A daily calendar analysis of substance use and dating violence among high risk urban youth

Longitudinal Associations Between Adolescent Dating Violence Victimization and Adverse Outcomes: A Systematic Review

Evidence on the outcomes of adolescent dating violence (ADV) victimization mainly derives from cross-sectional studies, which have limitations in suggesting causal relationships. Furthermore, the complexity of factors and overlapping dimensions in dating violence research, such as the forms of violence experienced, may have contributed to the variability of findings across the literature. To address these gaps and provide a more comprehensive understanding of the impact of ADV, this study reviews findings from prospective cohort studies, with a focus on the type of violence experienced and the gender of the victim. A systematic search was conducted in nine electronic databases and additional relevant journals. Prospective longitudinal studies were included if dating violence victimization occurred during adolescence and chronologically preceded the outcomes. A quality assessment was conducted using the Mixed Methods Appraisal Tool. A narrative approach was used to synthesize findings. After screening 1,838 records, 14 publications met the selection criteria and were included in this review. Our findings suggest that experiencing ADV is longitudinally associated with many adverse outcomes, including higher internalizing symptoms and externalizing behaviors, poorer well-being, increased substance use, and increased revictimization. However, the associations are not consistently reported across studies when considering the type of ADV experienced and the gender of the victim. This review highlights the limited number of longitudinal studies examining the outcomes of ADV victimization, the unbalanced approach in investigating different forms of violence, and the lack of diverse samples examining this subject. Implications for research, policy, and practice are outlined.

The company you keep: The neglected role of affiliating with delinquent friends in the development of the cannabis-violence link

A growing body of research suggests a potential role of cannabis use on aggressive behaviors. In literature on adolescents, the lack of consideration of important confounders, such as adolescent's affiliation with delinquent peers, limits the possibility to determine whether there might be a direct or indirect link between cannabis use and aggression. Therefore, we sought to examine the effect of delinquent peers on the association between cannabis use and violence. We re-analyzed data from 850 ninth graders who were followed from mid-adolescence to early adulthood. Generalized Estimations Equations (GEE) were conducted to examine whether affiliation with delinquent peers may mediate the relationship between cannabis use and violence. Cross-Lagged Panel Models were also conducted to estimate the directionality of these relationships over time. We additionally tested whether similar relationships may be identifiable when examining rule-breaking behaviors and/or alcohol use. GEE models revealed that both cannabis use and affiliation with delinquent peers were statistically associated with aggressive behaviors. Cannabis use, alcohol use and delinquent peers also predicted rule-breaking behaviors. More precisely, cross-lagged models showed that affiliation with delinquent peers played a partially mediating role in the cannabis-aggression link, and that similar cross-lagged estimates were observed when examining rule-breaking behaviors instead of aggression. Our results indicate that cannabis use may be associated with aggression as well as rule-breaking behaviors, suggesting a broader effect on conduct problems. More importantly, our study highlights the non-negligible role of affiliating with delinquent peers during adolescence.

Experiencing violence and other predictors of within-person same-day use of multiple substances in youth: a longitudinal study in emergency settings

Background: Although experiencing violence is a risk factor for substance use among youth, its association with same-day use of multiple substances (a form of polysubstance use) and mitigating factors is less well understood.Objectives: To identify whether prosocial factors modified the effect of experiencing violence on the frequency of same-day use, and examine gender-specific risk/protective factors for same-day use.Methods: We analyzed longitudinal data from a cohort of youth who use drugs aged 14-24 (n = 599; 58% male) presenting to an urban emergency department between 2009-2011 and assessed biannually for two years. Using Poisson-generalized linear models with person-level fixed effects, we estimated within-person associations between self-reported experiencing violence and same-day use and analyzed gender and peer/parent support as effect modifiers. We adjusted for negative peer influence, parental drug and alcohol use, family conflict, anxiety and depression, and age.Results: Overall, positive parental support corresponded to lower rates of same-day use (rate ratio [RR]:0.93, 95% CI:0.87-0.99) and experiencing violence was associated with higher rates of same-day use (RR:1.25, 95% CI:1.10-1.41). Violence exposure was a risk factor among males (RR:1.42, 95% CI:1.21-1.66), while negative peer influences and parental substance use were risk factors among females (RR:1.63, 95% CI:1.36-1.97 and RR:1.58, 95% CI:1.35-1.83, respectively). Positive peer support reduced the association between violence exposure and same-day use among males (RR:0.69, 95% CI:0.57-0.84, p < .05).Conclusions: Tailored interventions may address gender differences in coping with experiencing violence - including interventions that promote parental support among males and reduce influence from parental substance use among females.

Combined use of cocaine and alcohol: A violent cocktail? A systematic review

It is generally believed that the use of alcohol and cocaine alone and especially in combination elicits aggression and violent behaviour. Though there is overwhelming proof that heavy alcohol use is associated with violence, this is not the case for cocaine. Still, in the popular press and by spokesmen of the police, cocaine use is seen as a cause of violent incidents. In the current systematic review, available data from human studies on the relation between cocaine and violent behaviour is presented. In particular, we present scientific data on the acute induction of violence by cocaine alone, as well as, that by the combination of cocaine and alcohol known to be frequently used simultaneously. RESULTS: show that there is only weak scientific evidence for the acute induction of violent behaviour by cocaine, either when used alone or in combination with alcohol. Based on these data we were also able to refute misconceptions about the relation between cocaine and violence published in the popular press and governmental reports, because it appeared that there was hardly any empirical support for this widely shared opinion. Probably, contextual factors, including cocaine use disorder and personality disorder, may better explain the assumed association between cocaine and violence.

Adaptive interventions for alcohol misuse and violent behaviors among adolescents and emerging adults in the emergency department: A sequential multiple assignment randomized controlled trial protocol

Alcohol use and violent behaviors among youth are associated with morbidity and mortality. An emergency department (ED) visit provides an opportunity to initiate prevention efforts. Despite promising findings from our single session SafERteens brief intervention (BI), impact is limited by modest effect sizes, with data lacking on optimal boosters to enhance effects. This paper describes the protocol for a sequential, multiple assignment, randomized trial (SMART). Adolescents and emerging adults (ages 14-20) in the ED screening positive for alcohol use and violent behaviors (physical aggression) were randomly assigned to: 1) SafERteens BI + Text Messaging (TM), or 2) SafERteens BI + remote Health Coach (HC). Participants completed weekly surveys over 8 weeks after the ED visit to tailor intervention content and measure mechanisms of change. At one-month, intervention response/non-response is determined (e.g., binge drinking or violent behaviors). Responders are re-randomized to continued intervention condition (e.g., maintenance) or minimized condition (e.g., stepped down). Non-responders are re-randomized to continued condition (e.g., maintenance), or intensified condition (e.g., stepped up). Outcomes were measured at 4 and 8 months, including primary outcomes of alcohol consumption and violence, with secondary outcomes of alcohol consequences and violence consequences. Although the original goal was to enroll 700 participants, COVID-19 impacts on research diminished recruitment in this trial (enrolled n = 400). Nonetheless, the proposed SMART is highly innovative by blending real-time assessment methodologies with adaptive intervention delivery among teens with comorbid alcohol misuse and violent behaviors. Findings will inform the content and timing booster interventions to alter risk behavior trajectories. Trial Registration:ClinicalTrials.govNCT03344666. University of Michigan # HUM00109156.

Daily Reports of Aggressive Behaviors in Interpersonal Conflicts

Interpersonal conflicts are inevitable, but the probability that conflicts involve aggressive behavior varies. Prior research that has tended to focus on victimization in intimate partnerships reported through retrospective designs. Addressing these limitations, the current study examines daily reports of behaving aggressively in any conflict across relationships in a sample of 512 young adults drawn from the nationally representative iCOR cohort. Respondent attitudes and affective measures were collected at the end of the daily data collection period. Regression methods were applied to examine the probability and frequency of aggression, investigating early and recent exposure to adversities, attitudes, self-control, affect and emotional states, and alcohol use behavior. Recent adversities and the propensity to endorse a defensive honor code attitude, consistent with theory and retrospective studies of aggression, predicted both prevalence and frequency of aggressive behavior. The associations of childhood maltreatment and self-control with the prevalence of behaving aggressively were as expected, but these constructs were significantly associated with the frequency of aggression with unexpected, inverse directionality. Moreover, respondents' affect and other emotional states were only associated with the frequency, not the prevalence, of aggressive behavior. Overall, this daily data collection constructively distinguished risk and protective factors for behaving aggressively more often. Further research is needed to disentangle the extent to which affective states drive or is a consequence of frequent aggressive behavior.

Directionality of Dating Violence Among High School Youth: Rates and Correlates by Gender and Sexual Orientation

Sexual minority adolescents are at greater risk for experiencing teen dating violence (TDV) in their dating relationships. Although adolescents in dating relationships often report experiencing and perpetrating various forms of TDV, the directionality of TDV based on youth's reported gender and sexual orientation is not known. A sample of 10th-grade students (N = 1,622) recruited from high schools in the Northeastern United States completed assessments of TDV victimization and perpetration and reported their past-month heavy alcohol use and marijuana use. Sexual minority girls (58%) and boys (36%) were more likely to experience TDV than heterosexual girls (38%) and boys (25%), respectively. Sexual minority boys were less likely, although the confidence intervals included one, to engage in dual-role physical TDV (odds ratio [OR] = 0.14, 95% confidence interval [CI] [0.00, 1.26]) and threatening TDV (OR = 0.14, 95% CI [0.00, 1.02]), and instead were more likely to be victimized. In contrast, the profiles of TDV were similar for girls, with sexual minority girls only being more likely than heterosexual girls to report dual-role physical TDV (OR = 2.23, 95% CI [1.07, 4.66]). Compared with unidirectional TDV, bidirectional TDV was significantly associated with sexual minority girls' substance use, but not with heterosexual girls' substance use. Sexual minority youth report higher rates of TDV, with sexual minority boys being distinctly at-risk for being victimized within their dating relationships. Engagement in both TDV victimization and perpetration was distinctly associated with substance use for sexual minority girls, highlighting the need for integrated prevention efforts and support.

Advances in clinical trials methodology: Intervention optimization approaches in emergency medicine

The classical two-arm randomized clinical trial (RCT) is designed to test the efficacy or effectiveness of an intervention, which may consist of one or more components. However, this approach does not enable the investigator to obtain information that is important in intervention development, such as which individual components of the intervention are efficacious, which are not and possibly should be removed, and whether any components interact. The Multiphase Optimization Strategy (MOST) is a new framework for development, optimization, and evaluation of interventions. MOST includes the RCT for purposes of evaluation, but inserts a phase of research before the RCT aimed at intervention optimization. The optimization phase requires one or more separate trials similar in scope to an RCT, but employing a different experimental design. The design of the optimization trial is selected strategically so as to maximize the amount of scientific information gained using the available resources. One consideration in selecting this experimental design is the type of intervention to be optimized. If a fixed intervention, i.e. one in which the same intervention content and intensity is provided to all participants, is to be optimized, a factorial experiment is often appropriate. If an adaptive intervention, i.e. one in which intervention content or intensity is varied in a principled manner, is to be optimized, a sequential multiple-assignment randomized trial (SMART) is often a good choice. The objective of this article is to describe MOST and the scientific rationale for its use; describe two current applications of MOST in emergency medicine research, one using a factorial experiment and the other using a SMART; and discuss funding strategies and potential future applications in studying the care of individuals with acute illness, injury, or behavioral disorders.

The gender symmetry problem in physical teen dating violence: A commentary and suggestions for a research agenda

Dating violence is a serious manifestation of harmful behaviour during adolescence. During the past decades, considerable research has shed light on patterns, causes, and consequences of dating violence. One of the most notable findings emerging from widely used survey instruments is that female adolescents report perpetrating physical dating violence more or equally frequently as male adolescents. Similarly, male youth appear to equally frequently report that they have been victims of physical dating violence as female adolescents. This commentary reviews issues emerging from the debate on gender symmetry in dating violence and proposes directions for future research. It suggests that future research needs to consider three interrelated issues to advance the field, namely: to improve the understanding of differences in harm, advance the knowledge of gender differences in the short-term dynamics involved in conflict and aggression, and strengthen the evidence base on shared and gender-specific developmental aetiologies of dating violence.

Time-varying associations of alcohol and cannabis use with intimate partner violence for black and white young women

BACKGROUND

Substance use is linked to increases in young women's risk for intimate partner violence (IPV). Increased understanding of the magnitude of and changes in the associations between substance use and risk for IPV in the transition to emerging adulthood, and differences between Black and White women, could inform efforts to protect women from substance use-related harm.

METHODS

Young women (N = 1,852; 59% Black, 41% White) in the Pittsburgh Girls Study completed yearly assessments at ages 17-21 on frequency of alcohol and cannabis use, and experiences of IPV (minor physical assault). Time-varying effect models (TVEMs) were used to examine changes in the strength of the association between frequency of alcohol and cannabis use with IPV across ages 17-21, controlling for time-invariant covariates (socioeconomic status, conduct problems, and depression).

RESULTS

Across ages 17 to 21, White, relative to Black, women reported more frequent alcohol use and less frequent cannabis use, and lower rates of IPV. Alcohol use was not significantly associated with IPV at ages 17-21 among White women, but among Black women, alcohol use was associated with increased likelihood of IPV at ages 17-20. Cannabis use was associated with increased likelihood of IPV at ages 19-21 among Black women, and at ages 20-21 among White women.

CONCLUSIONS

Associations between IPV (specifically minor assault) in the context of a romantic relationship differed for alcohol and cannabis across ages 17-21, and by race, among White and Black women. Results highlight the importance of substance-specific prevention efforts that are timed and tailored to subgroups.

Daily and situational reports of substance use and dating violence among college students: A 10-week prospective study

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Dating violence was nearly twice as likely if either partner drank alcohol.

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Women were nearly twice as apt to perpetrate dating violence when they used drugs.

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Men were 1.4 times more likely to perpetrate dating violence when they used drugs.

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Estimated blood alcohol level and binge drinking were related to dating violence.

Introduction

Although the association between substance use and dating violence is well-established in the research literature, there is limited research establishing the temporal co-occurrence of these variables. The primary objective was to examine the temporal relationship between alcohol and drug use and subsequent dating violence using a proximal effects model.

Methods

This prospective study obtained daily diary data and weekly situational reports on abusive relationship events and substance use from 72 college women in dating relationships over a 10-week interval.

Results

Significant day-to-day associations were found between substance use and dating violence for women’s reports of their own behavior, and that of their male partners. The odds of dating violence were approximately 2.0 times higher on days when perpetrators drank alcohol. Women were approximately 2.0 times more likely to perpetrate dating violence when using drugs, and men were approximately 1.4 times more likely when they used drugs. Estimated blood alcohol concentration levels and binge drinking were associated significantly with dating violence perpetration for women’s reports of men’s behavior as well as for women’s reports of their own aggression. These findings held when examining severe versus minor dating violence as well as any versus no dating violence.

Conclusions

These results further support an association between substance use and partner aggression at daily and situational levels of analysis, extending prior clinical findings to a college dating sample. Taken with previous research findings, our results suggest the need for college sexual assault and dating violence prevention programs to target reductions in substance use.

Testing Differential Item Functioning in Small Samples

Differential item functioning (DIF) is a pernicious statistical issue that can mask true group differences on a target latent construct. A considerable amount of research has focused on evaluating methods for testing DIF, such as using likelihood ratio tests in item response theory (IRT). Most of this research has focused on the asymptotic properties of DIF testing, in part because many latent variable methods require large samples to obtain stable parameter estimates. Much less research has evaluated these methods in small sample sizes despite the fact that many social and behavioral scientists frequently encounter small samples in practice. In this article, we examine the extent to which model complexity-the number of model parameters estimated simultaneously-affects the recovery of DIF in small samples. We compare three models that vary in complexity: logistic regression with sum scores, the 1-parameter logistic IRT model, and the 2-parameter logistic IRT model. We expected that logistic regression with sum scores and the 1-parameter logistic IRT model would more accurately estimate DIF because these models yielded more stable estimates despite being misspecified. Indeed, a simulation study and empirical example of adolescent substance use show that, even when data are generated from / assumed to be a 2-parameter logistic IRT, using parsimonious models in small samples leads to more powerful tests of DIF while adequately controlling for Type I error. We also provide evidence for minimum sample sizes needed to detect DIF, and we evaluate whether applying corrections for multiple testing is advisable. Finally, we provide recommendations for applied researchers who conduct DIF analyses in small samples.

Association Between the Use of Cannabis and Physical Violence in Youths: A Meta-Analytical Investigation

OBJECTIVE

The aim of this meta-analysis was to investigate the extent to which cannabis use among youths is associated with the risk of perpetrating physical violence.

METHODS

Searches were conducted in PubMed, PsycINFO, Web of Science, and Google Scholar for articles published from the inception of each database to July 2019. All studies that examined both cannabis use and the perpetration of physical violence in a sample of youths and young adults <30 years old were included. The meta-analysis was performed with a random-effects model. Risk of publication bias was assessed with Egger's test. Guidelines from the Meta-Analysis of Observational Studies in Epidemiology were followed.

RESULTS

After screening 11,348 potential studies, 30 study arms were included, yielding a total of 296,815 adolescents and young adults. The odds ratio for the pooled studies was 2.11 (95% CI=1.64, 2.72). The pooled odds ratios were 2.15 (95% CI=1.58, 2.94) and 2.02 (95% CI=1.26, 3.23) for the cross-sectional and longitudinal studies, respectively. Preliminary evidence suggests that the risk of violence was higher for persistent heavy users (odds ratio=2.81, 95% CI=1.68, 4.74) compared with past-year users (odds ratio=2.05, 95% CI=1.5, 2.8) and lifetime users (odds ratio=1.94, 95% CI=1.29, 2.93). The odds ratio for unadjusted studies was 2.62 (95% CI=1.89, 3.62), and for studies using odds ratios adjusted for potential confounding factors, 2.01 (95% CI=1.57, 2.56).

CONCLUSIONS

These results demonstrate a moderate association between cannabis use and physical violence, which remained significant regardless of study design and adjustment for confounding factors (i.e., socioeconomic factors, other substance use). Cannabis use in this population is a risk factor for violence.

Review of Medicinal Use of Cannabis Derivatives and the Societal Impact of Legalization

Background:

In recent past, there has been a rush to legalize marijuana along with a lot of support for its medicinal uses. This review intends to discuss the medicinal uses of marijuana and its adverse effects based on the current available evidence. Furthermore, it discusses the impact of legalization of marijuana.

Methodology:

This was a narrative review for which a thorough literature search was conducted on the Medline and PubMed databases. A detailed search of the Internet to find relevant information on webpages was also performed.

Results:

High-quality evidence for the majority of medical indications of marijuana remains investigational. Most of the available literature compares it against placebos. Postlegalization usage of marijuana has increased.

Conclusion:

It would be prudent to wait for studies which prove beyond doubt the advantages of marijuana over the existing drugs and also outweigh its side effects and addiction potential. Moreover, further legalization of marijuana should only be considered after evaluating its effects at places where it is already legally available.

Substance use and mental health predictors of patterns of non-partner youth violence among high-risk urban youth

OBJECTIVE

This study examined the association between baseline substance use and mental health, and non-partner violence trajectories among youth presenting to an urban emergency department who screened positive for drug use. Non-partner violence is physically violent victimization or aggression involving someone other than a dating partner.

METHODS

Group-based trajectory modeling was used to identify longitudinal trajectories of non-partner violence in N = 599 youth (14-24 years old) at baseline, 6, 12, 18 and 24 month follow-ups. Multinomial logistic regression analyses were used to examine associations between baseline substance use and mental health conditions (i.e., anxiety, depression, and post-traumatic stress disorder [PTSD]), and non-partner violence trajectories.

RESULTS

Six trajectory groups were identified for non-partner violence. Binge drinking and cannabis, illicit drug, nonmedical prescription stimulant, and polysubstance use in the 30 days leading up to their initial ED visit were associated with the likelihood of medium to high non-partner violence group membership during the two years following their ED visit. Post-traumatic stress disorder (PTSD) and depression/anxiety at baseline were also associated with greater risk of belonging to medium to high non-partner violence trajectory groups.

CONCLUSIONS

Our findings highlight distinct trajectories of violent behavior, with roughly 60 % of young adults belonging to one of the non-partner violence groups. Although general trajectory trends were of decreasing violent behavior, the constellation of baseline risk factors differentially predicted group membership. These findings indicate that violence does not operate in a vacuum; interventions to reduce violence should also address previous trauma, substance use, and mental health issues.

Unintentional drug overdose: Is more frequent use of non-prescribed buprenorphine associated with lower risk of overdose?

BACKGROUND

Unintentional drug overdoses have reached epidemic levels in the U.S. This study tests the hypothesis that people who have used non-prescribed buprenorphine more frequently in the past six months were less likely to experience a drug overdose during that same time period.

METHODS

Participants age 18 years or older with opioid use disorder who reported use of non-prescribed buprenorphine in the last six months were recruited from the Dayton, Ohio, area using a combination of targeted and modified respondent-driven sampling. Participants completed a structured interview, including six-month timeline follow-back, after informed consent. Logistic regression was used to test the association between (log-transformed) frequency of non-prescribed buprenorphine use and overdose in the previous six months, adjusted for confounding due to sex, homelessness, incarceration, substance use treatment, previous overdose, heroin/fentanyl injection, psychiatric comorbidity, and (log-transformed) frequencies of other (non-opioid) drug use.

RESULTS

Almost 89% of 356 participants were white, 50.3% were male, and 78.1% had high school or greater education. Over 27% (n = 98) reported experiencing an overdose in the past six months. After adjusting for confounding, greater frequency of non-prescribed buprenorphine use was significantly associated with lower risk of overdose (AOR = 0.81, 95% CI = 0.66, 0.98; p = .0286). Experiencing an overdose more than six months ago (AOR = 2.19, 95% CI = 1.24, 3.97); injection as the most common route of administration of heroin/fentanyl (AOR = 2.49, 95% CI = 1.36, 4.71); and frequency of methamphetamine use (AOR = 1.13, 95% CI = 1.02, 1.27) were strongly associated with increased risk of recent overdose in multivariable analysis.

DISCUSSION

The findings support our hypothesis that higher frequency of non-prescribed buprenorphine use is associated with lower risk of drug overdose, a potential harm reduction consequence of diversion. Improving the availability of buprenorphine though standard substance use disorder treatment, primary care, and other innovative methods is urgently needed.

Daily patterns of substance use and violence among a high-risk urban emerging adult sample: Results from the Flint Youth Injury Study

OBJECTIVE

Interpersonal violence is a significant public health problem, with substance use a key risk factor. Intensive longitudinal methods (ILMs) provide data on daily patterns/relationships between substance use and violence, informing prevention. Prior daily research has not focused on these relationships among urban minority samples.

METHODS

Within an RCT comparing ILM assessment/schedule methods, 162-participants completed daily IVR (n = 81) or SMS (n = 81) assessments measuring 19 substance use and violence (partner/non-partner) behaviors daily for 90-days. GLMMs characterized between- and within-person predictors of daily violence.

RESULTS

Participants [48.7%-female; age = 24.4; 62.3%-African-American; 66.7%-public assistance] completed an average of 46.5 daily reports [SD = 26.7]. Across 90-days, alcohol was characterized by episodic weekend use (average = 10 days-of-use, 34.4% drinking-days involved binge-drinking), while marijuana use was continuous (average = 27 days-of-use; 1.7 times/day), with no weekend differences. Among 118-violent conflicts, 52.5% occurred on weekends; 57.6% were with non-partners/peers; 61.0% involved perpetration/57.6% victimization; and 52.5% involved severe violence. For violence conflicts, 27.1% were preceded by alcohol/22.9% preceded by drug use. Between-person predictors of daily violence included retaliatory attitudes (AOR = 3.2) and anxiety (AOR = 1.1). Within-person predictors included weekends (AOR = 1.6), binge drinking (AOR = 1.9), non-medical prescription opioid use (AOR = 3.5) and illicit drug use (AOR = 8.1).

CONCLUSION

Among a high-risk urban minority sample, we found that higher baseline retaliatory attitudes and anxiety, as well as same-day binge drinking, non-medical prescription opioid use, and illicit drug use were associated with daily violence, likely reflecting both pharmacological and socio-contextual factors. Addressing substance use and retaliatory violence with tailored prevention efforts may aid in decreasing negative interpersonal violence outcomes.

Collecting Self-Reported Data on Dating Abuse Perpetration From a Sample of Primarily Black and Hispanic, Urban-Residing, Young Adults: A Comparison of Timeline Followback Interview and Interactive Voice Response Methods

Dating abuse is a prevalent and consequential public health problem. However, relatively few studies have compared methods of collecting self-report data on dating abuse perpetration. This study compares two data collection methods-(a) the Timeline Followback (TLFB) retrospective reporting method, which makes use of a written calendar to prompt respondents' recall, and (b) an interactive voice response (IVR) system, which is a prospective telephone-based database system that necessitates respondents calling in and entering data using their telephone keypads. We collected 84 days of data on young adult dating abuse perpetration using IVR from a total of 60 respondents. Of these respondents, 41 (68%) completed a TLFB retrospective report pertaining to the same 84-day period after that time period had ended. A greater number of more severe dating abuse perpetration events were reported via the IVR system. Participants who reported any dating abuse perpetration were more likely to report more frequent abuse perpetration via the IVR than the TLFB (i.e., may have minimized the number of times they perpetrated dating abuse on the TLFB). The TLFB method did not result in a tapering off of reported events past the first week as it has in prior studies, but the IVR method did result in a tapering off of reported events after approximately the sixth week. We conclude that using an IVR system for self-reports of dating abuse perpetration may not have substantial advantages over using a TLFB method, but researchers' choice of mode may vary by research question, resources, sample, and setting.

Age-Specific Associations Between Violence Exposure and Past 30-Day Marijuana and Alcohol Use

Using data from a cohort study of students at risk for high school dropout, we examined associations between violence exposure and past 30-day alcohol and marijuana use. We used varying-coefficient regression with person-level fixed effects to estimate how those associations changed within-person across ages approximately 14-23. Generally, violence perpetration was most strongly associated with substance use, within-person. Substance use became increasingly associated with both observed violence and violence perpetration during early/middle adolescence; this increase continued longer into development (age 18+) for alcohol use. Across most of the age range studied here, violence victimization was minimally associated with within-person changes in substance use. Results indicate age-specific associations between violence exposure and alcohol and other drug use, which may be useful for informing prevention strategies.

Understanding the Role of Alcohol, Anxiety, and Trait Mindfulness in the Perpetration of Physical and Sexual Dating Violence in Emerging Adults

This study examines alcohol consumption, anxiety, trait mindfulness, and physical and sexual dating violence aggression (PDV and SDV) among 735 emerging adults (18-25 years) in an urban emergency department. Of the total sample, 27.2% perpetrated PDV and 16.5% perpetrated SDV. Alcohol was positively associated with PDV/SDV. Anxiety was positively associated with PDV. Mindfulness was negatively associated with PDV/SDV. Interaction analyses revealed women had lower PDV with higher nonjudgment facet of mindfulness. Higher act aware was associated with lower PDV regardless of high versus low alcohol. Findings indicate different contributing factors among perpetrators of PDV/SDV; some factors may be attenuated by mindfulness.

Risky Interactions: Relational and Developmental Moderators of Substance Use and Dating Aggression

Physical dating aggression is a prevalent and costly public health concern. A theoretical moderator model of substance use and dating aggression posits that associations between them are moderated by relational risk factors. To test these theoretical expectations, the current study examined seven waves of longitudinal data on a community-based sample of 100 male and 100 female participants in a Western U.S. city (M age Wave 1 = 15.83; 69.5% White non-Hispanic, 12.5% Hispanic, 11.5% African Americans, & 12.5% Hispanics). Multilevel models examined how links between substance use and dating aggression varied by relational risk and how these patterns changed developmentally. Main effects of relational risk and substance use emerged, particularly in adolescence. In young adulthood significant three-way interactions emerged such that substance use was more strongly associated with physical aggression when conflict and jealousy were higher. Thus, relational risk factors are integral to models of dating aggression, but their role changes developmentally.

Sexual Violence Victimization Among Youth Presenting to an Urban Emergency Department: The Role of Violence Exposure in Predicting Risk

Sexual violence (SV) is a widespread public health problem among adolescents and emerging adults with significant short- and long-term consequences. Young people living in urban, disadvantaged communities with high rates of violence may be especially at risk for SV victimization. Understanding interconnections between different forms of violence is critical to reducing SV risk among youth. Participants were youth ( N = 599) ages 14 to 24 years ( M = 20.05, SD = 2.42) presenting to an urban emergency department with a Level 1 trauma designation as part of a prospective cohort study and followed-up for 24 months. We used logistic regression to examine the probability of reporting SV during the 24-month follow-up based on baseline reports of community and peer violence exposure, accounting for previous SV victimization, substance use, and sociodemographic characteristics. Among youth presenting to an urban emergency department, 22% of youth not seeking care for a sexual assault reported any lifetime SV (forced and/or substance-induced sexual intercourse) at baseline. During the 24-month follow-up, 12% reported SV victimization. We found high community violence exposure (odds ratio [OR] = 2.96, 95% confidence interval [CI] [1.01, 8.68]) and peer violence exposure (OR = 1.58, 95% CI [1.19, 2.08]) were associated with increased odds of reporting SV during follow-up in addition to previous SV victimization (OR = 2.71, 95% CI [1.45, 5.09]). Sex, age, parent education, and alcohol or other drug use at baseline were not associated with odds of SV during follow-up. Investigating interconnections between SV victimization and other forms of violence across socioecological levels provides an opportunity to advance SV research and identify promising avenues for prevention based on other violence prevention research. Future strategies for SV prevention that incorporate community and peer components as well as SV-specific content may help reduce SV victimization among youth living in urban, disadvantaged communities.

Alcohol and Marijuana use in Undergraduate Males: Between- and Within-Person Associations with Interpersonal Conflict

BACKGROUND

Among college students, interpersonal conflict with others is a common, yet stressful negative interpersonal experience. Research suggests that drinking episodes may contribute to the occurrence of conflict. Marijuana use, independently or in conjunction with alcohol, may also influence the likelihood of subsequent conflict.

OBJECTIVES

We considered the temporal effects of independent and simultaneous alcohol and marijuana use episodes on the occurrence of interpersonal conflict. Use of multilevel modeling allowed us to distinguish the within-person effects of substance use from between-person differences in frequency of use.

METHODS

Within a sample of 427 college freshman males over 56 days of daily reports, we examined the independent and interactive effects of episodes of alcohol and marijuana on the odds of conflict within the next 1-, 2-, 3-, and 4 hours.

RESULTS

Multilevel modeling analyses showed that drinking episodes increased the likelihood of conflict occurring within the next 1, 2, 3, and 4 hours. Marijuana had weaker positive effects, significant only within the 2 hour window. There were no alcohol by marijuana interaction effects in any analysis.

CONCLUSIONS/IMPORTANCE

Both marijuana and alcohol independently increased the likelihood of interpersonal conflict; however, the marijuana effect appeared less robust. As marijuana use becomes more normative and accessible for college students, it is important to understand the extent to which marijuana use results in negative consequences and the contexts under which these effects unfold.

Emergency Department Alcohol Intervention: Effects on Dating Violence and Depression

OBJECTIVES

With this study, we examined secondary outcomes of an emergency department (ED)-based brief intervention (BI) on dating violence perpetration and victimization and depression symptoms over 3, 6, and 12 months.

METHODS

ED patients (14-20 years) were screened for risk drinking. Patients who received positive screen results were randomly assigned to a computer BI (n = 277), therapist BI (n = 278), or control condition (n = 281). After the 3-month assessment, participants were randomly assigned to receive the post-ED BI or control condition. BIs were used to address alcohol consumption and consequences (eg, dating violence and depression symptoms) by using motivational interviewing.

RESULTS

A total of 836 patients were enrolled in the randomized controlled trial of 4389 patients screened and 1054 who reported risky drinking. Regression models were used to examine longitudinal effects of the alcohol BI on dating violence perpetration, dating violence victimization, and depression symptoms. The therapist BI resulted in a significant reduction of dating violence perpetration up to 12 months (incidence rate ratio [IRR] = 0.53; 95% confidence interval [CI]: 0.37-0.77) and depression symptoms up to 3 months (IRR = 0.85; 95% CI: 0.72-1.00) after the intervention. Computer BI resulted in a reduction of dating violence perpetration (IRR = 0.52; 95% CI: 0.35-0.76) and depression symptoms (IRR = 0.78; 95% CI: 0.66-0.94) 6 months postintervention. Post-ED BIs were associated with lower perpetration at 12 months and lower victimization at 6 and 12 months, irrespective of BI intervention randomization at baseline; however, they did not affect depression symptoms.

CONCLUSIONS

A single-session ED BI revealed previously to show promise in reducing underage drinking also demonstrates promise in preventing dating violence perpetration and depression symptoms. These technology-enhanced BIs could be particularly helpful given the potential for more efficient resource usage and ease of future implementation.

Does Marijuana Contribute to Intimate Partner Aggression? Temporal Effects in a Community Sample of Marijuana-Using Couples

OBJECTIVE

Although patterns of marijuana use are positively associated with intimate partner aggression, there is little evidence that episodes of marijuana use contribute to the occurrence of episodes of relationship conflict and aggression. The present ecological momentary assessment study considered the temporal relationship between marijuana use episodes and the occurrence of conflict, verbal aggression, and physical aggression between intimate partners in the next 2 hours.

METHOD

A sample of 183 cohabiting marijuana-using couples (ages 18-30) were recruited from the community. For 30 consecutive days, each partner independently reported episodes of marijuana use and partner conflict, including verbal and physical aggression perpetration and victimization within conflicts. Temporal associations between each partner's marijuana use and subsequent conflict and aggression were examined using the Actor-Partner Interdependence Model. Analyses accounted for between-person effects of marijuana use frequency and total conflicts.

RESULTS

We observed temporal effects of actor (but not partner) marijuana use on men's and women's reports of conflict and verbal aggression perpetration and victimization within 2 hours of use. Marijuana use episodes did not alter the likelihood of physical aggression in the next 2 hours. Partner concordance in marijuana use had no effect on verbal or physical aggression or victimization. The positive temporal effects of marijuana on conflict and verbal aggression remained significant after accounting for the effect of drinking episodes.

CONCLUSIONS

Within generally concordant, marijuana-using young couples, marijuana use episodes contribute to the occurrence of relationship conflict and verbal aggression.

Loaded: Gun involvement among opioid users

INTRODUCTION

Despite ample research examining how alcohol use relates to gun involvement, little is known about the relationship between opioids and gun involvement. In the current study, we examined correlates of gun possession, accessibility, and related behaviors in an opioid dependent sample.

METHODS

Between October 2016 and April 2017, we surveyed persons entering a brief, inpatient opioid detoxification (n = 386) and 51 contemporaneous persons seeking alcohol detoxification at the same facility in Massachusetts and recorded their lifetime experiences with gun involvement.

RESULTS

Participants averaged 33 years of age, 74% were male, 83% were White, and 64% had a history of incarceration. Opioid users had significantly higher rates of gun involvement than persons in alcohol detoxification; for example, 31.3% (vs. 3.9%) had carried a gun for protection, 45.1% (vs. 25.5%) had been threatened with a gun, and 13.8% (vs. 2.0%) had shot at another person. Among persons misusing opioids, male and non-White respondents, and those with a history of incarceration or poorer self-control reported greater gun involvement.

CONCLUSIONS

Opioid users, both men and women, lead gun-involved lives.

Physical and Sexual Dating Violence and Nonmedical Use of Prescription Drugs

BACKGROUND

Little information is available on the associations between nonmedical use of prescription drugs (NMUPD) and dating violence victimization (DVV) among high school students and how associations vary by sex.

METHODS

We used data from the 2015 national Youth Risk Behavior Survey, a cross-sectional survey of a nationally representative sample of students in grades 9 to 12. The sample was restricted to students who dated during the 12 months before the survey, resulting in a sample of 5136 boys and 5307 girls. Sex-stratified logistic regression models estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between lifetime NMUPD and DVV. In our analyses, we examined a 4-level DVV measure: no DVV, physical only, sexual only, and both physical and sexual.

RESULTS

Male students had a significantly lower prevalence of DVV compared with female students. By using the 4-level measure of DVV, after adjusting for covariates, sexual DVV only (aPR = 1.61, 95% CI: 1.21-2.12) and both physical and sexual DVV (aPR = 1.65, 95% CI: 1.26-2.17) were positively associated with NUMPD among boys, whereas among girls, physical DVV only (aPR = 1.42, 95% CI: 1.16-1.75) and both physical and sexual DVV (aPR = 1.43, 95% CI: 1.03-1.99) were positively associated with NMUPD.

CONCLUSIONS

NMUPD was associated with experiences of DVV among both male and female students. Community- or school-based adolescent violence and substance use prevention efforts would be enhanced by considering the association between DVV and substance use, particularly NMUPD among both male and female adolescents, to address these public health problems.

Latent Class Analysis for Multiple Discrete Latent Variables: A Study on the Association Between Violent Behavior Drug-Using Behaviors

This paper proposes a new type of latent class analysis, joint latent class analysis (JLCA), which provides a set of principles for the systematic identification of the subsets of joint patterns for multiple discrete latent variables. Inferences about the parameters are obtained by a hybrid method of EM and Newton-Raphson algorithms. We apply JLCA in an investigation of adolescent violent behavior and drug-using behaviors. The data are from 4,957 male high-school students who participated in the Youth Risk Behavior Surveillance System 2015. The JLCA approach identifies the different joint patterns of four latent variables: violent behavior, alcohol consumption, tobacco cigarette smoking, and other drug use. The JLCA uncovers four common violent behaviors and three representative behavioral patterns for each of three other latent variables. In addition, the JLCA supports three common joint classes, representing the most probable simultaneous patterns for being violent and being a drug user among adolescent males.

Perpetrators' and Victims' Attributions for IPV: A Critical Review of the Literature

Research shows that there are a variety of reasons why people self-report engaging in intimate partner violence (IPV) perpetration, but few studies report victims' attributions for their partners' IPV perpetration. Because there are two acting partners in relationships, as well as the IPV incidents that occur in the relationships, to fully understand the dynamics of IPV, both partners' perceptions of why the incidents occur must be understood. The authors of this article systematically reviewed the available empirical evidence regarding male and female perpetrators' endorsed attributions for their IPV perpetration, as well victims' attributions for their partners' IPV perpetration. Several literature databases were explored, resulting in 50 articles that met the criteria for inclusion in this review. IPV perpetrators' commonly endorsed attributions for physical and psychological IPV consisted of control, anger, retaliation, self-defense, to get attention, and an inability to express oneself verbally. Research has not examined endorsed attributions for coercive control. The few studies examining attributions for sexual IPV found that it was attributed to dominance or hedonism. Themes regarding victims' attributions were largely similar to those of the perpetrators, however, there were some differences. Victims' attributions for physical IPV perpetration consisted of anger, control, jealousy, and the influence of drugs/alcohol, which are similar to perpetrators' self-reported attributions for engaging in IPV perpetration. Victims' attributions for their partners' psychological IPV perpetration consisted of the perpetrator's personality, relationship dissolution, alcohol, and their partners' jealousy. Victims' attributions for their partners' sexual IPV perpetration, however, differed from perpetrators' attributions, consisting of the victim believing that the perpetrator thought they wanted it, being under the influence of alcohol/drugs, and doing it out of love. Methodological inconsistencies, directions for future research, and treatment implications are also discussed.

Marijuana use and physical dating violence among adolescents and emerging adults: A systematic review and meta-analysis

BACKGROUND

As restrictions on marijuana are loosened, there is concern of a coming increase in marijuana use among adolescents and emerging adults, which could be coupled with commensurate increases in behavioral problems associated with use, such as physical dating violence (PDV). To summarize what is known about the association between marijuana use and PDV victimization and perpetration among 11-21year olds, we conducted a systematic review and meta-analysis of the relevant literature published between 2003 and 2015.

METHODS

Candidate articles were identified with a systematic search, and we used inclusion and exclusion criteria to review titles, abstracts, and the full text of studies for consideration. There were 13 articles examining marijuana in association with PDV; five addressed victimization and 11 addressed perpetration.

RESULTS

Findings suggest that marijuana use is associated with a 54% increase in the odds PDV victimization, and a 45% increase in the odds of perpetration.

CONCLUSIONS

Findings suggest that dating violence is a correlate of marijuana use, and that association is strongest among adolescents (vs. emerging adults) and girls (vs. boys). Therefore, it should be routinely included as a core data item in marijuana surveillance systems, so as to allow for behavioral monitoring.

Marijuana use trajectories among drug-using youth presenting to an urban emergency department: Violence and social influences

AIMS

This paper examined longitudinal marijuana use trajectories among drug-using youth presenting to the ED to inform intervention development.

METHODS

Given interest in substance use and violence, this study oversampled those presenting with assault injuries. Assault-injured youth (ages 14-24) endorsing past 6-month drug use (n=349), and a sex and age proportionally-sampled comparison group (n=250) endorsing drug use, completed a baseline assessment and follow-ups at 6, 12, 18, and 24 months. Latent class trajectory analyses examined days of marijuana use over 2 years. Multinomial regression analyses examined baseline, 12-month and 24-month factors associated with substance use trajectory groups.

RESULTS

Trajectory analyses identified 5 groups: Low (Low; 28.2%; n=169); Intermittent (INT; 16.2%; n=97); Moderate Decline (MD; 12.0%; n=72); High decline (HD, 13.2%; n=79) and Chronic (C; 30.4%; n=182). At baseline, as compared to the Low group, the other trajectory groups were more likely to be male and have greater levels of physical aggression. At 12- and 24-months, negative and positive peer influences, incarceration and community violence were additional characteristics associated with the greater marijuana use trajectories (as compared to the Low group).

CONCLUSIONS

Interventions for drug-using youth presenting to the urban ED should address peer influences, physical aggression and community violence exposure, given the association between these characteristics and greater marijuana use trajectories.

Substance Use as a Risk Factor for Sleep Problems Among Adolescents Presenting to the Emergency Department

OBJECTIVES

To determine correlates of sleep problems among adolescents. Specifically, to assess the relative strength of associations between sleep problems and dating victimization, reasons for emergency department (ED) visit, depression, unhealthy alcohol use, and other drug use (marijuana, nonmedical use of prescription opioids, stimulants, and tranquilizers).

METHODS

A total of 1852 adolescents aged 14 to 20 years presenting for care to the University of Michigan Emergency Department, Ann Arbor, Michigan, during 2011-2012, self-administered a computerized health survey. Sleep problems were identified if any of the 4 items on the Sleep Problems Questionnaire were rated by a patient as greater than 3 on a 0 to 5 scale. Adolescents who were too sick to be screened in the ED were eligible to participate in the study during their inpatient stay. Exclusion criteria for baseline included insufficient cognitive orientation precluding informed consent, not having parent/guardian present if younger than 18 years, medical severity precluding participation, active suicidal/homicidal ideation, non-English-speaking, deaf/visually impaired, or already participated in this study on a prior visit.

RESULTS

23.5% of adolescents reported clinically significant sleep problems. Female gender, depression, dating victimization, tobacco use, nonmedical use of prescription medication, and an ED visit for medical reasons were each associated with sleep problems among adolescents, even while controlling for age, other types of drug use, receiving public assistance, and dropping out of school.

CONCLUSIONS

These exploratory findings indicate that ED-based screening and brief intervention approaches addressing substance use and/or dating victimization may need to account for previously undiagnosed sleep problems.

The couple that smokes together: Dyadic marijuana use and relationship functioning during conflict

Self-reported marijuana use has been associated with poor relationship functioning and decreased stability over time. The present study examined the behavioral interactions of couples with concordant and discordant patterns of marijuana use during conflict, using individual self-reports and observation by independent coders. Heavy drinking community couples (N = 149) participated in a conflict resolution paradigm. Interactions were recorded and coded by naïve coders. Approximately 30% of the sample reported past year marijuana use. Actor-Partner Interdependence Models and analysis of covariance (ANCOVA) were used to evaluate the individual and interactive effects of dyadic marijuana use on maladaptive relationship functioning. A Robust Actor × Partner Marijuana Use interaction was detected for a range of behavioral outcomes, assessed by both self-report and direct observation, including relationship satisfaction, anger experience, patterns of demand and withdrawal during conflict, constructive behaviors, and overall relationship quality. Specifically, couples in which both partners used or abstained from marijuana displayed more adaptive relationship functioning across indicators relative to couples in which only 1 partner identified as a marijuana user. This pattern was particularly strong for couples in which the female partner used marijuana and the male partner did not. Couples with discordant, rather than concordant, marijuana use displayed distinct conflict resolution behaviors that were consistent with the long-term negative relationship outcomes that have been observed in previous studies. (PsycINFO Database Record

Reasons for Fighting among Violent Female Adolescents: A Qualitative Investigation from an Urban, Midwestern Community

This qualitative study examines the self-reported reasons for fighting among female adolescents (N = 72). Data are drawn from brief intervention sessions addressing violent behavior and alcohol use. Young women age 14 to 18 (Mean = 16) were recruited in an urban emergency department (58.3% African American/Black, 31.9% White, and 9.7% other races/ethnicities). Participants identified multiple reasons that they engage in fights including self-protection/self-defense, enhancing social status and respect, safety (e.g., preventing future fights or sexual assaults), revenge/retaliation, social motivations (e.g., defending family or friends, fighting over romantic interests), coping, and enjoyment. Results provide insight into opportunities and challenges in developing interventions addressing aggression among female adolescents.

Dating Violence and Substance Use: Exploring the Context of Adolescent Relationships

The connection between adolescent dating violence (ADV) and substance use is important to consider because of the serious consequences for teens who engage in these behaviors. Although prior research shows that these two health problems are related, the context in which they occur is missing, including when (i.e., the timeline) in the relationship these events occur. To fill this gap, eight sex-specific focus groups were conducted with 39 high school-aged teens, all of whom had experienced prior relationship violence. Adolescents discussed using alcohol and/or drugs at the start of the dating relationship and after the relationship ended as a way to cope with the break-up. Alcohol and drugs were also used throughout to cope with being in an abusive relationship. The intersection of ADV and substance use occurred during instances when both partners were using alcohol and/or drugs, as well as when only one partner was using. These findings provide support for prevention and intervention programs that consider the intersection of ADV and substance use.

Self-wise, Other-wise, Streetwise (SOS) training: a novel intervention to reduce victimization in dual diagnosis psychiatric patients with substance use disorders: protocol for a randomized controlled trial

BACKGROUND

Psychiatric patients are more likely to be victims of crime than others in the community. Dual diagnosis patients with comorbid psychiatric and substance use disorders are especially prone to victimization. Victimization is associated with substance abuse, more severe symptomatology and homelessness. There is a strong need for interventions to reduce victimization in this population. We developed the Self-wise, Other-wise, Streetwise (SOS) training to reduce victimization in patients with dual diagnosis.

METHODS/DESIGN

This study is a randomized controlled trial using a parallel group design to determine the effectiveness of adding the SOS training to care as usual. Patients with dual diagnosis (N = 250) will be allocated to either care as usual plus SOS training (N = 125) or care as usual only (N = 125) using computer-generated stratified block randomization. To compare effectiveness participants will be interviewed at baseline and 2, 8 and 14 months follow-up. The primary outcome measure is treatment response (yes/no), defined as either no victimization at 14 months follow-up or at least a 50% reduction in incidents of victimization at 14 months follow-up compared to baseline assessment. Victimization is measured with the Safety Monitor, an adequate self-report instrument used by Statistics Netherlands to measure victimization on a large scale in the Netherlands. Outcome assessors are blind to treatment allocation. An economic evaluation will be performed alongside the randomized controlled trial and will take the societal perspective.

DISCUSSION

This study is the first randomized controlled trial to examine the effectiveness of an intervention that aims to reduce victimization in patients with dual diagnosis. If the intervention is effective it can be implemented in mental health care and contribute to the safety and well-being of patients.

TRIAL REGISTRATION

Dutch Trial Register (NTR): 4472, date of registration: 24-03-2014.

Does Marijuana Use Contribute to Intimate Partner Aggression? A Brief Review and Directions for Future Research

Marijuana users are more likely to perpetrate intimate partner aggression (IPA) than non-users, yet the mechanism responsible for this association is unknown. Recent studies considering the association between episodes of marijuana use and episodes of IPA have failed to find evidence consistent with an acute effect of marijuana. Research gaps are highlighted and a heuristic model of marijuana's potential effects on IPA is presented. Research priorities include consideration of mediating mechanisms, moderating variables at the individual and couple level, and examination of acute effects of marijuana using daily report and EMA designs.

Substance Use and Physical Dating Violence: The Role of Contextual Moderators

INTRODUCTION

Theoretic models suggest that associations between substance use and dating violence perpetration may vary in different social contexts, but few studies have examined this proposition. The current study examined whether social control and violence in the neighborhood, peer, and family contexts moderate the associations between substance use (heavy alcohol use, marijuana, and hard drug use) and adolescent physical dating violence perpetration.

METHODS

Adolescents in the eighth, ninth, and tenth grades completed questionnaires in 2004 and again four more times until 2007 when they were in the tenth, 11th, and 12th grades. Multilevel analysis was used to examine interactions between each substance and measures of neighborhood, peer, and family social control and violence as within-person (time-varying) predictors of physical dating violence perpetration across eighth through 12th grade (N=2,455). Analyses were conducted in 2014.

RESULTS

Physical dating violence perpetration increased at time points when heavy alcohol and hard drug use were elevated; these associations were weaker when neighborhood social control was higher and stronger when family violence was higher. Also, the association between heavy alcohol use and physical dating violence perpetration was weaker when teens had more-prosocial peer networks and stronger when teens' peers reported more physical dating violence.

CONCLUSIONS

Linkages between substance use and physical dating violence perpetration depend on substance use type and levels of contextual violence and social control. Prevention programs that address substance use-related dating violence should consider the role of social contextual variables that may condition risk by influencing adolescents' aggression propensity.

Physical dating violence among adolescents and young adults with alcohol misuse

BACKGROUND

This study determined prevalence and correlates of physical dating violence (victimization or aggression) among male and female youth with alcohol misuse and seeking emergency department (ED) care.

METHODS

Patients age 14-20 seeking care at a single large university-based ED completed a computerized, self-administered, cross-sectional survey. Measures included demographics, alcohol and substance use, mental health problems, health service use, peer influences, parent support, and community involvement. Bivariate and multivariate regression assessed physical dating violence correlates.

RESULTS

Among 842 male and female youth seeking ED care who screened positive for alcohol misuse, 22.3% (n=188) reported dating violence in the past year. Multivariate analyses showed variables associated with dating violence were female gender (AOR 2.17, CI 1.46-3.22), Caucasian race (AOR 0.59, CI 0.37-0.93), receipt of public assistance (AOR 1.82, CI 1.16-2.87), AUDIT Score (AOR 1.06, CI 1.02-1.10), older age of drinking onset (AOR 0.86, CI 0.77-0.96), suicidal ideation or attempt (AOR 1.95, CI 1.13-3.37), frequency of ED visits (AOR 1.22, CI 1.05-1.46), negative peer influences (AOR 1.05, CI 1.01-1.10), and positive peer influences (AOR 0.86, CI 0.80-0.93).

CONCLUSIONS

Nearly 1 in 4 youth with alcohol misuse seeking ED care report dating violence. Key correlates of dating violence included alcohol use severity, suicidal ideation, ED services, and peer influences. Evidence-based dating violence interventions addressing these correlates are needed for youth with alcohol misuse seeking ED care.

The Effect of Neighborhood Context on the Relationship Between Substance Misuse and Weapons Aggression in Urban Adolescents Seeking ED Care

BACKGROUND

Frameworks for studying the ecology of human behavior suggest that multiple levels of the environment influence behavior and that these levels interact. Applied to studies of weapons aggression, this suggests proximal risk factor (e.g., substance use) effects may differ across neighborhoods.

OBJECTIVES

To estimate how the association between weapons aggression and substance use varies as a function of several community-level variables.

METHODS

Individual-level measures (demographics, behavioral measures) were obtained from a survey of youth aged 14-24 years old seeking care at a Level-1 ED in Flint, Michigan. Community-level variables were obtained from public sources. Logistic generalized additive models were used to test whether community-level variables (crime rates, alcohol outlets, demographics) modify the link between individual-level substance use variables and the primary outcome measure: self-reported past 6-month weapon (firearm/knife) related aggression.

RESULTS

The effect of marijuana misuse on weapons aggression varied significantly as a function of five community-level variables: racial composition, vacant housing rates, female headed household rates, density of package alcohol outlets, and nearby drug crime rates. The effect of high-risk alcohol use did not depend on any of the eight community variables tested.

CONCLUSIONS

The relationship between marijuana misuse and weapons aggression differed across neighborhoods with generally less association in more disadvantaged neighborhoods, while high-risk alcohol use showed a consistently high association with weapons aggression that did not vary across neighborhoods. The results aid in understanding the contributions of alcohol and marijuana use to the etiology of weapon-related aggression among urban youth, but further study in the general population is required.

Alcohol outlet density, drinking contexts and intimate partner violence: a review of environmental risk factors

Alcohol use is a robust predictor of intimate partner violence (IPV). A critical barrier to progress in preventing alcohol-related IPV is that little is known about how an individual's specific drinking contexts (where, how often, and with whom one drinks) are related to IPV, or how these contexts are affected by environmental characteristics, such as alcohol outlet density and neighborhood disadvantage. The putative mechanism is the social environment in which drinking occurs that may promote or strengthen aggressive norms. Once these contexts are known, specific prevention measures can be put in place, including policy-oriented (e.g., regulating outlet density) and individually oriented (e.g., brief interventions to reduce risk for spousal aggression) measures targeting at-risk populations. This paper reviews applicable theories and empirical research evidence that links IPV to drinking contexts and alcohol outlet density, highlights research gaps, and makes recommendations for future research.

Substance use and violence among youth: a daily calendar analysis

BACKGROUND

While researchers have identified factors that contribute to youth violence, less is known about the details of violent incidents. In addition, substance use has been linked to youth violence; however, little is known about actual substance use on days in which violence occurs.

OBJECTIVE

This study examined reasons for peer violence and the association between substance use and violence using daily calendar-based analyses among at-risk urban youth.

METHODS

Data were collected from Emergency Department (ED) patients (ages 14-24; n = 599; 59% male, 65% African American) who screened positive for substance use in the past 6 months. Daily data regarding past 30-day substance use and violence and reasons for violent incidents were obtained via semi-structured interviews. Multi-level multinomial regression models were conducted to test the associations between substance use and peer violence incidents (i.e., none, moderate and severe).

RESULTS

Conflict over 'personal belongings' was a common reason for violence among males; 'jealousy'/'rumors' were common reasons among females. Moderate victimization was more likely to be reported on days in which participants reported alcohol and cocaine use. Severe victimization was more likely to be reported on days in which participants reported alcohol use. Moderate or severe aggression was more likely to be reported on days in which participants reported alcohol and non-medical sedative use.

CONCLUSIONS

RESULTS suggest that youth violence prevention that addresses differential reasons for violence among males and females as well as substance use would be beneficial.

Nonmedical prescription stimulant use among youth in the emergency department: prevalence, severity and correlates

This study examined the prevalence, severity and correlates of nonmedical prescription stimulant use (NPSU) among youth in the emergency department (ED). Participants 14-20 years old presenting to the ED completed a survey. A multinomial logistic regression was used to compare those without NPSU, with mild NPSU and with moderate/severe NPSU on demographics, risk factors and ED utilization. There were 4389 participants; 8.3% reported past-year NPSU and 44% of those with past 3-month NPSU reported at least monthly use. After controlling for demographics, participants with mild NPSU or moderate/severe NPSU had higher odds of all substance use risk factors compared to those with no NPSU. Also, those with moderate/severe NPSU were more likely to report dating violence and nonmedical use of opioids or sedatives and less likely to use marijuana compared to those with mild NPSU. Healthcare setting screening and intervention efforts should consider NPSU concomitant with other substance use and explore the association of dating violence with NPSU.

Feasibility of applying the life history calendar in a population of chronic opioid users to identify patterns of drug use and addiction treatment

Uncovering patterns of drug use and treatment access is essential to improving treatment for opioid dependence. The life history calendar (LHC) could be a valuable instrument for capturing time-sensitive data on lifetime patterns of drug use and addiction treatment. This study describes the methodology applied when collecting data using the LHC in a sample of individuals with long-term opioid dependence and aims to identify specific factors that impact the feasibility of administering the LHC interview. In this study, the LHC allowed important events such as births, intimate relationships, housing, or incarcerations to become reference points for recalling details surrounding drug use and treatment access. The paper concludes that the administration of the LHC was a resource-intensive process and required special attention to interviewer training and experience with the study population. These factors should be considered and integrated into study plans by researchers using the LHC in addiction research.

Distal and proximal factors associated with aggression towards partners and non-partners among patients in substance abuse treatment

Studies of violence in substance use disorder (SUD) treatment settings typically focus on partner aggression (PA) although non-partner aggression (NPA) is also a common problem. This study examines potentially distinct paths of distal and proximal risk factors related to aggression towards non-partners (NPA) and partners (PA) among a SUD treatment sample. The sample included 176 adults reporting past-year violence. Bivariate analyses indicated several distal and proximal factors were associated with NPA and PA. According to multivariate, multiple mediation analyses youth aggression history was a factor for both NPA and PA. Alcohol and cocaine use and psychological distress were associated with NPA; marijuana use was associated with PA. There also was evidence of indirect effects of distal factors on NPA and PA. The results suggest that there may be substantially different dynamics associated with NPA and PA, and have implications for developing screening, assessment and treatment protocols targeting violence among individuals in SUD treatment.

Changes in substance use-related health risk behaviors on the timeline follow-back interview as a function of length of recall period

The timeline follow-back (TLFB) interview was adopted to collect retrospective data on daily substance use and violence from 598 youth seeking care in an urban Emergency Department in Flint, Michigan during 2009-2011. Generalized linear mixed models with flexible smooth functions of time were employed to characterize the change in risk behaviors as a function of the length of recall period. Our results suggest that the 1-week recall period may be more effective for capturing atypical or variable patterns of risk behaviors, whereas a recall period longer than 2 weeks may result in a more stable estimation of a typical pattern.

Prospective risk factors for traumatic event reexposure in community syringe exchange participants

BACKGROUND

Traumatic event reexposure in injecting drug users is associated with increased drug use and potential for psychiatric symptoms. This is the first study to examine fixed and time-varying factors that are prospectively associated with new traumatic event reexposure in injecting drug users.

METHODS

Injecting drug users registered in a syringe exchange program were enrolled in a 16-month parent study comparing strategies to increase drug abuse treatment enrollment. Participants (N=162) completed baseline measures of demographics, psychiatric treatment history, and lifetime traumatic event exposure. Monthly follow-ups assessed past-month traumatic event exposure, days of heroin and cocaine use, criminal activity, and drug abuse treatment participation. Generalized estimating equations models tested the influence of fixed baseline and time-varying factors on traumatic event reexposure in the same month, the following month, and two months later.

RESULTS

Significant fixed risk factors for traumatic event reexposure include female gender and past psychiatric treatment. In addition, each past traumatic event exposure was associated with an increased likelihood of reexposure. After accounting for all other factors, each day of cocaine use was associated with a small but persistent increased risk of traumatic event reexposure. Reexposure to a traumatic event in the prior month more than doubled the risk of subsequent reexposure.

CONCLUSIONS

Injecting drug users experience a pattern in which drug use is associated with increased risk of subsequent traumatic event reexposure, and traumatic event reexposure is associated with further drug use and continued reexposure. Implications for addressing these concerns in injecting drug users are presented.