Multiple substance use patterns in adolescents-A multilevel latent class analysis

The Transition of Sociodemographic and Substance Abuse Characteristics, Pairwise Co-occurrences and Factors Associated with Polysubstance Use Among US Adolescents and Young Adults

Background

Substance abuse by adolescents and young adults is a major public health issue. This study aimed to (i) show the transition of sociodemographic and substance abuse characteristics from 1992 to 2017 among US adolescents and young adults, (ii) evaluate the likelihood of co-occurrence of substances, and (iii) identify significant sociodemographic characteristics in association with polysubstance abuse.

Methods

This study extracted data for adolescents and young adults from 1992 and 2017 Treatment Episode Data Set-Admission (TEDS-A) datasets. The extracted sample included 337858 admissions in 1992 and 333322 in 2017.

Findings

Both years experienced significant admissions. A significant transition in 2017 compared to 1992 was evident in education, living status, and ethnicity. Substance-specific transition showed alcohol was dominant in 1992, while marijuana/ hashish was dominant in 2017. Also, heroin, other opiates/synthetics, and methamphetamine experienced an increase, while cocaine/crack decreased. The pairwise co-occurrences exhibited a considerable variation in the likelihood of using one substance given another one. The odds ratios (ORs) obtained from generalized ordered logit models showed significantly higher odds of one or more substances with age, while education showed the opposite scenario. A mixed effect of gender was evident in 1992, whereas females were significantly less likely with one or more substances than males in 2017. Other significant vulnerable groups were those not in the labor force, homeless, white, and Mexican Americans.

Conclusion

The findings may help to understand the overall changes between 1992 and 2017 and take necessary measures to reduce the burden of this public health problem.

A two-step estimator for multilevel latent class analysis with covariates

We propose a two-step estimator for multilevel latent class analysis (LCA) with covariates. The measurement model for observed items is estimated in its first step, and in the second step covariates are added in the model, keeping the measurement model parameters fixed. We discuss model identification, and derive an Expectation Maximization algorithm for efficient implementation of the estimator. By means of an extensive simulation study we show that (1) this approach performs similarly to existing stepwise estimators for multilevel LCA but with much reduced computing time, and (2) it yields approximately unbiased parameter estimates with a negligible loss of efficiency compared to the one-step estimator. The proposal is illustrated with a cross-national analysis of predictors of citizenship norms.

Personality-specific pathways from bullying victimization to adolescent alcohol use: a multilevel longitudinal moderated mediation analysis

Bullying victimization is common in adolescence and has been associated with a broad variety of psychopathology and alcohol use. The present study assessed time-varying associations between bullying victimization and alcohol use through internalizing and externalizing symptoms and whether this indirect association throughout time is moderated by personality. This 5-year longitudinal study (3,800 grade 7 adolescents) used Bayesian multilevel moderated mediation models: independent variable was bullying victimization; moderators were four personality dimensions (anxiety sensitivity, hopelessness, impulsivity, and sensation seeking); internalizing symptoms (anxiety, depressive symptoms) and externalizing symptoms (conduct, hyperactivity problems) were the mediators; and alcohol use, the outcome. Results indicated significant between, within, and lagged effects on alcohol use through internalizing and externalizing symptoms. There were significant between and within effects on alcohol use through internalizing symptoms for adolescents with high anxiety sensitivity and hopelessness, and significant between, within, and lagged effects on alcohol use through externalizing symptoms for adolescents with high impulsivity and sensation seeking. These findings implicate two risk pathways that account for how bullying victimization enhances alcohol use risk and emphasize the importance of personality profiles that can shape the immediate and long-term consequences of victimization.

Associations Between Gender-Specific Substance Use Patterns and Mental Health Among Adolescents in the Republic of Korea: A Latent Class Analysis

PURPOSE

Although gender differences in adolescent substance use are complex and substance use accompanies mental health problems, most previous studies have focused on gender-specific association between single substance use and mental health. This study aimed to investigate gender-specific substance use patterns and to examine their association with mental health characteristics.

METHODS

Nationally representative data from the Korea Youth Risk Behavior Survey collected in 2018 were analyzed. To identify substance use patterns among male adolescents (n = 30,463) and female adolescents (n = 29,577), multiple-group latent class analysis was conducted using eight substance use indicators. In addition, we conducted a latent class analysis with covariates to examine the association between substance use patterns and mental health characteristics.

RESULTS

Among both gender samples, the four-class model best fit the data: nonusers (86.4%), frequent smokers (2.9%), risky drinkers (7.1%), and heavy tobacco and alcohol users with lifetime heated tobacco product use (3.6%) for male adolescents, and nonusers (89.8%), frequent smokers (0.5%), risky drinkers (8.0%), and heavy tobacco and alcohol users with a drunkenness episode (1.7%) for female adolescents. Depression, suicidal plans, and suicidal attempts predicted the latent class model for both genders. In addition, stress level predicted the latent class model for female adolescents.

CONCLUSIONS

The findings indicate that homogeneous patterns of substance use by gender are differentially associated with mental health problems. Therefore, health professionals should develop interventions tailored to gender-specific substance use patterns, taking into account the mental health characteristics of each pattern.

The role of trauma and positive youth development in polysubstance use among rural middle school students: a latent class analysis

BACKGROUND

Rural youth often begin developing polysubstance use and other risk behaviors during middle school. However, little polysubstance use research focuses on rural middle school youth. Our research uses Latent Class Analysis to understand existing patterns of rural middle school polysubstance use and risk and protective factors associated with polysubstance use.

METHODS

We used survey data from a rural middle school pregnancy prevention program (N = 2,708). The survey included measures of demographics, lifetime substance use, trauma (adverse childhood experiences and bullying victimization) and aspects of youth development (parent communication on drugs and alcohol, parent connectedness and school connectedness). We used latent class analysis to produce participant polysubstance use profiles and multinomial regression to examine associations between polysubstance use, demographics, trauma and aspects of youth development.

RESULTS

We categorized our participants into four latent classes. Our analysis classified 2.2% of participants as Regular Polysubstance users, 6.9% as Polysubstance experimenters, 19% as Vape + Alcohol experimenters and 71.9% as Non-Users. More adverse childhood experiences were associated with greater risk of polysubstance use and experimentation. Bullying was positively associated with greater risk of vape and alcohol experimentation. Higher reported parental and school connectedness were associated with lower risk of high frequency polysubstance use. Higher reported school connection was also associated with lower risk of polysubstance experimentation.

CONCLUSION

Rural substance use prevention programs should begin during middle school, as polysubstance use development is common among rural middle schoolers. These programs should be trauma informed and focus on connectedness as a modifiable factor to reduce risk of polysubstance use development.

TRIAL REGISTRATION

This article does not report results of a health care intervention on human participants.

Smoking and drinking behavior, knowledge, and attitudes among urban and rural public-school students in Efate Island, Vanuatu: a comparative study

Background

Underage smoking and drinking are public health issues in Vanuatu. This study aims to describe the behavior, knowledge, attitudes, and perceptions of parents, siblings, and peers regarding smoking and drinking among urban and rural public-school students in Vanuatu.

Methods

This cross-sectional study included 358 students (urban, 217; rural, 141; aged 12–14 years) from the public schools in Efate Island, Vanuatu. Data were collected using self-administered questionnaires. Chi-square and Mann–Whitney U tests were used to determine the rural–urban differences.

Results

Urban students showed a higher prevalence of ever smoking (13.5%), ever drinking (16.9%), intention to smoke (11.1%), and intention to drink (14.0%) compared to rural students (10.3%, 8.3%, 5.8%, and 9.5%, respectively); although a significant difference was only observed in the prevalence of ever drinking. Urban students were more likely to be aware of the health hazards of substance use and showed higher self-efficacy to refuse tobacco and alcohol compared to rural students. Parents in rural areas were less likely to talk about the health hazards of substance use with their children and were more likely to offer tobacco or alcohol to them compared to parents in urban areas.

Conclusions

The results provide evidence of rural–urban differences in the behavior, attitude, knowledge, and perceptions of parental behavior regarding smoking and drinking. The findings suggest that issues related to underage smoking and drinking differ between urban and rural students. Future intervention programs for reducing underage smoking and drinking should be adapted in recognition of urban and rural differences.

Exploring the dynamic transitions of polysubstance use patterns among Canadian youth using Latent Markov Models on COMPASS data

Background

Understanding what factors lead to youth polysubstance use (PSU) patterns and how the transitions between use patterns can inform the design and implementation of PSU prevention programs. We explore the dynamics of PSU patterns from a large cohort of Canadian secondary school students using machine learning techniques.

Methods

We employed a multivariate latent Markov model (LMM) on COMPASS data, with a linked sample (N = 8824) of three-annual waves, Wave I (W_I, 2016-17, as baseline), Wave II (W_II, 2017-18), and Wave III (W_III, 2018-19). Substance use indicators, i.e., cigarette, e-cigarette, alcohol and marijuana, were self-reported and were categorized into never/occasional/current use.

Outcomes

Four distinct use patterns were identified: no-use (S1), single-use of alcohol (S2), dual-use of e-cigarettes and alcohol (S3), and multi-use (S4). S1 had the highest prevalence (60.5%) at W_I, however, S3 became the prominent use pattern (32.5%) by W_III. Most students remained in the same subgroup over time, particularly S4 had the highest transition probability (0.87) across the three-wave. With time, those who transitioned typically moved towards a higher use pattern, with the most and least likely transition occurring S2→S3 (0.45) and S3→S2 (<0.01), respectively. Among all covariates being examined, truancy, being measured by the # of classes skipped, significantly affected transition probabilities from any low→high (e.g., OR_S2→S4 = 2.41, 95% CI [2.11, 2.72], p < 0.00001) and high→low (e.g., OR_S3→S1 = 0.38, 95% CI [0.33, 0.44], p < 0.00001) use directions over time. Older students, blacks (vs. whites), and breakfast eaters were less likely to transition from low→high use direction. Students with more weekly allowance, with more friends that smoked, longer sedentary time, and attended attended school unsupportive to resist or quit drug/alcohol were more likely to transition from low→high use direction. Except for truancy, all other covariates had inconsistent effects on the transition probabilities from the high→low use direction.

Interpretation

This is the first study to ascertain the dynamics of use patterns and factors in youth PSU utilizing LMM with population-based longitudinal health surveys, providing evidence in developing programs to prevent youth PSU.

Funding

The Applied Health Sciences scholarship; the Microsoft AI for Good grant; the Canadian Institutes of Health Research, Health Canada, the Canadian Centre on Substance Abuse, the SickKids Foundation, the Ministère de la Santé et des Services sociaux of the province of Québec.

Individual factors associated with the consumption of illicit substances: a review of reviews

INTRODUCTION

According to national studies, the use of illicit drugs is growing in Colombia. With this, the prevalence of substance use disorders and the set of health effects related to this practice also increases. Knowledge of the factors associated with the use of illicit drugs is necessary to guide the comprehensive care of the phenomenon.

METHODS

This is a systematic review of reviews on factors associated with the consumption of illicit drugs with seven databases and evaluation of the quality of the manuscripts according to AMSTAR.

RESULTS

Information was extracted from 38 reviews on individual factors associated with the use of illicit drugs. Demographic factors are associated with consumption through other factors. There is evidence of the association between mental and behavioural disorders and personality disorders.

CONCLUSIONS

The likelihood of consumption of illicit substances and disorders due to their use is affected by a set of personal factors including sociodemographic characteristics, mental health conditions, sexual behaviour, legal drug use, age of onset and risk perception.

Polysubstance use among national samples of in-school adolescents in Tonga and Vanuatu

The study aimed to provide estimates on current polysubstance use among adolescents in Tonga and Vanuatu. Cross-sectional and national school health survey data were analyzed from 5028 adolescents (mean age 15.4 years) in Tonga and Vanuatu in 2016-2017. Polysubstance use was defined as currently using two or three substances of tobacco, alcohol, and cannabis. Results indicate that 72.9% of students reported zero current substance use, 14.5% single current substance use, and 12.6% current polysubstance use (2 or 3 types of substance use). In the adjusted multinational logistic regression analysis factors associated with current single and polysubstance included older adolescents (15-18 years or older), male sex, bullied, passive smoking, high psychological distress, and low peer support, whereby the associations with current polysubstance use were stronger than with current single substance use. In addition, parental tobacco use was associated with single substance use, and school truancy and frequent soft drink consumption (≥3 times/day) were associated with current polysubstance use, and high parental support was negatively associated with polysubstance use. More than one in ten of the participating students engaged in current polysubstance use. Several factors associated with current single and polysubstance use were found which can help in designing intervention strategies.

Stress and Affect as Daily Risk Factors for Substance Use Patterns: an Application of Latent Class Analysis for Daily Diary Data

At the population level, use of multiple substances (or "co-use") is prevalent in young adulthood and linked with increased risk for experiencing substance-related harms. Less understood is the heterogeneity of substance use behaviors within individuals and across days, as well as the proximal predictors of these daily use patterns. The present study applied latent class analysis to daily diary data to identify daily substance use patterns and compare day-level class membership based on day-level stress and positive and negative affect among a higher-risk sample of young adult substance users. Participants (n = 152) completed up to 13 daily assessments of stress, affect, and substance use behavior. Among substance use days, five classes of days were identified: cannabis (some alcohol; 43% of days), alcohol-only (26%), vaping (some alcohol, cannabis; 24%), stimulant + alcohol (some cannabis, vaping; 4%), and cigarette-only (3%) days. Days with lower levels of perceived stress were significantly more likely to be alcohol-only Days relative to being days characterized by cigarette use, cannabis use, or multiple drug combinations. Days with higher levels of stress and negative affect were more likely to be cigarette-only days relative to cannabis and vaping days. Study findings document the wide range of substance use and co-use behaviors exhibited among young adults in daily life and highlight the importance of considering risk factors that correspond to days of problematic use patterns.

Bullying patterns and their associations with child maltreatment and adolescent psychosocial problems

INTRODUCTION

This study aimed 1) to identify underlying heterogeneous patterns of bully-victim; 2) to examine whether the different types of child maltreatment predict the patterns of bully-victim; and 3) to investigate the association between patterns of bully-victim and adolescent psychosocial problems (depression, trouble at school, and substance use).

METHODS

This study included a sample of 1139 (48.7% girls, 53.4% Black) drawn from the Fragile Families and Child Wellbeing Study. Children's self-reported bullying victimization at age 9 was used using the Panel Study of Income Dynamics Child Development Supplement III. Teacher's reported bullying perpetration at age 9 was used using Social Skills Rating System. Child maltreatment types were assessed at age 5 using the Parent-Child Conflict Tactics Scale Coding. At age 15, adolescent depression was measured using modified Center for Epidemiologic Studies Depression Scale; trouble at school was measured using modified Add Health In-School Questionnaire; and self-reported substance use was used.

RESULTS

Latent class analysis produced four classes: bully-victim (19.8%), victim (16.3%), no bully-victim (38.9%), and bully (24.9%). Individuals who have been neglected are more likely to be in the victim class compared to all other classes. Physical abuse to be at heightened risk of involvement in the bully-victim, compared to victim class. Additionally, individuals in the victim group are greater risk for depression, problems at school, and alcohol, as compared to those in the other classes.

CONCLUSIONS

This study augments the knowledge base on bully/victim, child maltreatment, and behavioral health outcomes and elucidates several suggestions for research and policy.

Polysubstance use classes and health outcomes among women attending specialist substance use treatment services

INTRODUCTION

Substance use is increasingly prevalent among women. Little research examines subgroups of women with substance use issues to identify their characteristics and thus enable treatment recommendations. The present study used latent class analysis to identify subgroups of substance use among women in substance-use treatment based on use in the 30 days prior to intake and examined changes in mental health and treatment outcomes following 60 days of treatment.

METHODS

Participants were women (N = 493) attending specialist non-government substance use treatment services in New South Wales, Australia.

RESULTS

Four distinct classes of substance users were identified: (i) Amphetamine Type Stimulants (ATS) Polysubstance (40.6%, n = 200); (ii) Alcohol Only (33.1%, n = 163); (iii) Cannabis and Alcohol (17.0%, n = 84) and (iv) Other Polysubstance (9.3%, n = 46). Women in the ATS Polysubstance class were the youngest and those in the Alcohol Only class were the oldest.

DISCUSSION AND CONCLUSIONS

Findings show that classes with high polysubstance use (ATS Polysubstance) differed from the single-substance use class (Alcohol Only). The ATS Polysubstance class had significantly greater improvements in health outcomes after 60 days compared to the Alcohol Only class. These findings suggest that although women with polysubstance use can benefit from substance use treatment, younger women (ATS Polysubstance) may benefit even more than older women (Alcohol Only). Future research should utilise a longitudinal design and examine additional psychosocial characteristics to extend on current findings.

Family and parent-child relationship correlates of pediatric cancer survivors' substance use

OBJECTIVE

The primary aims of this research were to examine substance use among adolescent and young adult survivors of pediatric cancer (AYA survivors) and AYA without a history of chronic or life threatening illness (AYA comparisons) and to explore links between demographic, medical, caregiver-AYA, and family system factors with AYA substance use patterns.

METHODS

Participants included 289 AYA (survivors, n = 171; comparisons = 118; 51% female; M_age = 17.15, SD_age = 2.86) and their caregivers (M_age = 46.54, SD_age = 6.81; 88% mothers). AYA and caregivers completed the family environment scale, and caregivers completed the parenting relationship questionnaire at the initial assessment. Two years later, AYA completed an assessment of substance use. Chi-square and frequency analyses were used to compare differences in substance use among AYA survivors and comparisons. Multivariate analysis of variance was used to examine links between AYA substance use patterns with family and caregiver-AYA system level factors.

RESULTS

Patterns of substance use did not differ between AYA survivors and comparisons. AYA survivors were more likely to report polysubstance use if caregivers endorsed problematic caregiver-AYA relationship patterns. Family functioning and caregiver relationship patterns did not predict AYA comparison substance use.

CONCLUSION

AYA survivors were just as likely as AYA comparisons to engage in substance use, increasing their vulnerability to problematic health outcomes. Findings indicate that the role caregiver-AYA relationship patterns may have on youth at risk for substance use and potential mechanisms for future intervention.

Medical use and misuse of psychoactive prescription medications among US youth and young adults

OBJECTIVE

To investigate prevalence and correlates of medical use and misuse of psychoactive prescription medications among US youth and young adults.

DESIGN

Cross-sectional, self-reported surveys from the 2015-2018 National Survey of Drug Use and Health. Sampling was probabilistic and nationally representative.

SETTING

The target population included individuals from households, non-institutional group quarters (eg, college dormitories) and civilians living on military bases. Questionnaires were completed using computer-assisted self-interview methods.

PARTICIPANTS

Our analytical sample included youth and young adults aged 12-25 years (n=110 556). Psychoactive prescription medication misuse was a report by the respondent that they had used psychoactive prescription medications in the past year in any way not directed or prescribed for them. Medical use was defined as past-year use without a report of misuse. Because certain variables were assessed only among adults, our multivariable analysis to identify correlates of misuse was restricted to young adults aged 18-25 years (n=55 690).

RESULTS

Among US youth aged 12-17 years, 25.0% reported use of any psychoactive prescription medication assessed, and 5.7% reported past-year use of at least two psychoactive prescription medications. Among youth who used any psychoactive prescription medications, 20.9% (1.3 million) reported misuse; 3.4% were classified as having substance use disorder. Past-year use of each psychoactive prescription medication was: opioids (19.0%), stimulants (7.2%), tranquillisers (4.3%) and sedatives (2.2%). Among users of each psychoactive prescription medication, the estimated percentage reporting misuse was as follows: opioids (17.6%, 0.8 million), stimulants (24.2%, 0.4 million), tranquillisers (40.1%, 0.4 million) and sedatives (14.2%, 80 000). Among users of each psychoactive prescription medication, the estimated percentage having substance use disorder was as follows: opioids 2.6%, stimulants 3.0%, tranquillisers 7.0% and sedatives 3.6%. Analyses among young adults aged 18-25 years revealed that, compared with never users of non-prescription substances (including alcohol, tobacco, marijuana, cocaine, heroin), opioid misuse increased with: more recent use of non-prescription substances (adjusted prevalence ratios (APRs)=8.26, 2.75 and 2.41 for past ≤30-day, ≤12-month and >12-month use, respectively); and a higher number of substances used (APRs=1.69, 3.44, 6.82, 10.60 and 20.60 for 1, 2, 3, 4 and 5+ substances, respectively) (all p<0.05). Similar patterns were seen for stimulants, tranquillisers and sedatives.

CONCLUSIONS

It is important to monitor the diversity of medication misuse behaviours among youth and young adults, given their potential for abuse liability. Modifiable risk factors for prescription substance misuse, such as tobacco and other non-prescription substance use, underscore the need for comprehensive approaches towards health promotion among youth and young adults.

Patterns of substance use among adolescents: A systematic review

PURPOSE

This review characterizes empirically derived patterns of multiple (multi-) substance use among adolescents. A secondary objective was to examine the extent to which mental health symptomatology was included in the empirical analyses examining substance use patterns.

METHODS

Eligible studies included those that used cluster-based approaches, included the assessment of at least two different substances, and were based on study samples with mean ages between 11 and 18 years. 4665 records were screened including 461 studies for full-text screening.

RESULTS

70 studies were included with common clusters being: low use, single or dual substance use, moderate general multi-use, and high multi-use. The most common patterns of single or multi-substance use were: alcohol only, alcohol with cannabis and/or tobacco, and use of alcohol, tobacco, and cannabis with and without other drugs. Lower socioeconomic status, older age, and male gender were consistent predictors of multi-use clusters. Only 37 % of studies compared differences in levels of mental health across clusters with symptoms consistently associated with a greater likelihood of multi-use. Only 29 % of studies included mental health indicators in cluster-based analyses, with over half identifying distinct mental health and substance use clusters. Fit indices in cluster analyses and measurement properties of substance use were heterogeneous and inconsistently reported across studies.

CONCLUSIONS

Distinct patterns of substance use were derived but methodological differences prevented direct comparison and reduced capacity to generalize across studies. There is a need to establish standardized methodological approaches to identify robust patterns of substance use to enhance etiological, prognostic, and intervention research.

A latent class analysis of changes in adolescent substance use between 1988 and 2011 in Sweden: associations with sex and psychosomatic problems

AIMS

To characterize changes in patterns of adolescent substance use in Sweden between 1988 and 2011, and to assess whether sex and psychosomatic problems were associated with substance use and whether these associations changed over time.

DESIGN

Secondary analysis of repeated cross-sectional survey data. Survey data were collected eight times and analyzed as four cohorts (1988-91, 1995-98, 2002-05 and 2008-11).

SETTING AND PARTICIPANTS

The sample included all 15-16-year-olds in Värmland County, Sweden (n = 20 057).

MEASUREMENTS

Binary-coded substance use measures included life-time use of alcohol and tobacco, getting drunk and past school year use of inhalants. An eight-item scale was used to assess psychosomatic problems.

FINDINGS

A three-class model fitted the data best (i.e. non/low use, mainly alcohol use and polysubstance use). The patterns of substance use were different among cohorts; most notably, adolescents in the last cohort had lower odds of being included in the alcohol and polysubstance use classes rather than the non/low use class than in the earlier cohorts (all Ps < 0.001). Males had higher odds than females of being in the polysubstance use class rather than the non/low use class among the first three cohorts (all Ps < 0.001) but not the last. Sex was not associated with inclusion in the alcohol use class rather than the non/low use class. Adolescents who reported more psychosomatic problems had higher odds of being included in the alcohol and polysubstance use classes rather than the non/low use class (all Ps < 0.001). The associations of sex and psychosomatic problems with class inclusion did not change during the study period.

CONCLUSIONS

Between 1988 and 2011, patterns of substance use among adolescents in Sweden shifted away from polysubstance use and alcohol use to non-use or low use. Associations between patterns of substance use and sex and psychosomatic problems remained largely consistent across the study period.

Social Distancing and Stigma: Association Between Compliance With Behavioral Recommendations, Risk Perception, and Stigmatizing Attitudes During the COVID-19 Outbreak

Introduction: Following behavioral recommendations is key to successful containment of the COVID-19 pandemic. Therefore, it is important to identify causes and patterns of non-compliance in the population to further optimize risk and health communication.

Methods: A total of 157 participants [80% female; mean age = 27.82 years (SD = 11.01)] were surveyed regarding their intention to comply with behavioral recommendations issued by the German government. Latent class analysis examined patterns of compliance, and subsequent multinomial logistic regression models tested sociodemographic (age, gender, country of origin, level of education, region, and number of persons per household) and psychosocial (knowledge about preventive behaviors, risk perception, stigmatizing attitudes) predictors.

Results: Three latent classes were identified: high compliance (25%) with all recommendations; public compliance (51%), with high compliance regarding public but not personal behaviors; and low compliance (24%) with most recommendations. Compared to high compliance, low compliance was associated with male gender [relative risk ratio (RRR) = 0.08 (0.01; 0.85)], younger age [RRR = 0.72 (0.57; 0.93)], and lower public stigma [RRR = 0.21 (0.05; 0.88)]. Low compliers were also younger than public compliers [RRR = 0.76 (0.59; 0.98)].

Discussion: With 25% of the sample reporting full compliance, and 51% differing in terms of public and personal compliance, these findings challenge the sustainability of strict regulatory measures. Moreover, young males were most likely to express low compliance, stressing the need for selective health promotion efforts. Finally, the positive association between public stigma and compliance points to potential othering effects of stigma during a pandemic, but further longitudinal research is required to examine its impact on health and social processes throughout the pandemic.

Prevalence and correlates of youth poly-substance use in the COMPASS study

BACKGROUND AND AIMS

Youth poly-substance use, associated with long-term negative health and social outcomes, is of increasing concern following the rise of e-cigarette vaping and cannabis legalization in Canada. This work aimed to investigate current evidence on correlates of this behaviour to inform effective prevention and harm reduction programming.

DESIGN

Cross-sectional sample taking part in a cohort study.

SETTING

Canadian high schools (AB, BC, ON, QC) PARTICIPANTS: 74,501 Canadian high school students who completed the COMPASS student questionnaire in 2018/2019.

MEASUREMENTS

Self-report data on use of five substances (alcohol, cigarettes, e-cigarettes, cannabis, and opioids) alongside demographic factors, social and school support, and mental health-related measures.

RESULTS

Of the 39% of youth who reported current substance use, 53% reported using two or more. E-cigarette vaping was most prevalent (28%) and most often combined with other substances. Feeling supported by friends and having no problem with seeking help at school were associated with higher levels of poly-substance use. Family support, school connectedness, and school support to resist drugs decreased the risk of substance co-use.

CONCLUSIONS

The evidence presented here suggests that interventions for youth poly-substance use should rely on joint efforts between parents, schools, and communities to focus on structural factors rather than problematizing the individual.

Individual Factors Associated with the Consumption of Illicit Substances: a Review of Reviews

INTRODUCTION

According to national studies, the use of illicit drugs is growing in Colombia. With this, the prevalence of substance use disorders and the set of health effects related to this practice also increases. Knowledge of the factors associated with the use of illicit drugs is necessary to guide the comprehensive care of the phenomenon.

METHODS

This is a systematic review of reviews on factors associated with the consumption of illicit drugs with seven databases and evaluation of the quality of the manuscripts according to AMSTAR.

RESULTS

Information was extracted from 38 reviews on individual factors associated with the use of illicit drugs. Demographic factors are associated with consumption through other factors. There is evidence of the association between mental and behavioural disorders and personality disorders.

CONCLUSIONS

The likelihood of consumption of illicit substances and disorders due to their use is affected by a set of personal factors including sociodemographic characteristics, mental health conditions, sexual behaviour, legal drug use, age of onset and risk perception.

The contribution of drinking culture at comprehensive school to heavy episodic drinking from adolescence to midlife

BACKGROUND

The school context is associated with adolescent alcohol use, but it is not clear whether this association continues into adulthood. This study examined whether exposure to drunkenness oriented drinking culture in 9th grade school class is associated with individuals' heavy episodic drinking (HED) from adolescence to midlife.

METHODS

Participants in the 'Northern Swedish Cohort' study aged 16 years in 1981 were followed-up when aged 18, 21, 30 and 43 (N = 1080). Individual-level factors were HED, positive attitudes towards drunkenness, early initiation of HED and peer-oriented spare-time. School class-level drinking culture was measured as classmate reported HED, positive attitudes, early initiation of HED and peer-oriented spare time. Multilevel log-binomial regression analyses were adjusted for gender, parental socioeconomic background, family structure and HED at age 16.

RESULTS

After adjustment for sociodemographic factors several cross-sectional and longitudinal associations were found between class-level indicators of drinking culture and individual HED. After additional adjustment for age 16 HED, most associations attenuated. The risk ratio (95% confidence interval) for engaging in HED at age 43 was 1.58 (1.03-2.42) times higher for those who at age 16 had many classmates reporting positive attitude towards drunkenness.

CONCLUSIONS

These findings suggest that drinking culture in school may have a long-lasting impact on drinking habits in adulthood. The associations with HED at follow-ups are likely mediated by HED in adolescence. Studies on alcohol use would benefit from taking into account both individual and contextual factors in a life course perspective.

Alcohol and tobacco consumption associated factors among college students: A review

Aim

Alcohol and tobacco consumption, common among college students, may lead to future health and social problems. We aim to identify the factors associated with those consumptions among college students.

Method

A literature review was performed using PRISMA recommendations. Records were selected through PubMed and Scopus. Through inclusion and exclusion criteria, data from the selected studies were analysed through meta-syntheses.

Results

Twenty studies were included in the analysis. Tobacco consumption was associated with having smoker friends, sedentary behaviours and male sex. Drinking was associated with having parents/friends who drink, having smoker friends and male sex.

Conclusion

This review contributes to identify the consumption factors, allowing health care workers to develop and improve the effectiveness of possible interventions for this population, such as health education programs or psycho-educational interventions, aiming to decrease consumptions behaviours, by targeting the students who are at risk.

Using polytomous latent class analysis to compare patterns of substance use and co-occurring health-risk behaviors between students in alternative and mainstream high schools

INTRODUCTION

Alternative high school (AHS) students, an understudied and underserved population, experience educational, social, and health disparities relative to students in mainstream high schools. Disparities in single types of substance use are particularly high, yet no known studies have compared patterns of substance use or relationships between these patterns and other health-risk behaviors between AHS and mainstream high schools.

METHODS

Using data from the Texas Alternative School Health Survey (n = 515; mean age 17.1 years, 49% male, 59% Hispanic, 23% White, 15% Black) and the Texas Youth Risk Behavior Survey (n = 2,113; mean age 16 years, 47% male, 64% Hispanic, 22% White, 7% Black), we used latent class analyses to compare patterns of substance use in AHSs and mainstream high schools. We used latent class regression to examine relationships between patterns of substance use and involvement in other health-risk behaviors in each school setting.

RESULTS

Students in AHSs and mainstream high schools had similar patterns of substance use, and youth in higher risk categories engaged in higher levels of other health-risk behaviors. A substantially greater proportion of AHS students, however, fell into the moderate and high use categories, in support of continuing disparities for AHS students.

CONCLUSIONS

Additional support is needed in AHSs to address the prevalence of high-risk patterns of substance use and associated health-risk behaviors. For example, ongoing public health surveillance is needed in AHSs, just as is done in mainstream high schools, to monitor trends in substance use and impact of policies and interventions.

Gender-specific substance use patterns and associations with individual, family, peer, and school factors in 15-year-old Portuguese adolescents: a latent class regression analysis

BACKGROUND

Adolescence is a critical period of vulnerability to substance use. Recent research has shown that gender differences in adolescence substance use are complex and in constant flux. The present study aims to investigate gender differences in substance use and initiation patterns in male and female adolescents, and to assess individual, family, peer, and school associated factors of these patterns.

METHODS

We applied latent class regression analysis to a Portuguese representative population sample of 1551 15-year-old adolescents, drawn from the 2010 'Health Behavior in School-Aged Children' survey, to characterise different profiles of substance use and initiation for boys and girls, and to identify factors associated with latent class membership, stratifying the associations analysis by gender.

RESULTS

Three common classes were found for both genders, specifically, Non-Users (boys [B] 34.42%, girls [G] 26.79%), Alcohol Experimenters (B 38.79%, G 43.98%) and Alcohol and Tobacco Frequent Users (B 21.31%, G 10.36%), with two additional unique classes: Alcohol Experimenters and Tobacco Users in girls (18.87%), and Early Initiation and Poly-Substance Users in boys (5.48%). Poor school satisfaction, bullying, fighting and higher family affluence scale score formed a common core of associated factors of substance use, although we found gender differences in these associations. In girls, but not in boys, family factors were associated with more problematic substance use. Not living with both parents was associated with girl's Alcohol and Tobacco Frequent Users (gATFU) class (OR 3.78 CI 1.18-12.11) and Alcohol Experimenters and Tobacco Users (AETU) class (OR 3.22 CI 1.4-7.44). Poor communication with mother was also associated with gATFU class membership (OR 3.82 CI 1.26-11.53) and AETU class (OR 3.66 CI 1.99-6.75). Additionally, a higher psychological symptoms score was associated with gATFU class membership (OR 1.16 CI 1.02-1.31).

CONCLUSION

Although we found common patterns and associated factors between boys and girls, we report two unique patterns of substance use in boys and girls and specific associations between family, school and peers, and individual factors with these patterns. These findings underscore the need for substance use prevention and health promotion programmes that address potential differences in substance use patterns and associated factors.

Bullying involvement and substance use among Brazilian adolescent students

Objective

Although bullying involvement has been associated with adolescent substance use, most of this evidence comes from high-income countries. Little is known about substance use among perpetrator-victims in low- and middle-income countries. This study explores the association between types of bullying involvement and adolescent substance use in Brazil.

Methods

Data for this cross-sectional study came from the 2015 Pesquisa Nacional de Saúde do Escolar [National Adolescent School-based Health Survey] (PeNSE), a nationwide school-based survey of Brazilian ninth graders. Substance use was analyzed as any substance use (i.e., use of alcohol, cigarettes, or marijuana in the previous 30 days) and substance co-use (i.e., use of all three substances). Logistic regression analyses were conducted, and adjusted odds ratios (aORs) were calculated, adjusting for demographic characteristics and student loneliness.

Results

Odds of any substance use for bullying perpetrators-only and for perpetrator-victims, respectively, were significantly higher compared to no bullying involvement (aOR = 2.99, 95% CI = 2.71-3.30 and aOR = 2.52, 95% CI = 2.31-2.75). Adjusted odds of substance co-use were also significantly higher among perpetrators-only and perpetrator-victims (aOR = 4.04, 95% CI = 3.05-5.35 and aOR = 3.49, 95% CI = 2.71-4.51, respectively). Victimization-only was associated with a 14% increase in the odds of any substance use (aOR = 1.14, 95% CI = 1.07-1.22).

Conclusions

The results underscore the complex relationship between adolescent bullying involvement and substance use. Findings also indicate the type of bullying involvement, as well as demographic and psychological factors, should be taken into consideration when assessing adolescent health-risk behaviors.

Who is seeking whom? A person-centred approach to help-seeking in adults with currently untreated mental health problems via latent class analysis

PURPOSE

Global surveys point to a gap in mental health service utilisation. However, contacting more than one source of professional help may influence the estimates of utilisation. Currently, few studies statistically differentiate between different sources of help based on patient characteristics.

METHODS

We assessed sociodemographic and psychosocial data in a convenience sample of 188 adults with mental health problems (M_age = 50.34 years; SD = 16.19; 71% female), who reported their help-seeking behaviour during the next 6 months. We analysed their behaviour via latent class analysis and compared baseline characteristics between classes.

RESULTS

We found four latent classes: "mental health professionals" (MHP; 9.0%), "multiple sources" (4.3%), "primary care" (35.6%), and "non-seekers" (51.1%). All classes had moderate to high probabilities of seeking help from friends or family. Primary care utilisers were more often in a cohabiting partnership; MHP utilisers were more experienced in mental health treatment and reported lower well-being and more depressive symptoms than non-seekers. By trend, non-seekers were younger, and both non-seekers and primary care utilisers reported fewer depressive and somatic symptoms than utilisers of multiple sources and MHP.

CONCLUSIONS

In our analysis, MHP utilisation was even lower (9.0%) than in previous studies. However, MHP utilisers appeared to suffer from more serious conditions than other latent classes. As informal sources such as family and friends were present in all latent classes, help-seeking behaviour seems to transcend traditional MHP-focused approaches. Further research is necessary to investigate tenability and trajectories of different latent classes of help-seeking in larger and representative samples with longer follow-ups.

E-cigarette use and quantity of cigarette smoking among adolescent cigarette smokers: A finite mixture model analysis

BACKGROUND

E-cigarette use is popular among adolescents and youth, but its long-term public health implications remain largely unknown. Much of the literature has focused on understanding the relationship between e-cigarette use and youth cigarette initiation. However, very little is known about e-cigarette use and cigarette quantity among those who continue to smoke cigarettes. The objective of the present study was to examine the association between current e-cigarette use and quantity of cigarette smoking.

METHODS

Cross-sectional data on current smokers were drawn from the 2014-2015 Canadian Student Tobacco, Alcohol and Drugs Survey among high school students (n = 1411). A finite mixture model (FMM) was employed to account for unobserved heterogeneity due to clusters of finite sub-populations.

RESULTS

Current e-cigarette users reported smoking more conventional cigarettes in the past week compared to non-e-cigarette users (t [1409] = 4.7998; p < 0.001 in unadjusted analysis). Results from a finite mixture regression showed that current e-cigarette use was significantly associated with the number of cigarettes smoked in the past week, but only among light smokers (IRR = 1.40; CI = 1.05-1.85). However, additional analyses found that the association between e-cigarette use and quantity of cigarette smoked varied by individual smoking pattern. An FMM with a group or class modelling using individual smoking pattern showed a weaker association between e-cigarette use and quantity of cigarette smoking.

CONCLUSION

Findings of this study suggest that the significant association between e-cigarette use and quantity of cigarette smoking may be driven by patterns of use among experimental or beginner smokers.

Polysubstance use profiles among electronic dance music party attendees in New York City and their relation to use of new psychoactive substances

BACKGROUND

Electronic Dance Music (EDM) party attendees are often polysubstance users and are at high risk for use of new psychoactive substances (NPS). We sought to identify patterns of use of common illegal drugs among EDM party attendees, sociodemographic correlates, and use of NPS as a function of patterns of use of more common drugs to inform prevention and harm reduction.

METHOD

Using time-space-sampling, 1045 individuals aged 18-40 were surveyed entering EDM parties in New York City. We queried past-year use of common illegal drugs and 98 NPS. We conducted latent class analysis to identify polysubstance use profiles of use of eight common drugs (i.e., ecstasy, ketamine, LSD, mushrooms, powder cocaine, marijuana, amphetamine, benzodiazepines). Relationships between drug classification membership and sociodemographics and use of drugs within six NPS categories were examined.

RESULTS

We identified four profiles of use of common drugs: non-polysubstance use (61.1%), extensive polysubstance use (19.2%), moderate polysubstance use/stimulants (12.8%), and moderate polysubstance use/psychedelics (6.7%). Those in the moderate/psychedelic group were at higher odds of using NPS with psychedelic-type effects (2C, tryptamines, and other "new" psychedelics; Ps<0.05). Extensive polysubstance users were at increased odds of reporting use of 2C drugs, synthetic cathinones ("bath salts"), tryptamines, other new (non-phenethylamine) psychedelics, new dissociatives, and synthetic cannabinoids (Ps<0.05).

CONCLUSION

NPS preference is linked to the profile of use of common drugs among individuals in the EDM scene. Most participants were identified as non-polysubstance users, but findings may help inform preventive and harm reduction interventions among those at risk in this scene.

Substance Use among Adolescents Involved in Bullying: A Cross-Sectional Multilevel Study

Being involved in bullying as a victim or perpetrator could have deleterious health consequences. Even though there is some evidence that bullies and victims of bullying have a higher risk for drug use, less is known about bystanders. The aim of this research was to study the association between bullying experience (as victims, bullies, or bystanders) and substance use. We gathered complete information from a nationally representative sample of 36,687 students (51.4% female) attending 756 schools in Chile. We used a self-reported questionnaire which was developed based on similar instruments used elsewhere. This questionnaire was piloted and presented to an expert panel for approval. We used multilevel multivariate logistic regression analyses, controlling for several variables at the individual (e.g., school membership, parental monitoring) and school levels (e.g., school type, school denomination). This study shows that bullies and bully-victims have a high risk for cigarette, alcohol, and cannabis use than bystanders. This is one of the few studies exploring the association between witnessing bullying and substance use. These findings add new insights to the study of the co-occurrence of bullying and substance use. Other factors, such as higher academic performance, stronger school membership, and better parental monitoring reduced the risk of any substance use, while the experience of domestic violence and the perception of social disorganization in the neighborhood, increased the risk. These findings may help the design of preventive interventions.

Individual and contextual factors associated with tobacco, alcohol, and cannabis use among Chilean adolescents: A multilevel study

We studied the association between individual and contextual variables and the use of tobacco, alcohol, or cannabis in the last 30 days preceding the study, considering the hierarchical nature of students nested in schools. We used the 7th Chilean National School Survey of Substance Use (2007) covering 45,273 students (aged 12-21 years old) along with information from 1465 schools provided by the Chilean Ministry of Education. Multilevel univariable and multivariable logistic regression models were performed. We found a significant intra-class correlation within schools for all substances in the study. Common (e.g., availability of pocket money, more time spent with friends, poor parental monitoring, poor school bonding, bullying others, and lower risk perception of substance use) and unique predictors (e.g., school achievement on national tests) were identified. These findings may help in planning and conducting preventive interventions to reduce substance use.

Polydrug use among urban adolescent cigarette smokers

PURPOSE

Adolescent smokers are at increased risk for polydrug use, which is associated with more consequences than use of a single drug. Here we classified subgroups of polydrug use among urban adolescent cigarette-smokers; described the sociodemographic, smoking, and depression correlates; and identified three-year outcomes associated with subgroup membership.

METHODS

Adolescent cigarette smokers (N=176; Mage=16.1; 35% male; 27% white) completed surveys assessing drug use, smoking characteristics, demographics, and depressive symptoms at baseline and 12, 24, and 36months follow-up.

RESULTS

Almost all participants (96%) reported using, on average, two (SD=0.97) substances (including other tobacco products) in addition to cigarettes. Latent class analysis revealed two distinct classes of polydrug users. "Limited Range Use" (84%) class members reported current use of other tobacco, alcohol, and marijuana, as did "Extended Range Use" class members (16%) who also reported current use of "harder drugs" (i.e., cocaine/crack, hallucinogens, ecstasy, and misused prescriptions). The classes did not differ on demographics or baseline likelihood of marijuana (χ2=0.25; p<0.62) or alcohol use (χ2=3.3; p<0.07). At baseline, a larger proportion of Extended Range Use class members reported both smoking the entire cigarette and symptoms of clinical depression. Extended Range Use class membership at baseline predicted higher mean depression scores at 24 and 36months.

CONCLUSION

Adolescent cigarette-smokers who reported extended range use (18%) also reported symptoms of clinical depression at baseline and follow-up. These findings indicate a need for early monitoring of depression symptoms and prevention and cessation interventions targeting this high-risk group.

Latent class analysis of current e-cigarette and other substance use in high school students

OBJECTIVE

There is limited research on adolescents' use of e-cigarettes and other substances.

MATERIALS AND METHODS

2241 Connecticut high school students completed anonymous, cross-sectional surveys assessing e-cigarette and other substance use. We used latent class analysis (LCA) to: (1) classify students based on their past-month use of e-cigarettes, cigarettes, cigars, smokeless tobacco, hookah, blunts, marijuana, and alcohol, and (2) determine if age, sex, or race predicted class membership.

RESULTS

Past-month e-cigarette use was 11.6%, and use rates for the remaining substances ranged from 2.8% (smokeless tobacco) to 20.7% (alcohol). The optimal latent class solution comprised four classes: (1) primarily abstainers (81.6%; abstainers), (2) primarily e-cigarette and alcohol users (4.6%; E-cigarette-Alcohol), (3) primarily marijuana and alcohol users (6.9%; Marijuana-Alcohol), and (4) primarily users of all products (6.9%; All Products). Compared to abstainers, (1) all substance-using classes comprised older students, (2) the All Products and E-cigarette-Alcohol classes were more likely to comprise males and less likely to comprise Blacks, and (3) the Marijuana-Alcohol class was more likely to comprise Blacks and Latinos. Relative to the All Products and E-cigarette-Alcohol classes, the Marijuana-Alcohol class was more likely to comprise females, Blacks, and Latinos.

CONCLUSIONS

LCA identified four substance use classes, two of which included elevated e-cigarette use. Class membership differed by age, sex, and race. Additional research should evaluate characteristics that may explain the different product use profiles identified in the current study including cultural differences, peer group norms, and differing perceptions of the harmfulness of each substance.

Patterns of Substance Use Across the First Year of College and Associated Risk Factors

Starting college is a major life transition. This study aims to characterize patterns of substance use across a variety of substances across the first year of college and identify associated factors. We used data from the first cohort (N = 2056, 1240 females) of the "Spit for Science" sample, a study of incoming freshmen at a large urban university. Latent transition analysis was applied to alcohol, tobacco, cannabis, and other illicit drug uses measured at the beginning of the fall semester and midway through the spring semester. Covariates across multiple domains - including personality, drinking motivations and expectancy, high school delinquency, peer deviance, stressful events, and symptoms of depression and anxiety - were included to predict the patterns of substance use and transitions between patterns across the first year. At both the fall and spring semesters, we identified three subgroups of participants with patterns of substance use characterized as: (1) use of all four substances; (2) alcohol, tobacco, and cannabis use; and (3) overall low substance use. Patterns of substance use were highly stable across the first year of college: most students maintained their class membership from fall to spring, with just 7% of participants in the initial low substance users transitioning to spring alcohol, tobacco, and cannabis users. Most of the included covariates were predictive of the initial pattern of use, but covariates related to experiences across the first year of college were more predictive of the transition from the low to alcohol, tobacco, and cannabis user groups. Our results suggest that while there is an overall increase in alcohol use across all students, college students largely maintain their patterns of substance use across the first year. Risk factors experienced during the first year may be effective targets for preventing increases in substance use.