Adolescents at risk for drug abuse: a 3-year dual-process analysis

Generational Immigration Status Modifies the Association Between Psychosocial Distress and Substance Use Among Alternative High School Students

PURPOSE

Alternative high schools (AHS) are designed to provide individualized education, more flexible scheduling, and smaller class sizes for students referred out of traditional high school. AHS students report higher levels of substance use (SU) and face disproportionately higher levels of trauma and toxic stress than their traditional high school peers. We sought to examine whether generational immigration (GenIm) status modifies the association of mental health and SU among AHS students using a longitudinal study of 1,060 Southern California AHS students.

METHODS

Subscales from the 21-item Depression Anxiety Stress Scale were administered. Effect modification was examined by GenIm status defined as first generation (born outside of the United States), second generation (born in the United States with a parent born outside the United States), or third generation (born in the United States with US-born parent(s)). Main outcomes included the number of times different substances were used in the past year over a 3-year period.

RESULTS

Multilevel, negative binomial, covariate-adjusted latent growth curve models generated incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of the time-varying association between depression, anxiety, or stress and the use of cigarettes, e-cigarettes, cigars, alcohol, or marijuana. Multiple-group models examined effect modification by GenIm status.

DISCUSSION

The link between mental health and SU was stronger among first- and second-generation students than third-generation students. For example, a one-unit increase in stress relative to the average stress of students from the same school was associated with an increase in the rate of e-cigarette use among first-generation (IRR = 2.03, 95% CI = 1.07-3.85), second-generation (IRR = 2.25, 95% CI = 1.86-2.72), and third-generation (IRR = 1.68, 95% CI = 1.31-2.16) students. Effective strategies tailored to subgroups of AHS students are needed to counter disparities between traditional and alternative school systems that may contribute to long-term trajectories of SU.

Underage Alcohol Use by Intersectional Identity Among Alternative High School Students

PURPOSE

To examine alcohol use (AU) among intersectional subgroups within a longitudinal cohort of predominantly Hispanic/Latino alternative high school (AHS) students in southern California.

METHODS

Past month AU was measured over a period of three years among 1,029 students (mean age 17.5 years, 49.7% female, 76.1% Hispanic/Latino) from 29 AHSs. Multilevel models that adjusted for age, socioeconomic status, parental education, weekly income, sensation seeking, depression, anxiety, and stress estimated trends in AU over time among intersectional subgroups defined by gender, ethnicity, and generational immigration.

RESULTS

Students with parents born in the United States had high rates of AU at the baseline that remained stable over time. In contrast, first-generation Hispanic/Latino students had lower levels of AU at the baseline that increased over time. First-generation, female, Hispanic/Latino students exhibited one of the lowest probabilities of AU at the baseline (28.6%, confidence interval [CI]: 15.9%-41.3%) but at the two-year follow-up had one of the highest probabilities (47.4%, CI: 29.3%-65.5%). A similar trend was observed among first-generation, male, Hispanic/Latino students whose probability of past month AU rose between the baseline (23.1%, CI: 12.4%-33.8%) and two-year follow-up (36.0%, CI: 19.2%-52.7%).

DISCUSSION

Findings underscore the heterogeneity of AHS students, showing a more nuanced picture of AU by the intersection of gender, ethnicity, and generational immigration. Underage AU prevention efforts among AHS students must provide targeted messages to intersectional identities.

Adolescent's explicit and implicit cigarette cognitions predict experimentation with both cigarettes and e-cigarettes

Background: Past year, month, and lifetime adolescent e-cigarette use rates remain persistently high, despite falling cigarette use rates. Previous investigations have noted a strong relationship between an individual's positive and negative cognitions related to a behavior, and subsequent initiation of that behavior.Objective: This investigation was conducted to determine the impact positive and negative explicit and implicit cigarette-related cognitions may have on the use of cigarettes and e-cigarettes among at-risk, cigarette-naive adolescents.Methods: A three-year longitudinal investigation evaluated the relationship between cigarette-related cognitions and subsequent cigarette and e-cigarette use among 586 alternative high school students (female: 50.8%; mean age: 17.4 years; Hispanic/Latino: 75.0%) who had never smoked cigarettes at the baseline assessment. Multilevel logistic regression models were used to generate demographics-adjusted odds ratios (OR) and 95% confidence intervals (95% CI).Results: Students with higher positive explicit cigarette cognitions at the baseline had greater odds of subsequent cigarette use (OR = 1.72, 95% CI 1.11-2.68). If students also reported an increase over time in positive (OR = 3.45, 95% CI 2.10-5.68) or negative (OR = 1.93, 95% CI 1.03-3.61) explicit cigarette cognitions, the odds of cigarette use increased. The odds of dual use of cigarettes and e-cigarettes were greater among students who had higher negative implicit cigarette cognitions at the baseline (OR = 2.07, 95% CI 1.03-4.17) compared to those with lower levels of negative implicit cognitions.Conclusion: Prevention programming that focuses on decreasing positive cognitions related to nicotine and tobacco use may have greater overall effect on decreasing use compared to programs that only focus on increasing negative cognitions individuals form surrounding cigarette or e-cigarettes.

Acceptance of Drug Use Mediates Future Hard Drug Use Among At-Risk Adolescent Marijuana, Tobacco, and Alcohol Users

Alternative high school (AHS) students typically report higher levels of alcohol and other drug use compared to students attending traditional high schools. Greater use of such drugs as heroin, methamphetamines, and cocaine in this at-risk population may be driven, in part, by a greater latitude of acceptance toward substance use in general, which may accelerate the transition from gateway drugs to hard drugs. Seven hundred seventy-seven adolescents (mean age 16.6; 56% female) were recruited from alternative high schools throughout Southern California. To understand the factors that may lead AHS students to use hard drugs, a model was tested in order to determine if AHS students' latitude of acceptance toward substance use was a mediator between the relationship of past use of gateway drugs and future use of hard drugs. Latitude of acceptance was found to be a statistically significant mediator of future hard drug use (b = 0.03, 95% confidence intervals = 0.01 to 0.05) among gateway drug users. An individual's latitude of acceptance to various drug use behaviors may be consistent with societal norms. However, after exposure to, or use of, gateway drugs, attitudes that are more permissive toward hard drug use may be encountered, the acceptance of hard drugs may expand, and the use of hard drugs may escalate. Interventions designed to reduce the use of hard drugs among at-risk youth may be more persuasive by crafting messages that are within the latitude of acceptance of the target population and prevent the acceptance of hard drug use.

Testing the dual process model of adolescent cannabis use with prospective three-way interactions between self-regulation, negative outcome expectancies, and implicit cannabis attitudes

OBJECTIVE

Dual-process models of substance use (Wiers et al., 2007) propose that whether automatic processes (i.e., implicit attitudes) influence use depends on self-regulation, such that an individual is more likely to act in accordance with automatically activated implicit attitudes when there is limited capacity for self-regulation (a two-way interaction). In this model, the relevance of self-regulation likely depends on whether an individual recognizes reasons or the need to inhibit substance use. The current study tested a three-way interaction between implicit cannabis attitudes, self-regulation, and negative expectancies to prospectively predict adolescent cannabis use.

METHOD

A community sample of late adolescents (N = 246; M age = 19.02) were assessed across two annual time points. Negative binomial regressions predicting adolescent cannabis use were estimated to test the proposed interaction using two indictors of self-regulation (effortful control and working memory) above and beyond prior cannabis use and demographic covariates.

RESULTS

There was support for a three-way interaction with effortful control, but not working memory. As hypothesized, implicit cannabis attitudes were positively associated with cannabis use for adolescents with low levels of negative expectancies and low levels of effortful control.

CONCLUSION

Findings suggest expecting negative outcomes of cannabis use is germane to dual process interactions between controlled and automatic processes. How to best operationalize self-regulation is an important consideration for future work.

Associations Between Family and Peer E-Cigarette Use With Adolescent Tobacco and Marijuana Usage: A Longitudinal Path Analytic Approach

INTRODUCTION

Research indicates a link between adolescent e-cigarette use and combustible tobacco cigarette (CTC) initiation, and recent studies suggest their connection with marijuana uptake. Our 3-year longitudinal cohort study investigated the implications of adolescent, peer, and family e-cigarette use with adolescents' expectations and willingness to initiate CTC use, and subsequent CTC and marijuana use.

AIMS AND METHODS

Relationships were examined in a secondary analysis of a 3-year longitudinal cohort subsample involving adolescents enrolled in alternative California high schools (N = 1025). Analyses examined responses over three yearly observations. Family, peer, and respondents' e-cigarette use, respondents' positive cigarette expectancies and willingness to use CTCs were assessed in the study's first year (T1). CTC use in the survey's second year (T2) and marijuana use in the third year (T3) were assessed via path analysis.

RESULTS

Respondents reporting at least one family member or peer using e-cigarettes were more likely to use e-cigarettes at T1 than those whose peers/family members did not. They reported more positive expectancies about CTCs and greater willingness to initiate use. These variables predicted CTC use at T2, which directly anticipated marijuana use in the survey's third year (T3), as did adolescents' use of e-cigarettes at T1. All model relations were statistically significant.

CONCLUSIONS

Analysis demonstrated the strong association of family members' and peers' behaviors with adolescent e-cigarette use, and the temporal precedence of e-cigarette use with subsequent CTC and marijuana uptake. The predictive implications of e-cigarettes for other dangerous substance use should be examined in future prevention campaigns.

IMPLICATIONS

The presented study expands upon existing literature connecting adolescent e-cigarette use and later CTC and marijuana use. The findings indicate the significant implications of exposure to e-cigarette use by parents and peers and demonstrate in a longitudinal 4-year panel survey the direct and indirect predictive implications of e-cigarette use for CTC and marijuana uptake. The research illustrates the utility of programs and campaigns that target peer and family groups to maximize impacts on adolescent willingness to try CTCs, positive expectancies, and possible onset of CTC and marijuana use.

Automatic cognitions as mediators of parental influence on adolescent cannabis use

AIMS

Multiple social influences affect cannabis use in adolescents, including parental and peer cannabis use norms. However, the mechanisms of influence underlying these social influences remain unclear. Recent studies have suggested that cognitions about cannabis use and the effects of cannabis may mediate social influences. The current study explored the relationship between automatic self-generated cognitions and their relationship with parental influences on cannabis use in a sample of n = 675 11 to 16-year-old adolescents over three years (Mean Age: 13.96, SD = 0.88, 56.4% female).

METHODS

Participants reported perceptions of parental cannabis use and completed a cannabis word association task (CWAT), an open-ended cannabis outcome expectancy liking (COEL) task, and measures of cannabis use in the past year.

RESULTS

Perceived parental use did not directly predict cannabis use two years later. However, a latent construct loading on both CWAT and COEL scores strongly predicted cannabis use over the following year. Structural modelling demonstrated that the association between previous cannabis use and parental cannabis use and adolescents' cannabis use over the next two years was fully mediated by cognitions.

CONCLUSION

The results of the study are discussed and interpreted through the lens of dual-process theories.

The prospective association between illicit drug use and nonprescription opioid use among vulnerable adolescents

In recent years, more than half of all drug overdose deaths in United States involved an opioid. To address this epidemic, antecedents to opioid misuse must be identified and empirically validated. The objective of the current investigation was to examine whether illicit drug use was prospectively associated with nonprescription opioid use among adolescents from a vulnerable population with a greater prevalence of substance abuse. A population-based cohort study of 1060 adolescents from 29 alternative high schools in southern California was conducted over a two-year period. A total of 929 adolescents (mean age 17.5 years, 49.9% female, 76.4% Hispanic) who had not experimented with nonprescription opioids at the baseline assessment were included in the analytic sample. The outcome was self-reported use of nonprescription opioids within two years. The predictors tested were illicit drug use, illicit drug use excluding marijuana, and the use of nonmedical marijuana. Covariates included age, sex, ethnicity, socioeconomic status, parental education, weekly income, sensation seeking, stress, anxiety, depression, and the use of alcohol and nicotine products. Multilevel, covariate-adjusted logistic regression models indicated that the odds of experimentation with nonprescription opioids was greater among adolescents who had used illicit drugs or illicit drugs excluding marijuana. Nonmedical marijuana use alone was a statistically significant predictor in unadjusted but not covariate-adjusted models. While prior studies have examined the progression from nicotine, alcohol, and marijuana use to nonprescription opioid use, the present findings emphasize the importance of illicit drug use as a detectable and empirically supported risk factor for future opioid misuse.

Working Memory and Response Inhibition Effects on At-Risk Youth's Willingness to Use Multiple Nicotine and Tobacco Products

Purpose: Past research has suggested that executive functions, such as working memory and response inhibition, predict the use of nicotine and tobacco products (NTPs). The current study extends prior research by assessing whether response inhibition and working memory are associated with at-risk youth's willingness to use NTPs. Methods: A sample of 1060 at-risk youth were recruited from alternative high schools in southern California. Participants were randomly assigned to complete the Symmetry Span Task, an indicator of working memory ability, or the cued Go/No-Go task, an indicator of response inhibition. Participants who reported never using NTPs (n = 348) indicated how willing they would be try NTPs. Results: Results from a cross-sectional zero-inflated negative binomial (ZINB) regression suggest that females with stronger working memory skills and individuals with weaker response inhibition skills were more likely to be unwilling to use NTPs. Conclusion: While further research is needed to determine whether executive functions can prospectively predict NTP use among at-risk youth, the current study indicates that both working memory and response inhibition may play a significant role.

Retail outlets prompt associative memories linked to the repeated use of nicotine and tobacco products among alternative high school students in California

Numerous studies have examined how youth are influenced by the presence of tobacco retail outlets that use point-of-sale marketing tactics to promote nicotine and tobacco products. The current investigation extends this research by assessing whether tobacco retail outlets function as environmental cues that prompt associative memories linked to the repeated use of cigarettes, electronic cigarettes, and cigars. Students (N = 1060) from 29 alternative high schools in California were recruited into a three-year cohort study. A repeated measures latent profile analysis was conducted to identify latent subgroups of students. Analyses suggested the presence of one subgroup of students that did not use nicotine and tobacco products and five subgroups of students that used multiple products. A multinomial logistic regression revealed that images of gas stations, convenience stores, and liquor stores presented in the first year of the study prompted spontaneous associations in memory that increased the odds a student would belong to one of the five subgroups that repeatedly used nicotine and tobacco products over a three-year period. These findings suggest that tobacco retail outlets may act as environmental cues that prompt the use of addictive products among at-risk youth. Policymakers should consider implementing strategies that reduce the potency and prevalence of these cues.

A dual process perspective on advances in cognitive science and alcohol use disorder

There is a tremendous global and national (US) burden associated with alcohol misuse and alcohol use disorder (AUD). Further, of the mental health disorders, AUD has the widest treatment gap. Thus, there is a critical need for improved understanding of the etiology, maintenance, and treatment of AUD. The application of cognitive science to the study of AUD has a longstanding history of attempting to meet this need. In this selective review, we identified and focused on four domains of recent (i.e., in the last decade) applications of cognitive science to the study of AUD: implicit cognitive biases, executive function, behavioral economic approaches to alcohol decision making, and functional connectivity neuroimaging. We highlighted advances within these four domains and considered them in the context of dual process models of addiction, which focus on the contribution and interplay of two complementary neurocognitive systems (impulsive and control systems). Findings across the domains were generally consistent with dual process models. They also suggest the need for further model refinements, including integrating behavioral economic approaches and findings from functional connectivity neuroimaging studies. Research evaluating candidate interventions associated with these domains is emergent but promising, suggesting important directions for future research.

Affect, craving, and cognition: An EMA study of ad libitum adolescent smoking

Reducing smoking among adolescents is a public health priority. Affect, craving, and cognitive processes have been identified as predictors of smoking in adolescents. The current study examined associations between implicit attitude for smoking (assessed via the positive-negative valence implicit association test) and affect, craving, and smoking assessed using ecological momentary assessment (EMA). Adolescent smokers (n = 154; Mage = 16.57, SD = 1.12) completed a laboratory assessment of implicit smoking attitudes and carried a palm-top computer for several days while smoking ad libitum. During EMA, they recorded affect, craving, and smoking behavior. Data were analyzed using a multilevel path analysis. At the between-subjects level, more positive implicit smoking attitude was indirectly associated with smoking rate via craving. This association was moderated by positive affect, such that it was stronger for those with greater traitlike positive affect. At the event (within-subject) level, implicit attitude potentiated associations between stress and craving and between positive affect and craving. Individuals with a more positive implicit attitude exhibited more robust indirect associations between momentary stress-positive affect and smoking. In sum, a more positive implicit attitude to smoking was associated with overall levels of craving and smoking and might have potentiated momentary affect-craving associations. Interventions that modify implicit attitude may be an approach for reducing adolescent smoking. (PsycINFO Database Record

Trajectories of cannabis-related associative memory among vulnerable adolescents: Psychometric and longitudinal evaluations

Indirect tests of memory associations relevant to cannabis have been shown to be useful in explaining and predicting adolescent cannabis use habits. This study sought to increase the understanding of adolescent cannabis-related associative memory and cannabis use behavior over time. A longitudinal sample of alternative high school students (N = 775) was assessed yearly for 3 years. The study first conducted extensive longitudinal measurement analyses of the cannabis-related word association test (WAT) applying contemporary psychometric models. Second, the study examined the longitudinal trajectories of cannabis-related associative memory and cannabis use and their contemporaneous and longitudinal relationships. Results showed that the cannabis-related WAT provided strong evidence of sound psychometric properties. Longitudinal change in cannabis-related associative memory was best described by modeling either a linearly decreasing trajectory or two separate trajectories: During middle adolescence, levels of cannabis-related associative memory were highest and stable but then gradually decreased toward late adolescence. Moreover, cannabis-related associative memory was contemporaneously predictive of cannabis use within ages 15 to 19 while controlling for the underlying growth process of cannabis use and time-invariant covariates (TICs) of gender and lifetime concurrent use of alcohol and cigarettes. Partial support of longitudinal prediction of cannabis use was also obtained from age 17 to 18 and age 19 to 20 while adjusting for growth in cannabis use and the TICs. These results demonstrated that predictive effects of cannabis-related memory associations on cannabis use were detected within some of the 1-year age spans and were consistent within ages across adolescent years. (PsycINFO Database Record