High-risk Substance Use Research Articles

Predicting HCV Incidence in Latinos with High-Risk Substance Use: A Data Science Approach

ABSTRACTHepatitis C virus (HCV) in the U.S. has tripled in the prior five years, and injecting drug use is the primary risk for HCV, with up to 90% of older and former people who inject drugs (PWIDs) testing positive. Laboratory testing of HCV for any PWIDs is the gold standard, however many PWIDs lack access to health treatment or services. Identifying risks of HCV via a data science approach would aid community health workers (CHW) to rapidly link those most at risk of infection with treatment. This study employed a data-science approach to determine the strongest risk factors of HCV in a sample of Mexican-Americans WIDs n = 221 (96 negative/125 positive). Data included 238 demographic and psychosocial predictors. A Random Forest machine learning algorithm demonstrated significant prediction improvement over baseline no information rate comparison. Strongest risks for positive HCV included sharing drug-use equipment and younger age at first heroin use; receiving drug-education during incarceration was protective. A ROC curve fit to the prediction yielded an area under the curve of 0.77. Predictive variables of HCV in the present analysis can be obtained via screening by CHW. Identification of patients most at risk of HCV within community settings can maximize treatment utilization.

Longitudinal associations between minority stressors and substance use among sexual and gender minority individuals

BackgroundSexual and gender minority individuals (SGM) are at increased risk for substance use and substance use problems compared to heterosexual individuals. A growing cross-sectional literature has demonstrated that minority stressors are associated with higher risk for substance use among SGM individuals. However, longitudinal research in this area is limited and existing longitudinal studies have focused almost exclusively on one type of substance use (alcohol) and one minority stressor (SGM victimization). MethodsTo extend the longitudinal body of research on associations between minority stressors and substance use, we utilized seven waves of data from a longitudinal cohort study of 1091 SGM individuals assigned male at birth to examine associations between three minority stressors, general stress, and marijuana and alcohol use. ResultsAt the within-person level, results indicated that when individuals experienced more internalized stigma, microaggressions, victimization, or general stress than usual, they reported more concurrent alcohol problems. Further, when individuals experienced more microaggressions or general stress than usual, they also experienced more concurrent marijuana use problems. However, stressors were not prospectively associated with higher rates of alcohol or marijuana problems six months later. ConclusionsFindings indicate that minority stressors are consistently associated with more concurrent alcohol problems, while these associations may be less consistent for marijuana problems. The lack of prospective effects of minority stress on substance use points to the need for innovative methods for examining these effects, such as daily or weekly diary studies.

Risk and protective factors for transgender youths' substance use.

Research at the intersection of substance use and protective factors among transgender youth is scarce; emerging evidence suggests high risk for substance use for transgender youth. We analyzed data from 323 transgender youth aged 14–18 (Mage = 16.67) to investigate the extent that risk (enacted stigma) and protective factors (support from family, school, friends) were related to substance use (i.e., cannabis and tobacco use, binge drinking). Enacted stigma was linked to higher odds of substance use behaviors, family connectedness was related to lower levels of tobacco and cannabis use, and more than one protective factor significantly lowered the probability of engaging in substance use behaviors. Support from multiple sources may be differentially protective against substance use for transgender youth.

Dealing with gender-related and general stress: Substance use among Brazilian transgender youth

IntroductionAdolescent substance use is a major public health concern since it enhances adolescent morbidity and mortality, affecting adulthood health and well-being. Although current evidence shows a high risk for substance use among transgender populations, to date, few studies evaluate substance use among transgender youth. MethodBrazilian transgender youth (ages between 16 and 25 years old) answered an online questionnaire measuring demographics, substance use and modifiable factors associated with drug use to deal with general stress, gender-related stress, and recreational use. ResultsCannabis was the most frequent substance used among transgender youth (20.88%; CI 95% 23.71–36.19), whereas 11.45% (CI 95% 11.38–21.47) of volunteers disclosed use of pain medication, such as codeine, and 5.05% (CI 95% 3.71–10.78) revealed use of sedatives and tranquilizers in the last 30 days. ADH medication (not prescribed), as well as cocaine and other drugs (such as antihistamines and Hookah), was also reported by 2.36% (CI 95% 0.92–5.84), 2.69% (CI 95% 1.24–6.49) and 4.04% (CI 95% 2.61–8.98) of transgender youth. ConclusionA logistic regression model showed that discrimination and home instability were the primary determinants of vulnerable to substance use among youth. Therefore, the harm reduction strategies must affect the social and physical aspects of transgender youth lives.

Defining “High-risk Sexual Behavior” in the Context of Substance Use

Introduction: Sexual behavior is a behavior exhibited by individuals to gratify one of their basic needs, that is the sexual need. Often the way in which sexual behavior is practiced may lead to negative consequences. However, the definition of a sexual behavior as risky varies with regards to culture, gender, age, and the threshold. Objectives: This review aims to study different definitions of high-risk sexual behavior available in literature, the differences in the prevalence of various risks associated with risky sex in substance-using population as compared to general population, and eventually formulating a tentative definition of “high-risk sexual behavior” in the context of substance use. Current evidence and results of literature search as we have entered into the epidemic of human immunodeficiency virus globally, it is important clinically as well as from the public health perspective to define high-risk sexual behavior discretely helping the researchers quantify the burden and the clinicians focus on the population at risk. High-risk sexual behavior has often been discussed and studied in various studies till date. However, literature lacks a discrete definition of high-risk sexual behavior. Risky sex (or high-risk sexual behavior) has been variably defined in different studies. Majority of the definitions in the studies focus on sexually transmitted infection, especially human immunodeficiency virus. A few studies talk about unintended pregnancies or abortions. Conclusion: The association between high-risk sexual behavior and substance use has been well established. Further research is warranted to obtain a definition which has greater precision and clinical utility, and which can be integrated in preventive and promotive pursuits.

Violence Victimization, Substance Use, and Suicide Risk Among Sexual Minority High School Students - United States, 2015-2017.

Youths identifying as lesbian, gay, bisexual, or another nonheterosexual identity (sexual minority youths) report more violence victimization, substance use, and suicide risk than do heterosexual youths (1). These disparities are generally attributed to minority stress (the process through which stigma directed toward sexual minorities influences health outcomes) (2,3). Sexual minority youths might experience negative outcomes associated with minority stress differently across sexual identities, but to date, no nationally representative study has examined differences in victimization, substance use, and suicide risk within sexual minority youth. Using pooled data from the 2015 and 2017 national Youth Risk Behavior Surveys (YRBS), relationships between sexual identity groups and victimization, substance use, and suicide risk were evaluated with sex-stratified logistic regression models. Compared with heterosexual students, bisexual females and all sexual minority males reported more victimization; lesbian and bisexual females reported more use of alcohol, cigarettes, and marijuana; and all sexual minority youths reported elevated high-risk substance use and suicide risk. Programmatic efforts to reduce and prevent victimization, substance use, and suicide risk among sexual minority youths might benefit from consideration of issues within group differences.

Group-based trajectories of parent-child communication and parental knowledge between sexual minority and heterosexual girls and their associations with substance use

IntroductionSexual minority girls (SMGs) may be at high risk for substance use partially due to anti-gay discrimination. Low levels of parent-child communication and parental knowledge may contribute to this risk. This study seeks to identify parent-child communication and parental knowledge trajectories, determine the likelihood of SMGs following these trajectories, and describe the relationships between these trajectories, sexual orientation, and substance use. MethodsThis is a secondary data analysis of the Pittsburgh Girls Study (N = 2450), a longitudinal study on the changes in behaviors among girls throughout childhood. We generated group trajectory models of parentchild communication and parental knowledge starting from age 12 to age 17 years. We then tested the likelihood of SMGs belonging to these group trajectories and the association between group trajectory membership and substance use at age 18 years. ResultsSMGs were more likely than were heterosexual girls to follow the infrequent decreasing parent-child communication trajectory and the slowly decreasing parental knowledge trajectory and were more likely than were heterosexual girls to engage in substance use at age 18 years. Parent-child communication and parental knowledge trajectories were statistically significant mediators between sexual orientation and substance use. ConclusionFrequency of parent-child communication and levels of parental knowledge may be determinants of substance use among SMGs. These results have implications for developing substance use prevention programs among sexual minority youth targeting parent-child relationships.

Family and Peer Influences on Substance Attitudes and Use among Juvenile Justice-Involved Youth.

Juvenile justice-involved youth experience high rates of substance use, which is concerning given associated negative consequences, including health and functional deficits. Family and peer factors are associated with a high risk of substance use among justice-involved youth. It is hypothesized that this risk process operates through pro-drug attitudes. However, limited research has been conducted on the mechanisms through which family and peer factors increase risk for substance use among juvenile justice involved youth. The current study examined both the direct and indirect effects of family and peer substance use on youth's substance use (alcohol and illicit drug use). We also examined whether this relationship differs by race. 226 detained youth (81.9% male; 74.3% Black) were recruited from an urban county in the Midwest and completed a clinical interview and substance use assessment battery. A direct effect of family/peer risk on illicit drug use was found for all youth, though the effect was stronger among White youth. Results also supported the indirect effect pathway from family/peer risk to both illicit drug use and alcohol use through pro-drug attitudes. This pathway did not vary by race. These findings suggest that interventions should focus on targeting both family/peer risk and pro-drug attitudes to reduce substance use. Given the racial difference in the direct effect of family/peer risk on illicit drug use, there may be other factors that influence risk more strongly for White youth, which warrants further investigation.

Trajectories of callous-unemotional traits from childhood to adolescence in referred youth with a disruptive behavior disorder who received intensive multimodal therapy in childhood.

PurposeOur aims were to explore the developmental trajectories of callous–unemotional (CU) traits using a growth curve analysis in Italian children with disruptive behavior disorders treated with a multimodal intervention, and to test both predictors and distal outcomes of CU traits trajectories.Patients and methodOne hundred and sixty-eight children were enrolled, of whom 24 were lost in the follow-up and 144 were followed up from ages 8–9 to 14–15 years with four assessment points. Patients included 128 males (88.9%) with a mean age of 8.7 years, 96 with oppositional defiant disorder (66.7%) and 48 with conduct disorder (CD) (33.3%). The developmental trajectories of CU traits were assessed with the Inventory of Callous–Unemotional Traits (ICU).ResultsOur findings revealed that CU features were likely to fit a quadratic model from childhood to adolescence. The CU traits tended to decrease during childhood, with stabilization in adolescence and a significant variability in the growth curves. Pretreatment CD and higher levels of externalizing behavioral problems were associated with higher level of CU traits at baseline, whereas positive parenting was associated with lower levels. No significant effects were found for all the other predictors (socioeconomic status, negative parenting, combined pharmacotherapy). Regarding outcomes into adolescence, both higher levels of CU traits at the baseline and a lower decrease of CU traits across time points predicted a higher risk of CD diagnosis, and higher rate of referrals to mental health services and of substance use. Furthermore, pretreatment CD and negative parenting predicted a higher risk of substance use into adolescence.ConclusionOur findings suggest that a close monitoring of CU traits in referred children with disruptive behavior disorders may help to detect the patients at higher risk of poor outcome.

The crossover effect: A review of racial/ethnic variations in risk for substance use and substance use disorder across development.

The "crossover" effect, a phenomenon by which some minority groups switch from low to high risk for substance use as a function of age, was first documented 25 years ago. However, rigorous methodological research examining the crossover effect has only recently emerged. The current paper reviews the past 25 years of research on the crossover effect, which has primarily examined the shift from low to high substance use risk among Blacks relative to Whites. Although findings regarding the crossover effect vary based on gender, socioeconomic status, and substance, Blacks and Hispanics appear to be at lower risk for some substance use- particularly binge drinking and cigarette smoking-than Whites during adolescence and early adulthood, but at higher risk for use in later life. Research regarding the crossover effect of substance use disorder and related problems is limited but more consistent with a similar pattern of effects observed. Due to significant limitations of the extant literature examining the crossover effect, it requires additional research clarifying sociodemographic differences in the, identifying its mechanisms, and determining its clinical implications. Such research may have important implications for preventing racial/ethnic disparities in the consequences associated with disordered substance use.

Substance Use Among American Indian Youths on Reservations Compared With a National Sample of US Adolescents

American Indian adolescents attending schools on or near reservations are historically at high risk for substance use. To compare rates of substance use among reservation-based American Indian adolescents vs rates among national US youths. Population-based survey study of 8th-, 10th-, and 12th-grade students attending participating schools on or near reservations, stratified by region, during the 2016-2017 school year. Substance use rates were compared with those of a national sample of comparably aged students from the Monitoring the Future study. Lifetime and last-30-day self-reported use of alcohol, marijuana, and other drugs, using relative risk (RR) ratios with 95% confidence intervals to compare American Indian student rates with Monitoring the Future student rates. Participants included 570 students in eighth grade (49.6% girls; mean age, 13.5 years), 582 in 10th grade (50.0% girls; mean age, 15.4 years), and 508 in 12th grade (53.5% girls; mean age, 17.4 years). American Indian students reported substantially higher lifetime and last-30-day substance use rates compared with the Monitoring the Future students, with greatest disparity at eighth grade: last-30-day substance use RRs for grade 8 were 2.1 (95% CI, 1.4-3.0) for alcohol, 4.2 (95% CI, 3.1-5.8) for marijuana, and 2.4 (95% CI, 1.7-3.3) for other illicit drugs. Compared with 2009 to 2012 data, the RRs between American Indian and Monitoring the Future students for lifetime alcohol and marijuana use did not change substantially from the 2016-2017 school year (alcohol: RR, 1.5 [95% CI, 1.4-1.6] vs RR, 1.3 [95% CI, 1.2-1.4], respectively; marijuana: RR, 2.0 [95% CI, 1.8-2.1] vs RR, 2.1 [95% CI, 1.9-2.3], respectively), but increased substantially for other drugs (RR, 1.8 [95% CI, 1.7-1.9] vs RR, 3.0 [95% CI, 2.9-3.2], respectively). Reservation-based American Indian students are at high risk for substance use compared with US youths in general, making prevention efforts critical. Cultural and value-based characteristics unique to American Indian populations may provide beneficial targets for prevention, but there is limited evidence on how cultural factors work to prevent risky behaviors. Without increased attention to these disparities, the costs to American Indian youths and their communities will remain high.

Prior Exposure to Intimate Partner Violence Associated With Less HIV Testing Among Young Women.

Low-income minority women are disproportionately represented among those living with HIV in the United States. They are also at risk for the SAVA (substance abuse, violence, and HIV/AIDS) syndemic issues. Women who have recently given birth are at high risk for substance use and intimate partner violence (IPV), and HIV testing is not routinely administered during the postpartum visit. We explored the relationship between substance use, IPV, and HIV testing among low-income young adult women attending Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a federally supported nutrition program. A survey assessed substance use, relationships in particular with violence exposure, and HIV testing behavior in the past 6 months among a convenience sample of 100 women aged 18 to 30. The survey was conducted at several WIC offices in an urban setting in the Mid-Atlantic region between June and December 2015. Physical violence was the only IPV variable significantly associated (p = .022) with not being tested for HIV in the past 6 months, remaining significant even after adjusting for demographic and other significant variables (adjusted odds ratio [AOR] = 0.02; 95% confidence interval [CI] = [0.00, 0.41]). Women exposed to physical IPV or psychological IPV in the past year were significantly more likely to have ever used an illicit drug (physical IPV: 34% vs. 59%, p = .052; psychological IPV: 22% vs. 53%. p = .002). These findings between physical IPV and HIV testing history highlight the need to further understand how the context of violence affects HIV testing behaviors. Providing convenient, safe, and accessible HIV testing sites in spaces like WIC may increase HIV testing rates overall and specifically among women experiencing IPV.

Are men's misogynistic attitudes associated with poor mental health and substance use behaviors? An exploratory study of men in Tijuana, Mexico.

Men's misogynistic attitudes (i.e., dislike or contempt for women) have been shown to be associated with men's perpetration of physical/sexual violence against women and poor health outcomes for women. However, these attitudes have rarely been examined for their influence on men's own health. This paper examines the socio-demographic, substance use, and mental health correlates of misogynistic attitudes among a binational sample of men (n=400) in Tijuana, Mexico with high-risk substance use and sexual behaviors. We used a 6-item scale to measure misogynistic attitudes (α = .72), which was developed specifically for this context. We used descriptive statistics to describe our sample population and the extent to which they hold misogynistic attitudes. Then, using misogynistic attitudes as our dependent variable, we conducted bivariate linear regression and multivariable linear regression to examine the relationship between these attitudes and socio-demographic characteristics, substance use behaviors (i.e., use of alcohol, marijuana, heroin, methamphetamines, cocaine), and mental health (i.e., depression, self-esteem). In the multivariable model, we found significant relationships between misogynistic attitudes and education level (t = -4.34, p < 0.01), heroin use in the past 4 months (t = 2.50, p = 0.01), and depressive symptoms (t = 3.37, p < 0.01). These findings suggest that misogynistic attitudes are linked to poor health outcomes for men and future research needs to further explore the temporality of these relationships and identify strategies for reducing men's misogynistic attitudes with the ultimate aim of improving the health and well-being of both women and men.

Energy and sports drinks in children and adolescents.

Sports drinks and caffeinated energy drinks (CEDs) are commonly consumed by youth. Both sports drinks and CEDs pose potential risks for the health of children and adolescents and may contribute to obesity. Sports drinks are generally unnecessary for children engaged in routine or play-based physical activity. CEDs may affect children and adolescents more than adults because they weigh less and thus experience greater exposure to stimulant ingredients per kilogram of body weight. Paediatricians need to recognize and educate patients and families on the differences between sport drinks and CEDs. Screening for the consumption of CEDs, especially when mixed with alcohol, should be done routinely. The combination of CEDs and alcohol may be a marker for higher risk of substance use or abuse and for other health-compromising behaviours.

Trauma, Family Factors and the Mental Health of Homeless Adolescents.

Family factors, such as poor family functioning and trauma, have been associated with negative outcomes for homeless adolescents. Further study is needed to better understand how family factors and trauma jointly relate to mental health problems and externalizing behaviors among homeless adolescents. Structural equation modeling was used to examine the influence of trauma (encompassing traumatic events experienced prior to, and after, becoming homeless) and family factors (poor family functioning and family conflict) on mental health problems and externalizing behaviors (substance use, delinquent behaviors, and sexual risk) among 201 homeless adolescents, ages 12 to 17 years. Trauma, poor family functioning, and family conflict significantly predicted greater mental health problems, delinquent behaviors, high-risk sexual behaviors and substance use. Overall, the findings suggest that family factors appear to be key to understanding mental health problems and externalizing behaviors among homeless adolescents. Implications, limitations and future directions are addressed.

The association between residential eviction and syringe sharing among a prospective cohort of street-involved youth

BackgroundSyringe sharing is a high-risk practice associated with the transmission of infectious diseases, such as HIV and HCV. While youth who contend with housing instability are known to be more likely to engage in high-risk substance use, the potential relationship between being evicted from housing and syringe sharing has not been examined. This study assessed whether residential eviction was associated with syringe sharing among street-involved youth in Vancouver, Canada.MethodsData were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use drugs age 14–26 in Vancouver, Canada. The study period was June 2007 to May 2014, and the potential relationship between residential eviction and syringe sharing was analyzed using multivariable generalized estimating equations (GEE) logistic regression.ResultsAmong 405 street-involved youth who injected drugs, 149 (36.8%) reported syringe sharing, defined as borrowing or lending a syringe, at some point during the study period. In a multivariable GEE analysis, recent residential eviction remained independently associated with syringe sharing (adjusted odds ratio (AOR) = 1.72, 95% confidence interval (CI): 1.16–2.57), after adjusting for potential confounders.ConclusionsSyringe sharing was significantly elevated among youth who had recently been evicted from housing. These findings indicate that policy and programmatic interventions that increase housing stability may help mitigate high-risk substance use practices among vulnerable youth.

Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review.

About 3.5% Americans identify themselves as lesbian, gay, or bisexual while 0.3% identify themselves as transgender. The LGBT (lesbian, gay, bisexual, and transgender) community belongs to almost every race, ethnicity, religion, age, and socioeconomic group. The LGBT youth are at a higher risk for substance use, sexually transmitted diseases (STDs), cancers, cardiovascular diseases, obesity, bullying, isolation, rejection, anxiety, depression, and suicide as compared to the general population. LGBT youth receive poor quality of care due to stigma, lack of healthcare providers’ awareness, and insensitivity to the unique needs of this community. The main objective of this literature review is to highlight the challenges faced by the LGBT youth and to enhance the awareness among physicians about the existing disparities in order to provide a more comprehensive, evidence-based, and humane medical care to this community.

History of being in government care associated with younger age at injection initiation among a cohort of street-involved youth.

Compared to the general population of youth, health-related disparities experienced by youth exposed to the child welfare system are well documented. Amongst these vulnerabilities are elevated rates of substance use, including injection drug use; however, less is known about when these youth transition to this high-risk behaviour. We sought to assess whether having a history of government care is associated with initiating injection drug use before age 18. Between September 2005 and May 2014, data were derived from the At-Risk Youth Study, a cohort of street-involved youth who use illicit drugs in Vancouver, Canada. Multivariable logistic regression analysis was employed to examine the relationship between early initiation of injection drug use and having a history of being in government care. Among the 581 injecting street-involved youth included, 229 (39%) reported initiating injection drug use before 18years of age. In multivariable analysis, despite controlling for a range of potential confounders, having a history of government care remained significantly associated with initiating injection drug use before age 18 (adjusted odds ratio=1.69; 95% confidence interval: 1.15-2.48). Youth with a history of being in government care were significantly more likely to initiate injection drug use before age 18 than street-involved youth without a history of being in care. These findings imply that youth in the child welfare system are at higher risk and suggest that interventions are needed to prevent transitions into high-risk substance use among this population.

Enhancing Social Work Students’ Knowledge and Attitudes Regarding Substance-Using Clients Through SBIRT Training

ABSTRACTScreening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based protocol that addresses both moderate-risk and high-risk substance use problems for individuals. In an urban college’s master’s and bachelor’s social work programs with 218 students, SBIRT training was introduced into core course curricula, with many students subsequently using SBIRT in their field placements. Evaluation of the initiative demonstrated increases in the students’ knowledge and favorable attitudes regarding working with substance using clients. Students’ ratings of the usefulness and effectiveness of SBIRT were high. In response to studies indicating the lack of preparedness of graduating social work students to work with substance users, this study demonstrated the effectiveness of SBIRT training to educate students to work with this population.

Psychological Distress and Associated Factors Among Mexican American Adolescent Females.

Mental health literacy is a critical component of adolescent health enabling recognition, management, and prevention of psychological distress. Adolescents engaging in risk behaviors and experiencing interpersonal violence, substance use, and pregnancy are at high risk for psychological distress. Secondary analysis of data collected via a control randomized trial among Mexican American females (aged 14-18 years; N = 461) experiencing high-risk sexual behavior, interpersonal violence, and sexually transmitted infection was conducted with comparisons of psychological distress by pregnancy status. At study entry, 46.4% (n = 214) self-reported ever experiencing pregnancy (ever-pregnant) while 53.6% (n = 246) self-reported never experiencing pregnancy (never-pregnant). Adolescents reporting ever-pregnancy status were older and school dropouts. However, adolescents reporting never-pregnancy experienced higher sexual risk behaviors, substance use, interpersonal violence, and psychological distress than those reporting ever-pregnancy. A higher proportion of ever- versus never-pregnant adolescents were born in Mexico and preferred Spanish language indicating less acculturation. Findings support the need for mental health literacy concerning psychological distress with consideration of implications of acculturation among adolescents experiencing high-risk sexual behavior, interpersonal violence, and substance use. More never- than ever-pregnant adolescents were attending school, presenting opportunities for implementation of health promotion strategies within community health settings for mental health literacy.