Higher rates of adolescent substance use in child welfare versus community populations in the United States

Youth participation in substance use prevention: A national profile, 2011-2019

PURPOSE

Prevention efforts are critical to avoid the negative consequences of substance use in adolescents. This study aimed to examine national trends and sociodemographic differences in adolescents' participation in school-based substance use prevention (SUP) education, community-based SUP programs, as well as family conversations about substance use.

METHODS

Publicly available data for adolescents aged 12-17 from the annual cross-sectional surveys of the National Survey on Drug Use and Health 2011-2019 were analyzed.

RESULTS

Across the survey years, up to 74.9%, 12.2%, and 58.1% of adolescents reported having participated in school-based SUP education, community-based SUP programs, and family conversations about the danger of substance use in the past-year, respectively. From 2011 to 2019, statistically significant decreases were observed in adolescents' participation in school-based SUP education (OR = 0.97, 95% CI: 0.96, 0.98, p < 0.001) and community-based SUP programs (OR = 0.98, 95% CI: 0.97, 0.99, p < 0.001). Meanwhile, no significant changes were observed in adolescents' participation in family conversations about the dangers of substance use. Overall, lower levels of participation in school-based and community-based SUP programs were found in adolescents aged 16-17. Adolescents living in rural areas showed lower levels of participation in school-based SUP programs and family conversations about SUP. Racial/ethnic minority adolescents overall were less likely to participate in conversations with parents about SUP than Whites.

CONCLUSIONS

Further development and implementation of developmentally appropriate, gender-specific, culturally sensitive, and contextually informed SUP programs at school, community, and family levels are needed.

The relative effects of parental alcohol use disorder and maltreatment on offspring alcohol use: Unique pathways of risk

Childhood adversity represents a robust risk factor for the development of harmful substance use. Although a range of empirical studies have examined the consequences of multiple forms of adversity (i.e., childhood maltreatment, parental alcohol use disorder [AUD]), there is a dearth of information on the relative effects of each form of adversity when considered simultaneously. The current study utilizes structural equation modeling to investigate three unique and amplifying pathways from parental AUD and maltreatment exposure to offspring alcohol use as emerging adults: (1) childhood externalizing symptomatology, (2) internalizing symptomatology, and (3) affiliation with substance-using peers and siblings. Participants (N = 422) were drawn from a longitudinal follow-up study of emerging adults who participated in a research summer camp program as children. Wave 1 of the study included 674 school-aged children with and without maltreatment histories. Results indicated that chronic maltreatment, over and above the effect of parent AUD, was uniquely associated with greater childhood conduct problems and depressive symptomatology. Mother alcohol dependence was uniquely associated with greater affiliation with substance-using peers and siblings, which in turn predicted greater alcohol use as emerging adults. Results support peer and sibling affiliation as a key mechanism in the intergenerational transmission of substance use between mothers and offspring.

Patterns of Violence Exposure and Substance Use among Child Welfare Involved Youth

Emerging research suggests an association between exposure to violence, specifically indirect forms, and substance use among youth involved in the child welfare (CW) system. However, this has only been recently and tentatively explored. This study examined the associations among various forms of indirect violence exposure and substance use among subgroups of youth involved in the CW system. The analytic sample consisted of participants (aged 11 years or older) in the baseline year of the second National Survey of Child and Adolescent Well-Being (2008-2012), including youth and their caregivers. Latent class analysis was used to examine associations among distinct forms of indirect violence exposure and substance use and the potential identification of unique at-risk groups. Models for the overall sample suggested two classes of at-risk youth, with the higher-risk class having higher probabilities of alcohol, marijuana, and hard drug use, which coincided with higher probabilities of exposure to arrests, stealing, drug deals, and weapon use. However, stratified models suggested unique results for youth aged 13-14 and 15-17, suggesting that the confluence of these risks appears to differ developmentally. Prevention and intervention services for CW-involved youth should assess and address violence exposure types among youth as a potential opportunity to mitigate substance use and subsequent high-risk behavior.

Using machine learning to determine the shared and unique risk factors for marijuana use among child-welfare versus community adolescents

OBJECTIVE

This study used machine learning (ML) to test an empirically derived set of risk factors for marijuana use. Models were built separately for child welfare (CW) and non-CW adolescents in order to compare the variables selected as important features/risk factors.

METHOD

Data were from a Time 4 (Mage = 18.22) of longitudinal study of the effects of maltreatment on adolescent development (n = 350; CW = 222; non-CW = 128; 56%male). Marijuana use in the past 12 months (none versus any) was obtained from a single item self-report. Risk factors entered into the model included mental health, parent/family social support, peer risk behavior, self-reported risk behavior, self-esteem, and self-reported adversities (e.g., abuse, neglect, witnessing family violence or community violence).

RESULTS

The ML approaches indicated 80% accuracy in predicting marijuana use in the CW group and 85% accuracy in the non-CW group. In addition, the top features differed for the CW and non-CW groups with peer marijuana use emerging as the most important risk factor for CW youth, whereas externalizing behavior was the most important for the non-CW group. The most important common risk factor between group was gender, with males having higher risk.

CONCLUSIONS

This is the first study to examine the shared and unique risk factors for marijuana use for CW and non-CW youth using a machine learning approach. The results support our assertion that there may be similar risk factors for both groups, but there are also risks unique to each population. Therefore, risk factors derived from normative populations may not have the same importance when used for CW youth. These differences should be considered in clinical practice when assessing risk for substance use among adolescents.

Advancing Our Understanding of the Risk Factors Associated with Crossover Youth in the Child Welfare and Juvenile Justice Systems: A Trauma-Informed Research Agenda

Previous research has provided robust evidence demonstrating that a notable proportion of youth become involved in both the child welfare (CW) system and the juvenile justice (JJ) system, a population often referred to as crossover youth. Prior work has identified a number of risk factors associated with crossing over between these systems. However, there are limitations to the extant literature, key among which is a lack of systematic attention to the influence of trauma exposure and posttraumatic sequelae on the crossover trajectory. In contrast, viewing this research through a trauma-informed lens promises to enhance our ability to integrate findings across studies and to derive theoretically derived hypotheses about underlying mechanisms which will better inform future research and the development of effective prevention and intervention efforts. Accordingly, the purpose of this article is to present a trauma-informed research agenda that would strengthen future research in the field. After providing a brief critique of the existing studies that has documented known risk factors associated with the crossover population, we outline ways in which future research could apply relevant theoretical trauma-informed approaches, including developmental traumatology, to further advance our knowledge of risk factors and mechanisms associated with the crossover trajectory. We conclude by discussing policy and system-wide implications related to the proposed research agenda.

Relative importance of caregiver characteristics for future alcohol consumption in youth involved with child welfare system

BACKGROUND

Adolescents involved with child welfare system are disproportionately at risk for underage drinking. Little empirical evidence has informed interventions targeting child welfare caregivers to prevent alcohol consumption among adolescents involved with the system.

METHODS

The present study addressed this gap by examining modifiable caregiver characteristics most predictive of future underage drinking in a cohort of adolescents (N = 1205) in a nationally representative child welfare dataset. We used dominance analyses to examine direct contributions of each caregiver predictor to the overall variance of future alcohol use. This is the first study to apply the reputable Turrisi and Jaccard (2001) framework of familial processes affecting underage drinking to the child welfare population.

RESULTS

Findings highlight the role of caregiver-adolescent relational quality and communications for predicting underage alcohol use, and downplay the role of caregiver monitoring.

CONCLUSIONS

Child welfare service systems may help prevent underage drinking by systematically training and motivating caregivers to foster trusting, helping relationships and regular communications with the adolescents in their care.

The Perfect Storm: Mapping the Life Course Trajectories of Serial Killers

Since the 1970s, scholars have produced a large body of research attempting to establish the mechanisms by which sexual serial killers come to arrive at a life of repeat fatal violence. From the standpoint of developmental psychology, however, the explanations offered are far too limited in scope. Human development is the product of complex reciprocal transactions that occur between an individual and their environment throughout their life span. This present study is meant to encourage a critical reconsideration of past knowledge (mainly static traits) in favor of the recognition of the complexity of human development. Using life span developmental psychology as a guiding framework, this study traces the developmental mechanisms that come together to shape the psychopathology that drives the motivations of sexual serial killers.

The prevalence of substance use in child welfare and general population eighth graders in the United States

Background: Early substance use is an established risk factor for substance abuse and dependence. Objective: The current study sought to examine whether child welfare-involved eighth graders have higher rates of early substance use than general population eighth graders. Data from the first National Survey of Child and Adolescent Well-Being (NSCAW) were analyzed to assess the prevalence of self-reported substance use, including alcohol, marijuana, and inhalant use in child welfare-involved eighth graders (N = 896). These figures were compared to general eighth grade student population estimates from the Monitoring the Future Study (N = 16,900) using 95% confidence intervals (CIs). Finally, regression analyses were conducted to examine demographic predictors (i.e., age, gender, race/ethnicity, and out-of-home placement) of substance use among child welfare eighth graders. Results: Results indicated comparable or lower incidence of substances among child welfare eighth graders relative to the general population, but higher past 30-day inhalant use among child welfare youth in out-of-home placement (17.1%, 95% CI: 6.0%, 40.2%) than the general population (4.2%, 95% CI: 3.7%, 4.7%). Out-of-home placement was associated with higher inhalant use (lifetime β = .659, p = .034; 30-day β = .763, p = .040) and alcohol use (lifetime β = .415, p = .028). Conclusions/Importance: These findings imply the need for screening and prevention education about substance use in child welfare populations, particularly in regards to inhalant use.

Risk and Protective Factors for Alcohol, Marijuana, and Cocaine Use Among Child Welfare-Involved Youth

Youth involved in child welfare services (CWS) are at elevated risk for substance use. CWS involvement may provide an opportunity for intervention to prevent subsequent use; however, little is known about mitigating substance use risk in this population. Using data from the second National Survey of Child and Adolescent Well-Being (NSCAW II), the present study examined individual, psychological, and contextual risk factors (e.g., prior substance use, depression, posttraumatic stress, maltreatment experiences) and protective factors (e.g., caregiver monitoring, peer relationships) following CWS involvement (Wave 1) in relation to alcohol, marijuana, and cocaine use 36 months later (Wave 3). The nationally-representative sample of CWS-involved youth was restricted to individuals who were aged 11 years or older at Wave 1 and had at least a partial interview at Wave 3 (N = 763). Three logistic regression models showed that Wave 1 substance use increased the likelihood of marijuana and cocaine use at Wave 3 [marijuana OR = 1.41 (1.19-1.68); cocaine OR = 1.26 (1.07-1.50)] but not binge alcohol use [OR = 1.44 (0.95-2.19)]. Other risk and protective factors had limited predictive value for Wave 3 substance use. The present findings suggest that initiating substance use prior to or at the time of CWS involvement is a critical risk factor for later substance use. Substance use screening and referral to treatment is imperative for CWS-involved youth.

Partner influences on young women's risky drug and sexual behavior

Background

Adolescent girls with a history of maltreatment are at heightened risk for health-risking behaviors, including unsafe sexual behaviors and drug use. However, few studies have examined the views of this population in regard to sexual partner choice, sexual behaviors, and decisions to use drugs with sexual partners.

Methods

We conducted 15 semistructured, open-ended qualitative interviews with young women ages 18–24 with a history of maltreatment and asked them to reflect on their experiences as adolescents. We used the constant comparison method to group the qualitative coded data into themes.

Results

Analysis of the interviews suggested that adolescent girls with maltreatment histories often report that they chose partners who are promotive of risky drug and sexual behavior. The interviews also provided insight into why this population is likely to use drugs with their partner and why they might be hesitant to talk about or practice safe sex with their partner.

Conclusion

The young women’s feedback highlighted five areas where adolescent girls with maltreatment histories could benefit: (a) provision of information about partner characteristics that are promotive of both risky behavior and those that are linked to healthy relationships, (b) provision of information about how one’s partner can influence one’s own drug use, (c) practice talking about safe sex with partners, (d) provision of information about safe sex practices and the risks associated with unsafe sex, and (e) provision of information about the risks associated with drug use and unsafe sexual behavior to adolescent boys.

Child maltreatment and age of alcohol and marijuana initiation in high-risk youth

INTRODUCTION

Youth with a history of child maltreatment use substances and develop substance use disorders at rates above national averages. Thus far, no research has examined pathways from maltreatment to age of substance use initiation for maltreated youth. We examined the longitudinal impact of maltreatment in early childhood on age of alcohol and marijuana use initiation, and whether internalizing and externalizing behaviors at age 8 mediates the link between maltreatment and age of substance use initiation.

MATERIALS AND METHODS

Data were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) at ages 4, 8, 12, and 18. Maltreatment was assessed through reviews of administrative records and youth self-reports. Behavior problems were assessed with the Child Behavior Checklist. Age of substance use initiation was assessed with the Young Adult version of the Diagnostic Interview Schedule for Children.

RESULTS

Path analyses indicated mediated effects from a history of maltreatment to age at first alcohol and marijuana use through externalizing behaviors. Considering type of maltreatment, direct effects were found from physical abuse to age of alcohol initiation, and mediated effects were found from sexual abuse and neglect to initial age of alcohol and marijuana use through externalizing behaviors. Direct effects for marijuana use initiation and indirect effects through internalizing behavior problems were not significant for either substance.

CONCLUSIONS

Externalizing behavior is one pathway from childhood maltreatment to age of substance use initiation. Services for maltreated youth should incorporate substance use prevention, particularly among those with early externalizing problems.

Childhood adversity and the risk of substance use and delinquency: The role of protective adult relationships

Youth involved in the child welfare system experience multiple early adversities that can contribute to increased risk of substance use and delinquency. Although adverse childhood experiences (ACEs) have been associated with poorer behavioral outcomes among youth, less is known about the possible protective factors that may influence the relationship between early adversity and risk-taking behavior. This study examined whether protective adult relationships moderated the link between cumulative ACEs and substance use and delinquency after controlling for demographic characteristics in child welfare-involved youth. The sample included 1054 youth, ages 11-17, from the National Survey of Child and Adolescent Well-Being II who were in the first wave of data collection. Results showed that protective adult relationships moderated the relationship between ACEs and substance use, but not for delinquency. Specifically, under lower levels of protective adult relationships, cumulative ACEs related to increased substance use among youth. Implications for child welfare practices to target youths' support systems are discussed.

Functioning Among Youth with Comorbid Mood Disorder and Chronic Physical Illness in Public Sector Care

OBJECTIVE

The current study examines parent/caregiver and youth report of psychosocial and health-related functioning among youth served in public systems of care, with mood disorder only, comorbid mood disorder and chronic physical illness, and chronic physical illness only.

METHOD

Participants were 539 youths (ages, 11-18; 64% male) with a mood disorder and/or chronic physical illness enrolled in a study of public sector care. Presence of mood disorder was based on youth report on the Diagnostic Interview Schedule for Children-IV. Parents reported whether they had been told by a school or health professional that their child had 1 of 8 categories of chronic physical illnesses. Psychosocial functioning was assessed with the Child Behavior Checklist and Youth Self Report. Parent and child versions of the Child Health Questionnaire assessed health-related functioning. Covariates included demographic variables, substance use, mental health service utilization, disruptive behavior disorders, and anxiety disorders. Multivariate analysis of covariances assessed differences on outcome measures among the 3 groups.

RESULTS

Parents and youths reported significantly worse psychosocial and health-related functioning for youth with comorbid mood and physical illnesses. Generally, parents reported lower functioning in youth with a physical illness compared with mood disorder, and youth with mood disorders reported lower functioning than those with physical illness.

CONCLUSION

Youth with comorbid mood disorder and chronic physical illness experience high levels of impairment. Increased screening of mood disorders in pediatric health settings is warranted. Health systems, clinics, and clinicians should focus on integrating mental and physical health diagnosis and treatment.

Adolescent inhalant use prevention, assessment, and treatment: A literature synthesis

Inhalant use refers to the use of substances such as gases, glues, and aerosols in order to achieve intoxication, while inhalant use disorder (IUD) encompasses both DSM-IV-TR criteria for inhalant abuse and dependence. Inhalant use among adolescents is an international public health concern considering the severe medical and cognitive consequences and biopsychosocial correlates. In this paper, we summarize the current state of the literature on inhalant use among adolescents focusing on social context, prevention, assessment, and treatment strategies. Psychoeducation, skills training, and environmental supply reduction are helpful strategies for preventing adolescent inhalant use, while parent and adolescent self-report as well as physician report of medical signs and symptoms can aid in assessment and diagnosis. Although research has only begun to explore the treatment of inhalant use, preliminary findings suggest that a multimodal approach involving individual counselling (i.e., CBT brief intervention), family therapy, and activity and engagement programs is the first-line treatment, with residential treatment programs indicated for more severe presentations. The limited nature of treatments developed specifically for inhalant use combined with high prevalence rates and potential for significant impairment within the adolescent population indicate the need for further research. Research should focus on understanding the social context of use, establishing the efficacy of current adolescent substance use treatments adapted for inhalant use, and exploring long-term outcomes.

Self-reported ecstasy (MDMA) use and past occurrence of sexually transmitted infections (STIs) in a cohort juvenile detainees in the USA

The current study was designed to determine the extent to which self-reported ecstasy use in a population of juvenile adolescent detainees in a southern state is associated with high-risk health behaviors pertaining to sexually transmitted infection (STI) symptomology and past history of STI occurrence. Participants were 2,260 juvenile offenders housed at selected Youth Development Campuses in the state of Georgia. Adjusted odds ratios (ORs) with 95 % confidence intervals (CIs) are presented. Juveniles who reported having used ecstasy previously were more likely to report that they had sore bumps of blisters near their sex organs before (OR 1.28, 95 % CI 0.74-2.21), with males who had used ecstasy prior incarceration being more than two times more likely to indicated that they had experienced having a drip or drainage from the penis (OR 1.76, 95 % CI 0.72-4.32), having vaginal discharge or odor from their vagina (OR 2.33, 95 % CI 1.16-4.65).

Alcohol consumption is higher among left-behind Chinese children whose parents leave rural areas to work

AIM

Over the past few decades, a large number of rural residents have migrated to cities in China and left their children behind. This study estimated how many 10- to 14-year-old children in rural Anhui drank alcohol and examined the association between parental migration and children's alcohol use.

METHODS

A cross-sectional study was conducted in six cities in Anhui between July and August 2012. All participants had lived in the study villages for at least six months during the previous year and were interviewed face-to-face using a standardised questionnaire.

RESULTS

More than half (57%) of the 1367 subjects were left-behind children, 43% lived with both parents and 9.6% currently drank alcohol. When we controlled for other variables, the rate of alcohol use was statistically higher among left-behind children if both parents had migrated (14.0%) than among children living with both parents (7.8%) (p = 0.002). Boys, children with siblings and those with a poorer academic performance were more likely to drink.

CONCLUSION

Children in rural China were more likely to drink if both their parents had migrated in search of work. School-based interventions could help to reduce alcohol use among rural left-behind children, especially boys.