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Wang Y, Zhang Y, Zhao Z, Jelsma E, Cham H, Wadsworth H, Yan J, Johnson S, Alegría M, Yip T. Multiple Discrimination and Substance Use Intention in Late Childhood: Findings From the Adolescent Brain Cognitive Development (ABCD) Study. J Adolesc Health 2024; 74:1217-1224. [PMID: 38483374 PMCID: PMC11102326 DOI: 10.1016/j.jadohealth.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/24/2023] [Accepted: 01/10/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The study aimed to investigate longitudinal, bidirectional associations between discrimination due to multiple reasons (race/ethnicity, sexual orientation, weight; termed multiple discrimination) and substance use (SU) intention in late childhood. These associations were compared across youth with no, single, and multiple (i.e., intersecting) marginalized identities based on race/ethnicity, sexual orientation, and overweight status. METHODS Data were drawn from a national sample of youth in the Adolescent Brain Cognitive Development study (N = 8,530; 9-12 years old). Youth reported both their experiences of multiple discrimination (the number of forms of discrimination youth experienced) and SU intention at one-year and two-year follow-ups. Theoretically relevant covariates were included. RESULTS Compared to non-marginalized youth (n = 2,689) and youth with single marginalized identities (n = 3,399), youth with intersecting marginalized identities (n = 2,442) reported the highest SU intention and multiple discrimination across waves. Only for this last group, multiple discrimination predicted stronger SU intention subsequently (β = 0.07, 95% confidence interval [0.02, 0.11]), whereas stronger SU intention predicted lower levels of multiple discrimination over time (β = -0.06, 95% confidence interval [-0.09, -0.02]). Sensitivity analyses yielded similar patterns with some nuances among subgroups of youth with varying intersecting marginalized identities. DISCUSSION Multiple discrimination predicted stronger SU intention over time in late childhood, particularly among youth with intersecting marginalized identities. Policies and practices should consider addressing multiple discrimination to reduce SU disparities among diverse youth.
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Affiliation(s)
- Yijie Wang
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan.
| | - Youchuan Zhang
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan
| | - Zhenqiang Zhao
- Psychology Department, Fordham University, Bronx, New York
| | - Elizabeth Jelsma
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan; Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas
| | - Heining Cham
- Psychology Department, Fordham University, Bronx, New York
| | - Hannah Wadsworth
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan
| | - Jinjin Yan
- Psychology Department, Fordham University, Bronx, New York
| | | | - Margarita Alegría
- the Desparities Research Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Tiffany Yip
- Psychology Department, Fordham University, Bronx, New York
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Lyons VH, Myers MG, Cunningham RM, Zimmerman MA, Carter PM, Walton MA, Goldstick J. Experiencing violence and other predictors of within-person same-day use of multiple substances in youth: a longitudinal study in emergency settings. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:218-228. [PMID: 38563511 DOI: 10.1080/00952990.2024.2307546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/06/2024] [Indexed: 04/04/2024]
Abstract
Background: Although experiencing violence is a risk factor for substance use among youth, its association with same-day use of multiple substances (a form of polysubstance use) and mitigating factors is less well understood.Objectives: To identify whether prosocial factors modified the effect of experiencing violence on the frequency of same-day use, and examine gender-specific risk/protective factors for same-day use.Methods: We analyzed longitudinal data from a cohort of youth who use drugs aged 14-24 (n = 599; 58% male) presenting to an urban emergency department between 2009-2011 and assessed biannually for two years. Using Poisson-generalized linear models with person-level fixed effects, we estimated within-person associations between self-reported experiencing violence and same-day use and analyzed gender and peer/parent support as effect modifiers. We adjusted for negative peer influence, parental drug and alcohol use, family conflict, anxiety and depression, and age.Results: Overall, positive parental support corresponded to lower rates of same-day use (rate ratio [RR]:0.93, 95% CI:0.87-0.99) and experiencing violence was associated with higher rates of same-day use (RR:1.25, 95% CI:1.10-1.41). Violence exposure was a risk factor among males (RR:1.42, 95% CI:1.21-1.66), while negative peer influences and parental substance use were risk factors among females (RR:1.63, 95% CI:1.36-1.97 and RR:1.58, 95% CI:1.35-1.83, respectively). Positive peer support reduced the association between violence exposure and same-day use among males (RR:0.69, 95% CI:0.57-0.84, p < .05).Conclusions: Tailored interventions may address gender differences in coping with experiencing violence - including interventions that promote parental support among males and reduce influence from parental substance use among females.
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Affiliation(s)
- Vivian H Lyons
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Firearm Injury & Policy Research Program, Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA, USA
- Social Development Research Group, University of Washington, Seattle, WA, USA
| | - Matthew G Myers
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca M Cunningham
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Marc A Zimmerman
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Prevention Research Center of Michigan, University of Michigan, Ann Arbor, MI, USA
| | - Patrick M Carter
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Maureen A Walton
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Jason Goldstick
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
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Dunn CB, Farrell AD. Patterns of alcohol use among middle school students in rural communities: Associations with community violence exposure. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 72:157-169. [PMID: 37421594 DOI: 10.1002/ajcp.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/21/2023] [Accepted: 06/15/2023] [Indexed: 07/10/2023]
Abstract
Stress-coping theory posits that exposure to stressors, such as community violence, increases risk for early alcohol initiation. The current study identified patterns of alcohol use in an ethnically diverse sample of early adolescents in rural communities, and examined relations between different forms of exposure to community violence and severity of adolescents' alcohol use patterns. Participants were 5011 middle school students (46.4% non-Hispanic White, 25.5% Latinx, and 13.4% Black; 50% female) living in rural communities in the southeastern United States. Latent class analysis identified subgroups that differed in their patterns of lifetime and past 30-day alcohol use, and subgroup differences in exposure to community violence. Five subgroups were identified: abstainers (56.5%), initiators of wine and beer (12.5%); moderately frequent wine and beer users (10.3%); moderately frequent wine, beer, and liquor users who got drunk (12.0%); and highly frequent wine, beer, and liquor users who got drunk (8.6%). Subgroups differed across sex, grade, and racial-ethnic background. Subgroups characterized by severe alcohol use reported more frequent exposure to community violence and physical victimization, while controlling for nonviolent stressors. Consistent with stress-coping theory, the results indicate that experiencing physical victimization and witnessing community violence robustly relate to adolescents' high-risk alcohol use.
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Affiliation(s)
- Courtney B Dunn
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Albert D Farrell
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
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Gong CH, Bushman G, Hohl BC, Kondo MC, Carter PM, Cunningham RM, Rupp LA, Grodzinski A, Branas CC, Vagi KJ, Zimmerman MA. Community engagement, greening, and violent crime: A test of the greening hypothesis and Busy Streets. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 71:198-210. [PMID: 36214281 PMCID: PMC10893845 DOI: 10.1002/ajcp.12622] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 05/07/2023]
Abstract
Researchers have documented that vacant lot greening can reduce community-level crime and violence. Busy Streets Theory (BST) suggests that residents who are involved in the greening process can help to improve physical environments and build social connections that deter crime and violence. Yet few researchers have explored how community engagement in the greening process may affect crime and violence outcomes. We applied BST to test the effects of community-engaged vacant lot greening compared to vacant lots that received either professional mowing or no treatment, on the density of violent crime around study lots. Using mixed effects regression models, we analyzed trends in violent crime density over the summer months from 2016 to 2018 at 2102 street segments in Youngstown, OH. These street segments fell within 150 meters of an intervention parcel that was classified as one of three conditions: community-engaged maintenance, professional mowing, or no treatment (control). We found that street segments in areas receiving community-engaged maintenance or professional mowing experienced greater declines in violent crime density than street segments in areas receiving no treatment, and more decline occurred in the community-engaged condition compared to the professional mow condition. Our findings support BST and suggest that community-engaged greening of vacant lots in postindustrial cities with a concentrated vacancy can reduce crime and violence.
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Affiliation(s)
- Catherine H. Gong
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Gregory Bushman
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Bernadette C. Hohl
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Michelle C. Kondo
- USDA Forest Service, Northern Research Station, Philadelphia, Pennsylvania, USA
| | - Patrick M. Carter
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Laney A. Rupp
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Alison Grodzinski
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Charles C. Branas
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, New York, USA
| | - Kevin J. Vagi
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marc A. Zimmerman
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Focardi M, Grassi S, Raddi S, Rosati ME, Cazzato F, D'Onofrio P, Doretti V, Bianchi I, Vetrugno G, Oliva A, Pinchi V. Trend in 167 cases of minors witnessing violence: The role played by COVID-19 pandemic. Front Pediatr 2022; 10:949922. [PMID: 36275057 PMCID: PMC9581130 DOI: 10.3389/fped.2022.949922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There currently is no evidence that COVID-19 has had an impact on the rates of psychological abuses occurring when a minor witnesses interpersonal violence. AIM Our aim was to describe the accesses of the last four years to the Emergency Department of a tertiary hospital (Careggi University Hospital-Florence, Italy) due to this issue and then to evaluate whether the COVID-19 has had an impact on this trend. METHODS We collected data regarding cases of abuse in which at least a minor had reportedly witnessed the event. Medical records stored between January 1, 2018 to January 1, 2022 were analyzed, extracting sex, age and nationality of the victim; sex of the perpetrator and relationship with the victim; known previous episodes of abuse in the medical history of the victim; setting of the abuse (domestic vs. non-domestic); type of abuse (physical, psychological, sexual); whether the perpetrator was under the influence of alcohol/drugs; whether the victim was hospitalized; prognosis of the victim; number, relation with the victim and involvement in the abuse (as co-victim) of the minor(s) who witnessed the abuse. RESULTS A total of 167 eligible cases were registered. 69% of victims had previous episodes of abuse. The perpetrators were all known and mainly males (96%).The abuses were mainly domestic (79%). In 74% of the cases only a type of violence was perpetrated. In 12% of the cases, the minors were also victims of physical abuse. No statistically significant relationships were found between the start of the COVID-19 pandemic and the changes in the number of cases of domestic abuse (p = 0.07), physical abuse (p = 0.62), psychological abuse (p = 0.83) or sexual abuse (p = 0.88). However, during the institutional lockdown in Italy (March-May 2022) only two cases occurred - a number that did not allow period-specific statistical inference. CONCLUSIONS Empowering the hospital policies specifically aimed at identifying and protecting the victims of violence/witnessed violence remains a critical goal from both a public health and medico-legal point of view.
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Affiliation(s)
- Martina Focardi
- Department of Health Science, University of Florence, Florence, Italy
| | - Simone Grassi
- Department of Health Science, University of Florence, Florence, Italy
| | - Silvia Raddi
- Department of Health Science, University of Florence, Florence, Italy
| | | | - Francesca Cazzato
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola D'Onofrio
- Responsible for the Unit of the Rose Code, Area of Emergency Rooms of Careggi Hospital, Florence, Italy
| | - Vittoria Doretti
- Head of Department Health Promotion and Health Ethics, Azienda USL Toscana Sud Est, Careggi Hospital, Florence, Italy
| | - Ilenia Bianchi
- Department of Health Science, University of Florence, Florence, Italy.,Department of Law, University of Macerata, Macerata, Italy
| | - Giuseppe Vetrugno
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Oliva
- Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vilma Pinchi
- Department of Health Science, University of Florence, Florence, Italy
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Couture MC, Kang JE, Hemenway D, Grinshteyn E. Associations between having been threatened or injured with a weapon and substance use and mental health among high school students in the United States. Int J Inj Contr Saf Promot 2021; 29:93-102. [PMID: 34923925 DOI: 10.1080/17457300.2021.2004608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Being threatened or injured with a weapon is a serious form of physical bullying. Little is known about the effects of being threatened or injured with a weapon on substance use and mental health among adolescents. A secondary analysis of 2017 Youth Risk Behavior Survey data assessed the associations between having been threatened or injured with a weapon and substance use (binge drinking, marijuana, tobacco use, prescription medication misuse) and mental health (feeling sad or hopeless, considering suicide). Multiple logistic regression models with complex survey weights were used, controlling for potential confounders. Approximately 6.0% of students reported having been threatened/injured with a weapon. After adjusting for covariates, having been threatened/injured with a weapon was associated with binge drinking (AOR = 2.5; 95% CI: 1.9-3.4), marijuana (AOR = 2.1; 95% CI: 1.6-2.7), tobacco use (AOR = 2.6; 95% CI: 2.0-3.5), and misuse of prescription medication (AOR = 2.2; 95% CI: 1.6-3.0) compared with students who have not been threatened/injured. Having been threatened/injured with a weapon was associated with 1.6 times the odds (95% CI: 1.2-2.2) of feeling sad/hopeless and 1.7 times the odds (95% CI: 1.3-2.3) of considering suicide. Having been threatened or injured with a weapon is an important public health issue associated with negative mental health and substance use.
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Affiliation(s)
- Marie-Claude Couture
- Department of Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Jee Eun Kang
- Department of Health Professions, University of San Francisco, San Francisco, CA, USA
| | - David Hemenway
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Erin Grinshteyn
- Department of Health Professions, University of San Francisco, San Francisco, CA, USA
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Goldstick JE, Lyons VH, Myers MG, Walton MA, Heinze JE, Cunningham RM. Within- and between-person associations with drug use disorder among adolescents and emerging adults presenting to an urban emergency department. Drug Alcohol Depend 2021; 221:108605. [PMID: 33631548 PMCID: PMC8026687 DOI: 10.1016/j.drugalcdep.2021.108605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The distinction between within- and between-person associations with drug use disorder (DUD) has implications for intervention targets and content. We used longitudinal data from youth entering an urban emergency department (ED) to identify factors related to changes in DUD diagnosis, with particular emphasis on alcohol use. METHODS Research staff recruited youth age 14-24 (n = 599) reporting any past six-month drug use from a Level-1 ED; participants were assessed at baseline and four biannual follow-ups. Participants self-reported validated measurements of peer/parental behaviors, violence/crime exposure, drug use self-efficacy, and alcohol use. Research staff performed diagnostic interviews for DUD with nine substances, post-traumatic stress disorder (PTSD), and major depressive disorder (MDD). We used repeated measures logistic regression models with person-level covariate means, and person-mean-centered covariates, as separate variables, to separate within- and between-person covariate effects. RESULTS Among 2,630 assessments, 1,128 (42.9 %) were DUD diagnoses; 21.7 % were co-diagnoses with multiple drugs. Positive (aOR = 0.81, 95 %CI:[0.70, 0.94]) and negative (aOR = 1.73, 95 %CI:[1.45, 2.07]) peer behaviors related to DUD, primarily through between-person effects. Parental support (aOR = 0.92, 95 %CI:[0.83, 0.99]), community violence/crime (aOR = 1.28, 95 %CI:[1.14, 1.44]), PTSD/MDD diagnosis (aOR = 1.36, 95 %CI:[1.04, 1.79]), and alcohol use quantity (aOR = 1.06, 95 %CI:[1.02, 1.11]) were associated with DUD, showing primarily within-person effects. Other factors, such as interpersonal violence involvement (aOR = 1.47, 95 %CI:[1.21, 1.78]), showed both within- and between-person effects. CONCLUSIONS DUD is prevalent in this population, and within-person changes in DUD are predictable. Within-person effects suggest the importance of addressing escalating alcohol use, enhancing parental support, crime/violence exposure, and other mental health diagnoses as part of DUD intervention.
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Affiliation(s)
- Jason E Goldstick
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, United States; Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, United States; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, United States.
| | - Vivian H Lyons
- Harborview Injury Prevention and Research Center, University of Washington, Gerberding Hall G80 Box 351202, Seattle, WA, 98195, United States
| | - Matthew G Myers
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, United States; Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, United States
| | - Maureen A Walton
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, United States; Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, United States
| | - Justin E Heinze
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, United States; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, United States; Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, United States
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, United States; Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, United States; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, United States; Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, United States; Hurley Medical Center, Department of Emergency Medicine, 1 Hurley Plaza, Flint, MI, 48503, United States
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Goldstick JE, Walton MA, Bohnert ASB, Heinze JE, Cunningham RM. Predictors of alcohol use transitions among drug-using youth presenting to an urban emergency department. PLoS One 2019; 14:e0227140. [PMID: 31891632 PMCID: PMC6938309 DOI: 10.1371/journal.pone.0227140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background Precipitants of alcohol use transitions can differ from generalized risk factors. We extend prior research by predicting transitions in alcohol use disorder (AUD) during adolescence and emerging adulthood. Methods From 12/2009-9/2011, research assistants recruited 599 drug-using youth age 14–24 from Level-1 Emergency Department in Flint, Michigan. Youth were assessed at baseline and four biannual follow-ups, including a MINI Neuropsychiatric interview to diagnose AUD (abuse/dependence). We modeled AUD transitions using continuous time Markov Chains with transition probabilities modulated by validated measures of demographics, anxiety/depression symptoms, cannabis use, peer drinking, parental drinking, and violence exposure. Separate models were fit for underage (<21) and those of legal drinking age. Results We observed 2,024 pairs of consecutive AUD states, including 264 transitions (119 No-AUD→AUD; 145 AUD→No-AUD); 194 (32.4%) individuals were diagnosed with AUD at ≥1 assessment. Among age 14–20, peer drinking increased AUD onset (No-AUD→AUD transition) rates (Hazard ratio—HR = 1.70; 95%CI: [1.13,2.54]), parental drinking lowered AUD remission (AUD→No-AUD transition) rates (HR = 0.53; 95%CI: [0.29,0.97]), and cannabis use severity both hastened AUD onset (HR = 1.18; 95%CI: [1.06,1.32]) and slowed AUD remission (HR = 0.85; 95%CI: [0.76,0.95]). Among age 21–24, anxiety/depression symptoms both increased AUD onset rates (HR = 1.35; 95%CI: [1.13,1.60]) and decreased AUD remission rates (HR = 0.74; 95%CI: [0.63,0.88]). Friend drinking hastened AUD onset (HR = 1.18, 95%CI: [1.05,1.33]), and slowed AUD remission (HR = 0.84; 95%CI: [0.75,0.95]). Community violence exposure slowed AUD remission (HR = 0.69, 95%CI: [0.48,0.99]). In both age groups, males had >2x the AUD onset rate of females, but there were no sex differences in AUD remission rates. Limitations, most notably that this study occurred at a single site, are discussed. Conclusions Social influences broadly predicted AUD transitions in both age groups. Transitions among younger youth were predicted by cannabis use, while those among older youth were predicted more by internalizing symptoms and stress exposure (e.g., community violence). Our results suggest age-specific AUD etiology, and contrasts between prevention and treatment strategies.
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Affiliation(s)
- Jason E. Goldstick
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
| | - Maureen A. Walton
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, United States of America
| | - Amy S. B. Bohnert
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, United States of America
| | - Justin E. Heinze
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States of America
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States of America
- Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States of America
- Hurley Medical Center, Department of Emergency Medicine, Flint, MI, United States of America
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9
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Goldstick JE, Carter PM, Heinze JE, Walton MA, Zimmerman M, Cunningham RM. Predictors of transitions in firearm assault behavior among drug-using youth presenting to an urban emergency department. J Behav Med 2019; 42:635-645. [PMID: 31367929 PMCID: PMC6999855 DOI: 10.1007/s10865-019-00021-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 02/14/2019] [Indexed: 12/14/2022]
Abstract
Risk and protective factors for firearm assault (FA) have been established, but little is known about factor preceding transitions in FA behavior. We modeled covariate effects on individuals' transitions in FA behavior (Yes/No) using inhomogeneous, continuous-time, Markov Chains. 3287 assessments were made across five initial biannual follow-ups, and two additional biannual follow-ups (an average of 2.2 years later) from a follow-on study; 2687 pairs of transitions were observed (2414 No-FA → No-FA; 89 No-FA → FA; 121 FA → No-FA; 63 FA → FA). Non-firearm peer violence (HR = 2.31, 95% CI [1.28,4.21]), firearm victimization (HR = 2.57, 95% CI [1.31,5.04]), and marijuana ASSIST sum (HR = 1.27, 95% CI [1.05,1.54]) all preceded transitions into FA, but not transitions out of FA. Delinquent peer associations both hastened transitions into FA (HR = 1.19, 95% CI [1.00,1.40]) and slowed transitions out of FA (HR = 0.84, 95% CI:[0.72,1.00]), with analogous findings regarding attitudes favoring retaliation. Efforts to prevent FA initiation should focus on those currently reporting firearm violence victimization, and on factors indicating an escalating delinquency trajectory (e.g. non-firearm violence, substance use), while programs focusing on peer influences and social norms may be effective at preventing FA regardless of current FA status.
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Affiliation(s)
- Jason E Goldstick
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA.
| | - Patrick M Carter
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Justin E Heinze
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
| | - Maureen A Walton
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Department of Psychiatry, University of Michigan School of Medicine, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
- University of Michigan Addiction Center, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Marc Zimmerman
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, USA
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, USA
- Youth Violence Prevention Center, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, USA
- Department of Emergency Medicine, Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, USA
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