
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Edidin JP, Ganim Z, Hunter SJ, Karnik NS. The mental and physical health of homeless youth: a literature review. Child Psychiatry Hum Dev 2012; 43:354-75. [PMID: 22120422 DOI: 10.1007/s10578-011-0270-1] [Citation(s) in RCA: 188] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Youth homelessness is a growing concern in the United States. Despite difficulties studying this population due to inconsistent definitions of what it means to be a youth and homeless, the current body of research indicates that abuse, family breakdown, and disruptive family relationships are common contributing factors to youth homelessness. Moreover, the experience of homelessness appears to have numerous adverse implications and to affect neurocognitive development and academics, as well as mental and physical health. Substance use, sexually transmitted infections, and psychiatric disorders are particularly prevalent in this population. Whereas some of these problems may be short-lived, the chronic stress and deprivation associated with homelessness may have long-term effects on development and functioning. Further, difficulties accessing adequate and developmentally-appropriate health care contribute to more serious health concerns. Suggestions for future research and interventions are discussed.
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Affiliation(s)
- Jennifer P Edidin
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
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Black JJ, Tran GQ, Goldsmith AA, Thompson RD, Smith JP, Welge JA. Alcohol expectancies and social self-efficacy as mediators of differential intervention outcomes for college hazardous drinkers with social anxiety. Addict Behav 2012; 37:248-55. [PMID: 22112424 DOI: 10.1016/j.addbeh.2011.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 09/08/2011] [Accepted: 10/10/2011] [Indexed: 11/25/2022]
Abstract
The current pilot study examined the roles of two cognitive factors - positive alcohol expectancies of social anxiety reduction and drink refusal self-efficacy relevant to social situations - in mediating greater reduction in alcohol behaviors by the Brief Intervention for Socially Anxious Drinkers (BISAD; n=21) compared to an alcohol psychoeducation (n=20) in a sample of college hazardous drinkers with social anxiety. Mediation analysis results indicated that decreased positive alcohol expectancies and increased drink refusal self-efficacy relevant to social situations accounted for an average of 67% of the variance in treatment outcomes as measured by total quantity of alcohol consumption, heavy drinking days and problems related to alcohol use in the past month. Study results may enhance the understanding of cognitive factors' role in alcohol treatment outcomes, which could in turn improve the efficacy of interventions aimed to reduce hazardous drinking and comorbid social anxiety.
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Buckner JD, Ecker AH, Proctor SL. Social anxiety and alcohol problems: the roles of perceived descriptive and injunctive peer norms. J Anxiety Disord 2011; 25:631-8. [PMID: 21382688 DOI: 10.1016/j.janxdis.2011.02.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 11/20/2022]
Abstract
Although people with higher social anxiety (HSA) appear particularly vulnerable to alcohol-related problems it remains unclear why people with HSA experience such problems. One possibility is that HSA people's drinking behavior is influenced by their beliefs about others' drinking (i.e., descriptive norms) and/or others' approval of drinking (i.e., injunctive norms). The current study investigated the relationship between social anxiety, alcohol-related problems, drinking frequency and quantity, and descriptive and injunctive norms. The sample consisted of current drinkers with clinically elevated social anxiety (HSA; n=86) or lower social anxiety (LSA; n=86). Injunctive norms moderated the relationship between social anxiety group status and alcohol-related problems such that HSA participants with higher injunctive norms reported the most alcohol-related problems. Descriptive norms moderated the relationship between social anxiety and drinking quantity such that among participants with higher descriptive norms, LSA participants drank more than HSA participants.
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Affiliation(s)
- Julia D Buckner
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA 70808, USA.
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Dick DM, Aliev F, Viken R, Kaprio J, Rose RJ. Rutgers alcohol problem index scores at age 18 predict alcohol dependence diagnoses 7 years later. Alcohol Clin Exp Res 2011; 35:1011-1014. [PMID: 21323682 PMCID: PMC3083486 DOI: 10.1111/j.1530-0277.2010.01432.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND The Rutgers Alcohol Problem Index (RAPI) is widely used to assess adolescent drinking-related problems. We asked how well RAPI, administered in late adolescence, predicts alcohol diagnoses at age 25 in a 7-year follow-up. METHODS At age 18, a population-based sample of Finnish twins completed RAPI by postal questionnaire; 597 (300 male) twins, from pairs discordant and concordant for age 18 RAPI scores, were interviewed at age 25 with the SSAGA, yielding DSM-IIIR diagnoses. Polychoric correlations between RAPI and alcohol diagnoses and symptoms, the area under the response operator characteristic (ROC) curve, and the odds ratio of outcome diagnosis per unit change in adolescent RAPI were analyzed. Twin pairs discordant for both adolescent RAPI and adult diagnoses permitted within-family replications for the full sample and separately by sex. RESULTS Nearly half the interviewed twins met diagnostic criteria for alcohol dependency (46.2%) or abuse (1.5%). Age 18 RAPI scores significantly correlated with diagnoses (0.52) and symptom counts (0.55). ROC analysis found a 74% probability that adolescent RAPI scores will be higher among those with an alcohol diagnosis at age 25 than for those without. The odds ratio of outcome alcohol diagnosis per unit increase in adolescent 18 RAPI exceeded 10.0. Within-family comparisons of 117 twin pairs discordant for both age 18 RAPI and age 25 alcohol diagnoses replicated the between-family associations. In both between-family and within-family analyses, RAPI was more predictive of alcohol diagnoses among females. CONCLUSIONS Our results offer evidence, including that from informative comparisons of co-twins discordant for both predictor and outcome, that RAPI scores in late adolescence robustly predict alcohol diagnoses in early adulthood. Accordingly, our results also provide new evidence that one pathway to problem drinking in early adulthood is a direct one from problem drinking in adolescence.
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Affiliation(s)
| | - Fazil Aliev
- Virginia Commonwealth University, USA
- Ankara University, Turkey
| | | | - Jaakko Kaprio
- University of Helsinki & National Public Health Institute, Finland
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The Role of Social Anxiety in a Brief Alcohol Intervention for Heavy-Drinking College Students. J Cogn Psychother 2011. [DOI: 10.1891/0889-8391.25.1.7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Brief Alcohol Screening and Intervention for College Students (BASICS) reduces alcohol use and alcohol-related problems among undergraduates, yet variability in outcomes exists. Identifying individual difference variables related to outcomes could inform efforts to improve treatment protocols. The current study evaluated the role of social anxiety during BASICS. High socially anxious (HSA; n = 26) and low socially anxious (LSA; n = 44) heavy-drinking undergraduates were randomly assigned to BASICS (n = 38) or an assessment-only control (n = 32). HSA patients reported higher baseline alcohol consumption (typical drinks, weekly quantity, and frequency). BASICS significantly decreased weekly alcohol consumption and alcohol-related problems relative to the control group. Social anxiety moderated outcomes such that in the BASICS condition; HSA patients reported heavier typical drinks at posttest, even after controlling for referral status, baseline typical drinks, and trait anxiety. This was not the case in the control group. HSA patients may benefit from social anxiety-specific interventions during BASICS.
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McCarthy MD, Thompson SJ. Predictors of Trauma-Related Symptoms Among Runaway Adolescents. JOURNAL OF LOSS & TRAUMA 2010. [DOI: 10.1080/15325020903375842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bender K, Ferguson K, Thompson S, Komlo C, Pollio D. Factors associated with trauma and posttraumatic stress disorder among homeless youth in three U.S. cities: the importance of transience. J Trauma Stress 2010; 23:161-8. [PMID: 20146399 DOI: 10.1002/jts.20501] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Homeless youth experience disproportionately high rates of trauma and posttraumatic stress disorder (PTSD). This study examined correlates of trauma and PTSD among homeless youth with a focus on the impact of homeless culture, substance addiction, and mental health challenges. Homeless youth (N = 146) from Los Angeles, California, Denver, Colorado, and St. Louis, Missouri, were recruited from organizations providing services to homeless youth using comparable methods. Results indicate that 57% of respondents had experienced a traumatic event and 24% met criteria for PTSD. A multinomial logistic regression model revealed greater transience, alcohol addiction, mania, and lower self-efficacy predicted PTSD whereas trauma exposure was associated with alcohol addiction only. Findings have implications for screening and intervening with traumatized homeless youth across service settings.
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Affiliation(s)
- Kimberly Bender
- Graduate School of Social Work, University of Denver, Denver, CO 80208, USA.
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Hustad JTP, Carey KB, Carey MP, Maisto SA. Self-regulation, alcohol consumption, and consequences in college student heavy drinkers: a simultaneous latent growth analysis. J Stud Alcohol Drugs 2009; 70:373-82. [PMID: 19371488 DOI: 10.15288/jsad.2009.70.373] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Lower levels of self-regulation have been associated with higher rates of alcohol-related consequences. Self-regulation refers to the effortful ability to plan and achieve delayed adaptive outcomes through goal-directed behavior, and this skill may play a role in adaptive behavioral change. The purpose of this prospective, longitudinal study was to test predictions from self-regulation theory about the relationship among self-regulation and weekly alcohol consumption and alcohol-related consequences over 12 months. METHOD Participants were 170 heavy drinking college students who provided data on alcohol use and consequences at baseline and at 1-, 6-, and 12-month assessments. RESULTS Using a simultaneous latent growth model, self-regulation ability predicted the amount of initial alcohol-related consequences, the rate of change for alcohol-related consequences, and the rate of change for drinks per week. In contrast, self-regulation was not related to the initial level of alcohol use. CONCLUSIONS Collectively, these results suggest that lower self-regulation ability functions as a risk factor for experiencing alcohol-related consequences and attenuates naturally occurring reductions in alcohol use and consequences over time for heavier drinking college students.
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Affiliation(s)
- John T P Hustad
- Center for Health and Behavior, Syracuse University, Syracuse, New York 13244-2340, USA.
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