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Green R, Wolf BJ, Chen A, Kirkland AE, Ferguson PL, Browning BD, Bryant BE, Tomko RL, Gray KM, Mewton L, Squeglia LM. Predictors of Substance Use Initiation by Early Adolescence. Am J Psychiatry 2024; 181:423-433. [PMID: 38706327 DOI: 10.1176/appi.ajp.20230882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Substance use initiation during early adolescence is associated with later development of substance use and mental health disorders. This study used various domains to predict substance use initiation, defined as trying any nonprescribed substance (e.g., alcohol, tobacco, cannabis), by age 12, using a large longitudinal data set. METHODS Substance-naive youths from the Adolescent Brain Cognitive Development Study (ages 9-10; N=6,829) were followed for 3 years. A total of 420 variables were examined as predictors of substance use initiation, using a penalized logistic regression with elastic net; domains spanned demographic characteristics, self and peer involvement with substance use, parenting behaviors, mental and physical health, culture and environment, hormones, neurocognitive functioning, and structural neuroimaging. RESULTS By age 12, 982 (14.4%) children reported substance initiation, with alcohol being the most common. Models with only self-report predictors had similar prediction performance to models adding hormones, neurocognitive factors, and neuroimaging predictors (AUCtest=0.66). Sociodemographic factors were the most robust predictors, followed by cultural and environmental factors, physical health factors, and parenting behaviors. The top predictor was a religious preference of Mormon (coefficient=-0.87), followed by a religious preference for Jewish (coefficient=0.32), and by Black youths (coefficient=-0.32). CONCLUSIONS Sociodemographic variables were the most robust predictors of substance use initiation. Adding resource-intensive measures, including hormones, neurocognitive assessment, and structural neuroimaging, did not improve prediction of substance use initiation. The application of these large-scale findings in clinical settings could help to streamline and tailor prevention and early intervention efforts.
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Affiliation(s)
- ReJoyce Green
- Department of Psychiatry and Behavioral Sciences (Green, Kirkland, Browning, Bryant, Tomko, Gray, Squeglia) and Department of Public Health Sciences (Wolf, Chen, Ferguson), Medical University of South Carolina, Charleston; Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Mewton)
| | - Bethany J Wolf
- Department of Psychiatry and Behavioral Sciences (Green, Kirkland, Browning, Bryant, Tomko, Gray, Squeglia) and Department of Public Health Sciences (Wolf, Chen, Ferguson), Medical University of South Carolina, Charleston; Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Mewton)
| | - Andrew Chen
- Department of Psychiatry and Behavioral Sciences (Green, Kirkland, Browning, Bryant, Tomko, Gray, Squeglia) and Department of Public Health Sciences (Wolf, Chen, Ferguson), Medical University of South Carolina, Charleston; Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Mewton)
| | - Anna E Kirkland
- Department of Psychiatry and Behavioral Sciences (Green, Kirkland, Browning, Bryant, Tomko, Gray, Squeglia) and Department of Public Health Sciences (Wolf, Chen, Ferguson), Medical University of South Carolina, Charleston; Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Mewton)
| | - Pamela L Ferguson
- Department of Psychiatry and Behavioral Sciences (Green, Kirkland, Browning, Bryant, Tomko, Gray, Squeglia) and Department of Public Health Sciences (Wolf, Chen, Ferguson), Medical University of South Carolina, Charleston; Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Mewton)
| | - Brittney D Browning
- Department of Psychiatry and Behavioral Sciences (Green, Kirkland, Browning, Bryant, Tomko, Gray, Squeglia) and Department of Public Health Sciences (Wolf, Chen, Ferguson), Medical University of South Carolina, Charleston; Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Mewton)
| | - Brittany E Bryant
- Department of Psychiatry and Behavioral Sciences (Green, Kirkland, Browning, Bryant, Tomko, Gray, Squeglia) and Department of Public Health Sciences (Wolf, Chen, Ferguson), Medical University of South Carolina, Charleston; Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Mewton)
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences (Green, Kirkland, Browning, Bryant, Tomko, Gray, Squeglia) and Department of Public Health Sciences (Wolf, Chen, Ferguson), Medical University of South Carolina, Charleston; Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Mewton)
| | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences (Green, Kirkland, Browning, Bryant, Tomko, Gray, Squeglia) and Department of Public Health Sciences (Wolf, Chen, Ferguson), Medical University of South Carolina, Charleston; Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Mewton)
| | - Louise Mewton
- Department of Psychiatry and Behavioral Sciences (Green, Kirkland, Browning, Bryant, Tomko, Gray, Squeglia) and Department of Public Health Sciences (Wolf, Chen, Ferguson), Medical University of South Carolina, Charleston; Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Mewton)
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences (Green, Kirkland, Browning, Bryant, Tomko, Gray, Squeglia) and Department of Public Health Sciences (Wolf, Chen, Ferguson), Medical University of South Carolina, Charleston; Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Mewton)
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Kwon E, Oshri A, Zapolski TCB, Zuercher H, Kogan SM. Substance use trajectories among emerging adult Black men: Risk factors and consequences. Drug Alcohol Rev 2023; 42:1816-1824. [PMID: 37486247 PMCID: PMC10805973 DOI: 10.1111/dar.13728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Young, Black American men experience greater social, legal and economic consequences of substance use compared with White men for comparable levels of consumption. The development of tailored interventions requires prospective information on their substance use patterns, risk factors and consequences. We identified longitudinal substance use profiles and examined their links to childhood adversity, racial discrimination and young adult problem substance use and mental health. METHODS Emerging adult Black men (n = 504, mean age = 20.26, SD = 1.08) provided fours waves of data between January 2012 and March 2021. We conducted a parallel process latent class growth analysis for three substances to explore conjoint longitudinal use patterns and investigated the risk factors and consequences of each pattern. RESULTS Three trajectory classes emerged: non-using (n = 201, 39.9%), cannabis using (n = 202, 40.1%) and poly-substance using (n = 101, 20%) groups. Threat-based childhood adversity and racial discrimination were associated with higher odds of being members of cannabis or poly-substance groups than non-using group. Deprivation-based adversity was associated with higher odds for membership in poly-substance than non-using group. At Wave 4, elevated depressive symptoms were more prevalent among poly-substance compared with cannabis using group. DISCUSSION AND CONCLUSIONS Heterogeneous substance use patterns emerged among Black American men and each pattern has distinct risk factors and outcomes in young adulthood. For prevention, more attention is needed for cannabis use patterns and psychosocial adversities that are unique to Black population.
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Affiliation(s)
- Elizabeth Kwon
- Department of Public Health, Baylor University, Waco, USA
| | - Assaf Oshri
- Department of Human Development and Family Science, University of Georgia, Athens, USA
| | - Tamika C. B. Zapolski
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, USA
| | | | - Steven M. Kogan
- Department of Human Development and Family Science, University of Georgia, Athens, USA
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Jacobs W, Lu W, McDonald A, Yang JS. Human Capital Development Factors and Black Adolescent Tobacco and Cannabis Use. Nicotine Tob Res 2023; 25:1447-1454. [PMID: 37075137 PMCID: PMC10347968 DOI: 10.1093/ntr/ntad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/24/2023] [Accepted: 04/18/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION This study examined the association of four domains of human capital development (cognitive development, social and emotional development, physical health, and mental health) and exclusive and concurrent tobacco and cannabis use (TCU) among black youth. AIMS AND METHODS Nationally representative annual cross-sectional data for black adolescents (12-17 years; N = 9017) in the National Survey on Drug Use and Health 2015-2019 were analyzed. Analyses examined the influence of human capital factors (cognitive development, social and emotional development, physical health, and mental health) on exclusive and concurrent TCU. RESULTS In total, 50.4% were males; prevalence of 12-month tobacco use fluctuated insignificantly between 5.6% and 7.6% across survey years. Similarly, prevalence of 12-month cannabis use remained relatively stable around 13%, with no significant linear change. Prevalence of concurrent TCU also fluctuated insignificantly between 3.5% and 5.3%. Investment in cognitive development decreased the odds of tobacco (aOR = 0.58, p < .001), cannabis (aOR = 0.64, p < .001), and concurrent tobacco and cannabis (aOR = 0.58, p < .001) use. Similarly, investment in social and emotional development reduced the odds of tobacco (aOR = 086, p < .001), cannabis (aOR = 0.83, p < .001), and concurrent tobacco and cannabis (aOR = 0.81, p < .001) use. Good physical health reduced the odds of tobacco (aOR = 0.52, p < .1), cannabis (aOR = 0.63, p < .05), and concurrent TCU (aOR = 0.54, p < .05). Major depressive episodes increased the likelihood of cannabis use (aOR = 1.62, p < .001). CONCLUSIONS Investment in cognitive, social, and emotional aspects of human capital development, and physical health among black youth is protective against TCU. Efforts to sustain human capital development among black adolescents may contribute to reducing TCU disparities. IMPLICATIONS This is one of few studies to examine human capital development factors and their associations with TCU among black youth. Efforts to eliminate tobacco/cannabis-related disparities among black youth should also invest in social, emotional, cognitive, and physical health development opportunities.
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Affiliation(s)
- Wura Jacobs
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Wenhua Lu
- Department of Community Health and Social Medicine, City University of New York, New York, NY, USA
| | - Andrea McDonald
- Department of Health and Kinesiology, Prairie View A and M University, Prairie View, TX, USA
| | - Joshua S Yang
- Department of Public Health, California State University, Fullerton, CA, USA
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Kalinowski J, Layland EK, Eaton LA, Watson RJ. Strong Ethnic Identity Buffers the Association of Heterosexism with Substance Use Among Black Sexual Minority Men. J Racial Ethn Health Disparities 2023; 10:1270-1279. [PMID: 35556225 PMCID: PMC9936572 DOI: 10.1007/s40615-022-01312-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Heterosexist stigma, including microaggressions experienced in their own racial/ethnic communities, may partially explain disproportionate levels of substance use involvement among Black sexual minority men (BSMM). A strong sense of ethnic identity may provide BSMM with a protective resource. The purpose of this study was to explore associations between ethnic identity and substance use in BSMM. METHODS Data were from Black sexual minority men (n = 390 Mage = 25.28; SD = 2.81) in the PrEP and Substance Use National Survey collected from March 2020 to August 2020 that included self-reported cannabis, cocaine, methamphetamines, inhalants, hallucinogens, prescription drugs misuse, and overall substance use involvement. Using zero-inflated negative binomial regression, we assessed the association between heterosexist microaggressions within BSMM's racial/ethnic communities and substance use involvement, moderated by subjective sense of ethnic identity. RESULTS More than half of participants reported past 3-month substance use. Heterosexist microaggressions were associated with higher relative risk of cannabis use involvement (RR = 1.76; 95% CI 1.13-2.73) and overall substance use involvement (RR = 2.23; 95% CI 1.39-3.56). Stronger ethnic identity buffered the association of heterosexism on substance use involvement (cannabis: RR = 0.82; 95% CI 0.72-0.95; overall: RR = 0.77; 95% CI 0.66-0.89). CONCLUSION Nurturing ethnic identity development and reducing heterosexist stigma in Black communities may be a culturally responsive, two-pronged approach to reducing substance use involvement among BSMM. BSMM with strong ethnic identity demonstrated resilience to heterosexist stigma. Future research should examine the extent to which ethnic identity may be cultivated as a protective resource against substance use involvement.
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Affiliation(s)
- Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, 06279-1248, USA.
| | - Eric K Layland
- Center for Interdisciplinary Research On AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Lisa A Eaton
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, 06279-1248, USA
| | - Ryan J Watson
- Human Development and Family Sciences, University of Connecticut, Storrs, CT, 06279-1248, USA
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Sartor CE, Li EY, Black AC. Profiles of substance use related protective and risk factors and their associations with alcohol and tobacco use initiation among black adolescents. J Ethn Subst Abuse 2022; 23:72-94. [PMID: 35468309 DOI: 10.1080/15332640.2022.2064383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Insufficient attention to protective and risk factors of particular salience for Black youth (e.g., racial identity and racial discrimination) in population-based substance use studies has left gaps in our understanding of alcohol and tobacco use development in Black adolescents. The current study aimed to capture the clustering of such understudied factors and their collective influence on alcohol and tobacco use initiation among Black adolescents. Data were drawn from The National Survey of American Life (n = 1,170; age range = 13-17; 6.9% Afro Caribbean, 93.1% African American; 50.0% female). Latent profile analysis applied to 11 indicators representing family, community, and individual level protective and risk factors revealed (1) High Vulnerability (high risk, low protective factors; 17.5%), (2) Moderate Vulnerability (moderate on both; 63.2%), and (3) Low Vulnerability (high protective, low risk factors; 19.3%) classes. Classes differed significantly by religious community support, school bonding, quality of relationship with mother, religious involvement, and interpersonal trauma. Relative to Class 2, Class 1 had higher odds of alcohol (OR = 1.518, CI:1.092-2.109) and tobacco use (OR = 1.998, CI:1.401-2.848); Class 3 had lower odds of alcohol (OR = 0.659, CI:0.449-0.968) but not tobacco use (OR = 0.965, CI:0.611-1.523). Findings suggest that alcohol and tobacco use initiation among Black adolescents is shaped by the collective influence of community and family level support, with commonly experienced risk factors such as non-interpersonal trauma distinguishing liability to a lesser degree. The equally modest prevalence of tobacco use among low and moderate vulnerability classes further indicates that fostering these connections may be especially effective in reducing tobacco use risk.
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Montgomery L, Dixon S, Mantey DS. Racial and Ethnic Differences in Cannabis Use and Cannabis Use Disorder: Implications for Researchers. CURRENT ADDICTION REPORTS 2022; 9:14-22. [PMID: 35251891 PMCID: PMC8896813 DOI: 10.1007/s40429-021-00404-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Heavy and prolonged use of cannabis is associated with several adverse health, legal and social consequences. Although cannabis use impacts all U.S. racial/ethnic groups, studies have revealed racial/ethnic disparities in the initiation, prevalence, prevention and treatment of cannabis use and Cannabis Use Disorder (CUD). This review provides an overview of recent studies on cannabis and CUD by race/ethnicity and a discussion of implications for cannabis researchers. FINDINGS The majority of studies focused on cannabis use and CUD among African American/Black individuals, with the smallest number of studies found among Native Hawaiians/Pacific Islanders. The limited number of studies highlight unique risk and protective factors for each racial/ethnic group, such as gender, mental health status, polysubstance use and cultural identity. SUMMARY Future cannabis studies should aim to provide a deeper foundational understanding of factors that promote the initiation, maintenance, prevention and treatment of cannabis use and CUD among racial/ethnic groups. Cannabis studies should be unique to each racial/ethnic group and move beyond racial comparisons.
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Affiliation(s)
- LaTrice Montgomery
- University of Cincinnati College of Medicine, Center for Addiction Research/Addiction Sciences Division, Cincinnati, Ohio
- Corresponding Author: LaTrice Montgomery, Ph.D., University of Cincinnati College of Medicine, Center for Addiction Research/Addiction Sciences Division, 3131 Harvey Avenue, Suite 204, Cincinnati, Ohio 45229; ; Phone: 513-585-8286
| | - Shapree Dixon
- University of Cincinnati College of Medicine, Center for Addiction Research/Addiction Sciences Division, Cincinnati, Ohio
| | - Dale S. Mantey
- Department of Health Promotion and Behavioral Science, University of Texas Health Science Center, Houston, Texas
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Hall OT, Jordan A, Teater J, Dixon-Shambley K, McKiever ME, Baek M, Garcia S, Rood KM, Fielin DA. Experiences of racial discrimination in the medical setting and associations with medical mistrust and expectations of care among black patients seeking addiction treatment. J Subst Abuse Treat 2021; 133:108551. [PMID: 34244014 DOI: 10.1016/j.jsat.2021.108551] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Experiences of racial discrimination in the medical setting are common among Black patients and may be linked to mistrust in medical recommendations and poorer clinical outcomes. However, little is known about the prevalence of experiences of racial mistreatment by healthcare workers among Black patients seeking addiction treatment, or how these experiences might influence Black patients' medical mistrust or expectations of care. METHODS Participants were 143 Black adults recruited consecutively from two university addiction treatment facilities in Columbus, Ohio. All participants completed validated surveys assessing perceptions of prior racial discrimination in the medical setting and group-based medical mistrust. Participants were also asked a series of questions about their expectations of care with regard to racial discrimination and addiction treatment. Descriptive analyses were used to characterize the sample with regard to demographics, perceived racial discrimination and medical mistrust. Kendall tau-b correlations assessed relationships between racial discrimination, mistrust and expectations of care. RESULTS Seventy-nine percent (n = 113) of participants reported prior experiences of racial discrimination during healthcare. Racial discrimination in the medical setting was associated with greater mistrust in the medical system and worse expectations regarding racial discrimination in addiction treatment including delays in care-seeking due to concern for discrimination, projected non-adherence and fears of discrimination-precipitated relapse. CONCLUSIONS Black patients seeking addiction treatment commonly report experiencing racial discrimination by healthcare workers which may be associated with mistrust in the medical system and expectations of care. Strategies to eliminate and mitigate experiences of racial discrimination may improve addiction treatment receptivity and engagement.
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Affiliation(s)
- O Trent Hall
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
| | - Ayana Jordan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Julie Teater
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Kamilah Dixon-Shambley
- Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Monique E McKiever
- Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Mikyung Baek
- Kirwan Institute for the Study of Race and Ethnicity, the Ohio State University, Columbus, OH, United States of America
| | - Stephanie Garcia
- College of Medicine, the Ohio State University, Columbus, OH, United States of America
| | - Kara M Rood
- Department of Obstetrics and Gynecology, Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - David A Fielin
- Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States of America; Yale School of Public Health, New Haven, CT, United States of America
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