Alcohol, Tobacco, And Other Drug Research Articles

Changes in alcohol, tobacco, cannabis, and other substance use and its association with mental health during the COVID-19 pandemic among sexual minority men in Eastern European and Central Asian countries

BackgroundThe COVID-19 pandemic had a particularly negative impact on mental wellbeing of vulnerable individuals, such as sexual minority men (SMM) living in Eastern Europe and Central Asia (EECA), where the social-political climate may be restrictive for SMM. Alcohol, tobacco, and other drugs (ATOD) use may be another factor contributing to exacerbated mental health among SMM in this region. MethodsSecondary analyses were conducted using data collected as part of the COVID-19 disparities survey from active users of Hornet, a popular geo-social networking app for SMM in late 2020. Using a subset of SMM living in EECA (n = 3209) and pre-validated scales (AUDIT-C and PHQ-4), we used multivariable logistic regression models to examine the relationship between changes in participants' use of ATOD and their mental wellbeing. ResultsBased on AUDIT-C, 35.1 % SMM screened for alcohol use disorder (AUD), 18.6 % reported an increase in alcohol use since the pandemic began. Over 30 % screened for depressive symptoms and anxiety based on PHQ-4 (30.4 % and 30.7 %, respectively). In multivariable models, AUD was significantly associated with screening positive for depressive symptoms and anxiety. Other factors associated with mental distress included lower socioeconomic status, unemployment, ethnic minority identity, IPV victimization, and financial and economic vulnerability. LimitationsCross-sectional data cannot be used to infer causality. ConclusionsOur results support the needs for integrated substance use reduction and mental health services tailored for SMM in EECA. Programs aimed at promoting mental wellbeing among SMM in EECA must consider both interpersonal and structural barriers.

Native Hawaiian/Pacific Islander alcohol, tobacco and other drug use, mental health and treatment need in the United States during COVID-19.

IntroductionBefore COVID‐19, Native Hawaiians/Pacific Islanders (NH/PI) endured a heavy burden of alcohol, tobacco and other drug (ATOD) use in prior US data. Responding to reports that many NH/PI communities experienced severe COVID‐19 disparities that could exacerbate their ATOD burden, we partnered with NH/PI communities to assess the substance use patterns and treatment needs of diverse NH/PIs during COVID‐19.MethodsCollaborating with NH/PI community organisations across five states with large NH/PI populations, we conducted a large‐scale investigation of NH/PI ATOD use, mental health and treatment need during COVID‐19. Between April and November 2021, NH/PI‐heritage research staff from our community partners collected data involving 306 NH/PI adults using several community‐based recruitment methods (e‐mail, telephone, in‐person) and two survey approaches: online and paper‐and‐pencil. Multivariate regressions were conducted to examine potential predictors of NH/PI alcohol use disorder and need for behavioural health treatment.ResultsDuring COVID‐19, 47% and 22% of NH/PI adults reported current alcohol and cigarette use, while 35% reported lifetime illicit substance use (e.g., cannabis, opioid). Depression and anxiety were high, and alcohol use disorder, major depression and generalised anxiety disorder prevalence were 27%, 27% and 19%, respectively. One‐third of participants reported past‐year treatment need with lifetime illicit substance use, COVID‐19 distress and major depression respectively associating with 3.0, 1.2, and 5.3 times greater adjusted odds for needing treatment.ConclusionsNH/PI adults reported heavy ATOD use, depression, anxiety and treatment need during COVID‐19. Targeted research and treatment services may be warranted to mitigate COVID‐19's negative behavioural health impact on NH/PI communities.

Comparing substance use outcomes by sexual identity among women: Differences using propensity score methods

BackgroundDifferences in alcohol, tobacco, and other drug (ATOD) use by sexual identity vary across samples of women recruited using different sampling methods. We used propensity score (PS) weighting methods to address two methodological questions: (1) Do disparities between sexual minority women (SMW) and heterosexual women persist when differences in risk and protective factors are similarly distributed between groups, and (2) Does accounting for SMW-specific resiliency factors impact differences between non-probability samples of SMW? Methods: Four samples included SMW from a longitudinal study with a nonprobability sample (n = 373), a national general population panel sample (n = 373), and a national LGBTQ-specific panel sample (n = 311), as well as a national probability sample of heterosexual women (n = 446). Between-groups analyses using double-robust PS weighted models estimated differences in ATOD use under hypothetical conditions in which samples have similar risk and protective factors. Results: After PS weighting, imbalance in confounders between SMW and heterosexual samples was substantially reduced, but not eliminated. In double-robust PS weighted models, SMW samples consistently had significantly greater odds of drug use than heterosexuals, with odds from 8.8 to 5.6 times greater for frequent marijuana use and 4.8–3.2 greater for other drug use. Few differences between SMW samples in ATOD outcomes or other variables remained after PS weighting. Conclusion: Relative to heterosexual women, disparities in marijuana and other drug use among SMW are evident regardless of sampling strategy. The results provide some reassurance about the validity of large nonprobability samples, which remain an important recruitment strategy in research with SMW.

Health-Promoting Behavior and Lifestyle Characteristics of Students as a Function of Sex and Academic Level.

University students frequently engage in unhealthy behaviors. However, there is a lack of studies examining a wide range of their lifestyle characteristics by sex and academic level of study. This cross-sectional survey of students enrolled in BSc, MSc, or PhD programs at one university in Germany (N = 3389) assessed physical activity (PA), sedentary behavior (SB), nutrition, sleep quality, and alcohol, tobacco, and other drug (ATOD) use by sex and academic level and was conducted with EvaSys version 8.0. Chi-squared tests compared categorical variables by sex, and binary logistic regression analyses adjusted for sex with Bonferroni adjustments evaluated differences across academic level. Although 91% of students achieved the aerobic PA guidelines, only 30% achieved the muscle strengthening exercises (MSE) guidelines, and 44% had high SB. Likewise, <10% met the fruit and vegetable consumption (FVC) recommendations, >40% of students experienced impaired sleep, and >30% had hazardous alcohol consumption. Less than 20% of the sample achieved the guideline/recommendation of all three PA, MSE and SB. Some behaviors exhibited significant sex and academic level differences. The identified at-risk groups included males (lower FVC), females (eating more during stress), and BSc students (poorer nutrition/sleep quality, more ATOD use). Given the above findings, multipronged strategies are needed with an overarching focus highlighting the health–academic achievement links. Behavioral interventions and environmental policies are required to raise awareness and promote student health.

The Relationship Between Sexual Intercourse Before the age of 13 and Alcohol, Tobacco, and Other Drug use among High School Students.

Research has indicated that early sexual intercourse in high school is associated with poor health outcomes such as unintentional pregnancy and sexually transmitted infections (STIs). What is lacking in the research is an understanding of the relationship between even earlier sexual initiation (i.e., before the age of 13) and alcohol, tobacco, and other drug (ATOD) use behaviors. As such, the purpose of this study was to assess whether sexual intercourse younger than 13 years of age was predictive of ATOD use among students currently in high school. Data was derived from the 2015 Youth Risk Behavior Survey (n = 15,624). This national study is conducted every odd year, and is a representative sample of high school students in the United States. Logistic regression was used to determine the relationship between sexual initiation younger than 13 years of age and current ATOD use among high school students. The results of this study found that early sexual initiation was predictive of current high school ATOD use with students who had initiated early sexual intercourse having significantly higher prevalence rates among all variables measured. The results of this study indicates health education regarding ATOD use, as well as sexual health education should be introduced to US student at an earlier age. These results indicate that continued education is needed in the pre-teen years to prevent early health risk behaviors in our youth.

Adolescent Health Series - Alcohol, tobacco, and other drug use among adolescents in sub-Saharan Africa: A narrative review.

Alcohol, tobacco, and other drug (ATOD) use by adolescents are major contributors to death and disability in sub-Saharan Africa (SSA). This paper reviews the extent of adolescents' ATOD use, risk and protective factors, and studies evaluating prevention interventions for adolescents in SSA. It also describes the harms associated with adolescents' ATOD use in SSA, which mainly include interpersonal violence, sexual risk behaviours, and negative academic outcomes. We use the socio-ecological model as our framework for understanding ATOD use risk and protective factors at individual, interpersonal, peer/school, and societal/structural levels. We used two strategies to find literature evaluating ATOD interventions for adolescents in SSA: (a) we sought systematic reviews of adolescent ATOD interventions in SSA covering the period 2000-2020; and (b) we used a comprehensive evidence review strategy and searched for studies that had evaluated ATOD interventions in all SSA countries between 2000 and 2020. Only two community interventions (a brief intervention and an HIV prevention intervention), out of four that were identified, were partially effective in reducing adolescent ATOD. Furthermore, only one school-based intervention (HealthWise), out of six that we uncovered, had any effect on ATOD use among adolescents. Possible reasons why many interventions were not effective include methodological limitations, involvement of non-evidence-based education-only approaches in some studies, and shortcomings in adaptations of evidence-based interventions. The scale of ATOD and related problems is disproportionate to the number of evaluated interventions to address them in SSA. More ATOD interventions need to be developed and evaluated in well-powered and well-designed studies.

Predicting Success of a Digital Self-Help Intervention for Alcohol and Substance Use With Machine Learning.

BackgroundDigital self-help interventions for reducing the use of alcohol tobacco and other drugs (ATOD) have generally shown positive but small effects in controlling substance use and improving the quality of life of participants. Nonetheless, low adherence rates remain a major drawback of these digital interventions, with mixed results in (prolonged) participation and outcome. To prevent non-adherence, we developed models to predict success in the early stages of an ATOD digital self-help intervention and explore the predictors associated with participant’s goal achievement.MethodsWe included previous and current participants from a widely used, evidence-based ATOD intervention from the Netherlands (Jellinek Digital Self-help). Participants were considered successful if they completed all intervention modules and reached their substance use goals (i.e., stop/reduce). Early dropout was defined as finishing only the first module. During model development, participants were split per substance (alcohol, tobacco, cannabis) and features were computed based on the log data of the first 3 days of intervention participation. Machine learning models were trained, validated and tested using a nested k-fold cross-validation strategy.ResultsFrom the 32,398 participants enrolled in the study, 80% of participants did not complete the first module of the intervention and were excluded from further analysis. From the remaining participants, the percentage of success for each substance was 30% for alcohol, 22% for cannabis and 24% for tobacco. The area under the Receiver Operating Characteristic curve was the highest for the Random Forest model trained on data from the alcohol and tobacco programs (0.71 95%CI 0.69–0.73) and (0.71 95%CI 0.67–0.76), respectively, followed by cannabis (0.67 95%CI 0.59–0.75). Quitting substance use instead of moderation as an intervention goal, initial daily consumption, no substance use on the weekends as a target goal and intervention engagement were strong predictors of success.DiscussionUsing log data from the first 3 days of intervention use, machine learning models showed positive results in identifying successful participants. Our results suggest the models were especially able to identify participants at risk of early dropout. Multiple variables were found to have high predictive value, which can be used to further improve the intervention.

Multi-Substance Use Behaviors: Prevalence and Correlates of Alcohol, Tobacco and Other Drug (ATOD) Use among University Students in Finland.

Virtually no studies appraised the co-use of alcohol, tobacco, and other drug (ATOD) among Finn undergraduates. We assessed the associations between sociodemographic, health, academic, policy, and lifestyle characteristics (independent variables); and individual, multiple and increasing ATOD use (dependent variables) using regression analyses. Data were collected by online questionnaire at the University of Turku, Finland (1177 students). Roughly 22% of the sample smoked, 21% ever used illicit drug/s, 41% were high frequency drinkers, and 31.4%, 16.3%, and 6.7% reported 1, 2, or 3 ATOD behaviors respectively. Individual ATOD use was significantly positively associated with the use of the other two substances [adjusted odds ratio (Adj OR range 1.893–3.311)]. Multiple ATOD use was negatively associated with being single (p = 0.021) or agreeing with total smoking or alcohol ban policy on campus (p < 0.0001 for each); but positively associated with not living with parents (p = 0.004). Increasing ATOD behaviors were significantly less likely among those agreeing with total smoking or alcohol ban policy on campus (p range 0.024 to <0.0001). Demographics significant to either individual, multiple, or increasing ATOD use included males, being single, not living with their parents during semesters, and to some extent, religiosity. Age, depressive symptoms, perceived stress, self-rated health, health awareness, income sufficiency, and academic variables were not associated with individual, multiple, or increasing ATOD use. Education and prevention efforts need to reinforce abstinence from ATOD, highlight their harmful outcomes, and target risk groups highlighted above. University strategies should be part of the wider country-wide successful ATOD control policies.

Effects of Different Types of Childhood Victimization on Health Outcomes: A Study of African American Young Adults in Washington, D.C.

Some children experience violence and trauma with effects lasting into adulthood. We examine how five types of childhood exposure to violence (ETV) affect the current depression, sleep habits, and drug use of 638 African American youth ages 18 to 25, in Washington, D.C. We correlated childhood exposure to conventional crime, child maltreatment, peer/sibling victimization, sexual victimization, and witnessing crime/indirect (WC/I) victimization with depressive symptoms, depressive moods, trouble sleeping, current drug use, lifetime alcohol, tobacco, and other drug (ATOD) use, and current ATOD use problems. Depressive symptoms and lifetime ATOD use were significantly correlated with each childhood ETV measure; depressive moods with WC/I and peer/sibling victimization, trouble sleeping with childhood maltreatment and current drug use, and problems with ATOD with childhood sexual victimization. Specific types of ETV are correlated with different behavioral and health outcomes in young adulthood and these differences are important to study further.

Improving in-depth, epidemiological and economic understanding of substance use, harm and its prevention across countries

Welcome to the second issue of Volume 8 of IJADR for 2020. This issue includes papers that focus on the global burden of different substances and their costs as well as studies of substance use and related harm by authors in Scandinavia and North America. The five papers include qualitative and quantitative studies and involve diverse populations from Canada, Sri Lanka, Germany and the United States. In an attempt to identify substance use research priorities for Canada, Sornpaisarn and colleagues (2020) reviewed 2014-2019 publications and analysed secondary data sources to study the relative substance-attributable burden of disease for alcohol, tobacco and other drugs in Canada, finding that tobacco followed by other drugs contributed more to the burden of disease estimates than did alcohol. This pattern was also evident in North America and differs considerably from that observed in the overall global burden of disease estimates, where alcohol ranks higher than other drugs in terms of its contribution to GBD. Secondly, this article reported on wholly attributable relative substance use disorder diagnoses in Canada, finding that relative to alcohol, opioid use disorders required more admissions to hospital. Finally, this article highlights that the greatest societal costs tallied in 2014 were for the costs of alcohol, followed by tobacco and all other drugs combined. Both other drug use and alcohol diagnosis costs increased in the period between 2007 and 2014, with cannabis and opioid costs increasing and tobacco costs declining. Leifman and Trolldal (2020) undertook an interesting study of price and income elasticity in Sri Lanka, finding that the economic drivers of alcohol sales appeared not to be affected by price and income changes to the same extent as sales in high-income countries or in the few studies that have been undertaken in other low- and middle-income countries. Their paper discusses aspects of Sri Lankan drinking culture including limitations on women’s drinking, the greater prevalence of lighter drinking and abstinence, banning of drinking on public holidays and drinking by tourists that may explain why general patterns of alcohol sales are less affected by price and income than expected, but argues that further research is needed to understand drivers of consumption in Sri Lanka. In a study among sexual minority and non-sexual minority men and women in the United States, Karen Trocki and her colleagues (2020) examined the extent to which the protective effects of marriage on substance use that are commonly observed among heterosexual men and women apply to sexual minority groups. They found that marriage confers protective effects against substance use depending on individuals’ sexual minority or non-sexual minority status, their sex, and the substances under study. The researchers call for further research to unpack the factors that may explain the role of marriage as a protective factor against substance use in sexual minority individuals. Egerer and Hellman’s (2020) study considered techniques that may be employed for interpreting researchers’ subjectivity – a well-recognized element – in qualitative research. They introduced three techniques: a form of content analysis, quantification of researchers’ expectations, and analysis of speaker positions among study participants. Using examples of data from focus groups among social workers in Germany, the paper discusses some of the contrasting impressions of qualitative data that can emerge from the use of the different techniques. This paper is likely to be very informative for many readers, and particularly, for those who may not be familiar with methods of analyzing and interpreting qualitative data. Using multi-level data, Julie Croff and her colleagues (2020) examined the extent to which individual-level and school-level parental factors, school environmental factors, alcohol, tobacco and other drug (ATOD) descriptive norms and peer deviance are associated with early adolescents’ lifetime alcohol consumption in a study conducted among seventh grade students in the United States of America. They found that parents’ educational involvement and peer deviance at both the individual and school levels were associated with the adolescents’ alcohol use; however, only individual level ATOD norms were associated with lifetime alcohol use. A key implication of the findings concerns the role of parental involvement at the school level in early adolescents’ alcohol use. The authors concluded that “Parent educational engagement programs need not target all parents, as strong results at the school level may come from a core team of key parent leaders.” (page 93).

Pregnant Women's Acceptability of Alcohol, Tobacco, and Drug Use Screening and Willingness to Disclose Use in Prenatal Care.

Despite the prevalence of alcohol, tobacco, and other drug (ATOD) use screening as part of prenatal care, pregnant women's perspectives on screening are largely absent from research and clinical practice. This study examines pregnant women's acceptability of ATOD screening and willingness to disclose their ATOD use in prenatal care. Pregnant women completed a self-administered survey and structured interview at four prenatal care facilities in Louisiana and Maryland (N=589). Participants reported the acceptability of screening and their willingness to honestly disclose their ATOD use to their provider. Data were analyzed through descriptive statistics, tests of proportions, simple regression models, and coding of open-ended responses. Nearly all pregnant women found screening acceptable for alcohol (97%), tobacco (98%), and other drug use (97%) during prenatal care. The acceptability of alcohol use screening was higher among those who reported binge drinking (98% vs. 96%; p=.002) and risky alcohol consumption (99% vs. 96%; p=.018). The acceptability of screening for other drugs was higher among women reporting binge drinking (98% vs. 96%; p=.032) and other drug use (98% vs. 96%; p=.058). Almost all pregnant women indicated that they were willing to disclose their alcohol (99%), tobacco (99%), and other drug use (98%) to their provider. Almost all women considered verbal screening for ATOD use during prenatal care acceptable and indicated that they were willing to honestly disclose their ATOD use. Verbal screening may allow for the opportunity to initiate safe, nonjudgmental conversations about women's substance use, risk, and goals for their ATOD use, pregnancy, and parenting.

Normative Substance Use Antecedents among Sexual Minorities: A Scoping Review and Synthesis.

Although sexual minority stress remains the dominant perspective for understanding disproportionate substance use among lesbian, gay and bisexual (LGB) populations, social norms are among the most predictive and commonly targeted substance use antecedents in other high-risk groups. This scoping review seeks to bring clarity to the body of norms-focused alcohol, tobacco, and other drug (ATOD) research conducted with LGBs over the past 20 years, identify intervention implications, and present priority directions for future research. Fifty-two peer-reviewed studies published between June 1999 and June 2019 were identified from searches of PubMed, PsycInfo, and Medline databases using combinations of terms related to: social norms; sexual orientation or sexual minority status; and, the use of alcohol, tobacco, and other drugs. A far greater number of studies focused on actual ATOD norms than perceived ATOD norms or discrepancies between actual or perceived norms, illuminating the need for additional research focused on these levels of analysis. Taken together, this literature suggests that: (1) perceived ATOD norms are reliable predictors of LGBs' ATOD use; (2) actual ATOD use norms are low among LGBs participating in representative, population-based survey studies; and, (3) LGBs over-estimate the ATOD use of peers. Thus, intervention strategies including personalized normative feedback, psychoeducation, and social branding may hold promise in reducing LGBs substance use. However, additional research is needed to increase our understanding of injunctive ATOD norms, identify meaningful LGB reference groups, elucidate environmental influences on ATOD norms, and examine relationships between stigma experiences, perceived norms, and ATOD use.

The vulnerability to alcohol, tobacco, and drug use of adolescents in Hong Kong: a phenomenological study

BackgroundIn Hong Kong, the use of alcohol, tobacco, and other drugs (ATOD) is associated with strong peer influences; frequently absent parents; academic pressures; and a lack of interpersonal skills to cope with stress and conflict. It is posited that this social context alters the nature of the adolescent risk of using ATOD. The study aimed to explore how social interactions in their local context shape experiences of adolescents who smoke or use alcohol with their parents and other significant people (e.g., teachers, peers) in their lives.ResultsThe participants consistently indicated that the communication of risk was fundamentally influenced by the attachment between the primary parent(s) and the child. In secure attachments, parents could positively discourage ATOD use by instilling fear or expressing regret or disappointment over its use. However, some parents expressed an overly permissive attitude about ATOD use, or stated that they had a limited ability to influence their child, or that the harm arising from their child’s use of ATOD would be minimal. Under these conditions, the authors posited that the potential influence of peers to disrupt parental attachments was stronger.ConclusionsDescriptive phenomenology was adopted in this study and Colaizzi’s method was used to analyse the collected data. Focus group interviews were conducted with 45 adolescents, 11 parents, and 22 school teachers and social workers in two districts in Hong Kong. A secure attachment between a parent and a child enhances the child’s sense of self-efficacy in avoiding addictive behaviours such as ATOD use. In contrast, insecure parent-child attachments may trigger children to resist social norms, and disrupt their parental attachments. In these instances, parents may inadvertently convey the message that their children do not need protection from the risks of using ATOD. The key findings suggest that reinforcing secure parental attachments, as well as emphasizing how messages of vulnerability to ATOD are conveyed, may counter balance pressures (including peer influence) to use these substances. Further research is needed to uncover mechanisms of communication that add to the vulnerability of adolescents to using ATOD, and to the negative long-term consequences from ATOD use.

Patterns of Social Media Use and Their Relationship to Health Risks Among Young Adults

PurposeSocial media use is pervasive among young adults, and different sites have different purposes, features, and audiences. This study identified classes of young adults based on what combination of sites they use and how frequently, and compared their health risk factors and behaviors. MethodsLatent profile models were developed based on frequency of using 10 sites from a national sample of young adults aged 18–24 years (n = 1,062). Bivariate analyses and multivariable regressions examined the relationship between class membership and alcohol, tobacco, and other drug (ATOD) use, and symptoms of depression and anxiety. ResultsThe optimal model identified five classes: Low Users (7.9%), High Users (63.1%), Professional Users – high use of LinkedIn (10.1%), Creative Users – high use of Vine and Tumblr (11.5%), and Mainstream Users – high use of Facebook and YouTube (7.4%). Classes differed significantly on ATOD use and depressive symptoms. Compared to High Users, Creative Users had higher odds of using most substances and lower odds of depressive symptoms, Mainstream Users had higher odds of substances used socially (alcohol and hookah), Professional Users had higher odds of using alcohol, cigarettes, and cigars, and Low Users had higher odds of using other drugs (e.g., cocaine and heroin). ConclusionsA young adult's social media site use profile is associated with ATOD use and depressive symptoms. Use and co-use of certain sites may influence the volume and nature of ATOD-related content and norms young adults experience in social media. Targeting interventions to sites selected based on use patterns associated with each health risk may be effective.

Behavioral Health Risk Profiles of Undergraduate University Students in England, Wales, and Northern Ireland: A Cluster Analysis.

Limited research has explored clustering of lifestyle behavioral risk factors (BRFs) among university students. This study aimed to explore clustering of BRFs, composition of clusters, and the association of the clusters with self-rated health and perceived academic performance. We assessed (BRFs), namely tobacco smoking, physical inactivity, alcohol consumption, illicit drug use, unhealthy nutrition, and inadequate sleep, using a self-administered general Student Health Survey among 3,706 undergraduates at seven UK universities. A two-step cluster analysis generated: Cluster 1 (the high physically active and health conscious) with very high health awareness/consciousness, good nutrition, and physical activity (PA), and relatively low alcohol, tobacco, and other drug (ATOD) use. Cluster 2 (the abstinent) had very low ATOD use, high health awareness, good nutrition, and medium high PA. Cluster 3 (the moderately health conscious) included the highest regard for healthy eating, second highest fruit/vegetable consumption, and moderately high ATOD use. Cluster 4 (the risk taking) showed the highest ATOD use, were the least health conscious, least fruit consuming, and attached the least importance on eating healthy. Compared to the healthy cluster (Cluster 1), students in other clusters had lower self-rated health, and particularly, students in the risk taking cluster (Cluster 4) reported lower academic performance. These associations were stronger for men than for women. Of the four clusters, Cluster 4 had the youngest students. Our results suggested that prevention among university students should address multiple BRFs simultaneously, with particular focus on the younger students.

Changes in Alcohol, Tobacco, and Other Drug Use Over Five Years After Receiving Versus Being Denied a Pregnancy Termination

Research on effects of pregnancy termination on women's alcohol, tobacco, and other drug (ATOD) use suffers from methodological and conceptual problems. Improving on prior methodologies, this study examines changes in ATOD use over 5 years among women seeking terminations. Data are from the Turnaway Study, a longitudinal study of 956 women seeking terminations at 30 U.S. facilities. Participants presented just below a facility's gestational limit and received terminations (Near-Limits) or just beyond the limit and were denied terminations (Turnaways). Using mixed-effects logistic regression, we assessed differences in ATOD use over 5 years among Near-Limits and Turnaways. There were no differences in ATOD use before pregnancy recognition; 1 week after termination seeking, Turnaways had lower odds than Near-Limits of any and heavy episodic alcohol use (p < .001), but not alcohol problem symptoms, tobacco use, or other drug use. Although both groups increased in any alcohol use over time, Turnaways increased more rapidly. Neither group increased any other ATOD measures over time. Turnaways' lower odds of heavy episodic alcohol use at 1 week after termination seeking were maintained throughout the subsequent 5 years. There was no differential change in problem alcohol use or in tobacco or other drug use over time, yet fewer Turnaways than Near-Limits reported problem alcohol symptoms 6 months through 3.5 years. There is no indication that terminating a pregnancy led women to increase heavy episodic or problem alcohol use or to increase tobacco or other drug use. Women denied terminations had temporary or sustained reductions in all alcohol measures, but not tobacco or other drugs, suggesting that relationships between pregnancy/parenting and ATOD differ across substances.

Suicidal ideation among suburban adolescents: The influence of school bullying and other mediating risk factors

Objective: Prior research has identified multiple factors that influence suicidal ideation (SI) among bullied youth. The effects of school bullying on SI cannot be considered in isolation. In this study, we examined the influence of school bullying on SI, through a constellation of risks, which include depressive and anxiety symptoms, family conflict, and alcohol, tobacco, and other drug (ATOD) use. We also provide recommendations for therapists working with bullied youth.Method: Our sample consisted of 488 adolescents (ages 10-18 years) from a northern New Jersey, United States suburban community. Students were recruited through the district’s physical education and health classes. Students responded to multiple measures, which included family cohesion/conflict, ATOD use, mental health indicators, SI, and school bullying experiences. Following preliminary analyses, several logistic regression models were used to assess the direct influence of bullying on SI, as well as the unique effects of family conflict, depressive and anxiety symptoms, and substance use. In addition, a parallel multiple mediating model with the PROCESS macro in SPSS was used to further assess mediating effects.Results: Logistic regression results indicated that school bullying increased the odds of SI among males and females and that when mediating variables were added to the model, bullying no longer had a significant influence on SI. Overall, these results display that for both males and females, school bullying was a significant contributor to SI. Results from the parallel multiple mediating model further illustrated the mediating effects that family conflict, depression, and ATOD use had between bullying and SI. Some variation was noted based on gender.Conclusion: This study draws attention to the multiple experiences associated with school bullying on SI, and how these results may differ by gender. The results of this study are particularly important for those working directly and indirectly with bullied youth. Therapists that engage bullied youth need to consider the multiple spheres of influence that may increase SI among male and female clients. To holistically and adequately assess SI among bullied youth, therapists must also consider how these mechanisms vary between gender groups.

The Role of Gender in Adolescents' Social Networks and Alcohol, Tobacco, and Drug Use: A Systematic Review.

Despite previous research indicating an adolescents' alcohol, tobacco, and other drug (ATOD) use is dependent upon their sex and the sex composition of their social network, few social network studies consider sex differences and network sex composition as a determinant of adolescents' ATOD use behavior. This systematic literature review examining how social network analytic studies examine adolescent ATOD use behavior is guided by the following research questions: (1) How do studies conceptualize sex and network sex composition? (2) What types of network affiliations are employed to characterize adolescent networks? (3) What is the methodological quality of included studies? After searching several electronic databases (PsycINFO, EBSCO, and Communication Abstract) and applying our inclusion/exclusion criteria, 48 studies were included in the review. Overall, few studies considered sex composition of networks in which adolescents are embedded as a determinant that influences adolescent ATOD use. Although included studies all exhibited high methodological quality, the majority only used friendship networks to characterize adolescent social networks and subsequently failed to capture the influence of other network types, such as romantic networks. School-based prevention programs could be strengthened by (1) selecting and targeting peer leaders based on sex, and (2) leveraging other types of social networks beyond simply friendships.

Early adolescent substance use in Mexican origin families: Peer selection, peer influence, and parental monitoring

BackgroundBecause adolescents vary in their susceptibility to peer influence, the current study addresses potential reciprocal effects between associating with deviant peers and use of alcohol, tobacco and other drugs (ATOD), as well as the potential buffering role of parental monitoring on these reciprocal effects. Method674 children of Mexican origin reported at fifth and seventh grade (10.4 years old at fifth grade) on the degree to which they associated with deviant peers, intended to use alcohol, tobacco or other drugs (ATOD) in the future, and had used controlled substances during the past year. Trained observers rated parental monitoring from video-recorded family interactions at the first assessment. ResultsYouth who intended to use ATODs during fifth grade experienced a relative increase in number of deviant peers by seventh grade, and youth with more deviant peers in fifth grade were more likely to use ATODs by seventh grade. Parental monitoring buffered (i.e., moderated) the reciprocal association between involvement with deviant peers and both intent to use ATODs and actual use of ATODs. ConclusionsParental monitoring can disrupt the reciprocal associations between deviant peers and ATOD use during the transition from childhood to adolescence.

Using biological samples for youth ATOD survey validation

Objective: To identify the conditions under which (1) youth would prefer to participate and (2) parents would allow their child to participate in the collection of biological samples for the purposes of validating a self-report alcohol, tobacco, and other drug (ATOD) survey. Design: Focus groups were held with youth in grades six through 12 and parents of youth entering those grades in the pending academic year. Setting: This study was conducted in Monroe County, Indiana, USA.Method: Six focus groups were held with a total of 23 youth and eight parents in June and July of 2014. Participants were recruited using a tiered convenience sample. All utterances were transcribed verbatim in real time. Content was entered into the DeDoose software package for mixed methods analyses. Results: Significantly more youth respondents would assent to toenail and saliva collection than to urine or venous blood collection. Collection of the latter bio-specimens was perceived to be uncomfortable or was associated with punishment. Parents and youth suggested several ways to lessen concerns, such as adding more participant autonomy to procedures. Conclusion: Input from various stakeholders is important to the implementation of an ATOD bio-validation study in schools to address prevailing concerns and promote participation. Decisions about study procedures should consider the views/suggestions of students, parents, and school personnel, in conjunction with requirements to retain methodological rigor and purpose of the study. The results indicate an inherent tension between a researcher’s ability to simultaneously accommodate requests and adhere to desired methodological precision.