Trajectory classes of cannabis use and heavy drinking among rural African American adolescents: multi-level predictors of class membership

Substance use trajectories among emerging adult Black men: Risk factors and consequences

INTRODUCTION

Young, Black American men experience greater social, legal and economic consequences of substance use compared with White men for comparable levels of consumption. The development of tailored interventions requires prospective information on their substance use patterns, risk factors and consequences. We identified longitudinal substance use profiles and examined their links to childhood adversity, racial discrimination and young adult problem substance use and mental health.

METHODS

Emerging adult Black men (n = 504, mean age = 20.26, SD = 1.08) provided fours waves of data between January 2012 and March 2021. We conducted a parallel process latent class growth analysis for three substances to explore conjoint longitudinal use patterns and investigated the risk factors and consequences of each pattern.

RESULTS

Three trajectory classes emerged: non-using (n = 201, 39.9%), cannabis using (n = 202, 40.1%) and poly-substance using (n = 101, 20%) groups. Threat-based childhood adversity and racial discrimination were associated with higher odds of being members of cannabis or poly-substance groups than non-using group. Deprivation-based adversity was associated with higher odds for membership in poly-substance than non-using group. At Wave 4, elevated depressive symptoms were more prevalent among poly-substance compared with cannabis using group.

DISCUSSION AND CONCLUSIONS

Heterogeneous substance use patterns emerged among Black American men and each pattern has distinct risk factors and outcomes in young adulthood. For prevention, more attention is needed for cannabis use patterns and psychosocial adversities that are unique to Black population.

Predictors of problematic adult alcohol, cannabis, and other substance use: A longitudinal study of two samples

This study examined whether a key set of adolescent and early adulthood risk factors predicts problematic alcohol, cannabis, and other substance use in established adulthood. Two independent samples from the Child Development Project (CDP; n = 585; 48% girls; 81% White, 17% Black, 2% other race/ethnicity) and Fast Track (FT; n = 463; 45% girls; 52% White, 43% Black, 5% other race/ethnicity) were recruited in childhood and followed through age 34 (CDP) or 32 (FT). Predictors of substance use were assessed in adolescence based on adolescent and parent reports and in early adulthood based on adult self-reports. Adults reported their own problematic substance use in established adulthood. In both samples, more risk factors from adolescence and early adulthood predicted problematic alcohol use in established adulthood (compared to problematic cannabis use and other substance use). Externalizing behaviors and prior substance use in early adulthood were consistent predictors of problematic alcohol and cannabis misuse in established adulthood across samples; other predictors were specific to the sample and type of substance misuse. Prevention efforts might benefit from tailoring to address risk factors for specific substances, but prioritizing prevention of externalizing behaviors holds promise for preventing both alcohol and cannabis misuse in established adulthood.

Substance use disorders among African-American men in the rural south: A scoping review

African American (AA) men in the rural South may be at high risk for experiencing adverse health outcomes from substance use (SU). We conducted a scoping review to explore the research on SU among rural AA men in the rural South of the United States (US). Ten articles addressed the following thematic areas pertaining to SU: factors associated with SU (n = 6), associations between substance use and health outcomes (n = 2), and the influence of impulsivity on SU (n = 2). Additional research on SU among AA men in the rural South is needed, particularly pertaining to treatment-related considerations.

Focus on Rural Adolescent Cannabis Use and Abuse: Ignored Epidemiologic Trends, Unique Risks, Long-Term Concerns, and Hope

Cannabis-related issues for adolescents and young adults are emerging from the shadow of rural opioid addiction and deaths. The rural pediatric population has multiple risk factors putting them at increased risk for adverse consequences with the expansion of cannabis legalization across the United States. Research in this area is rich but scattered across professional disciplines. Differences in demographics and cultures between rural and urban youth are gaining attention. Epidemiological factors relevant to rurality as a risk for cannabis and other substance use are considered for formulating clinical care, public policymakers, and future research. Race, culture, community stability, basic demographics of age, gender, educational status, and demands for more and better, accessible services for rural, nonmetropolitan areas comprise factors for consideration and are detailed. Research findings provide direction for policymakers and clinicians for prevention and intervention efforts to improve care for rural populations, validating and expanding upon insights gained to date.

Syndemics of Sexually Transmitted Infections in a Sample of Racially Diverse Pregnant Young Women

Introduction

Syndemic theory posits that poor health outcomes co-occur and amplify each other in the context of harmful conditions that must be addressed simultaneously to improve health equity. This analysis identifies perinatal syndemic factors and examine how factors are related to STI in a sample of racially diverse young pregnant women.

Methods

Pregnant participants (n = 61) ages 14–21 from racially diverse backgrounds were recruited from a prenatal clinic for an ongoing longitudinal study between October 2019-February 2020. Participants completed a tablet survey assessing pregnancy intention, psychosocial factors (e.g., depression, stress, partner violence, pregnancy history) and consented to provide access to their medical records for STI and clinical urine samples screened for tobacco and cannabis use. Latent class analysis (LCA) was used to examine probabilities of co-occurring Syndemic indicators.

Results

Half of the women were Black (52%) and primigravida (54%). Three classes were identified in the LCA, two of them reflecting syndemics related to STI from the medical record. The largest class was half Black (51%), with a high rate of STI (65%), and was characterized by factors including depressive symptoms (93%), stress (64%), and substance use (65% cannabis, 82% tobacco). Additionally, the class with the highest rates of STI (74%) also had higher rates of partner violence (48%), morning sickness (100%), and prenatal cannabis use (63%).

Conclusion

Findings indicate evidence of a syndemic related to increased STI. A longitudinal evaluation of syndemics in this cohort may inform appropriately tailored intervention strategies to promote perinatal health in racially diverse young pregnant populations.

Sociopolitical control as a mediator between ethnic identity and social support on 30-day drug use among black girls

While Black girls have lower rates of drug use, they face worse health and wellbeing consequences associated with drug use. Understanding which strengths-based factors serve as buffers to limit adverse outcomes related to drug use among Black girls is essential for prevention. This study investigated the mediating role of sociopolitical control on drug use among Black girls (n = 340). Using path analysis, models were tested to include the variables of interest. Sociopolitical control (e.g. leadership competency and policy control) significantly mediated the relationship between ethnic identity and social support on drug use. Implications from this study may consider bolstering empowerment-based strategies in drug use prevention for Black girls.

A Longitudinal Analysis of Alcohol Use Behavior among Korean Adults and Related Factors: A Latent Class Growth Model

This study classified the changes in alcohol use behavior among Korean adults and explored the related factors. The study used data from the 4th (2009) to 14th (2019) waves of the Korean Welfare Panel Study. The subjects were 8267 adults aged 19-60 years. Latent class growth analysis was used to classify the latent classes of alcohol use behavior among Korean adults, and logistic regression analysis was performed to identify the specific factors that form the classes. Additionally, the 11-year trajectories of major variables associated with alcohol use behavior for the derived classes were analyzed using growth mixture modeling. Four classes were identified according to the trajectories of alcohol use behavior. There were statistically significant differences in the trajectories of depression, self-esteem, satisfaction in family relationships, and satisfaction in leisure activities according to the class of alcohol use behavior. In particular, self-esteem and satisfaction in family relationships indicated distinctly decreasing trajectories in the low- to moderate-risk class, which suggested the need for longitudinal analysis of the factors that influence alcohol use behavior. Moreover, it is recommended that interventions for the prevention of high-risk drinking target not only individuals but also family units.

The Role of the Rural Context in the Transition to Adulthood: A Scoping Review

Rural adolescents are transitioning to adulthood in the context of growing disparities. To advance research on the social, behavioral, and contextual factors that influence rural young adult development, this study conducted a scoping review. The review sought to identify how researchers defined rural and how/which theories guided their work; how they integrated the rural context into the research design and methods; and how they used variables, concepts, and outcomes to measure rural experiences. Included articles were published between January 2009 and November 2020, included young adults ages 18-29, measured adult role achievement and/or behavioral health outcomes and reported on these outcomes for young adults, and focused on a rural sample within the United States. A systematic search of four databases resulted in 25 empirical articles for the inductive, qualitative analysis. Most studies used atheoretical approaches focusing on outcomes related to adult social roles, substance use, and mental health. Five themes emerged focused on the definitions of rural, the level of integration into the research design and method, and variables salient to the rural experience. These results reveal that future research should clearly define the rural context and better integrate the rural context into the conceptualization, design, methods, and implications of the empirical research.

Contextual risks and psychosocial outcomes among rural African American emerging adults: A latent profile analysis

African American emerging adults face unique contextual risks that place them at heightened risk for poor psychosocial outcomes. The purpose of this study was to identify profiles of contextual risks among rural African American emerging adults and determine how risk profiles relate to psychosocial outcomes. Our representative sample included 667 fifth graders who live in the rural South and were followed from preadolescence into emerging adulthood. Contextual risks were assessed at ages 19-21 years via six indicators: perceived stress, daily stress, community disadvantage, parent-child conflict, racial discrimination, and childhood trauma. Four psychosocial variables were also assessed at ages 19-21 years: self-regulation, racial identity, parent support, and friend support. Psychosocial outcomes were assessed at age 25 years: education, substance use, future orientation, depressive symptoms, and externalizing behaviors. Latent profile analysis results indicated that the sample could be characterized by three patterns of contextual risk: low contextual risk, high contextual risk, and high contextual risk-childhood trauma. Risk profiles were associated with psychosocial outcomes, with the childhood trauma and high-risk profiles faring worse than the low-risk profile. Further, childhood trauma was particularly predictive of worse outcomes for emerging adults. Findings highlight the need for research and prevention programs that mitigate the effects of contextual risks on psychosocial outcomes for African American emerging adults in rural areas.

Trajectories of heroin use predict relapse risk among heroin-dependent patients: A 5-year follow-up study

OBJECTIVES

The relationship between past drug use trajectory and long-term relapse risk after rehabilitation among heroin-dependent patients remain understudied. The primary objectives were to identify longitudinal heroin use patterns of heroin-dependent patients, to determine the associative factors with trajectories and to investigate the impact of trajectory groups on relapse after finishing compulsory rehabilitation programs.

MATERIALS AND METHODS

A total of 564 heroin-dependent patients were recruited from 4 compulsory rehabilitation facilities in Shanghai, China between 2007 and 2008. The baseline data was linked to participants' follow-up data on relapse from official records. Group-based trajectory model was used to identify distinctive drug use trajectory groups. The association between the identified group and heroin relapse risk was then analyzed to understand the role of past drug use trajectory on relapse.

RESULTS

Five trajectory groups were identified in this cohort: (1) Rapid Decrease (9.9%); (2) Persistent High (32.0%); (3) Slow Decrease (34.1%); (4) Gradual Increase (4.5%); (5) Persistent Low (19.5%). Gender, age, education, and impulsivity were found to be different between the five groups. During the 5 years after discharged from the compulsory program, 291 (59.0%) individuals relapsed. Multivariate logistic regression analysis showed that the persistent high group (OR: 2.77 [1.46-5.24]), slow decrease group (OR: 2.31 [1.32-4.06]) and gradual increase group (OR: 3.50 [1.18-10.39]) was positively associated with the heroin relapse risk when compared to the persistent low group.

CONCLUSIONS

Heroin use trajectories vary among heroin-dependent patients in China. The trajectories of heroin use before compulsory rehabilitation are associated with subsequent long-term relapse risk.

Does a mindfulness-augmented version of the German Strengthening Families Program reduce substance use in adolescents? Study protocol for a randomized controlled trial

BACKGROUND

Mindfulness training (MT) for parents of adolescents has been shown to improve mental health and stress-related outcomes in individuals and their families. Studies of MT among young people are mainly delivered in educational or clinical settings, and there is a need for controlled studies on both parent-directed and adolescent-directed approaches. It is unclear whether MT has preventive effects for substance use outcomes. The primary objective of this trial is to evaluate the effectiveness of family-based MT targeting both adolescents and their parents to prevent adolescent substance use and enhance neurobehavioral self-regulation skills that play a major role in addiction development and mental health.

METHODS/DESIGN

The trial design is a superiority, two-arm, randomized controlled trial in which families will participate either in the full curriculum of the evidence-based Strengthening Families Program 10-14 (SFP 10-14, German adaptation) or in a mindfulness-enhanced version of this program (SFP-Mind). Both seven-session interventions are highly structured and will each be delivered over a period of approximately 7 weeks. The experimental intervention SFP-Mind is a modified version of the SFP 10-14 in which some elements were eliminated or changed to enable the inclusion of additional parent-directed and adolescent-directed mindfulness components. The primary outcome is adolescent self-reported alcohol use based on an alcohol initiation index at 18-month follow-up. Dispositional mindfulness, impulsivity, and emotion regulation will be included as secondary outcomes and potential mechanisms of action. The study will recruit and randomize 216 adolescents, aged 10-14 years, and their parents who will be followed up for 18 months.

DISCUSSION

This trial aims to evaluate the effectiveness of SFP-Mind for family-based prevention of substance use and promoting mental health in adolescence.

TRIAL REGISTRATION

German Register of Clinical Studies, DRKS00015678. Registered on 25 February 2019.

The Neuroscience of Drug Reward and Addiction

Drug consumption is driven by a drug's pharmacological effects, which are experienced as rewarding, and is influenced by genetic, developmental, and psychosocial factors that mediate drug accessibility, norms, and social support systems or lack thereof. The reinforcing effects of drugs mostly depend on dopamine signaling in the nucleus accumbens, and chronic drug exposure triggers glutamatergic-mediated neuroadaptations in dopamine striato-thalamo-cortical (predominantly in prefrontal cortical regions including orbitofrontal cortex and anterior cingulate cortex) and limbic pathways (amygdala and hippocampus) that, in vulnerable individuals, can result in addiction. In parallel, changes in the extended amygdala result in negative emotional states that perpetuate drug taking as an attempt to temporarily alleviate them. Counterintuitively, in the addicted person, the actual drug consumption is associated with an attenuated dopamine increase in brain reward regions, which might contribute to drug-taking behavior to compensate for the difference between the magnitude of the expected reward triggered by the conditioning to drug cues and the actual experience of it. Combined, these effects result in an enhanced motivation to "seek the drug" (energized by dopamine increases triggered by drug cues) and an impaired prefrontal top-down self-regulation that favors compulsive drug-taking against the backdrop of negative emotionality and an enhanced interoceptive awareness of "drug hunger." Treatment interventions intended to reverse these neuroadaptations show promise as therapeutic approaches for addiction.

[Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review]

Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review Adolescence is a vulnerable period for substance use disorders (SUD) as indicated by epidemiological studies. Research demonstrates the family's role for the etiology of SUD and provides a rationale for interventions based on family-associated risk and resilience factors. In this article, we summarize published results for family-based interventions from 2008-2018. Taken together, prevention programs can be effective when they focus on the promotion of broader developmental competencies and familial resources, rather than narrowly addressing substance use. Moreover, programs could benefit from targeting youth and parents as done in the "Strengthening Families Program 10-14"; most existing programs however target parents and do not include the adolescents. Family-based treatment programs with an evidence base are Multisystemic Therapy, Functional Family Therapy, Multidimensional Family Therapy and Brief Strategic Family Therapy. Overall, the effects of family-based interventions are small-to-middle sized but vary significantly across populations. Across the field of family-based interventions, there is a need for more knowledge on effective components and differential effects. The results could be improved by translational research such as on the emerging concept of mindfulness. Moreover, there is a need for implementation research and the effectiveness of service delivery programs on the community level in Germany.

[Prevention of substance use disorders]

Prevention of substance use disorders Abstract. Introduction: Adolescence is a vulnerable period for the development of Substance Use Disorders and preventive intervention is a public health priority. In this article, we summarize the available evidence for behavioral preventive action for Substance Use Disorders and related dysregulated behaviors during adolescence in various settings. Results: Current meta-analytic evidence is available mainly for the school and family settings and increasingly also for internet-based prevention. The literature is dominated by US-studies that focus on universal school-based approaches for legal substances in middle adolescence. Only few German studies are published. Taken together the results indicate that developmentally sensitive substance use prevention is effective across different settings with consistent small-to-middle sized effects. Differential effectiveness analyses for schoolbased prevention suggest that younger adolescents benefit most from universal prevention, while for older adolescents targeted approaches are more effective. Conclusions: Across the relevant settings, effective preventive measures are available. However, the results could be improved. There is a need for translational research on effective and more individualized approaches to prevention and differential effects of intervention modules. Moreover, there is a need for research on the implementation of evidence-based programs and especially in Germany, coordinated approaches on community levels are lacking.