Does individual risk moderate the effect of contextual-level protective factors? A latent class analysis of substance use

Mobile Health Interventions for Substance Use Disorders

Substance use disorders (SUDs) have an enormous negative impact on individuals, families, and society as a whole. Most individuals with SUDs do not receive treatment because of the limited availability of treatment providers, costs, inflexible work schedules, required treatment-related time commitments, and other hurdles. A paradigm shift in the provision of SUD treatments is currently underway. Indeed, with rapid technological advances, novel mobile health (mHealth) interventions can now be downloaded and accessed by those that need them anytime and anywhere. Nevertheless, the development and evaluation process for mHealth interventions for SUDs is still in its infancy. This review provides a critical appraisal of the significant literature in the field of mHealth interventions for SUDs with a particular emphasis on interventions for understudied and underserved populations. We also discuss the mHealth intervention development process, intervention optimization, and important remaining questions.

The Dynamic Nature of the Socioeconomic Determinants of Cardiovascular Health: A Narrative Review

Despite decades of social epidemiologic research, health inequities remain pervasive and ubiquitous in Canada and elsewhere. One reason may be our use of socioeconomic measurement, which has often relied on single point-in-time exposures. To explore the extent to which researchers have incorporated dynamic socioeconomic measurement into cardiovascular health outcome evaluations, we performed a narrative review. We estimated the prevalence of socioeconomic longitudinal cardiovascular research studies that identified socioeconomic exposures at 2 or more points in time between the years of 2019 and 2023. We defined cardiovascular outcome studies as those that examined coronary artery disease, myocardial infarction, acute coronary syndrome, stroke, heart failure, cardiac arrhythmias, cardiac death, cardiometabolic factors, transient ischemic attacks, peripheral artery disease, or hypertension. Socioeconomic exposures included individual income, neighbourhood income, intergenerational social mobility, education, occupation, insurance status, and economic security. Seven percent of socioeconomic cardiovascular outcome studies have measured socioeconomic status at 2 or more points in time throughout the follow-up period, hypothesized mechanisms by which dynamic socioeconomic measures affected outcome focused on social mobility, accumulation, and critical period theories. Insights, implications, and future directions are discussed, in which we highlight ways in which postal code data can be better used methodologically as a dynamic socioeconomic measure. Future research must incorporate dynamic socioeconomic measurement to better inform root causes, interventions, and health-system designs if health equity is to be improved.

Associations between Family Factors and Youth Substance Use Across the Rural-Urban Continuum: A Person-/Variable-Centered Approach

Few studies have evaluated the influence of both family factors and geographic location on youth substance use. To address this gap, a person-/variable-centered approach was used to: (1) identify latent profiles of family risk and protective factors for substance use, (2) test profile membership as a predictor of lifetime and 30-day substance use, (3) test rurality, as measured by school geographic location, as a predictor, and (4) explore interaction effects between profile membership and rurality. Youth (N=9,104; 53% female) residing in a state in the southeastern U.S. completed a statewide substance abuse and risk behavior survey including questions about family risk and protective factors and substance use behaviors. Using latent profile analysis to identify subgroups of participants with similar means and variances on the family factors, four latent profiles emerged. Risk of 30-day and lifetime substance use varied across profiles, with the profile characterized by high family-level protective factors and low family-level risk factors indicating the lowest risk for substance use. Urban youth had increased odds of reporting lifetime marijuana use compared to suburban youth; however, geographic location did not appear to confer significantly increased or decreased risk across other substances. No significant interaction results were found. These results emphasize the importance of family functioning on substance use regardless of geographic location, and that evidence-based prevention programming that reduces family risk, strengthens family protection, and is accessible to all types of communities is important to reducing or delaying substance use among youth.

Perceived racial discrimination and polysubstance use among racial/ethnic minority adolescents in the United States

OBJECTIVE

Polysubstance use among adolescents is a significant public health concern, yet most studies on adolescent substance use focus on a singular substance. This study is one of the first to investigate the association between perceived racial discrimination (PRD) in school and polysubstance use among racial/ethnic minority adolescents using a nationally representative sample.

METHODS

Data was from the 2021 Adolescent Behaviors and Experiences Survey. The sample included 4145 racial/ethnic minority adolescents (52.8% female). Hierarchical binary logistic regression was used to examine the association between PRD in school and polysubstance use among racial/ethnic minority adolescents.

RESULTS

About 12% of racial/ethnic minority adolescents engaged in polysubstance use and 23.4% reported experiencing PRD in school sometimes/most of the time/always. Controlling for other factors, experiencing PRD in school sometimes/most of the time/always was associated with 1.52 times higher odds of polysubstance use when compared to adolescents who never experienced PRD in school (OR=1.52, p=.044, 95% CI=1.01-2.30). Cyberbullying victimization, symptoms of depression, and being emotionally abused by a parent during COVID-19 were also associated with polysubstance use.

CONCLUSION

Controlling for demographic characteristics and psychosocial stressors, PRD in school was significantly associated with higher odds of polysubstance use among racial/ethnic minority adolescents. The findings of this study could inform clinicians and policymakers of the association between PRD in school and polysubstance use, which could contribute to early identification of polysubstance use among racial/ethnic minority adolescents.

Neighborhoods and adolescent polysubstance use in Jamaica

Background

The purpose of this study was to identify latent classes of polysubstance use among adolescents in Jamaica and the role of neighborhood factors in the association with polysubstance use class membership.

Methods

This secondary analysis utilized a national cross-sectional household drug use survey conducted across 357 households in Jamaica (April 2016-July 2016) among a total of 4,625 individuals. A total of 750 adolescents (11-17 years) were included in this analysis. Latent class analysis (LCA) was conducted to identify polysubstance use patterns as well as latent neighborhood constructs. Neighborhood factors included social disorganization, concentrated disadvantage, community resources, community violence, and police station concentration. Multinomial regression analysis was implemented to evaluate the association between polysubstance use class membership and latent classes of neighborhood factors.

Result

The prevalence of lifetime polysubstance use was 27.56%. Four classes of polysubstance use were identified by comparing a series of five class models. The Bootstrap Likelihood Ratio Test (BLRT) indicated a good fit for the four-class model (<0.001). The prevalence of alcohol latent classes was: (1) heavy alcohol users and experimental smokers (Class I) (15.20%), (2) most hazardous polysubstance users (Class II) (5.33%), (3) heavy smokers and moderate alcohol users (Class III) (7.07%), and (4) experimental alcohol users (Class IV) (72.44%). Three classes of neighborhoods were identified by comparing a series of four-class models. The prevalence of the neighborhood classes was: (1) low social disorganization and disadvantage (Class I) (58.93%), (2) high social disorganization and moderate disadvantage (Class II) (10.93%), and (3) high social disorganization related to perceived drug use and disadvantage (Class III) (30.13%). The BLRT indicated a good fit for the three-class model (p =  < 0.004). Multinomial regression analysis indicated that adolescents living in neighborhoods with high disorder and moderate disadvantage (Class II) were 2.43 times (odds ratio (OR)) = 2.43, confidence interval (CI)) = 1.30-4.56) more likely to be heavy alcohol users and experimental smokers (Class I) compared to experimental alcohol users, adjusting for sex, age, ethnicity, religion, and income. Class II of neighborhood classes presented with the highest levels of community violence (100%), perceived disorder crime (64.6%), police station concentration (6.7%), and community resources (low resources is 87.6%), while the concentrated disadvantage was moderate (14.8%).

Conclusions

Alcohol polysubstance use latent classes were identified among youth in this context. Neighborhoods with high disorder and moderate disadvantage (Class II) were associated with a higher likelihood of polysubstance use. The role of neighborhood conditions in shaping adolescent polysubstance use should be considered in policy, prevention, and treatment interventions.

Intersectional stigma subgroup differences in unhealthy drinking and disordered marijuana use among Black and Latino cisgender sexual minority young men

BACKGROUND

We investigated associations of intersectional stigma subgroups with alcohol and marijuana use among Black and Latino sexual minority young men. Subgroups included Minimal Stigma (low to no stigma), Select Social Stigma (occasional stigma in social relationships), Multiform Heterosexism (internalized and interpersonal heterosexism from family/friends), Multiform Racism (racism across diverse contexts), Compound Stigma (frequent, ubiquitous racism and heterosexism).

METHODS

Cohort of Black and Latino cisgender sexual minority young men (n = 414; baseline ages 16-25) surveyed semiannually 2016-2019. Generalized estimating equations integrated with latent class analysis modeled linear and quadratic age effects and association of stigma subgroups with past 6-month alcohol use, marijuana use, unhealthy drinking, and marijuana use disorder symptoms.

RESULTS

All past 6-month substance use peaked between ages 21-23 years old. Across all ages and relative to Minimal Stigma, odds of drinking were higher in every subgroup and highest in Compound Stigma (OR=2.72, 95% CI 1.17-6.35); unhealthy drinking was higher in every subgroup and highest in Multiform Heterosexism (β = 3.31, 95% CI 1.92-3.89); marijuana use disorder symptoms were higher in most subgroups and highest in Compound Stigma (β = 1.30, 95% CI 0.76-1.85). Marijuana use odds did not differ among groups.

CONCLUSION

By examining intersectional stigma subgroups, we identified subgroups for whom substance use was elevated during a development period when use tends to be highest. Young men experiencing stigma patterns characterized primarily by heterosexism or heterosexism together with racism may be especially at risk for developing unhealthy drinking behaviors and marijuana use disorder symptoms.

How Are Bystanders Involved in Cyberbullying? A Latent Class Analysis of the Cyberbystander and Their Characteristics in Different Intervention Stages

BACKGROUND

Cyberbullying is a phenomenon that occurs by means of digital devices in virtual environments. Although research reveals the relevant role played by bystanders in stopping cyberbullying, the patterns of cyberbullying bystanders among Chinese college students is not clear.

DATA

Participants were 1025 Chinese college students (62.0% girls, 38.0% boys). The present analyses empirically explored the roles of cyberbystanders (passive outsider online, defender of the cybervictim online, reinforcer of the cyberbully online, passive face-to-face outsider, face-to-face defender of the cybervictim, and face-to-face reinforcer of the cyberbully) using latent class analysis.

RESULTS

(1) Five latent classes were identified: defensive bystander (17.9%), indifferent bystander (10.1%), low-involved bystander (10.2%), medium-involved bystander (45.7%), and high-involved bystander (16.0%). (2) The cyberbystander patterns varied significantly for all stages of bullying intervention, among which the defensive bystander had the lowest score in the notice stage but the highest scores in the other stages. (3) There was a graded relationship between the five latent classes and the level of social network site use and cyber-victimization experience. College students with high usage of social network sites and high cyber-victimization experience were more likely to engage in diverse bystander behaviors.

Substance Use Among Youth During the COVID-19 Pandemic: a Systematic Review

PURPOSE OF REVIEW

To review the literature on the trends in substance use among youth during the coronavirus SARS-CoV-2 (COVID-19) pandemic.

RECENT FINDINGS

The pandemic has given rise to concerns about the mental health and social well-being of youth, including its potential to increase or exacerbate substance use behaviors. This systematic review identified and included 49 studies of use across alcohol, cannabis, tobacco, e-cigarettes/vaping, and other drugs, and unspecified substances. The majority of studies across all categories of youth substance use reported reductions in prevalence, except in the case of other drugs and unspecified drug and substance use, which included three studies that reported an increase in use and three studies that reported decrease in use. Overall, the results of this review suggest that the prevalence of youth substance use has largely declined during the pandemic. Youth substance use in the post-pandemic years will require monitoring and continued surveillance.

Youth risk profiles and their prediction of distal cannabis and tobacco co-use in the Population Assessment of Tobacco Health (PATH)

Background: Co-use of cannabis and tobacco is common and increases negative behavioral, physical and mental health consequences. This study aimed to describe latent profiles of youth internalizing and externalizing problems, sensation seeking, and family environment in the US and their relationships with substance co-use. Methods: Data come from the Population Assessment of Tobacco Health (PATH). Using latent profile analysis with a distal outcome, we conducted a secondary data analysis examining relationships between latent profiles and the distal outcome of cannabis/tobacco use and co-use one year later. Participants were a nationally representative sample of youth ages 12-17 (N = 13,651). Results: We identified five youth subgroups: (1;11%) Family Risk, (2;32%) Family Protection with Very Low Internalizing, (3;21%) Family Protection with High Youth Risk, (4;24%) Family Protection with Moderate Youth Risk, (5;12%) Family Risk with High Youth Risk. Relationships between group membership and tobacco/cannabis outcomes, one year later, indicated that the least likely tobacco/cannabis users were the Family Protection with Very Low Internalizing class (no lifetime use probability (PR)=0.86, standard error (SE)=0.007; no 30-day use PR = 0.96, SE = 0.004). In contrast, the Family Risk with High Youth Risk class had the highest probability of both co-use (lifetime co-use PR = 0.33; SE = 0.014; 30-day co-use PR = 0.10; SE = 0.010) and single substance use (probability of lifetime single substance use PR = 0.30; SE = 0.013; 30-day single substance use PR = 0.24; SE = 0.014). Conclusions: A "protective but reactive" risk buffering pattern effect of family factors on youth factors was observed in that the lowest rates of co-use were observed in the three classes with family protection. These findings highlight the need for interventions addressing multiple domains and focusing on youth and family risk factors.

Combinations of modifiable lifestyle behaviours in relation to colorectal cancer risk in Alberta's Tomorrow Project

The objective of this study was to identify distinct clusters of individuals that exhibit unique patterns of modifiable lifestyle-related behaviours and to determine how these patterns are associated with the risk of developing colorectal cancer (CRC). The study consisted of 26,460 participants and 267 CRC cases from Alberta's Tomorrow Project. Exploratory latent class analysis of risk behaviours (obesity, physical inactivity, meat consumption, smoking, alcohol consumption, and fruit and vegetable consumption) and Cox proportional hazard models were utilized. Seven unique behavioural groups were identified, where the risk of CRC was 2.34 to 2.87 times greater for high risk groups compared to the low risk group. Sex-specific models identified higher risk groups among men (Hazard Ratios [HRs]: 3.15 to 3.89) than among women (HRs: 1.99 to 2.19). Targeting groups defined by clustering of behaviours could potentially lead to more effective prevention of CRC on a population level.

Factors Associated with Smoking and Drinking among Early Adolescents in Vanuatu: A Cross-Sectional Study of Adolescents and Their Parents

This cross-sectional study determined whether various factors, such as parental behavior, attitude, and knowledge and sibling and peer behaviors, were associated with smoking and drinking among early adolescents in the Republic of Vanuatu. For this purpose, logistic regression analysis was used to determine the relative importance of the factors as well as the influences of the parents/guardians, siblings, and peers. The participants consisted of 157 seventh- and eighth-grade adolescents (mean age = 13.3 years; 52.2% girls), including their parents/guardians, from three public schools in Vanuatu. According to the results, the proportions of smokers and drinkers among the adolescents were 12.7% each, while the majority of the parents/guardians disapproved of underage smoking and drinking. In addition, peer influences (i.e., regularly smoking and/or drinking and offering tobacco and/or alcohol) was significantly associated with ever smoking and drinking, whereas parental and sibling influences did not have a significant impact on ever smoking and drinking. In sum, being given tobacco or alcohol from peers had the strongest association with ever smoking and drinking among the adolescents in this study. Thus, future school-based intervention programs should focus on enhancing early adolescents’ life skills, including the ability to resist offers of tobacco and/or alcohol from their peers.

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.

Purpose in life, social support, and internet gaming disorder among Chinese university students: A 1-year follow-up study

AIMS

Given the high prevalence of Internet gaming disorder (IGD) among university students and the beneficial effects of positive psychological factors on mental illness, the present longitudinal research aimed to investigate whether purpose in life and social support yields long-term results in protecting university students from IGD.

METHODS

We recruited 469 Chinese university students to voluntarily fill out an anonymous questionnaire at baseline, and 283 of them were followed up and given similar measures after one year.

RESULTS

The prevalence of probable IGD at the baseline and follow-up surveys was 14.8% and 9.9% respectively. Purpose in life and social support were negatively correlated with IGD symptoms in both surveys (p < .05). The results of a cross-lagged analysis showed that purpose in life, but not social support, assessed at baseline predicted fewer IGD symptoms at follow-up (p < .001). In addition, social support and purpose in life predicted one another across time.

CONCLUSIONS

The prevalence of probable IGD was high among Chinese university students. Purpose in life was shown to be an effective significant protective factor against IGD, while the effect of social support might be indirect. Positive psychology interventions, which promote the search for and attainment life purpose, may be incorporated in school-based program for IGD prevention.

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.

Telephone counseling for young Brazilian cocaine and/or crack users. Who are these users?

OBJECTIVE

To describe the users' drug abuse characteristics, problematic behaviors associated with addiction, the motivation of teenagers and young adults to quit cocaine and/or crack abuse, and then compare these characteristics.

METHODS

A cross-section study was conducted with 2390 cocaine/crack users (teenagers from 14 to 19 years of age, and young adults from 20 to 24 years of age); 1471 were young adults and 919 were teenagers who had called a phone counseling service between January 2006 and December 2013. Semi-structured interviews were performed via phone calls. The questionnaires included sociodemographic information; assessment of the characteristics of cocaine/crack abuse; assessment of the problematic behaviors; also, the Contemplation Ladder was used to evaluate the stages of readiness to cease substance abuse.

RESULTS

Participants reported using cocaine (48.2%), crack and other smoking forms (36.7%) and combined consumption of both drugs (15%). Young adults were more prone to using crack or crack associated with cocaine (OR=1.9; CI 95%=1.05-1.57) and they were exposed to substance abuse for longer than two years (OR=3.45; CI 95%=2.84-4.18), when compared to teenagers. On the other hand, they showed higher readiness to quit.

CONCLUSION

Data shows important differences in drug abuse characteristics, problematic behaviors and motivation to cease substance abuse between teenager and young adult cocaine and/or crack users. Behaviors displayed by young adults involve greater physical, mental and social health damages. These findings reinforce the importance of public policy to act on prevention and promoting health, to increase protection factors among teenagers and lower risks and losses during adult life.

An examination of child protective service involvement among children born to mothers in foster care

OBJECTIVE

This study identified children born to mothers in foster care and documented Child Protective Service (CPS) involvement among children.

METHODS

Probabilistically linked birth and CPS records from California (2009-2012) were used to identify all mothers in foster care on or after conception. Children were followed prospectively using linked records to identify CPS involvement occurring during the first three years of life. Differences between reported and unreported children were examined using χ2 tests. The Latent Class Analysis (LCA) identified classes of children born to mothers in care who were at increased risk of CPS involvement. Model fit was assessed using the Bayesian Information Criterion, entropy, and likelihood ratio tests. For each of the classes, the relationship to the distal outcome (i.e., a maltreatment report by age three), was examined.

RESULTS

Findings indicate that 53% of children born to mothers in care were reported. The proportion of children reported to CPS for maltreatment declined over time, from 63% of children born to mothers in foster care in 2009, to 46% in 2012. The LCA documented three distinct classes of mother-child dyads with varying risk of report. More than one third of children in Class 1 and nearly 70% of children in Class 3 were reported.

CONCLUSIONS

This study was the first to develop multi-dimensional class profiles of two-generation CPS involvement among mother-child dyads. This study documents that mothers' experiences in care and mental health conditions vary widely, underscoring the importance of providing services that fit the needs of dyads.

Identifying targets for cardiovascular medication adherence interventions through latent class analysis

OBJECTIVE

Reasons for nonadherence to cardiovascular medications vary widely between individuals. Yet, adherence interventions are often uniformly applied, limiting their effectiveness. This study employed latent class analysis (LCA) to identify multidimensional profiles of reasons for nonadherence to cardiovascular medications.

METHOD

Participants (N = 137; MAge = 58.8, SDAge = 11.8) were drawn from an observational study of the impact of cardiac-induced posttraumatic stress disorder (PTSD) on cardiac medication adherence in patients presenting to the emergency department with a suspected acute coronary syndrome. Demographics and depressive symptoms were assessed at baseline. Extent of nonadherence to cardiovascular medications, reasons for nonadherence, and PTSD symptoms were assessed 1 month after discharge.

RESULTS

LCA identified 3 classes of reasons for medication nonadherence: capacity (related to routine or forgetting; approximately 45% of the sample), capacity + motivation (related to routine/forgetting plus informational or psychological barriers; approximately 14% of the sample), and no clear reasons (low probability of endorsing any items; approximately 41% of the sample). Participants reporting greater nonadherence were more likely to be in the capacity + motivation or no clear reasons classes compared with the capacity class. Participants endorsing higher PTSD severity were more likely to be in the capacity + motivation or capacity classes compared with the no clear reasons class.

CONCLUSIONS

Three distinct classes of reasons for nonadherence were identified, suggesting opportunities for tailored interventions: capacity, capacity + motivation, and no clear reasons. These preliminary findings, if replicated, could aid identification of patients at risk for greater extent of medication nonadherence and inform tailored interventions to improve adherence. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Role of Individual and Contextual Factors in Differentiating Substance Use Profiles among Adolescents

BACKGROUND

Adolescent substance use is a significant public health concern due to its prevalence and associated negative consequences. Although many adolescents use substances, there is substantial heterogeneity in their use patterns. Identifying risk and protective factors that differentiate adolescents with different substance use profiles is important for preventing negative consequences for those at risk.

OBJECTIVE

This study identified distinct latent profiles of substance use by considering adolescents' involvement in multiple common and illicit substances as well as related problems and examined the extent to which individual and contextual factors in the family, peer, school, and neighborhood environments were related to adolescents' membership of substance use profiles.

METHOD

Data came from 9,155 high school students (51% female; 74% European American) who completed electronic surveys in the 2009 Dane County Youth Assessment (DCYA). Latent class analysis (LCA) was conducted to identify profiles of adolescent substance involvement and related problems. Multinomial logistic regression was conducted to examine associations between individual and contextual factors and latent class membership.

RESULTS

LCA identified four distinct profiles of adolescent substance use characterized by both licit and illicit substance use and related problems: Abstainers (56.3%), Alcohol-only users (25.6%), Alcohol-cigarette-marijuana users (13.8%), and Problem polysubstance users (4.3%). Controlling for demographics, individual and contextual factors were associated with adolescents' likelihoods of membership in substance use profiles; notably, the associations varied to some extent across substance use profiles.

CONCLUSIONS

Substance use is heterogeneous among adolescents. Effects of risk and protective factors on substance use vary depending on adolescents' substance use patterns.

Positive parenting predicts cortisol functioning six years later in young adults

Research which indicates that adverse experiences influence hypothalamic-pituitary-adrenal (HPA) axis functioning illustrates the social environment 'getting under the skin'. The present study extended this literature by examining whether positive social forces within the caregiving environment can also impact cortisol functioning. We conducted a prospective investigation of over 300 youth, half of whom were White and half were Black. Attachment, bonding and parental rewards for positive behaviors were observed or reported by the youth as an 8th grader. Twelve repeated measures of salivary cortisol were examined six years later when youth were young adults (mean age 20). Race differences were explored. Stronger attachment, bonding and teen-reported positive parenting were predictive of high waking cortisol and steeper diurnal slopes six years later. This effect was nonlinear and additive, such that youth whose social contexts were characterized by the strongest attachment, bonding and rewarding parental relationships had the highest waking cortisol. When effects were moderated by race, findings were such that links of positive parenting with HPA functioning were more consistent for White than Black youth. Findings suggest that positive aspects of the caregiving environment can also 'get under the skin' and these effects are additive across a range of caregiving indices. These findings dovetail with an emerging literature on the powerful role of social support for shaping the body's stress response system and are interpreted as consistent with the Adaptive Calibration Model which suggests that cortisol regulation can have adaptive significance. A video abstract of this article can be viewed at: https://youtu.be/8evHXpt_TXM.

Pattern Classification of Enterovirus 71-Associated Hand, Foot, and Mouth Disease in Chinese Medicine: A Retrospective Study in 433 Cases

OBJECTIVE

To determine whether patterns of enterovirus 71 (EV71)-associated hand, foot, and mouth disease (HFMD) were classified based on symptoms and signs, and explore whether individual characteristics were correlated with membership in particular pattern.

METHODS

Symptom-based latent class analysis (LCA) was used to determine whether patterns of EV71-HFMD existed in a sample of 433 cases from a clinical data warehouse system. Logistic regression was then performed to explore whether demographic, and laboratory data were associated with pattern membership.

RESULTS

LCA demonstrated a two-subgroup solution with an optimal fit, deduced according to the Bayesian Information Criterion minima. Hot pattern (59.1% of all patients) was characterized by a very high fever and high endorsement rates for classical HFMD symptoms (i.e., rash on the extremities, blisters, and oral mucosa lesions). Non-hot pattern (40.9% of all patients) was characterized by classical HFMD symptoms. The multiple logistic regression results suggest that white blood cell counts and aspartate transaminase were positively correlated with the hot pattern (adjust odds ratio=1.07, 95% confidence interval: 1.006-1.115; adjust odds ratio=1.051, 95% confidence interval: 1.019-1.084; respectively).

CONCLUSIONS

LCA on reported symptoms and signs in a retrospective study allowed different subgroups with meaningful clinical correlates to be defined. These findings provide evidence for targeted prevention and treatment interventions.

Substance Use Profiles Among Juvenile Offenders: A Lifestyles Theoretical Perspective

Base rates of illicit substances such as cocaine, crack cocaine, and heroin are typically low in community-based studies, which often inhibit more complex multivariate analysis. Additionally, single-item measures and aggregate scales mask within-group differences among those showing versatility in their substance use. Latent class analysis was used to model the substance use profiles of adjudicated female ( n = 98) and male ( n = 378) youth. Alcohol, marijuana, acid, mushrooms, ecstasy, cocaine, crack cocaine, heroin, crystal methamphetamine, and nonmedical use of prescription pills were used to define latent profiles of substance use. Three latent classes were identified that were qualitatively different across males and females. Multinomial logistic regression analyses indicated that time spent outside of the home of the biological parents, early substance use, and parental substance abuse were informative of the use of substances such as cocaine, crack cocaine, and heroin. Implications for more individualized treatment strategies are discussed.

Longitudinal Conjoint Patterns of Alcohol and Tobacco Use Throughout Emerging Adulthood

BACKGROUND

The concurrent use of alcohol and tobacco has a multiplicative effect on both social and physical consequences. While it is known that alcohol and tobacco use are strongly correlated in emerging adulthood, there is significant individual variability in use. However, little research has examined how patterns of concurrent use are related over time.

OBJECTIVES

The current study explores these longitudinal conjoint trajectories, as well as the associated sociodemographic factors.

METHODS

We used sequential latent class growth analysis to explore the co-occurring longitudinal patterns of recent alcohol and tobacco use across emerging adulthood (10 data collection periods, 2004-2009) with a diverse sample of 2,244 college students (60% female; 54% White).

RESULTS

Twenty distinct patterns of conjoint alcohol and tobacco use were found. There was more variation in tobacco use trajectories among alcohol users than variation in alcohol trajectories among tobacco users. Using multinomial logistic regression models we determined the impact of sociodemographic characteristics on classification into each conjoint pattern versus the normative trajectory (Abstaining tobacco/Low alcohol). Male gender, White race, fraternity/sorority affiliation, and higher family income were significantly associated with riskier conjoint trajectory patterns. Conclusions/Importance: Findings highlight the diversity of alcohol and tobacco use behaviors across emerging adulthood. The low variation in alcohol use among tobacco users indicates that tobacco use is a significant risk factor for heavier drinking. A better understanding of the covarying use of these two ubiquitous substances may provide new avenues for preventing and reducing the use of both.

Impulse Control and Callous-Unemotional Traits Distinguish Patterns of Delinquency and Substance Use in Justice Involved Adolescents: Examining the Moderating Role of Neighborhood Context

Both callous-unemotional (CU) traits and impulse control are known risk factors associated with delinquency and substance use. However, research is limited in how contextual factors such as neighborhood conditions influence the associations between these two dispositional factors and these two externalizing behaviors. The current study utilized latent class analysis (LCA) to identify unique classes of delinquency and substance use within an ethnically diverse sample (n = 1216) of justice-involved adolescents (ages 13 to 17) from three different sites. Neighborhood disorder, CU traits, and impulse control were all independently associated with membership in classes with more extensive histories of delinquency and substance use. The effects of CU traits and impulse control in distinguishing delinquent classes was invariant across levels of neighborhood disorder, whereas neighborhood disorder moderated the association between impulse control and substance use. Specifically, the probability of being in more severe substance using classes for those low in impulse control was stronger in neighborhoods with fewer indicators of social and physical disorder.

The Influence of Supervisory Neglect on Subtypes of Emerging Adult Substance Use After Controlling for Familial Factors, Relationship Status, and Individual Traits

BACKGROUND

This study is the first to explore how child supervisory neglect influences patterns of substance use among young adults. This study investigated patterns of substance use among males and females, 18 to 24 years old, after controlling for adolescent parental drinking, living with parents, relationship status, delinquency, and depression.

METHODS

The study sample (N=10,618) included individuals who participated in Waves I (1994-1995) and III (2001-2002) of the National Longitudinal Study of Adolescent Health (Add Health). The study used latent class analysis to ascertain how patterns of substance use emerged as distinct classes.

RESULTS

For both males and females, we identified the following 4 classes of substance use: (1) heavy polysubstance use, (2) moderate polysubstance use, (3) alcohol and marijuana, and (4) low-use substance use patterns. Multinomial logistic regression indicated that, for both males and females 18 to 24 years old, experiencing supervisory neglect, being depressed, being single, and engaging in adolescent delinquency serve as risk factors for heavy polysubstance use class membership. Conversely, being black or Hispanic lowered the likelihood of polysubstance use for males and females. For females only, living with parents served as a protective factor that reduced the risk of membership in heavy polysubstance use, moderate polysubstance use, and alcohol and marijuana classes. For males only, being less educated increased the risk of heavy polysubstance use class membership.

CONCLUSIONS

Results from this exploratory study underscore the enduring effect of supervisory neglect on substance use among male and female young adults. Future studies should explore whether these relationships hold over time.

Multiple health behaviours among mothers and partners in England: Clustering, social patterning and intra-couple concordance

Research on multiple health behaviours is increasing but little is known about parental behaviours and how they covary. Our study investigates cigarette smoking, alcohol intake, fruit and vegetable (F&V) consumption and physical activity among mothers and co-resident partners in England. Using the UK Household Longitudinal Study, we examined (i) clustering of health behaviours using observed-expected ratios and latent class analysis (ii) socio-demographic correlates of the derived latent classes and (iii) intra-couple concordance of individual health behaviours and their latent classes. We identified five latent classes for mothers and partners: Never smoked drinkers (28% of mothers; 29% of partners), Abstainers (25%; 17%), Drinkers and ex-smokers (19%; 26%), Unhealthy low frequency drinkers (18%; 16%) and Unhealthiest behaviour group (11%; 12%). These had distinctive social profiles. Never smoked drinkers were more likely than those in other groups to be white and socially advantaged: married, older, and with higher educational qualifications and incomes. Abstainers were non-smokers who never or occasionally drank, and were disproportionately drawn from ethnic minority groups and middle/lower income families. Drinkers and ex-smokers were the most physically active group and were more likely to be socially advantaged. Unhealthy low frequency drinkers were more likely to be disadvantaged and have a limiting long-standing illness. The Unhealthiest behaviour group had the highest proportion of smokers, heavy smokers and binge drinkers and the lowest F&V intake and physical activity levels. They were largely white and socially disadvantaged: younger, non-married and with lower educational levels. Mothers and their partners typically shared the same risk behaviours, and 44 per cent of partners and mothers belonged to the same latent class. Our findings point to the potential for a broadening of research and policy perspectives, from separate behaviours to combinations of behaviours, and from individuals to the domestic units and communities of which they are part.

Latent classes of polysubstance use among adolescents-a systematic review

BACKGROUND

This systematic review aims to summarize latent classes of polysubstance use in adolescents (10-19 years), and to describe predictors of polysubstance use.

METHODS

A systematic literature review was conducted in three databases (PUBMED, PsycINFO, PsycARTICLES) to identify peer-reviewed articles on latent classes of adolescent polysubstance use (published through June 30, 2015), and to assess the comparability of their results.

RESULTS

23 studies (N=450-N=419,698) met the inclusion criteria. The studies showed predominantly (18 studies) average to low risk of bias. 17 studies (74%) identified between three or four latent classes, with "no use" or "low use" classes being the largest and "polysubstance use" being the smallest ones. Intermediate classes included extensive single substance use, such as "alcohol only" classes. Polysubstance use classes were unanimously predicted by higher age, higher parental and peer substance use, and poor academic performance, other predictors were highly heterogeneous.

CONCLUSIONS

Latent classes deliver solid information on polysubstance use in adolescence. Despite their sample sensitivity, the studies possess manifold similarities, hence, modeling latent classes seems to be an ecologically valid approach to further research, e.g., for subgroup analyses or on substance use trajectories. Finally, latent classes may help to illustrate differential effects and special groups in prevention and treatment that depend on the actual consumption pattern. However, there are certain methodological recommendations to be considered in order to obtain reliable results.

Testing the Relations Among Family Disorganization, Delay Discounting, and Adolescent Alcohol Use: A Genetically Informed Study

BACKGROUND

Delay discounting is a potential etiological factor in adolescents' alcohol use, making it important to understand its antecedents. Family disorganization might contribute to delay discounting, but few studies have tested this relation. Moreover, because delay discounting is heritable, the effects of family disorganization on delay discounting might be moderated by adolescents' genetic risk for delay discounting. Thus, the current study examined the role of family disorganization, in interaction with genetic risk, in predicting adolescents' delay discounting and subsequent alcohol use.

METHODS

Adolescents participated in 4 waves of data collection. Adolescents self-reported their family disorganization at T1, completed a delay discounting questionnaire at T3, and self-reported their alcohol use both at T2 (covariate) and T4 (outcome). Using results from an independent sample, we created a polygenic risk score consisting of dopaminergic genes to index genetic risk for delay discounting.

RESULTS

Greater family disorganization predicted adolescents' greater delay discounting, but only for adolescents with low levels of genetic risk for delay discounting. Adolescents with high and mean levels of genetic risk for delay discounting showed elevated delay discounting regardless of their family's disorganization. Greater delay discounting prospectively predicted adolescents' greater alcohol use. Finally, the effects of family disorganization on adolescents' alcohol use were mediated through delay discounting, but only for adolescents with low levels of genetic risk.

CONCLUSIONS

Results suggest multiple pathways to delay discounting. Although there are genetically influenced pathways to delay discounting, family disorganization might represent an environmental pathway to delay discounting (and subsequent alcohol use) for a subset of adolescents at low genetic risk. These findings reinforce the utility of family interventions for reducing adolescents' delay discounting and alcohol use, at least for a subgroup of adolescents. Because higher family organization did not buffer against delay discounting among adolescents with high genetic risk, future research should explore other early environmental influences that could protect these high-risk adolescents from developing these risky behaviors.

Heterogeneity of alcohol, tobacco, and other substance use behaviors in U.S. college students: A latent class analysis

PURPOSE

To identify subgroups of college students with distinct profiles of traditional and alternative types of tobacco, alcohol, and other substance use and to examine how demographic characteristics and academic and social activities are associated with subgroup membership.

METHODS

We used latent class analysis to characterize subgroups of individuals in their fourth-year of college based on their patterns of seven substance use behaviors: extreme heavy episodic drinking (HED), cigarette use, cigar/cigarillo/little cigar use, smokeless tobacco use, hookah use, marijuana use, and non-medical prescription drug use. Demographic characteristics and academic and social activities were then incorporated as predictors of these latent classes.

RESULTS

We identified five classes defined by unique behavior patterns: (1) Non/Low Users, (2) Non-Hookah Tobacco Users, (3) Extreme HED & Marijuana Users, (4) Hookah and Marijuana Users, and (5) Poly-Substance Users. Being male, older, and involved in sports were associated with greater odds of being in the Poly-Substance User class compared to the Low/No User class, and participating in an honors society and reporting more positive peer relationships were associated with being in the Hookah and Marijuana User class compared to the Low/No User class.

CONCLUSION

Our findings of unique characteristics in the subgroups identified suggest that college substance users are a heterogeneous population requiring different targeted interventions. Of particular concern are subgroups with high rates of alternative tobacco products, as perceived risks of use may be inaccurate and this is not currently a focus of college substance use prevention interventions.

Transitions in Current Substance Use from Adolescence to Early-Adulthood

Substance use behaviors do not occur in isolation of one another and are not static over time. As adolescents age into early adulthood, there may be dynamic changes in their substance use behaviors, and these changes may be influenced by family and school factors. The current study uses Latent Transition Analysis to examine these changes by measuring transitions among different substance use profiles based on past 30-day alcohol, tobacco and marijuana use, and by estimating associations with demographic, family and school factors. Data were from youth (n = 850; 80% African American, 17% white, 3% mixed race, 50% female and 50% male) in grade 10 (Time 1), with 24- (Time 2) and 48-month (Time 3) follow-ups. Substance use profiles included Non-users (54%), Alcohol and Marijuana Users (20%), and Alcohol, Tobacco and Marijuana Users (26%). There were considerable transitions among profiles from Time 1 to Time 2, and fewer transitions from Time 2 to Time 3. At Time 1, African American race and positive school attitudes were negatively associated with being an Alcohol and Marijuana User, and being an Alcohol, Tobacco and Marijuana User. Family conflict, parental school involvement, female gender and African American race were associated with transitions among substance use profiles. Implications are discussed for a better understanding of transitions in substance use profiles, and for promoting maintenance of non-use and transitions from substance using profiles to non-use.

What Social Bonds have the Greatest Influence on Patterns of Substance Use among Child-Welfare-Involved Youth?

Child-welfare-involved youth may lack protective social bonds that could reduce their risk of substance use. We investigated whether caregiver, school, or peer bonds predict distinct patterns of substance use among child-welfare-involved youth. The sample included 720 participants in the National Survey of Child and Adolescent Well-Being II. Latent class analysis (LCA) and the three-step approach to incorporate indicator variables onto the latent classes were used. We found the following classes: (1) severe polysubstance use; (2) moderate polysubstance use; and (3) low use. Youth bonded to primary caregivers were less likely to be severe polysubstance drug users, but caregiver bonds did not protect against moderate polysubstance use. School bonds protected against severe polysubstance and moderate polysubstance. Youth bonded to deviant peers were more likely to be in the severe polysubstance use and moderate polysubstance use classes. Interventions targeting child-welfare-involved youth need to account for social bonds' effect on substance use.

Do physical abuse, depression, and parental substance use influence patterns of substance use among child welfare involved youth? Substance use misuse

To date studies have not explored patterns of substance use exclusively among youth in the child welfare system. Consequently, little is known about polysubstance use among child welfare-involved youth. This study aimed to explore whether physical abuse, parental substance use, depression, and demographic characteristics predict distinct patterns of substance use among child welfare-involved youth using latent class analysis (LCA). The sample included 822 11-17 year olds who participated in the National Survey of Child and Adolescent Well-being (NSCAW II) study between March 2008 and September 2009. We found the following three classes: (1) polysubstance use, (2) alcohol and marijuana use, and (3) low use. Older youth and youth who experienced physical abuse were at greater risk of being in the polysubstance use class, while living with a biological parent reduced the likelihood of polysubstance use class membership. Youth in the alcohol and marijuana use class were more likely to be older and depressed. Results from this study illuminate important targets for interventions.

Polydrug Use and HIV Risk Among People Who Inject Heroin in Tijuana, Mexico: A Latent Class Analysis

BACKGROUND

Although most people who inject drugs (PWID) in Tijuana, Mexico, primarily inject heroin, injection and non-injection use of methamphetamine and cocaine is common. We examined patterns of polydrug use among heroin injectors to inform prevention and treatment of drug use and its health and social consequences.

METHODS

Participants were PWID residing in Tijuana, aged ≥18 years who reported heroin injection in the past six months and were recruited through respondent-driven sampling (n = 1,025). Latent class analysis was conducted to assign individuals to classes on a probabilistic basis, using four indicators of past six-month polydrug and polyroute use: cocaine injecting, cocaine smoking or snorting, methamphetamine injecting, and methamphetamine smoking or snorting. Latent class membership was regressed onto covariates in a multinomial logistic regression.

RESULTS

Latent class analyses testing 1, 2, 3, and 4 classes were fit, with the 3-class solution fitting best. Class 1 was defined by predominantly heroin use (50.2%, n = 515); class 2 by methamphetamine and heroin use (43.7%, n = 448), and class 3 by methamphetamine, cocaine, and heroin use (6.0%, n = 62). Bivariate and multivariate analyses indicated a group of methamphetamine and cocaine users that exhibited higher-risk sexual practices and lower heroin injecting frequency, and a group of methamphetamine users who were younger and more likely to be female.

CONCLUSIONS

Discrete subtypes of heroin PWID were identified based on methamphetamine and cocaine use patterns. These findings have identified subtypes of heroin injectors who require more tailored interventions to reduce the health and social harms of injecting drug use.

Substance Use Among Adolescents in California: A Latent Class Analysis

Data from the California Healthy Kids Survey of 7th, 9th, and 11th graders were used to identify latent classes/clusters of alcohol, tobacco, and marijuana use (N = 418,702). Analyses revealed four latent classes of substance use, which included nonusers (61.1%), alcohol experimenters (some recent alcohol use; 22.8%), mild polysubstance users (lifetime use of all substances with less than 3 days of recent use; 9.2%), and frequent polysubstance users (used all substances three or more times in the past month; 6.9%). The results revealed that alcohol and marijuana use are salient to California adolescents. This information can be used to target and tailor school-based prevention efforts.

White and black adolescent females differ in profiles and longitudinal patterns of alcohol, cigarette, and marijuana use

Emerging research suggests that white youth are more likely to show continuity of alcohol use in the year after drinking onset, compared with black youth. Little is known, however, regarding racial differences in year-to-year continuity of alcohol, cigarette, and marijuana use during adolescence, particularly among females, who are at greater risk for certain substance-related harm than males. This study used latent class/transition analysis to identify profiles of past year alcohol, cigarette, and marijuana use at ages 13-17 in a community sample of 1076 adolescent females (57% black, 43% white). Three profiles of past year substance use were identified in separate analyses by race: "no use," "alcohol only," and "polydrug use." Although similar labels describe the profiles, the probability of endorsing use of a particular substance for a given profile differed by race, precluding direct comparison. Latent transition analyses of five annual waves covering ages 13-17 indicated that an intermittent pattern of use (e.g., use in one year, but not the next) was relatively low at all ages among white girls, but among black girls, an intermittent pattern of use began to decline at age 15. Among black girls, conduct problems at age 12 predicted substance using profiles at age 13, whereas among white girls, intentions to use alcohol and cigarettes at age 12 predicted substance using profiles at age 13. Racial differences in girls' substance use profiles suggest the potential utility of culturally tailored interventions that focus on differences in risk for specific substances and relatively distinct early patterns of use.

Latent class analysis of substance use among adolescents presenting to urban primary care clinics

BACKGROUND

Polysubstance use during adolescence is a significant public health concern. However, few studies have investigated patterns of substance use during this developmental window within the primary care setting.

OBJECTIVES

This study used an empirical method to classify adolescents into substance use groups, and examines correlates of the empirically defined groups.

METHODS

Data came from patients, ages 12-18 years, presenting to an urban, primary care community health clinics (Federally Qualified Health Centers) in two cities in the Midwestern United States (n = 1664). Latent class analysis (LCA) was used to identify classes of substance users. Multinomial logistic regression was used to examine variables associated with class membership.

RESULTS

LCA identified three classes: class 1 (64.5%) exhibited low probabilities of all types of substance use; class 2 (24.6%) was characterized by high probabilities of cannabis use and consequences; and class 3 (10.9%) had the highest probabilities of substance use, including heavy episodic drinking and misuse of prescription drugs. Those in class 2 and class 3 were more likely to be older and have poorer grades, poorer health, higher levels of psychological distress and more sexual partners than those in class 1. Individuals in class 3 were also less likely to be African-American than those in class 1.

CONCLUSION

Findings provide novel insight into the patterns of substance use among adolescents presenting to low-income urban primary care clinics. Future research should examine the efficacy of interventions that address the complex patterns of substance use and concomitant health concerns among adolescents.

A latent class analysis of drug abuse in a national Swedish sample

BACKGROUND

Drug abuse (DA) is a clinically heterogeneous syndrome. Using medical, legal, death and pharmacy records covering the entire population of Sweden, could we uncover meaningful subtypes of DA?

METHOD

We performed a latent class analysis (LCA) on all individuals in Sweden born 1950–1993 who were registered with DA or its consequences (n=192,501) and then validated these classes using demographics, patterns of co-morbidity with alcohol use disorder (AUD), non-DA crime and psychiatric illness, and the pattern of aggregation and co-aggregation in sibling pairs.

RESULTS

The best-fit LCA had six classes : (1) low-frequency pure criminal, (2) high-frequency medical criminal, (3) low-frequency pure medical, (4) high-frequency medical, (5) prescription and (6) death. Each class had a distinct pattern of demographic features and co-morbidity and aggregated within sibling pairs with at least moderate specificity. For example, class 2 was characterized by early age at registration, low educational attainment, high male preponderance, high rates of AUDs, strong resemblance within sibling pairs [odds ratio (OR) 12.6] and crime and the highest risk for DA in siblings (20.0%). By contrast, class 5 had a female preponderance, late age at registration, low rates of crime and AUDs, high rates of psychiatric illness, high familiality within sibling pairs (OR 14.7) but the lowest observed risk for DA in siblings (8.9%).

CONCLUSIONS

DA as assessed by public records is a heterogeneous syndrome. Familial factors contribute substantially to this heterogeneity. Advances in our understanding of etiological processes leading to DA will be aided by a consideration of this heterogeneity.

Clustering of modifiable biobehavioral risk factors for chronic disease in US adults: a latent class analysis

AIMS

Examining the co-occurrence patterns of modifiable biobehavioral risk factors for deadly chronic diseases (e.g. cancer, cardiovascular disease, diabetes) can elucidate the etiology of risk factors and guide disease-prevention programming. The aims of this study were to (1) identify latent classes based on the clustering of five key biobehavioral risk factors among US adults who reported at least one risk factor and (2) explore the demographic correlates of the identified latent classes.

METHODS

Participants were respondents of the National Epidemiologic Survey of Alcohol and Related Conditions (2004-2005) with at least one of the following disease risk factors in the past year (N = 22,789), which were also the latent class indicators: (1) alcohol abuse/dependence, (2) drug abuse/dependence, (3) nicotine dependence, (4) obesity, and (5) physical inactivity. Housing sample units were selected to match the US National Census in location and demographic characteristics, with young adults oversampled. Participants were administered surveys by trained interviewers.

RESULTS

Five latent classes were yielded: 'obese, active non-substance abusers' (23%); 'nicotine-dependent, active, and non-obese' (19%); 'active, non-obese alcohol abusers' (6%); 'inactive, non-substance abusers' (50%); and 'active, polysubstance abusers' (3.7%). Four classes were characterized by a 100% likelihood of having one risk factor coupled with a low or moderate likelihood of having the other four risk factors. The five classes exhibited unique demographic profiles.

CONCLUSIONS

Risk factors may cluster together in a non-monotonic fashion, with the majority of the at-risk population of US adults expected to have a high likelihood of endorsing only one of these five risk factors.

The topography of multiple drug use among adolescent Australians: findings from the National Drug Strategy Household Survey

INTRODUCTION AND AIMS

Despite evidence that many Australian adolescents have considerable experience with various drug types, little is known about the extent to which adolescents use multiple substances. The aim of this study was to examine the degree of clustering of drug types within individuals, and the extent to which demographic and psychosocial predictors are related to cluster membership.

DESIGN AND METHOD

A sample of 1402 adolescents aged 12-17 years were extracted from the Australian 2007 National Drug Strategy Household Survey. Extracted data included lifetime use of 10 substances, gender, psychological distress, physical health, perceived peer substance use, socioeconomic disadvantage, and regionality. Latent class analysis was used to determine clusters, and multinomial logistic regression employed to examine predictors of cluster membership.

RESULT

There were 3 latent classes. The great majority (79.6%) of adolescents used alcohol only, 18.3% were limited range multidrug users (encompassing alcohol, tobacco, and marijuana), and 2% were extended range multidrug users. Perceived peer drug use and psychological distress predicted limited and extended multiple drug use. Psychological distress was a more significant predictor of extended multidrug use compared to limited multidrug use.

DISCUSSION AND CONCLUSION

In the Australian school-based prevention setting, a very strong focus on alcohol use and the linkages between alcohol, tobacco and marijuana are warranted. Psychological distress may be an important target for screening and early intervention for adolescents who use multiple drugs.

Risk-Taking Behaviors and Subgrouping of College Students

Risk-taking behaviors have negative consequences on adolescent and young adult’s health. The aim of this study was to identify the subgroups of college students on the basis of risk-taking behaviors and to assess the role of demographic characteristics, religious beliefs, and parental support on membership of specific subgroup. The cross-sectional study took place in Tabriz (northwest of Iran) in April and May of 2011. The randomly selected sample consisted of 1,837 college students. A survey questionnaire was used to collect data. Latent class analysis was performed to achieve the study’s objectives. Four latent classes were identified: (a) low risk, (b) cigarette and hookah smoker, (c) sexual and drinking risk-takers (for males)/sexual risk takers (for females), and (d) high risk. Notably, 13.3% of the males and 4.3% of the females were in the high-risk class. The results identified evidence of protective influence of familial support and religiosity on risky behaviors. A fair number of college students, males in particular, were identified as high risk-takers. Design and implementation of preventive interventions for this segment of the population are necessary. Higher level of familial support and religiosity may serve as preventive factors in risk-taking behaviors.

Community epidemiology of risk and adolescent substance use: practical questions for enhancing prevention

To promote an effective approach to prevention, the community diagnosis model helps communities systematically assess and prioritize risk factors to guide the selection of preventive interventions. This increasingly widely used model relies primarily on individual-level research that links risk and protective factors to substance use outcomes. I discuss common assumptions in the translation of such research concerning the definition of risk factor elevation; the equivalence, independence, and stability of relations between risk factors and problem behaviors; and community differences in risk factors and risk factor-problem behavior relations. Exploring these assumptions could improve understanding of the relations of risk factors and substance use within and across communities and enhance the efficacy of the community diagnosis model. This approach can also be applied to other areas of public health where individual and community levels of risk and outcomes intersect.

How important is the context of an adolescent's first alcoholic drink? Evidence that parental provision may reduce later heavy episodic drinking

OBJECTIVE

This study examined the extent to which a retrospective measure of parental provision of the first alcoholic beverage was related to current heavy episodic drinking and current responsible drinking practices.

SAMPLE

608 14- to 17-year-olds from the 2007 Australian National Drug Strategy Household Survey.

MEASURES

Source of first alcoholic beverage (friends/parents/others), source of current alcohol, age of onset of alcohol use, current responsible drinking practices, and proportion of current friends who drink.

RESULTS

Binary logistic and multiple regression procedures revealed that parental provision of an adolescent's first alcoholic beverage predicted lower current heavy episodic drinking, and responsible drinking mediated this association.

DISCUSSION

The results suggested that for adolescents who become alcohol users, parental provision of the first drink may reduce subsequent alcohol-related risks compared to introduction to alcohol by friends and other sources. Alcohol-related risks remain significant for adolescents who consume alcohol, independent of who is the provider.

Latent Transition Analysis: Benefits of a Latent Variable Approach to Modeling Transitions in Substance Use

We apply latent transition analysis (LTA) to characterize transitions over time in substance use behavior profiles among first-year college students. Advantages of modeling substance use behavior as a categorical latent variable are demonstrated. Alcohol use (any drinking and binge drinking), cigarette use, and marijuana use were assessed in a sample (N=718) of college students during the fall and spring semesters. Four profiles of 14-day substance use behavior were identified: (1) Non-Users; (2) Cigarette Smokers; (3) Binge Drinkers; and (4) Bingers with Marijuana Use. The most prevalent behavior profile at both times was the Non-Users (with over half of the students having this profile), followed by Binge Drinkers and Bingers with Marijuana Use. Cigarette Smokers was the least prevalent behavior profile. Gender, race/ethnicity, early onset of alcohol use, grades in high school, membership in the honors program, and friendship goals were all significant predictors of substance use behavior profile.