Perceived risk of substance use and associations with early experimentation: A latent profile analysis using ABCD study data.

Profiles of lifetime substance use are differentiated by substance of choice, affective motivations for use, and childhood maltreatment

ABSTRACTBackground: Adolescent substance use is a significant public health concern due to its prevalence and associated negative consequences. Although many adolescents use substances, there is substantial heterogeneity in their use patterns. Identifying risk and protective factors that differentiate adolescents with different substance use profiles is important for preventing negative consequences for those at risk. Objective: This study identified distinct latent profiles of substance use by considering adolescents' involvement in multiple common and illicit substances as well as related problems and examined the extent to which individual and contextual factors in the family, peer, school, and neighborhood environments were related to adolescents' membership of substance use profiles. Method: Data came from 9,155 high school students (51% female; 74% European American) who completed electronic surveys in the 2009 Dane County Youth Assessment (DCYA). Latent class analysis (LCA) was conducted to identify profiles of adolescent substance involvement and related problems. Multinomial logistic regression was conducted to examine associations between individual and contextual factors and latent class membership. Results: LCA identified four distinct profiles of adolescent substance use characterized by both licit and illicit substance use and related problems: Abstainers (56.3%), Alcohol-only users (25.6%), Alcohol-cigarette-marijuana users (13.8%), and Problem polysubstance users (4.3%). Controlling for demographics, individual and contextual factors were associated with adolescents' likelihoods of membership in substance use profiles; notably, the associations varied to some extent across substance use profiles. Conclusions: Substance use is heterogeneous among adolescents. Effects of risk and protective factors on substance use vary depending on adolescents' substance use patterns.

Abstract. Substance use among Nigerian adolescents has increased significantly in the past decade, highlighting the need to implement evidence-based, effective prevention programs as one strategy to help reverse this trend. This study aimed to identify profiles of adolescent substance use and parenting and school correlates of these profiles to inform preventive interventions. Latent class analysis identified four distinct use patterns in 2,004 adolescents (46% male; M = 14.8 years) attending public and private schools in Lagos. Low levels of use distinguished the Low Use class (92.1% of the sample), while use of alcohol, cigarettes, and codeine defined the Alcohol Use class (2.9%). Moderate to high use of tramadol and codeine without a prescription differentiated the Nonmedical Use class (2.8%), and high use of most substances defined the High Use class (2.1%). Males, older youth, and private school students engaged in the riskiest substance use. Students in the Low Use class compared to students in the High Use class were more likely to attend public schools and had parents who solicited less information from them but were more disapproving of substance use. Students in the Low Use class relative to students in the Alcohol Use class also were more likely to attend public schools and had parents who solicited less information but knew more about their child’s activities. These findings suggest that tailored preventive interventions with parents and adolescents could be useful and that more research is needed to understand how the private school context confers risk for substance use.

Following in the footsteps of other large “population neuroscience” studies, the Adolescent Brain Cognitive Development℠ (ABCD) study is the largest in the U.S. assessing brain development. The study is examining approximately 11,875 youth from 21 sites from age 9 to 10 for approximately ten years into young adulthood. The ABCD Study® has completed recruitment for the baseline sample generally using a multi-stage probability sample including a stratified random sample of schools. The dataset has a wealth of measured attributes of youths and their environment, including neuroimaging, cognitive, biospecimen, behavioral, youth self-report and parent self-report metrics, and environmental measures. The initial goal of the ABCD Study was to examine risk and resiliency factors associated with the development of substance use, but the project has expanded far beyond this initial set of questions and will also greatly inform our understanding of the contributions of biospecimens (e.g., pubertal hormones), neural alterations, and environmental factors to the development of both healthy behavior and brain function as well as risk for poor mental and physical outcomes. This review outlines how the ABCD Study was designed to elucidate factors associated with the development of negative mental and physical health outcomes and will provide a selective overview of results emerging from the ABCD Study. Such emerging data includes initial validation of new instruments, important new information about the prevalence and correlates of mental health challenges in middle childhood, and promising data regarding neural correlates of both healthy and disordered behavior. In addition, we will discuss the challenges and opportunities to understanding both healthy development and the emergence of risk from ABCD Study data. Finally, we will overview the future directions of this large undertaking and the ways in which it will shape our understanding of the development of risk for poor mental and physical health outcomes.

Substance use onset in high-risk 9–13 year-olds in the ABCD study

Few studies have evaluated the influence of both family factors and geographic location on youth substance use. To address this gap, a person-/variable-centered approach was used to: (1) identify latent profiles of family risk and protective factors for substance use, (2) test profile membership as a predictor of lifetime and 30-day substance use, (3) test rurality, as measured by school geographic location, as a predictor, and (4) explore interaction effects between profile membership and rurality. Youth (N=9,104; 53% female) residing in a state in the southeastern U.S. completed a statewide substance abuse and risk behavior survey including questions about family risk and protective factors and substance use behaviors. Using latent profile analysis to identify subgroups of participants with similar means and variances on the family factors, four latent profiles emerged. Risk of 30-day and lifetime substance use varied across profiles, with the profile characterized by high family-level protective factors and low family-level risk factors indicating the lowest risk for substance use. Urban youth had increased odds of reporting lifetime marijuana use compared to suburban youth; however, geographic location did not appear to confer significantly increased or decreased risk across other substances. No significant interaction results were found. These results emphasize the importance of family functioning on substance use regardless of geographic location, and that evidence-based prevention programming that reduces family risk, strengthens family protection, and is accessible to all types of communities is important to reducing or delaying substance use among youth.

Adolescent substance use, externalizing and attention problems, and early life stress (ELS) commonly co-occur. These psychopathologies show overlapping neural dysfunction in the form of reduced recruitment of reward processing neuro-circuitries. However, it is unclear to what extent these psychopathologies show common v. different neural dysfunctions as a function of symptom profiles, as no studies have directly compared neural dysfunctions associated with each of these psychopathologies to each other. In study 1, a latent profile analysis (LPA) was conducted in a sample of 266 adolescents (aged 13-18, 41.7% female, 58.3% male) from a residential youth care facility and the surrounding community to investigate substance use, externalizing and attention problems, and ELS psychopathologies and their co-presentation. In study 2, we examined a subsample of 174 participants who completed the Passive Avoidance learning task during functional magnetic resonance imaging to examine differential and/or common reward processing neuro-circuitry dysfunctions associated with symptom profiles based on these co-presentations. In study 1, LPA identified profiles of substance use plus rule-breaking behaviors, attention-deficit hyperactivity disorder, and ELS. In study 2, the substance use/rule-breaking profile was associated with reduced recruitment of reward processing and attentional neuro-circuitries during the Passive Avoidance task (p < 0.05, corrected for multiple comparisons). Findings indicate that there is reduced responsivity of striato-cortical regions when receiving outcomes on an instrumental learning task within a profile of adolescents with substance use and rule-breaking behaviors. Mitigating reward processing dysfunction specifically may represent a potential intervention target for substance-use psychopathologies accompanied by rule-breaking behaviors.

Researchers examined the association between perceptions of harm from substance use and social self-efficacy (SSE) in a sample of early adolescents in public middle schools ( n = 4,122). One-way analysis of covariance and post hoc tests were used to assess the relationships between perceptions of harm from tobacco, alcohol, marijuana, and cocaine use and SSE while controlling for the effects of grade, sex, race, and socioeconomic status. Effect sizes were calculated from the post hoc comparisons to estimate practical importance. Results suggest that lower perceptions of harm from each examined substance were significantly associated with lower SSE ( p < .0001). Effect sizes were of medium practical importance. Enhancing SSE in early adolescents may be an effective component of interventions designed to reduce perceptions of harm associated and subsequent substance use.

The relationship between e-cigarette and cigarette harm perceptions and tobacco behaviors may vary by age. We examined longitudinal associations of harm perceptions with tobacco use behaviors among adults who smoke cigarettes. Data were from Waves 4 (2016-2018) and 5 (2018-2019) of the Population Assessment of Tobacco and Health survey. Weighted multivariable logistic regressions identified independent associations between relative and absolute e-cigarette and cigarette harm perceptions at baseline and continued smoking, dual use, complete switching, and quit intention at follow-up, stratified by age (young adults [YAs] 18-24, middle-aged adults [MAs] 25-44, and older adults [OAs] ≥45) among U.S. adults who smoke (n = 8231). Perceiving e-cigarettes as less harmful than cigarettes was associated with higher odds of complete switching from cigarettes to e-cigarettes (adjusted odds ratio [aOR] overall: 1.52; MAs: 1.68). Perceiving e-cigarettes as very/extremely harmful was associated with lower odds of dual use (overall aOR: 0.75; MAs: 0.72) and higher odds of quit intention (aOR OAs: 1.34). Perceiving cigarettes as very/extremely harmful was associated with lower odds of continued smoking (overall aOR: 0.69; MAs: 0.76; OAs: 0.53), and higher odds of complete switching (overall aOR: 1.65; MAs: 1.86) and quit intention (overall aOR: 1.58; MAs: 1.42; OAs: 1.80). No findings reached significance for YAs. E-cigarette relative and absolute harm perceptions were associated with different tobacco behaviors by age. Low cigarette harm perceptions were similarly associated with continued smoking and lower quit intentions in MAs and OAs. Future research should explore what beliefs inform these perceptions and age-related differences. The associations between harm perceptions and subsequent tobacco behaviors differed by age among adults who smoke. This study adds that low relative harm perceptions of e-cigarettes can promote complete switching among MAs who smoke. High absolute harm perceptions of e-cigarettes may deter dual use among MAs. Additionally, high absolute harm perceptions of cigarettes may reduce smoking and increase cigarette smoking quit intentions among MAs and OAs. Future research is needed to understand the beliefs that support harm perceptions among different age groups, why their effects differ by age, and what factors influence YAs' tobacco use behaviors.

A substance use offense reflects an encounter with law enforcement and the court system in response to breaking the law which may increase risk for substance use problems later in life. Individuals may also be at risk for substance use offending and substance use problems based on genetic predisposition. We examined a mediation model in which polygenic risk for aggression predicted adult substance use disorder diagnoses (SUD) via substance use offending in emerging adulthood. In addition, we explored for potential attenuation of genetic influences on these outcomes by a family-based intervention, the Family Check-Up (FCU). Secondary data analyses based upon the Project Alliance 1 sample was conducted among those with genetic data (n = 631; 322 from control and 309 from FCU intervention). The sample was ethnically diverse (30% African American, 44% European American, 6% Latinx, 4% Asian American, 3% Native American, and 13% Other). Greater polygenic risk for aggression was found to increase risk for substance use violations (age 19-23), which in turn was associated with greater likelihood of being diagnosed with SUD at age 27. A gene-by-intervention effect was found in which individuals in the control group had greater risk for SUD with increasing polygenic risk for aggression. Some convergence in results was found when replicating analyses in African American and European American subgroups. Results imply that genetic predisposition may increase risk for problematic substance use later in life via antisocial behavior, such as substance use offending, and that this can be attenuated by a family-centered intervention.

Commentary on Petersen <i>et al</i>. (2019): Development of problematic substance use in the years that follow diagnosis of schizophrenia

Background: Protective parenting clearly reduces the risk of substance use among young people, but its relationship with cumulative risk for substance use, or the number of risk factors a young person experiences, has not been examined. Objectives: The analysis explores how protective parenting is associated with cumulative risk for adolescent substance use. Methods: A nationally representative online survey of adolescents ages 12-17 (N = 965; 50.8% male; 49.2% female) explored the role of a number of protective parenting variables in predicting substance use risk among adolescents. Parenting behaviors, such as providing warmth, trust, and emotional support; spending time together; communicating about substance use; and monitoring were considered protective. Risk factors included having close friends who use substances, witnessing use, low perceptions of harm, unreliable sources of information about substances, perceived access, and lying to parents. Results: 21.7% of respondents reported 0-1 risk factors, 27.6% reported 2-3 risk factors, and 50.7% reported 4 or more risk factors. Controlling for demographics, a protective parenting composite measure of trust, warmth, and emotional support was associated with decreased risk of reporting 4 or more risk factors (0.45 RRR, p<.05) and spending time together was associated with decreased risk of reporting 2-3 and 4 or more risk factors compared to 0-1 risk factors (0.42 RRR, p<.05; 0.43 RRR, p<.05). Conclusion: These findings highlight the importance of protective parenting in mitigating the cumulative risk for youth substance use. Involving parents in prevention efforts should be a routine component of prevention practice, especially for youth at higher risk.

Background Changes in substance use among adolescence from before to after the COVID-19 lockdowns have been noted in the literature with mixed findings. Yet, no study has examined potential changes in risk or protective factors for substance use in that same period. This study assesses whether perceived parental/peer disapproval, and perceptions of substance harm among adolescents, changed from before to after COVID-19 lockdowns. Methods The Rhode Island Student Survey was administered to 17,751 middle and high school students from January 2020 – May 2021. Perceived parental/peer disapproval, as well as perception of harm, was measured for cigarettes, vaping, alcohol, marijuana, prescription drugs, and illegal drugs. Changes were assessed pre-post COVID-19 lockdown implementation using multivariable logistic regression. Results Perceptions of harm increased for all substances other than vaping, alcohol, and marijuana, and perceptions of peer and parental disapproval for all substances increased after COVID-19 lockdown implementation. Conclusion COVID-19 lockdown implementation may have led to greater perceptions of substance harm and peer/parental disapproval among adolescents. These shifts may have been associated with increased parental exposure and limited peer influence, which should be considered in future programming to prevent and treat adolescent substance use.

Background: Driving under the influence of cannabis (DUIC) almost doubles car crash risk (odds ratios range: 1.28-2.49). Known DUIC correlates include male gender, low perceived danger of DUIC, and greater frequency of cannabis and other drug use. Less is known about the role of executive cognitive functioning (e.g., skills in planning, organization) as a correlate of DUIC. Deficits in executive cognitive functioning could precede, and be exacerbated by heavy cannabis use, potentially contributing to DUIC risk. Objectives: This cross-sectional survey study used a person-centered analysis (latent profile analysis) to (1) identify prototypical profiles representing aspects of executive functioning and substance use in young adults, and (2) determine which profiles were associated with self-report of DUIC. We hypothesized that at least two profiles would be identified: mainly or only cannabis use vs polysubstance use. We also predicted that the polysubstance use profile would be associated with worse executive functioning and self-report of DUIC. Method: Young adults (N=69; ages 18-25; mean age=20.0 [SD=1.9]; 62.3% female; 75.4% White, 13.0% Black, 11.6% Other race/ethnicity) who reported weekly cannabis use were recruited from the community in Pittsburgh, PA to participate in a study of cannabis effects on cognition. Baseline collected demographics, self-reported age of cannabis use onset (age &lt;16 vs age &gt;16), NIDA modified ASSIST, Marijuana Withdrawal Checklist, Alcohol Use Disorders Identification Test (AUDIT), Behavior Rating Inventory of Executive Functioning (BRIEF) (working memory, organization/planning scales), and Marijuana Consequences Questionnaire (item on “driven a car when high” in past 6 months). Latent profile analysis (LatentGold 5.1) was used to identify distinct classes, testing the fit of 1-5 classes. Each model included 10 indicators: age of cannabis use onset, frequency of cannabis and tobacco use, cannabis withdrawal severity, ASSIST scores for cannabis, cocaine and hallucinogens (the substances most often reported), AUDIT score, and BRIEF working memory, and organization/planning scores. For the best fitting model, covariates (i.e., self-report of DUIC, age, gender) were examined as profile correlates in a separate, final step. Results: A model with 3 latent profiles was selected (see Figure). The profiles represented “Polysubstance Use” (40.8%), “Primary Cannabis” (22.3%), and “Later Onset Cannabis” (36.9%). Polysubstance use profile reported more cannabis-related problems and other drug use, and more problems with executive functioning than the other profiles (p&lt;.05). Later Onset (vs Polysubstance Use) profile had older onset age (p&lt;.05), and had the lowest level of cannabis involvement. Primary Cannabis and Later Onset profiles did not differ in report of problems with executive functioning. DUIC in the past 6 months (reported by 50.7% of the total sample) was more likely to be reported by Polysubstance use than Later Onset profile (p&lt;.01). Polysubstance use profile was younger than Primary Cannabis profile (p&lt;.05). The profiles did not differ by gender. Conclusions: As hypothesized, Polysubstance Use profile (which reported early cannabis use onset; and worse executive functioning, including problems with memory, planning/ organization) was associated with self-report of DUIC. Results highlight the role of self-reported executive functioning difficulties in DUIC risk, and the importance of targeting polysubstance use in preventing DUIC.

Young adult opioid misuse indicates a general tendency toward substance use and is strongly predicted by general substance use risk