Childhood socio-economic status, school failure and drug abuse: a Swedish national cohort study

Academic orientation and cannabis use-findings from a population-based study of Swedish adolescents in upper secondary school

AIM

To examine the association between academic orientation and frequent cannabis use among Swedish adolescents in upper secondary school and include pupils from introductory programs (IPs), a large group of adolescents previously overlooked in research on adolescent cannabis use.

METHODS

We used cross-sectional data from two anonymous school surveys carried out in upper secondary school in 2021. The samples consisted of pupils from all academic orientations, and the analysis included 3151 pupils in higher education preparatory programs (HEPs), 1010 pupils in vocational programs (VPs), and 819 pupils in IPs. The association between the exposure academic orientation and the outcome frequent (21+ times) cannabis was analyzed using multi-level mixed-effects Poisson regression.

RESULTS

Estimates from the first model showed a significant (P < 0.05) 2.45 times higher risk of frequent cannabis use among pupils in IPs compared with in HEPs [incidence rate ratio (IRR) 2.45, 95% confidence interval (CI) 1.28-4.66] and 82% higher in VPs (IRR 1.82, 95% CI 1.09-3.04) compared with in HEPs. However, the associations between academic orientation and frequent (21+ times) cannabis use were attenuated and no longer significant when socioeconomic status, truancy, school dissatisfaction, and early onset of substance use were adjusted for.

CONCLUSIONS

There was a higher risk of frequent (21+ times) cannabis use among pupils in IPs, and this differential was explained by higher exposure to risk factors in this group. This result is important from a policy perspective as it provides knowledge of a previously neglected risk group for frequent cannabis use.

Inability to start or complete upper secondary school strongly predicts unemployment and psychosocial and psychiatric adversities - A register-based follow-up study from southwestern Sweden

AIM

To study academic, social and psychiatric outcomes among adults in the general population in southwestern Sweden. Groups of individuals born in 1998 and ineligible, eligible but not completed, and eligible and completed upper secondary school were followed in 2020.

METHODS

Data were retrieved from Statistics Sweden, the Swedish National Agency for Education, the Longitudinal Integrated Database for Health Insurance and Labour Market Studies, the Swedish National Crime Register and the National Patient Register. The four adverse outcomes neither engaging in post-secondary studies nor having a regular salary, needing social benefits, having any criminal conviction, and having a psychiatric disorder at age ≥16 were examined.

RESULTS

Of the final sample of 2706 individuals who had attended 9th grade of compulsory school in 2014, 273 (10%) were ineligible for upper secondary school. Of eligible individuals, 82 (3%) never started, 282 (10%) did not complete and 2065 (77%) completed upper secondary school. Compared with completers, the odds ratios for adverse outcomes were markedly increased for all other groups up to 22 years old.

CONCLUSION

Inability to start or complete upper secondary school strongly predicted unemployment and psychosocial and psychiatric adversities. School authorities should consider offering vocational programmes post compulsory school without grade restrictions.

The impact of poverty and socioeconomic status on brain, behaviour, and development: a unified framework

In this article, we, for the first time, provide a comprehensive overview and unified framework of the impact of poverty and low socioeconomic status (SES) on the brain and behaviour. While there are many studies on the impact of low SES on the brain (including cortex, hippocampus, amygdala, and even neurotransmitters) and behaviours (including educational attainment, language development, development of psychopathological disorders), prior studies did not integrate behavioural, educational, and neural findings in one framework. Here, we argue that the impact of poverty and low SES on the brain and behaviour are interrelated. Specifically, based on prior studies, due to a lack of resources, poverty and low SES are associated with poor nutrition, high levels of stress in caregivers and their children, and exposure to socio-environmental hazards. These psychological and physical injuries impact the normal development of several brain areas and neurotransmitters. Impaired functioning of the amygdala can lead to the development of psychopathological disorders, while impaired hippocampus and cortex functions are associated with a delay in learning and language development as well as poor academic performance. This in turn perpetuates poverty in children, leading to a vicious cycle of poverty and psychological/physical impairments. In addition to providing economic aid to economically disadvantaged families, interventions should aim to tackle neural abnormalities caused by poverty and low SES in early childhood. Importantly, acknowledging brain abnormalities due to poverty in early childhood can help increase economic equity. In the current study, we provide a comprehensive list of future studies to help understand the impact of poverty on the brain.

Urban Violence, Migration and Alcohol, Tobacco, and Marijuana Use among Transnational Students in Northern Mexico

This article reports on the findings of a study of the relationship between transnational experiences in the United States (US) and the use of alcohol, tobacco, and marijuana among 7th grade students (n = 1418). The study was guided by a cross-national framework for research on immigrant health and assessed the accumulation of risk factors for transnational adolescents. Data came from a survey conducted in 2017 in Nogales, Mexico. In this study, the last 30-day prevalence of use of alcohol, tobacco, and marijuana among students was 21.7%, 8.3%, and 2.4%, respectively. Most students were born in Nogales (69.6%), while 10.5% were born in the US, 7.5% attended school in the US, and 3.6% engaged in health-related risk behaviors while living in or visiting the US. Students with transnational experiences, such as attending school in the US, reported the highest 30-day prevalence of tobacco (13.3%) and marijuana (9.5%) use. After adjusting for family, school, access to substances and neighborhood violence variables, students who engaged in health-related risk behavior in the US had significantly increased odds of alcohol and marijuana use while later attending school in Mexico. The article discusses the findings from a prevention science perspective and provides implications for policy, practice, and future research on the Mexico-US border region.

Offspring hospitalization for substance use and changes in parental mental health: A Finnish register-based study

Prior research indicates that parental psychiatric disorders increase their offspring's risk of substance use problems. Though the association is likely bidirectional, the effects of an adult child's substance use on parental mental health remain understudied. We examined parents' psychotropic medication use trajectories by parental sex and educational attainment before and after a child's alcohol- or narcotics-attributable hospitalization. We identified Finnish residents, born 1979-1988, with a first hospitalization for substance use during emerging adulthood (ages 18-29, n = 12,851). Their biological mothers (n = 12,283) and/or fathers (n = 10,765) were followed for the two years before and after the hospitalization. Psychotropic medication use was measured in three-month periods centered around the time of child's hospitalization, and the probability of psychotropic medication use at each time point was assessed using generalized estimating equations logit models. Among mothers, the prevalence of psychotropic medication use increased during the year before, peaked during the 0-3 months after hospitalization, and remained at a similarly elevated level until the end of follow-up. The prevalence among fathers increased gradually and linearly across follow-up, with minimal changes evident either directly before or after the hospitalization. Parents' educational attainment did not modify these trajectories. Our results highlight the importance of considering linked lives when quantifying substance use-attributable harms and underscore the need for future research examining the intergenerational spillover effects of substance use in both directions, particularly in mother-child dyads.

Overcrowded housing during adolescence and future risk of premature mortality: a 28-year follow-up of 556,191 adolescents from Switzerland

Background

Few large-scale studies have examined the health impacts of overcrowded housing in European countries. The aim of this study was to assess whether household crowding during adolescence increases the risk of all-cause and cause-specific mortality in Switzerland.

Methods

Study participants were 556,191 adolescents aged 10-19 years at the 1990 census from the Swiss National Cohort. Household crowding at baseline was measured as the ratio between the number of persons living in the household and the number of available rooms, categorized as none (ratio ≤ 1), moderate (1 < ratio ≤ 1.5), and severe (ratio > 1.5). Participants were linked to administrative mortality records through 2018 and followed for premature mortality from all causes, cardiometabolic disease and self-harm or substance use. Cumulative risk differences between ages 10 and 45 were standardized by parental occupation, residential area, permit status and household type.

Findings

Of the sample, 19% lived in moderately and 5% lived in severely crowded households. During an average follow-up of 23 years, 9766 participants died. Cumulative risk of death from all causes was 2359 (95% compatibility intervals: 2296-2415) per 100,000 persons when living in non-crowded households. Living in moderately crowded households led to 99 additional deaths (-63 to 256) per 100,000 persons and living in severely crowded households 258 additional deaths (-37 to 607) per 100,000 persons. The effect of crowding on mortality from cardiometabolic diseases, self-harm or substance use was negligible.

Interpretation

Excess risk of premature mortality in adolescents living in overcrowded households appears to be small or negligible in Switzerland.

Funding

University of Fribourg Scholarship Programme for foreign post-doctoral researchers.

Associations Between Peer Victimization and Problematic Internet Use Among Adolescents: Humor Makes a Difference

With the increasing development of science and technology, the Internet has become an essential part of people's daily lives providing great convenience. However, the Internet also leads to problematic Internet use (PIU) among adolescents, which has attracted increasing attention from the academic community. Peer victimization is a pervasive stressor among adolescents and has been proven to lead to a series of mental health challenges. Although the association between peer victimization and PIU has been well documented, the underlying mechanism remains unclear. This study aimed to understand how and when peer victimization increases the risk of PIU among adolescents. Building on Agnew's general strain theory, this study hypothesized that depression mediates the relationship between peer victimization and PIU and humor moderates the mediating model. To examine these hypotheses, 469 middle school students were recruited to complete a series of questionnaires on peer victimization, depression, humor, and PIU. The results showed that depression partially mediated the relationship between peer victimization and PIU. A moderated mediation analysis indicated that humor moderated the indirect pathway, consistent with the reverse stress-buffering model, the relationship between peer victimization and depression was stronger for adolescents with high humor. However, the relationship between depression and PIU was weaker in adolescents with high humor, which is in line with the stress-buffering model. These findings could be of significance in understanding the underlying mechanism of PIU associated with peer victimization and provide a new perspective for preventing PIU among adolescents, especially those experiencing peer victimization. The limitations and considerations for future research are discussed.

The moderation of the genetic risk for alcohol and drug use disorders in a Swedish national sample by the genetic aptitude for educational attainment

BACKGROUND

Does the genetic aptitude for educational attainment (GAEA) moderate the genetic risk for alcohol use disorder (AUD) and drug use disorder (DUD)?

METHODS

In the native Swedish population, born 1960-1980 and followed through 2017 (n = 1 862 435), the family genetic risk score (FGRS) for AUD and DUD and GAEA were calculated from, respectively, the educational attainment and risk for AUD and DUD, of 1st through 5th degree relatives from Swedish national registers. Analyses utilized Aalen's linear hazards models.

RESULTS

Risk for AUD was robustly predicted by the main effects of FGRSAUD [b = 6.32 (95% CI 6.21-6.43), z = 64.9, p < 0.001) and GAEA [b = -2.90 (2.83-2.97), z = 44.1, p < 0.001] and their interaction [b = -1.93 (1.83-2.03), z = 32.9, p < 0.001]. Results were similar for the prediction of DUD by the main effects of FGRSDUD [b = 4.65 (CI 4.56-4.74), z = 59.4, p < 0.001] and GAEA [-2.08 (2.03-2.13), z = 46.4, p < 0.001] and their interaction [b = -1.58 (1.50-1.66)), z = 30.2, p < 0.001]. The magnitude of the interactions between GAEA and FGRSAUD and FGRSDUD in the prediction of, respectively, AUD and DUD was attenuated only slightly by the addition of educational attainment to the model.

CONCLUSIONS AND RELEVANCE

The genetic propensity to high educational attainment robustly moderates the genetic risk for both AUD and DUD such that the impact of the genetic liability to AUD and DUD on the risk of illness is substantially attenuated in those with high v. low GAEA. This effect is not appreciably mediated by the actual level of educational attainment. These naturalistic findings could form the basis of prevention efforts in high-risk youth.

School-Level Longitudinal Predictors of Alcohol, Cigarette, and Marijuana Use

This study analyzed measures aggregated at the school level to identify key predictors of drinking alcohol, binge drinking, smoking cigarettes, and using marijuana. Using data collected from 6th through 12th grade students between 2011 and 2015, we identify school-level variables that predict school-level prevalence in the subsequent year. Data included prior year assessments of: (1) school-wide prevalence, (2) perceived ease of access to drugs, (3) perceived adult disapproval of drug use, (4) perceived peer disapproval of drug use, and (5) perceived prevalence of drug use. We regressed grade-level behaviors on predictor variables from the previous school year. In middle schools, prior grade prevalence and prior grade perceived norms were significant predictors of subsequent grade prevalence. For high schools, prior year prevalence, aggregated peer norms, and perceived ease of access predicted subsequent use. These analyses provide evidence that a school's culture is predictive of changes in prevalence over time.

Risk factors for substance use in Swedish adolescents: A study across substances and time points

Aim: The public health model for prevention of disease and disorder has been influential in informing interventions regarding substance use. While a number of risk factors within this model have been found to predict substance use, few studies have explored the associations across substances, at different time points and in the same individuals. The aim of this study was to test this model across legal and illegal substance use among adolescents, and to identify potential changes in associations over time. Methods: Data from two waves of a nationally representative cohort study among Swedish adolescents were used. Baseline data were collected in 2017 (9th grade) with a follow-up in 2019 (11th grade). Using modified Poisson regression analyses, we explored cross-sectional associations between factors from different domains and prevalence of cigarette use, binge-drinking and illegal drug use at both baseline and follow-up. Results: The results in part supported the public health model. Substance use was predicted by factors within the family, school and the individual/peer domain, but several associations were not statistically significant. The only consistent risk factors across substances and time points were lack of parental monitoring, truancy and minor criminal activities. Conclusion: Despite widely different prevalence rates across substances, some risk factors were consistently associated with adolescent substance use. Nonetheless, the findings challenge the assumption that risk factors are stable over adolescence. They suggest a need for flexible prevention interventions spanning across substances and legal boundaries of substances, but also over domains to reflect the heterogenous needs of adolescents.

The Secondary Harms of Parental Substance Use on Children's Educational Outcomes: A Review

Parental substance use, that is alcohol and illicit drugs, can have a deleterious impact on child health and wellbeing. An area that can be affected by parental substance use is the educational outcomes of children. Current reviews of the literature in the field of parental substance use and children's educational outcomes have only identified a small number of studies, and most focus on children's educational attainment. To grasp the available literature, the method from Arksey and O'Malley (2005) was used to identify literature. Studies were included if they were empirical, after 1950, and focused on children's school or educational outcomes. From this, 51 empirical studies were identified which examined the relationship between parental alcohol and illicit drug use on children's educational outcomes. Five main themes emerged which included attainment, behavior and adjustment, attendance, school enjoyment and satisfaction, academic self-concept, along with other miscellaneous outcomes. This paper highlights the main findings of the studies, the gaps in the current literature, and the challenges presented. Recommendations are made for further research and interventions in the areas of parental substance use and child educational outcomes specifically, but also for broader areas of adversity and child wellbeing.

The Changing Patterns and Correlates of Adolescent Substance Use in China's Special Administrative Region of Macau

Most of the research on adolescent substance use is from either the U.S, Europe, or other non-Eastern countries, but very little attention is paid to that in the Greater China Region. As a special administrative region of China, Macau is known for its gambling industry, its proximity to the Golden Triangle, and its lenient drug laws, all of which can be conducive to high-level drug use in the population, including its adolescents. Yet, the extent and patterns of adolescent substance use in Macau are not well understood. Using the data collected from two large representative samples of secondary school students in 2014 and 2018, this study provided population-based estimates of the prevalence rates of lifetime and past 30-day substance use among Macau adolescents in the two separate survey years. By comparing the two sets of estimates, it established the patterns of changes in cigarette smoking, alcohol use, and illicit drug use among adolescents in Macau during the period. Additionally, through the analysis of the data in the latest year, it identified risk factors for adolescent substance use in the special administrative region. Among the key results, the rates of cigarette smoking and illicit drug use were low to moderate while the rates of alcohol use were relatively high; cigarette smoking decreased during the period, but alcohol use and illicit drug use remained stable; Macau adolescents shared similar risk factors for substance use with adolescents elsewhere, but unique circumstances might exist to influence their alcohol consumption.

The impact of parental substance use disorder and other family-related problems on school related outcomes

Aims

To identify young people with different levels of family-related problems, including parental substance use disorder (PSUD), and investigate differences in grades at graduation from compulsory school and further enrollment in education.

Methods

Participants included 6784 emerging adults (aged 15-25 years) from samples drawn for two national surveys in Denmark 2014-2015. Latent classes were constructed using the following parental variables: PSUD, offspring not living with both parents, and parental criminality, mental disorders, chronic diseases and long-term unemployment. The characteristics were analyzed using an independent one-way ANOVA. Differences in grade point average and further enrollment were analyzed using linear regression and logistic regression, respectively.

Results

Four classes of families were identified: 1. "Low adverse childhood experiences (ACE) families", 2. "Families with PSUD", 3. "Families with unemployment" and 4. "High ACE families". There were significant differences in grades, with the highest average among youth from "Low ACE families" (males = 6.83; females = 7.40) and significant lower averages among both males and females from the other types of families, but lowest among young people from "High ACE families" (Males = 5.58; females = 5.79). Youth from "Families with PSUD" (Males: OR = 1.51; 95% CI: 1.01-2.26; females: OR = 2.16; 95% CI: 1.22-3.85) and "High ACE families" (Males: OR = 1.78; 95% CI: 1.11-2.26) were significantly more likely not to be enrolled in further education compared with "Low ACE families".

Conclusions

Young people who experience PSUD, both as the primary family-related problem as well as among multiple family-related problems, are at increased risk for negative school-related outcomes.

Poverty in adolescence and later drug use disorders: understanding the mediation and interaction effects of other psychiatric disorders

BACKGROUND

Poverty in adolescence is associated with later drug use. Few studies have evaluated the role of adolescent psychiatric disorders in this association.

AIMS

This study aimed to investigate mediation and interaction simultaneously, enabling the disentanglement of the role of adolescent psychiatric disorders in the association between poverty in adolescent and later drug use disorders.

METHOD

A national cohort study of 634 223 individuals born in 1985-1990, residing in Sweden between the ages of 13 and 18 years, was followed from age 19 years until the first in-patient or out-patient care visit with a diagnosis of drug use disorder. A four-way decomposition method was used to determine the total effect of the association with poverty and possible mediation by and/or interaction with diagnosis of adolescent psychiatric disorders.

RESULTS

The hazard ratios for drug use disorders among those experiencing poverty compared with those 'never in poverty' were 1.40 (95% CI, 1.32-1.63) in females and 1.43 (95% CI, 1.37-1.49) in males, after adjusting for domicile, origin and parental psychiatric disorders. Twenty-four per cent of this association in females, and 13% in males, was explained by interaction with and/or mediation by adolescent psychiatric disorders.

CONCLUSIONS

Part of the association between poverty in adolescence and later drug use disorders was due to mediation by and/or interaction with psychiatric disorders. Narrowing socioeconomic inequalities in adolescence might help to reduce the risks of later drug use disorders. Interventions aimed at adolescents with psychiatric disorders might be especially important.

Criminality among Young People With Substance Use Problems in Sweden: A One-Year Follow-Up Study

Swedish drug policy has a strong focus on minor drug violations. This longitudinal study analyses the association between criminality and substance use problems among young people who have received outpatient treatment and risk factors that predict continued problems with criminality. Research on this target group is under development in Sweden, but there are few follow-up studies. The study indicates that about one-quarters of the young people who begin outpatient treatment have been convicted of crimes at 1-year follow-up. Most of them who had been convicted with offences also have ongoing problems with substance use and three-quarters of the young people had been charged with a drug-related offence. More than five risk factors give an elevated risk of continued criminality. Interventions meeting the needs of young people, moving away from the current emphasis on penal law principles, may also contribute to reduced criminality in this target group.

Parental Posttraumatic Stress and School Performance in Refugee Children

Refugee children in the Nordic countries have been reported to perform poorly in school and carry a high burden of familial posttraumatic stress. The present study aimed to investigate the impact of maternal and paternal posttraumatic stress on the school performance of refugee children. We used national register data on school grades at age 15-16 along with demographic and migration indicators during 2011-2017 in a population of 18,831 children in refugee families in Stockholm County, Sweden. Parental posttraumatic stress was identified in regional data from three levels of care, including a tertiary treatment center for victims of torture and war. Multivariable linear and logistic regression models were fitted to analyze (a) mean grade point averages as Z scores and (b) eligibility for upper secondary school. In fully adjusted models, children exposed to paternal posttraumatic stress had a lower mean grade point average, SD = -0.14, 95% CI [-0.22, -0.07], and higher odds of not being eligible for upper secondary education, OR = 1.37, 95% CI [1.14, 1.65]. Maternal posttraumatic stress had a similar crude effect on school performance, SD = -0.15, 95% CI [-0.22, -0.07], OR = 1.25, 95% CI [1.00, 1.55], which was attenuated after adjusting for single-parent households and the use of child psychiatric services. The effects were similar for boys and girls as well as for different levels of care. Parental posttraumatic stress had a small negative effect on school performance in refugee children, adding to the intergenerational consequences of psychological trauma.

Inclusive Educational Spaces and Social Pedagogical Recognition: Interaction- and Social-Pedagogy-Inspired Analysis of Space Dynamics in Compulsory, Upper-Secondary and Post-Secondary Education

The purpose of this article is to provide a new understanding of the essence of inclusive educational spaces as a pedagogical phenomenon that presents different scientific approaches to the concept of educational space, and the importance of interpersonal interactions in educational spaces, and also presents the authors’ interpretations of their essence. The analytical basis is a literature review of various studies from the domains of symbolic interactionism, social constructivism, ethnomethodology, the sociology of knowledge, education, pedagogy and social pedagogy. Empirical sequences in the reviewed literature that exemplify inclusive educational spaces are derived from the organisational and practical work of compulsory and upper-secondary schools related to newly arrived students and students who use alcohol and narcotics, and from the context of the organisational and practical work of universities related to the education of future actors. The importance of recognizing the role of creative educational spaces as a leading requirement for the preparation of students for future communicative interactions in professional communication is revealed, and the structural characteristics of these spaces’ content and functional load are provided. Inclusive educational spaces and professionals’ inclusive approach demand that schools practically and collaboratively organise work with students in the educational space, show support for them and give them room to manoeuvre to ensure that professional actors in the school and university thrive in their practical work with students, both in relation to the expected normative right and deviant acting in the educational space and in relation to laws and governing documents that, to a certain extent, govern practical work in these educational spaces. The study contributes to the development of knowledge regarding (1) dealing with social interaction and inclusive educational spaces combining (a) the experiences of students in educational space, (b) the experiences of professional actors in educational space, and (c) the development of integration and social pedagogical recognition in educational space; (2) the significance of these social interactions and inclusive educational spaces in the creation and recreation of students’ and professionals’ identities; and (3) alternative social pedagogical approaches to analysing inclusive educational spaces in compulsory, upper-secondary and post-secondary education.

Association between poverty exposure during childhood and adolescence, and drug use disorders and drug-related crimes later in life

AIMS

To examine whether poverty exposure in childhood/adolescence increases the risk of later drug use disorder and drug crime conviction.

DESIGN, SETTING AND PARTICIPANTS

A national cohort study encompassing 634 284 individuals born between 1985 and 1990, residing in Sweden between 5 and 18 years of age, followed-up from January 2004 to December 2016, starting from the age of 19 years until the first visit to inpatient/outpatient care with a diagnosis of a drug use disorder or a drug crime offence.

MEASUREMENTS

The exposure variable was 'trajectories of poverty' based on household income, assessed through group-based trajectory analysis. Cox regression analysis was used to obtain hazard ratios for drug use disorders and drug crime convictions using age as the underlying time scale.

FINDINGS

We identified five trajectories of childhood/adolescence poverty: (1) 'moving out of poverty in childhood' (8.7%); (2) 'never poverty' (68.9%); (3) 'moving into poverty in adolescence' (11.0%); (4) 'moving out of poverty in adolescence' (5.4%); and (5) 'chronically poor' (5.9%). Compared with the 'never poor' group, almost all trajectory groups had higher risks for drug use problems. Young males 'moving into poverty in adolescence' had the highest risks of drug use disorder [hazard ratio (HR) = 1.48, 95% confidence interval (CI) = 1.40-1.57] and drug crime conviction (HR = 1.50, 95% CI = 1.38-1.62), after adjusting for calendar year, domicile, origin, psychiatric diagnosis and parental psychiatric diagnosis. The results were similar in females moving into poverty in adolescence (HR = 1.63, 95% CI = 1.52-1.76 and HR = 1.89, 95% CI = 1.74-2.05 for drug use disorders and drug crime, respectively).

CONCLUSION

In Sweden, poverty exposure early in life seems to increase the risk of drug use problems in adulthood. These associations are not explained fully by domicile, origin or other psychiatric disorders. Young males and females moving into poverty in adolescence are at highest risk.

Friends' childhood adversity and long-term implications for substance misuse: a prospective Swedish cohort study

BACKGROUND AND AIMS

Although an individual's childhood adversity is predictive of later substance misuse, the effect of adversity within an individual's friendship network has not been established. The current study aims to estimate the strength of the association between exposure to childhood adversity among individuals' friends at the onset of adolescence, relative to individuals' own exposure to childhood adversity, and hospitalization for substance misuse between young adulthood and retirement.

DESIGN

Prospective cohort study.

SETTING

Stockholm, Sweden.

PARTICIPANTS

Individuals born in 1953, living in Stockholm in 1963, and who nominated three best friends in the 6th grade school class (n = 7180; females = 3709, males = 3471), followed to 2016.

MEASUREMENTS

The outcome was hospitalization with a main or secondary diagnosis attributed to substance misuse, reflected in Swedish inpatient records (ages 19-63 years). Five indicators of childhood adversity (ages 0-12 years) were operationalized into composite measures for individuals and their friends, respectively. Friendships were identified using sociometric data collected in the school class setting (age 13 years).

FINDINGS

Individuals' own childhood adversity does not predict childhood adversity among friends (P > 0.05). Childhood adversity among friends is independently associated with an increased risk of an individual's later substance misuse [hazard ratio (HR) = 1.17, 95% confidence interval (CI) = 1.09-1.24], independently of an individual's own childhood adversity (HR = 1.47, 95% CI = 1.34-1.61). However, childhood adversity among friends does not moderate the association between individuals' own childhood adversity and later substance misuse.

CONCLUSIONS

Within a birth cohort of individuals born in 1950s Stockholm, Sweden, childhood adversity among an individual's friends appears to predict the individual's substance misuse in later life independently of an individual's own exposure to childhood adversity.

Are the well-off youth in Sweden more likely to use cannabis?

INTRODUCTION AND AIMS

Results from previous research are inconsistent regarding the association between socioeconomic status (SES) and cannabis use among adolescents. Since there are risks associated with cannabis use, a social gradient in cannabis use may contribute to reproducing socioeconomic differences in life opportunities. The aim of this study was to assess the association between childhood SES and cannabis use among youth in Sweden.

DESIGN AND METHODS

We used repeated cross-sectional data from three waves (2014-2016) of the Swedish national school survey among 11th graders. The analysis encompassed 9497 individuals in 668 school classes. Childhood SES was measured through parents' highest education, as reported by the students. Cannabis use was measured in terms of lifetime use and frequency of use. Data were analysed using multi-level mixed-effects Poisson regression.

RESULTS

Adolescents with at least 1 parent with university/college education had 17% (incidence rate ratio 1.17, confidence interval 1.05, 1.30) higher risk of lifetime use of cannabis compared with those whose parents had no university/college education, adjusting for sex, SES of the school environment, academic orientation, truancy, risk assessment and parental permissiveness. Among life-time users of cannabis, risk for frequent cannabis use was 28% (incidence rate ratio 0.72, confidence interval 0.53, 0.97) lower for those with at least 1 parent with university or college education.

DISCUSSION AND CONCLUSIONS

Childhood SES, in terms of parental education, was associated with cannabis use among Swedish adolescents. Adolescents from families with lower SES were less likely to ever try cannabis, but at higher risk for frequent use.

Educational attainment in offspring bereaved by sudden parental death from external causes: a national cohort study from birth and throughout adulthood

PURPOSE

Previous research has linked loss of a parent during childhood to reduced educational aspirations, school performance, and educational attainment later in life. The potential effect of maternal and paternal bereavement on attainment at all educational levels is, however, unknown. The present study aimed to investigate the potential influence of parental death by external causes on completion of compulsory education, high school, vocational education, and University or College education.

METHODS

The study was based on data from three national longitudinal registers in Norway. The study population comprised 373,104 individuals born between January 1st 1970 and December 31st 1994. Information concerning deceased parents' cause and date of death and offspring's education and sociodemographic data were retrieved. Data were analysed with Cox regression.

RESULTS

Children who had experienced parental death by external causes had a significantly reduced hazard ratio (HR) of completing all educational levels compared to children who did not have such experiences. The largest effects were evident for completion of high school (HR 0.68, 95% CI 0.65-0.71) and University or College education (HR 0.75, 95% CI 0.70-0.80). No differences were evident for different causes of death, genders of deceased or ages at bereavement, and generally no significant interactions between gender of the bereaved offspring and predictor variables were evident for completion of all educational levels.

CONCLUSION

Parental death by external causes has vast and long-lasting impacts on offspring's educational attainment at all levels. Health care interventions aimed at supporting bereaved children and adolescents should focus on challenges related to educational progress.

Are self-esteem and academic achievement reciprocally related? Findings from a longitudinal study of Mexican-origin youth

OBJECTIVE

Previous research has shown that self-esteem is associated with academic achievement. However, few studies have used longitudinal data to examine how self-esteem and achievement co-develop over a long time span, and even fewer have focused on ethnic minority youth.

METHOD

We used data from a longitudinal study of Mexican-origin youth (N = 674) to examine the bidirectional associations between self-esteem and academic achievement from 5th to 11th grade. Global and domain-specific self-esteem (academic, honesty, peer relationships, appearance) were assessed at ages 10, 12, 14, and 16 using Marsh et al.'s (2005) Self-Description Questionnaire. Academic achievement was assessed at the same ages using self-reported grades and standardized test scores from school records.

RESULTS

Youth with high global and academic self-esteem showed relative improvements in their grades (but not test scores), and youth who received higher grades and test scores showed relative increases in global and academic self-esteem. Youth with high honesty self-esteem showed relative increases in grades and test scores, and youth with higher grades showed relative increases in peer relationship self-esteem.

CONCLUSION

Students who feel better about themselves tend to show improvements in their grades, and getting better grades and test scores promotes more positive self-views.

Socioeconomic Status, Parental Education, School Connectedness and Individual Socio-Cultural Resources in Vulnerability for Drug Use among Students

Background and Aims: Families who live in a disadvantaged socioeconomic situation frequently face substandard housing, unsafe neighborhoods, inadequate schools and more stress in their daily lives than more affluent families, with a host of psychological and developmental consequences that can hinder their children’s development in many ways. However, the measurement of socioeconomic status among youth and its link with different forms of illicit substance use is challenging and still unclear. This paper extends existing research on the relationship between socioeconomic status and illicit drug use among adolescents by focusing on three different patterns of use (experimental, episodic and frequent) and making use of two indicators to improve the measurement of individual socioeconomic characteristics in a big sample of European students. Methods: Data were drawn from the European school Survey Project on Alcohol and other Drugs (ESPAD), which, since 1995, collects comparable data among 15-to-16-year-old students to monitor trends in drug use and other risk behaviors across Europe. The sample comes from 28 countries that participated in the 2015 data collection. The consumption of cannabis, cocaine and heroin are considered, and the related patterns are identified based on the frequency of use. Family characteristics at student level are defined through two dimensions: parental educational level and perceived socioeconomic status. Multivariate multilevel mixed-effects logistic regression was performed in order to measure the association between individual characteristics and vulnerability for drug use. Results: Some patterns of use, episodic and frequent in particular, were found strongly associated with a lower socioeconomic status and lower parental education. Conclusions: Our results suggest that drug policies should be combined with actions aimed at removing barriers to social inclusion that are attributable to the socioeconomic background of adolescents.

Clozapine Treatment and Offending: A Within-Subject Study of Patients With Psychotic Disorders in Sweden

Clozapine treatment may have beneficial effects on behavioral outcomes in psychotic disorders, including violent offending. Although clozapine and other antipsychotics have been linked to lower levels of violent behavior, these have been primarily in small selected samples, and population-based estimates have been limited and imprecise. We aimed to assess the effect of clozapine treatment on the rate of violent and nonviolent offending. We carried out a within-person mirror-image study of the Swedish population with linked prescription, hospitalization, and sociodemographic registers. Outcomes were violent, nonviolent, and overall offences occurring before and after clozapine, or olanzapine, initiation. Comparison of effects of clozapine and olanzapine on key variables was modeled with interaction terms. We found periods of mirror-image observation time with clozapine treatment were associated with a much lower rate of violent offending compared to periods before treatment (rate ratio [RR]: 0.13 (95% CI: 0.05, 0.34). Reductions in nonviolent offences were smaller in magnitude (RR: 0.37, 95% CI: 0.17, 0.80). There was a statistically greater rate reduction effect on violent offences for clozapine than olanzapine (RR for interaction: 4.84, 95% CI: 1.56, 14.86, P = .002). In patients with psychotic disorders, clozapine treatment is associated with a lower rate of violent offending compared to olanzapine.

Diseases of Despair and Social Capital: Findings from a Population-Based Survey on Opioid Misuse among Adolescents

Deaths related to opioid overdose have increased substantially in the past few years, raising concerns about how to combat this public health emergency. Objectives: We investigated the association of family, school, and community social capital with opioid misuse in the adolescent population. In addition, we examined if adolescents' depressive symptoms have any mediating effects on opioid misuse. Methods: We used the 2018 National Survey on Drug Use and Health (NSDUH) data, and two substantive models with binary logistic regressions. Three social capital variables were added to the full model with control for sociodemographic and health status variables. A mediation analysis was estimated for family and school social capital, major depressive episodes in the past year, and opioid misuse. Results: We found statistically significant relationships between adolescent opioid misuse and family and school social capital. Adolescents' odds of opioid misuse decreased 10% with each additional family situation where they felt supported. Not knowing students in their grade who drank alcohol or used marijuana/hashish decreased the odds of misusing opioids 42% (p < .01). Experience of depressive episodes acted as a mediator for the social capital effects on adolescents' opioid misuse. Conclusions: Our findings lend support that opioid misuse is associated with despair, and therefore, opioid prevention programs need to incorporate strategies to address mental health issues as well. Our findings also underscore the need for focusing on increasing parental awareness and involvement as well as scaling up prevention efforts in high schools where substance abuse is relatively higher.

Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life

BACKGROUND

While compromised stress resilience constitutes a recognised risk factor for somatic and psychiatric disease development in general, the knowledge about how individual variation in vulnerability to stress may specifically influence the long-term risks of disadvantageous health behaviours is limited.

METHODS

In this Swedish cohort study, we aimed to investigate the association between stress resilience in late adolescence and adult use of addictive substances. We included 9381 men with information on psychological stress resilience measured during military conscription examinations, who later responded to an extensive health survey (mean age 34.0±7.2 years) including detailed information on substance use. We modelled continuous outcomes using linear regression, binary outcomes with logistic regression and other categorical outcomes with multinomial logistic regression.

RESULTS

We found that low stress resilience in adolescence conferred increased risks of all studied measures of addictive behaviour. After adjusting for childhood socioeconomic information, low stress resilience was associated with adult current regular smoking (relative risk ratio: 5.85, 95% CI 4.32 to 7.93), higher nicotine dependence scores (beta: 0.76, 95% CI 0.29 to 1.23), hazardous use of alcohol (>14 alcoholic drink-equivalents per week, OR: 1.72, 95% CI 1.37 to 2.16), DSM-IV criteria for alcohol dependence (OR: 1.74, 95% CI 1.35 to 2.25), and drug use (OR: 1.77, 95% CI 1.51 to 2.08). The results remained largely unchanged after further adjustments for adult educational attainment and occupation as well as for additional conscription covariates.

CONCLUSION

Low stress resilience in late adolescence appears to be associated with an increased risk of disadvantageous and addictive health behaviours in adulthood.

Academic Achievement and Drug Abuse Risk Assessed Using Instrumental Variable Analysis and Co-relative Designs

Importance

Low academic achievement (AA) in childhood and adolescence is associated with increased substance use. Empirical evidence, using longitudinal epidemiologic data, may provide support for interventions to improve AA as a means to reduce risk of drug abuse (DA).

Objective

To clarify the nature of the association between adolescent AA and risk of DA by using instrumental variable and co-relative analysis designs.

Design, Setting, and Participants

This study, assessing nationwide data from individuals born in Sweden between 1971 and 1982, used instrumental variable and co-relative analyses of the association between AA and DA. The instrument was month of birth. Co-relative analyses were conducted in pairs of cousins (263 222 pairs), full siblings (154 295), and monozygotic twins (1623) discordant for AA, with raw results fitted to a genetic model. The AA-DA association was modeled using Cox regression. Data analysis was conducted from October 2017 to January 2018.

Exposures

Academic achievement assessed at 16 years of age (for instrumental variable analyses), and estimated discordance in AA in pairs of monozygotic twins (for co-relative analyses).

Main Outcomes and Measures

Drug abuse registration in national medical, criminal, or pharmacy registries.

Results

This instrumental variable analysis included 934 462 participants (478 341 males and 456 121 females) with a mean (SD) age of 34.7 (4.3) years at a mean follow-up of 19 years. Earlier month of birth was associated with a linear effect on AA, with the regression coefficient per month equaling -0.0225 SDs (95% CI, -0.0231 to -0.0219). Controlling for AA, month of birth had no association with risk of DA (hazard ratio [HR], 1.000; 95% CI, 0.997-1.004). Lower AA had a significant association with risk of subsequent DA registration (HR per SD, 2.33; 95% CI, 2.30-2.35). Instrumental variable analysis produced a substantial but modestly attenuated association (HR, 2.04; 95% CI, 1.75-2.33). Controlling for modest associations between month of birth and parental educational status and DA risk reduced the association to a HR of 1.92 (95% CI, 1.67-2.22). The genetic model applied to the results of co-relative analyses fitted the observed data well and estimated the AA-DA association in monozygotic twins discordant for AA to equal a HR of 1.79 (95% CI, 1.64-1.92).

Conclusions and Relevance

Two different methodological approaches with divergent assumptions both produced results consistent with the hypothesis that the significant association observed between AA at 16 years of age and risk of DA into middle adulthood may be causal. These results provide empirical support for efforts to improve AA as a means to reduce risk of DA.

The Temporal Relationship between Selected Mental Disorders and Substance-Related Disorders: A Nationwide Population-Based Cohort Study

Introduction. Previous studies have examined the association between specific mental disorders, particularly mood and anxiety disorders, and substance-related disorders; but the temporal link between them remains unclear. This study aimed to examine whether individuals with specific mental disorders, including affective psychoses, neurotic disorders, schizophrenia, personality disorders, and adjustment reaction, have higher risks for subsequently developing substance-related disorders compared to those without. Methods. A large-scale study with longitudinal data was conducted using the Taiwan National Health Insurance Research Database (NHIRD) consisting of 2,000,118 patients' medical records from 2000 to 2009. A total of 124,423 people diagnosed with selected mental disorders and the same number of people without the diagnoses of the selected disorders were identified between January 1, 2001, and December 31, 2006, and followed up for the diagnoses of substance-related disorders till the end of 2009. We estimated the risk for subsequently developing substance-related disorders among patients with the selected mental disorders compared to those without by using Cox proportional hazard models. The cumulative incidence of substance-related disorders was calculated using the Kaplan-Meier method. Results. The risk for developing substance-related disorders in patients with selected mental disorders is about 5 times (HR=5.09, 95% CI: 4.74-5.48) higher than those without after adjusting for potential confounding variables. From the multivariate analyses of subsamples stratified by age, sex, and urban and income levels, we found all adjusted hazard ratios were significantly higher than 1.0, ranging from 2.12 (95% CI: 1.72-2.62) to 14.55 (95% CI: 7.89-26.83). For children and adolescents aged 10-19 years, those with specific mental disorders had 14.55-fold higher risk for developing substance-related disorders in later life compared to their counterparts. Furthermore, patients with personality disorders had the highest risk (HR=25.05). Conclusions. The earlier onset of the selected mental disorders is a potential risk for developing substance-related disorders in later life, particularly for personality disorders. Health professionals should pay more attention to this at-risk population, especially to adolescents with mental disorders.

Impulsivity traits and addiction-related behaviors in youth

Background and aims Impulsivity is a risk factor for addictive behaviors. The UPPS-P impulsivity model has been associated with substance addiction and gambling disorder, but its role in other non-substance addiction-related behaviors is less understood. We sought to examine associations between UPPS-P impulsivity traits and indicators of multiple substance and non-substance addiction-related behaviors in youth with varying involvement in these behaviors. Methods Participants (N = 109, aged 16-26 years, 69% males) were selected from a national survey based on their level of externalizing problems to achieve a broad distribution of involvement in addiction-related behaviors. Participants completed the UPPS-P Questionnaire and standardized questionnaires assessing problematic use of substances (alcohol, cannabis, and other drugs) and non-substances (Internet gaming, pornography, and food). Regression analyses were used to assess associations between impulsivity traits and indicators of addiction-related behaviors. Results The UPPS-P model was positively associated with indicators of all addiction-related behaviors except problematic Internet gaming. In the fully adjusted models, sensation seeking and lack of perseverance were associated with problematic use of alcohol, urgency was associated with problematic use of cannabis, and lack of perseverance was associated with problematic use of other drugs than cannabis. Furthermore, urgency and lack of perseverance were associated with binge eating and lack of perseverance was associated with problematic use of pornography. Discussion and conclusions We emphasize the role of trait impulsivity across multiple addiction-related behaviors. Our findings in at-risk youth highlight urgency and lack of perseverance as potential predictors for the development of addictions and as potential preventative therapeutic targets.

Cause-specific mortality in Swedish males diagnosed with non-psychotic mental disorders in late adolescence: a prospective population-based study

BACKGROUND

While risk of premature death is most pronounced among persons with severe mental illness, also milder conditions are associated with increased all-cause mortality. We examined non-psychotic mental (NPM) disorders and specific causes of natural death in a cohort of late adolescent men followed for up to 46 years.

METHODS

Prospective cohort study of Swedish males (n=1 784 626) who took part in structured conscription interviews 1968-2005. 74 525 men were diagnosed with NPM disorders at or prior to conscription. Median follow-up time was 26 years. HRs for cause-specific mortality were calculated using Cox proportional hazards models.

RESULTS

Risks in fully adjusted models were particularly elevated for death by infectious diseases (depressive and neurotic/adjustment disorders (HR 2.07; 95% CI 1.60 to 2.67), personality disorders (HR 2.90; 95% CI 1.96 to 4.28) and alcohol-related and other substance use disorders (HR 9.02; 95% CI 6.63 to 12.27)) as well as by gastrointestinal causes (depressive and neurotic/adjustment disorders (HR 1.64; 95% CI 1.42 to 1.89), personality disorders (HR 2.77; 95% CI 2.27 to 3.38) and alcohol-related/substance use disorders (HR 4.41; 95% CI 3.59 to 5.42)).

CONCLUSION

Young men diagnosed with NPM disorders had a long-term increased mortality risk, in particular due to infectious and gastrointestinal conditions. These findings highlight the importance of early preventive actions for adolescents with mental illness.

Ketamine-Induced Lower Urinary Tract Symptoms: A Study of International Prostate Symptom Score and Quality of Life

Introduction

Ketamine associated cystitis was first reported in 2007. Although many articles have been published concerning the effects of ketamine on lower urinary tract, not much focus had been put on the Quality of Life (QoL). This study was to assess lower urinary tract symptoms (LUTS) and QoL in ketamine abusers.

Methods

One hundred ketamine abusers with LUTS were included in the study. All patients were interviewed by one of the three trained investigators through face-to-face interview. Their LUTS were evaluated by the survey instrument consisting of International Prostate Symptom Score (IPSS) and 7-points Likert-type QoL scale.

Results

Sixty-six of them had moderate symptoms and 16 suffered from heavy symptoms. Eighty-one percent patients reported storage symptoms compared to 41% with voiding symptoms. Mono-ketamine abusers (MKA) had higher scores in IPSS, QoL, storage and voiding symptoms than poly-drug abusers (PDA). Multiple linear regression analysis demonstrated that lower educational background, MKA, and longer duration of ketamine abuse were found to be predicting factors on IPSS and QoL.

Conclusions

LUTS in ketamine abusers are mostly moderate to severe, and their quality of life were wrecked. Mono-ketamine abusers have more severe LUTS and lower quality of life than poly-drug users. Lower educational level, mono-ketamine abuser and longer duration of abuse are independent predictors of severity of LUTS and QoL. (Hong Kong j.emerg.med. 2016;23:227-233)

Renomeando o fracasso escolar

Resumo Teve-se como objetivo investigar o significado atribuído por alunos, pais e professores ao termo fracasso escolar e apontar outros que poderiam substituí-lo. Foi realizado um estudo exploratório e transversal de abordagem mista, do qual participaram 65 alunos, 66 pais e 58 professores da rede de ensino fundamental de São Leopoldo/RS, os quais responderam um breve questionário. Os resultados indicaram que a maioria dos alunos e pais responsabilizou o aluno pelas reprovações, enquanto os professores ressaltaram a multicausalidade do fenômeno (indivíduo, família, escola, sociedade). As expressões mais referidas pelos alunos para substituir o termo foram desinteresse, baixo desempenho escolar e dificuldade de aprendizagem. Pais e professores indicaram as expressões baixo desempenho escolar e negligência/descaso político e social com a educação. Os professores também sugeriram o termo desafios na educação, que inspira a ideia de transpor as dificuldades e não recai sobre um único sistema. Um número pouco expressivo de participantes considerou adequado o termo fracasso escolar.

Social determinants of drug-related mortality in a general population

BACKGROUND

We investigated the association between social determinants and a broad selection of drug-related deaths in a general population.

METHODS

We conducted a follow-up of an 11% random sample of working-age Finnish residents for 1996-2007 linked with an oversampling of deaths and population registration data on social characteristics. We defined total drug-related deaths as those from psychoactive substance use disorders and drug-induced poisonings (drug-induced deaths) as well as drug-related accidents, homicides, illnesses, and suicides.

RESULTS

The number of drug-related deaths was three times that of drug-induced deaths. We found the highest hazard ratios (HRs) for total drug-related mortality for long-term unemployment (4.9; 95% confidence interval [CI], 4.3-5.6), short-term unemployment (3.9; 95% CI, 3.5-4.4), and retirement (5.8; 95% CI, 5.1-6.8). The HRs were highest for mortality related to psychoactive substance use disorders and lowest for mortality related to drug-related suicides. The differences were large for both sexes.

CONCLUSIONS

Drug-related mortality was associated with social disadvantage; however, the strength of the association varied by drug-related cause of death. Primary and secondary prevention of drug use should particularly target disadvantaged groups.

Insights into the link between drug use and criminality: Lifetime offending of criminally-active opiate users

BACKGROUND

We test whether the offending trajectory of those who test positive for opiates is greater than test-negative controls and whether the relationship is constant both prior to, and post, opiate initiation. We consider whether these relationships differ according to gender and offence type.

METHODS

The study provides an analysis of historical offending records in adults linked to test results for opiate and cocaine metabolites. Those testing positive for opiates were linked to treatment records to retrieve data on age of opiate initiation. Rate ratios (RR) were calculated to compare opiate positive testers to opiate and cocaine negative controls, separately by gender and adjusting for age and birth cohort. Age of opiate initiation was included in a second model as a time-dependent variable. Within-subject clustering was accounted for using generalised estimating equations.

RESULTS

Opiate-positive cases had higher rates of offending than test-negative controls, both prior to, and post, opiate initiation. Initiation of opiate use increased the RR by 16% for males but doubled it for females. The RR increase in non-serious acquisitive crime was greater than that seen in serious crime. For males only, opiate initiation narrowed the difference in violent offending rate between cases and controls. A larger offending increase was associated with opiate initiation in female, compared to male, users.

CONCLUSIONS

For most crime categories, the difference between groups is exacerbated by opiate initiation. The findings indicate that opiate prevention initiatives might be effective in reducing offending, particularly among females.

Swedish population-based study of pupils showed that foster children faced increased risks for ill health, negative lifestyles and school failure

AIM

This population-based study explored whether foster children faced a higher risk of health problems than children of the same age who were not in foster care.

METHODS

Data for 13 739 pupils aged 10, 13 and 16 years were obtained from the Pupil Health Database in the county of Värmland, Sweden, for the school years 2012/2013 and 2013/2014. These included data on school performance, health, lifestyle and social relationships, based on children's interviews with school nurses.

RESULTS

Of all the pupils, 171 (1.2%) were in foster care. Children in foster care were generally unhealthier than other children. Both girls and boys were at higher risk of chronic health problems, daily smoking, use of drugs and school failure. When the girls in foster care were compared to other girls, we found that they faced a higher risk of psychological and psychosomatic symptoms. This difference was not found for boys. Foster children were also more likely to express a more negative view on life.

CONCLUSION

We confirmed earlier studies that children in foster care tended to have inferior health and well-being than other children. These findings emphasise that health, risky behaviour and school performance should be considered together when assessing foster children.

Maternal-Fetal Monitoring of Opioid-Exposed Pregnancies: Analysis of a Pilot Community-Based Protocol and Review of the Literature

OBJECTIVES

To describe/analyse a novel, community-based prenatal monitoring protocol for opioid-exposed pregnancies developed by our centre in 2014 to optimize prenatal care for this population. A literature review of published monitoring protocols for this population is also presented.

METHODS

Retrospective comparison of pre-protocol (n = 215) and post-protocol (n = 251) cohorts. Medline and Embase were searched between 2000-2016 using MeSH terms: [fetal monitoring OR prenatal care] AND [opioid-related disorders OR substance-related disorders] in Medline and [fetal monitoring OR prenatal care] AND [opiate addiction OR substance abuse] in Embase, producing 518 results. Thirteen studies included protocols for monitoring opioid-exposed pregnancies. No comprehensive monitoring protocols with high-quality supporting evidence were found.

RESULTS

We evaluated 466 opioid-exposed pregnancies, 215 before and 251 after introduction of the protocol. Since implementation, there was a significant increase in the number of opioid-exposed patients who have underwent urine drug screening (72.6% to 89.2%, P < 0.0001); a significant reduction in the number of urine drug screenings positive for illicit opioids (50.2% to 29.1%, P < 0.0001); and a significant increase in the number of patients who discontinued illicit opioid use by the time of delivery (24.7% to 39.4%, P < 0.01). There was no difference in the CS rate (27.4% vs. 26.3%, P > 0.05). There were no observed differences in the rate of preterm birth, birth weight <2500 g, or Apgar score <7 (P > 0.05).

CONCLUSIONS

Care of women with increased opioid use during pregnancy is an important but under-studied health issue. A novel protocol for focused antenatal care provision for women with opioid-exposed pregnancies improves standard of care and maternal/fetal outcomes.

Mapping risk factors for substance use: Introducing the YouthMap12

BACKGROUND

In adolescence, psychological problems and regular use of alcohol, cigarettes, cannabis and other drugs (AOD) tend to cluster together, strongly indicating that certain groups of young people are at elevated risk of developing a problematic use of AOD.

OBJECTIVE

The aim of the present study was to develop an easy-to-implement screening instrument to identify subgroups of young people with different psychological problems at risk of problem use of AOD.

METHOD

3589 randomly selected young Danes between 15 and 25years of age, from a national survey (n=2702) and a municipality survey (n=887), answered a 12-item questionnaire (YouthMap12) with 6 items identifying externalizing problems (EP6) and 6 items identifying internalizing problems (IP6). Latent class analysis (LCA) was used to characterize groups at risk, and associations were estimated between EP6 and IP6 and regular use of AOD, and between latent class membership and regular use of AOD.

RESULTS

LCA identified 6 classes with varying degrees of externalizing and internalizing problems: 70% of youth were in the low problem score class, and the remaining 30% were at various levels of risk. Regular use of cigarettes, cannabis and alcohol was strongly associated with classes characterized by externalizing problems, while over-the-counter and prescription medicine was strongly associated with classes characterized by internalizing problems.

CONCLUSIONS

Youth at risk of problem use of AOD can be identified using a simple and easily administered instrument.

Hospital Admission and Criminality Associated with Substance Misuse in Young Refugees - A Swedish National Cohort Study

Background

High rates of mental health problems have been described in young refugees, but few studies have been conducted on substance misuse. This study aimed to investigate the patterns of hospital care and criminality associated with substance misuse in refugees who settled in Sweden as teenagers.

Methods

Gender stratified Cox regression models were used to estimate the risks of criminal convictions and hospital care associated with substance misuse from national Swedish data for 2005–2012. We focused on 22,992 accompanied and 5,686 unaccompanied refugees who were aged 13–19 years when they settled in Sweden and compared them with 1 million native Swedish youths from the same birth cohort.

Results

The risks of criminal conviction associated with substance misuse increased with the length of residency in male refugees, after adjustment for age and domicile. The hazard ratios (HRs) were 5.21 (4.39–6.19) for unaccompanied and 3.85 (3.42–4.18) for accompanied refugees after more than 10 years of residency, compared with the native population. The risks were slightly lower for hospital care, at 2.88 (2.18–3.79) and 2.52(2.01–3.01) respectively. Risks were particularly pronounced for male refugees from the Horn of Africa and Iran. The risks for all male refugees decreased substantially when income was adjusted for. Young female refugees had similar risks to the general population.

Conclusion

The risks of criminality and hospital care associated with substance misuse in young male refugees increased with time of residency in Sweden and were associated with a low level of income compared with the native Swedish population. Risks were similar in accompanied and unaccompanied refugees.

Pathways through opiate use and offending: A systematic review

BACKGROUND

Although evidence points to a strong link between illicit drug use and crime, robust evidence for temporal order in the relationship is scant. We carried out a systematic review to assess the evidence for pathways through opiate/crack cocaine use and offending to determine temporal order.

METHODS

A systematic review sourced five databases, three online sources, bibliographies and citation mapping. Inclusion criteria were: focus on opiate/crack use, and offending; pre-drug use information; longitudinal design; corroborative official crime records. Rate ratios (RR) of post-drug use initiation to pre-drug use initiation were pooled using random effects meta-analysis.

RESULTS

20 studies were included; UK (9) and US (11). All were of opiate use. Mean age at (recorded) offending onset (16.7yrs) preceded mean age at opiate-use onset (19.6yrs). Substantial heterogeneity (over 80%: unexplained by meta-regression) meant that RRs were not pooled. The RR for total (recorded) offending ranged from 0.71 to 25.7 (10 studies; 22 subsamples: positive association, 4: equivocal, 1: negative association). Positive associations were observed in 14/15 independent samples; unlikely to be a chance finding (sign test p=0.001). Individual offence types were examined: theft (RR 0.63-8.3, 13 subsamples: positive, 9: equivocal, 1 negative); burglary (RR 0.74-50.0, 9 subsamples: positive, 13: equivocal); violence (RR 0.39-16.0, 6 subsamples: positive, 15: equivocal); and robbery (RR 0.50-5.0, 5 subsamples: positive, 15: equivocal).

CONCLUSIONS

Available evidence suggests that onset-opiate use accelerates already-existing offending, particularly for theft. However, evidence is out of date, with studies characterised by heterogeneity and failure to use a matched non-opiate-user comparison group to better-establish whether onset-opiate use is associated with additional crime.

School Failure in the Perception of Adolescents, Parents and Teachers

Abstract This study aimed to understand school failure, defined as the distortion between age and school year of two or more years of teaching, through the perception of adolescents with a history of school failure as well as their parents and teachers. This is a qualitative, descriptive, and cross-sectional study. The participants consisted of three distinct groups: 35 adolescents, 11 parents and three teachers. The instruments used were an initial contact sheet as well as focus groups. For the content analysis three categories and their subcategories were derived related to the purpose of the study. The results point out to the complexity of school failure, revealed especially in the statements of teachers. However, it is still prevalent the discourse of personal and family blame among adolescents and their parents. It is evident the resulting suffering and the clinical and social consequences of school failure.

Does poor school performance cause later psychosocial problems among children in foster care? Evidence from national longitudinal registry data

Research has shown that children in foster care are a high-risk group for adverse economic, social and health related outcomes in young adulthood. Children's poor school performance has been identified as a major risk factor for these poor later life outcomes. Aiming to support the design of effective intervention strategies, this study examines the hypothesized causal effect of foster children's poor school performance on subsequent psychosocial problems, here conceptualized as economic hardship, illicit drug use, and mental health problems, in young adulthood. Using the potential outcomes approach, longitudinal register data on more than 7500 Swedish foster children born 1973-1978 were analyzed by means of doubly robust treatment-effect estimators. The results show that poor school performance has a negative impact on later psychosocial problems net of observed background attributes and potential selection on unobservables, suggesting that the estimated effects allow for causal interpretations. Promotion of school performance may thus be a viable intervention path for policymakers and practitioners interested in improving foster children's overall life chances.

On the track to adulthood: the missions of the young human being, dodging the risks and gaining the tools

Medical staff are expected to cooperate with other professions and agencies in helping the young human in achieving the goal of becoming a healthy, well- functioning adult that expresses her/his maximal potential. Achieving this goal should be cost-effective. Cost includes not just the economic burden but also psychosocial determinants such as emotional disruption, stress, living at risk, malfunctioning, and dependency. Acknowledging the risks and the expected achievements at each age are useful in analyzing the failure of community health programs and in planning preventive modalities and needed remedies.

Depressive symptoms, anxiety and academic motivation in youth: Do schools and families make a difference?

This longitudinal study aimed to examine the association between depressive and anxiety symptoms and academic motivation by gender, and whether positive school and family factors would be associated with academic motivation, in spite of the presence of such symptoms. Study participants were predominantly economically disadvantaged youths aged 13-15 years in a Northeastern US urban public school system. The Social and Health Assessment (SAHA) served as the basis for a survey undertaken in 2003 and 2004 with information being used from students who participated at both time points (N = 643). Multiple linear regression analyses showed that depressive symptoms were negatively associated with academic motivation, while anxiety was positively related to academic motivation in both genders. Teacher support, school attachment and parental control were positively related to academic motivation even in the presence of internalizing problems. The negative association of depressive symptoms with academic motivation may be potentially decreased by attachment to school.

Reasons for Rehospitalization in Children Who Had Neonatal Abstinence Syndrome

BACKGROUND AND OBJECTIVES

Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after the postnatal period are unclear. Our objectives were to characterize childhood hospitalization after NAS.

METHODS

Population-based linkage study of births, hospitalization, and death records of all children registered in New South Wales (NSW), Australia, between 2000 and 2011 to a maximum of 13 years. Infants with an International Statistical Classification of Disease and Related Problems, 10th Edition, Australian Modification, coding of NAS (P96.1, n = 3842) were compared with 1,018,421 live born infants without an NAS diagnosis.

RESULTS

Infants with NAS were more likely to be admitted into a nursery (odds ratio 15.6, 95% confidence interval: 14.5-16.8) and be hospitalized longer (10.0 vs 3.0 days). In childhood, they were more likely to be rehospitalized (1.6, 1.5-1.7), die during hospitalization (3.3, 2.1-5.1), and be hospitalized for assaults (15.2, 11.3-20.6), maltreatment (21.0, 14.3-30.9), poisoning (3.6, 2.6-4.8), and mental/behavioral (2.6, 2.1-3.2) and visual (2.9, 2.5-3.5) disorders. Mothers of infants with NAS were more likely to be Indigenous (6.4, 6.0-7.0), have no antenatal care (6.6, 5.9-7.4), and be socioeconomically deprived (1.6, 1.5-1.7). Regression analyses demonstrated that NAS was the most important predictor of admissions for maltreatment (odds ratio 4.5, 95% confidence interval: 3.4-6.1) and mental and behavioral disorders (2.3, 1.9-2.9), even after accounting for prematurity, maternal age, and Indigenous status.

CONCLUSIONS

Children with NAS are more likely to be rehospitalized during childhood for maltreatment, trauma, and mental and behavioral disorders even after accounting for prematurity. This continues to adolescence and emphasizes the critical need for continued support of this vulnerable group after resolution of NAS.

Parental death during childhood and subsequent school performance

OBJECTIVES

Parental death during childhood has been linked to increased mortality and mental health problems in adulthood. School failure may be an important mediator in this trajectory. We investigated the association between parental death before age 15 years and school performance at age 15 to 16 years, taking into account potentially contributing factors such as family socioeconomic position (SEP) and parental substance abuse, mental health problems, and criminality.

METHODS

This was a register-based national cohort study of 772,117 subjects born in Sweden between 1973 and 1981. Linear and logistic regression models were used to analyze school performance as mean grades (scale: 1-5; SD: 0.70) and school failure (finished school with incomplete grades). Results are presented as β-coefficients and odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

Parental death was associated with lower grades (ORs: -0.21 [95% CI: -0.23 to -0.20] and -0.17 [95% CI: -0.19 to -0.15]) for paternal and maternal deaths, respectively. Adjustment for SEP and parental psychosocial factors weakened the associations, but the results remained statistically significant. Unadjusted ORs of school failure were 2.04 (95% CI: 1.92 to 2.17) and 1.51 (95% CI: 1.35 to 1.69) for paternal and maternal deaths. In fully adjusted models, ORs were 1.40 (95% CI: 1.31 to 1.49) and 1.18 (95% CI: 1.05 to 1.32). The higher crude impact of death due to external causes (ie, accident, violence, suicide) (OR: -0.27 [90% CI: -0.28 to -0.26]), compared with natural deaths (OR: -0.16 [95% CI: -0.17 to -0.15]), was not seen after adjustment for SEP and psychosocial situation of the family.

CONCLUSIONS

Parental death during childhood was associated with lower grades and school failure. Much of the effect, especially for deaths by external causes, was associated with socially adverse childhood exposures.