Older Youth Research Articles

Do Peers, Neighborhood Disorder, Religiosity, Spirituality, and Family Support Influence Polysubstance Use Among Older Youth Transitioning from Foster Care?

ABSTRACT Purpose Few studies have explored polysubstance use among youths aging out of foster care, despite higher rates of substance misuse for youths exiting foster care than those in the general population. Polysubstance use has been linked to substance use disorders, health problems, cognitive impairment, suicide, and overdose. Method This study investigates understudied risk and protective factors associated with polysubstance use with data from 384 youth who turned 17 years old between December 1, 2001, and June 30, 2003, and were transitioning out of foster care from the Missouri Children’s Division. We conducted bivariate analyses with chi-square tests for categorical variables and Analysis of Variance with continuous independent variables. Then we conducted a multinomial logistic regression to explore differences between individuals who used 1 or no substances, individuals who used only alcohol and marijuana, and individuals who used 2 or more substances. Results Bivariate analyses found that being white, having deviant peers, and living in a more disordered neighborhood were risk factors for polysubstance use. Multinomial logistic regression results found that being white (RR = 6.89, p < .001), having deviant peers (RR = 1.15, p < .001), and living in a more disordered neighborhood (RR = 1.13, p < .05), increased the risk engaging in polysubstance use. Discussion Similar to findings in other studies, we found that deviant peers and neighborhood disorder increase the risk of polysubstance use, but family support, church attendance, and spirituality were not protective against polysubstance use. Conclusion Interventions should work to reduce deviant peer relationships among foster youth.

Youth intentions to provide social support to a peer with a concussion

ABSTRACT Objectives 1) To describe demographic factors, concussion knowledge, attitudes, subjective norms, self-efficacy and intentions to provide social support to a peer with a concussion and 2) to examine if demographic factors and concussion knowledge are associated with components of the Theory of Planned Behavior. Methods The survey was completed between October 2018 and February 2019 by 200 youth (M = 15.30 years, SD = 1.52). Questions were designed for athletes and non-athletes and inquired about various types of social support. Data analysis included descriptive statistics, Wilcoxon Rank Sum Tests and Spearman’s Rank-Order Correlation Coefficients. Results More favorable attitudes and intentions to provide social support were observed among females (W = 2576, p ≤ 0.001; W = 2411, p ≤ 0.001), older youth (rho = 0.32, p ≤ 0.001; rho = 0.41, p ≤ 0.001) and those with higher concussion knowledge (rho = 0.29, p ≤ 0.001; rho = 0.22; p ≤ 0.001). Participating in sports with a high-risk of concussion was associated with lower attitudes and intentions to provide social support (W = 6677; p ≤ 0.001; W = 6721; p ≤ 0.001). Self-reported concussion history or knowing someone with a concussion history was not significantly associated with social support intentions. Conclusion This study identified characteristics of youth who had positive intentions to provide social support. These findings identify individuals who may model providing social support to a peer, as well as opportunities for future concussion education.

A Longitudinal Study of Risk Factors for Sexual Victimization in Puerto Rican Youth.

To determine whether youth, family, and neighborhood factors and minoritized status are associated with youth-reported sexual victimization from childhood through young adulthood. We analyzed longitudinal data from 2 population-based samples of Puerto Rican youth living in the South Bronx (as a minoritized group) and Puerto Rico (as a nonminoritized group). Waves 1 to 3 were collected annually beginning in 2000 (youth age 5-13). Wave 4 was collected 2013 to 2017 (youth age 15-29). We estimated multivariable associations between youth, family, and neighborhood factors and minoritized status at Wave 1 (independent variables); and youth-reported sexual victimization at Waves 1 to 4 (dependent variables). None of the factors was associated with youth-reported sexual victimization at Wave 1 (N=1911). Among youth reporting no previous history of sexual victimization at Wave 1 (n=1823), youth in the South Bronx vs Puerto Rico were more likely to report sexual victimization at Waves 2 or 3 (odds ratio (OR) [95% confidence interval (CI)]=3.62 [1.46-8.97]). Older youth were less likely to report sexual victimization (OR [95% CI]=0.77 [0.65-0.91]) (all P < .01). Among youth reporting no history of sexual victimization at Waves 1 to 3 (n=1782), youth in the South Bronx (OR [95% CI]=2.53 [1.52-4.22]), female youth (OR [95% CI]=2.81 [1.83-4.30]), and youth whose parents had more than a high school degree (OR [95% CI]=2.25 [1.38-3.67]) were more likely to report sexual victimization at Wave 4 than their counterparts (all P ≤ .001). Future research should investigate how living as a minoritized youth may contribute to an increased risk of sexual victimization.

Driving under the influence of cannabis and alcohol: Evidence from a national sample of young drivers

ObjectiveDriving under the influence (DUI) of psychoactive substances is an important public health and criminal justice issue, impacting the lives of millions of Americans. Although recent research provides up-to-date information regarding DUI among adults, there is a pressing need for research that focuses specifically on younger/underage drivers. We draw from a large, nationally-representative sample to provide up-to-date evidence as to the prevalence and key criminal justice, substance use, and behavioral health correlates of DUI of cannabis and alcohol among drivers ages 16 to 20 in the United States. MethodsWe used data from the 2020 and 2021 National Survey on Drug Use and Health (young drivers ages 16–20; N=12,863). All analyses—survey adjusted prevalence estimates, logistic regression—were conducted using Stata SE 17.0 and weighted to account for the study’s stratified cluster sampling design. ResultsThe prevalence of DUI-cannabis for the full sample—including those not endorsing past-year use—was 6.3%. Among youth endorsing past-year cannabis use, 24.5% reported DUI of cannabis. In the full sample and among cannabis users, DUI-cannabis risk was elevated among older and male youth. The prevalence of DUI-alcohol was 2.6% among all youth and 6.1% among youth reporting past-year alcohol consumption. ConclusionsEstimates indicate that more than one million young drivers each year are placing their lives and those of others at risk by operating motor vehicles after consuming cannabis and/or alcohol. Findings underscore the importance of prevention efforts targeting underaged cannabis and alcohol-impaired driving.

Rising trends in the burden of migraine and tension-type headache among adolescents and young adults globally, 1990 to 2019

BackgroundHeadache disorders are major contributors to disability in adolescents and young adults worldwide. We aimed to analyze global trends in the burden of migraine and tension-type headache in 10 to 24-year-olds from 1990 to 2019.MethodsData were obtained from the Global Burden of Disease Study (GBD) 2019 to examine trends in incidence, prevalence, and disability-adjusted life years (DALYs) for migraine and tension-type headache in adolescents and young adults by location, age, sex and sociodemographic index (SDI). Joinpoint regression analyzed trends and identified years of significant change.ResultsGlobally, migraine and tension-type headache incidence, prevalence, and DALYs increased from 1990 to 2019, though with some fluctuations. The highest growth in migraine incidence occurred in males and individuals aged 10-14, while for tension-type headache incidence, it was observed in males and individuals aged 20-24. Prevalence and DALYs were highest for both disorders in females and those aged 20–24 years. Incidence increased fastest in East Asia for migraine and tension-type headache. For migraine, Tropical Latin America had the fastest increase in prevalence and DALYs. East Asia had the fastest increase in prevalence of tension-type headache, while North Africa and the Middle East had the highest growth in DALYs. Some high-income countries such as Singapore, Norway, and Iran (Islamic Republic of) demonstrated fast increases, while a few countries including Qatar, Thailand and Ethiopia decreased.ConclusionsThe incidence, prevalence and disability from migraine and tension-type headache are rising in adolescents and young adults, especially in males, older youth and middle SDI populations. The increasing trends highlight the need for targeted interventions focused on prevention and control in priority populations. Continued monitoring of trends can help identify strategies to promote headache health and reduce the life-course impacts of headache disorders globally.

Mentoring, employment assistance, and enhanced staff outreach for older youth in care: Outcomes from a randomized controlled trial

Youth who exit out-of-home care to live on their own face high risks for homelessness, unemployment, and incarceration. Federal support for the extension of services after age 18 provides the opportunity to better support youth in early adulthood, but to fully realize this potential requires the development of services with demonstrated positive impacts. This study contributes to the limited methodologically strong research in this area in a randomized controlled trial examining the impact of job readiness training, mentoring, and enhanced outreach by a youth specialist in an urban sample of youth (N = 152, 82% Black). Youth were interviewed at baseline when they were 17–20 years old and 14 months later to assess youth outcomes including employment, school enrollment, delinquency, and depression. Those randomized to receive enhanced services all received regular outreach from a youth specialist and could choose to participate in a mentoring and job readiness programs. Although less than a third of eligible youth fully completed either formal program, youth in the enhanced services condition had significantly fewer arrests, lower delinquency, and increased hours of employment. These outcomes were unrelated to changes in social support needs, counter to expectations. Future research is needed to build on these findings and those from other programs with positive effects in other areas such as educational outcomes to create effective service systems for older youth in care.

Trauma is only part of the story: Strengths moderate the relationship between trauma and needs for older youth in foster care.

Many youth in foster care endure traumatic experiences (TE) that can lead to lasting negative outcomes. However, the identification of strengths may mitigate the impact of TE. This study examines the frequency and distribution of identified strengths; whether strengths moderate the association between TE and various outcomes; and whether certain strengths have a larger moderation effect on the association between TE and life domain functioning. Administrative and clinical data, including the Child and Adolescent Needs and Strengths (CANS) assessment, were examined for 3324 transition age youth and emerging adults in out-of-home foster care in the United States. Participants were males and females between 14.5 and 21 years old. Pearson's chi-square tests of association were conducted to determine whether identification of strengths varied significantly by sex or race/ethnicity. Negative binomial regressions were used to determine whether strengths modified the association between TE and needs domains. Of 11 measured strengths, 56% of youth had 7 or more strengths identified as centerpiece strengths, and 20% had all 11. No significant differences in identification of strengths were found across sex or race/ethnicity. All strengths significantly moderated the association of TE and outcomes across CANS domains tested. While cumulative strengths had the largest overall moderation effects, identification of education setting, coping and savoring skills, and interpersonal strengths as centerpiece strengths had the largest moderation effect among specific strengths. Findings suggest assessing, identifying, and bolstering strengths may help to promote well-being after trauma exposure.

Identifying HIV-exposed uninfected children and adolescents in resource-limited settings: the HOPE study experience

HIV-exposed uninfected (HEU) children and adolescents are at higher risk of poor outcomes compared to HIV-unexposed children (HUU). In program settings, it is critical to understand how to identify HEU for screening services. We describe our experience identifying HEU for a neurodevelopment and mental health screening study. We recruited mothers living with HIV (MLHIV) and mothers not living with HIV (MNHIV) and enrolled their HEU or HUU children. We summarise the reasons for ineligibility and recruitment challenges. Among MLHIV, their child’s ineligibility increased with age: 12%, 27%, 50% and 80% in age groups 3–6, 7–10, 11–14, and 15–18, respectively (p < 0.001). Reasons for ineligibility were unknown maternal HIV status during pregnancy or breastfeeding (30%), and maternal disinterest due to fear of inadvertent disclosure of their HIV status to older youth. Recruiting older HEU youth is challenging. Maternal concerns of self-disclosing their HIV status impedes identification of older HEU.

Longitudinal Association Between Youth Multimorbidity and Psychological Distress: Impact of the COVID-19 Pandemic.

This research examined longitudinal associations between youth physical-mental multimorbidity and psychological distress before and during the COVID-19 pandemic; assessed the contextual impact of the pandemic on these associations; and, investigated potential moderating factors. The Multimorbidity in Youth across the Life-course, an ongoing study of youth aged 2-16 years (mean 9.4; 46.9% female) with physical illness, was used as the sampling frame for this COVID-19 sub-study, in which 147 parent-youth dyads participated. Psychological distress was measured using the Kessler-6 (K6). Multimorbidity was associated with higher pre-pandemic, but not with intra-pandemic distress. Disability moderated pre-pandemic distress-multimorbidity was associated with higher K6 among youth with high disability, but not among youth with low disability. Age moderated intra-pandemic distress-multimorbidity was associated with higher K6 in older youth, but not among younger youth.

1116-P: Increase in the Incidence of Type 2 Diabetes in Children &amp;lt;11 Years during the COVID-19 Pandemic

Objectives: To analyze the incidence and characteristics of new-onset type 2 diabetes (T2D) in youth &amp;lt; 11years prior to and during the COVID-19 pandemic, and to compare the metabolic parameters at presentation in younger (&amp;lt; 11 years) versus older youth (11-21 years). Study methods: We performed a retrospective chart review of newly diagnosed T2D among youth &amp;lt; 21 years at Hasbro Children's Hospital between 1/1/2017 and 12/31/2021. We analyzed the incidence of cases presenting at &amp;lt; 11 years pre (1/1/2017 to 2/29/20) and during (3/1/20-12/31/21) the COVID-19 pandemic. We compared metabolic parameters of those presenting &amp;lt; 11years to ≥ 11 years during the pandemic. Results:Eight youth &amp;lt; 11 years (8/145, (5.5 %)) presented with new-onset T2D during the study period (Table1), and all presented during the pandemic (8/89, 9%). Compared to older youth, those &amp;lt; 11years had higher BMI percentile (166% of the 95th%tile ± 38.4 vs. 139.4% ± 42.6, p=0.03), and were more likely to have diastolic hypertension (62.5% vs. 23.8%, p=0.03). Conclusions: We report an abrupt rise in the incidence of new-onset T2D in children &amp;lt; 11 years during the COVID-19 pandemic. Compared to older youth, younger children were more obese, and were more likely to have diastolic hypertension. Further study is needed to elucidate contributing factors to this concerning finding, and to further aid in pediatric T2D prevention. Disclosure S.Sasidharan pillai: None. P.Has: None. L.S.Topor: None. M.E.Fredette: None.

Longitudinal Associations of Adolescent Stress and Cortisol, Testosterone, and DHEA during the COVID-19 Pandemic

The COVID-19 pandemic is a prolonged, chronic stressor. We examined longitudinal associations of adolescent-reported pandemic-related stressors and cortisol, dehydroepiandrosterone (DHEA), and testosterone, in 11/20-02/21 [Winter20] and 08/21-10/21 [Fall21], during the second and third waves of US case counts. Participants included adolescents (10.5-18 years; 52% male) from the US-based Early Growth and Development Study. We analyzed six stress-related survey measures (nWinter20=124; nFall21=109): pandemic disruptions (e.g., to sleep, activity, leaving house), family activity restrictions, negative impacts of the pandemic, worry about covid/pandemic, stress attributed to covid/pandemic, and pandemic-related stress (e.g., attention to/stressfulness of pandemic-related changes). Hormones were assayed from hair (nWinter20=118; nFall21=40). We assessed correlations among and between survey and hormone measures at both timepoints for the full sample, and split at age 13 (older/younger). Stress measures were modestly stable, rs=.29(restrictions)-.49(pandemic-related stress; negative impacts), ns=75-77. Testosterone levels were stable, r=.59, but not cortisol or DHEA; Winter20 testosterone predicted Fall’21 DHEA, r=.62, ns=26. In Winter20, disruptions, COVID-attributed stress, and pandemic-related stress were related to lower testosterone, rs=-.25 to -.26, ns=69-70. For older youth, Winter’20 disruptions, negative impacts, and pandemic-related stress was related to Fall21 cortisol, rs=.50-.69, n=18. In Fall21, all stress measures except disruptions correlated with cortisol, rs=.49-.70, n=26. Pandemic-related stress was related to lower testosterone and higher cortisol. Associations of cortisol in Fall21 but not Winter20 may suggest that the longevity of the pandemic has worsening effects on adolescent cortisol.

Prevalence and Predictors of Intimate Partner Violence Among Youth With Foster Care Histories.

A small but growing body of research suggests that adolescents and young adults involved with the child welfare system and those transitioning out of foster care are at heightened risk of experiencing intimate partner violence (IPV). Understanding the factors that place youth at risk of IPV is central to prevention and treatment of this public health problem. However, questions remain about the prevalence and correlates of IPV among youth in foster care. Additionally, emotional abuse, a particular form of IPV in intimate partnerships, remains an understudied area in this population. This study aimed to address these gaps in research by exploring factors associated with IPV using longitudinal data from a representative sample of older youth in California Foster Care who participated in the California Youth Transitions to Adulthood Study (CalYOUTH). Our IPV outcome measures included victimization, perpetration, bidirectional IPV, and emotional abuse. Findings suggest that approximately one-fifth (20.4%) of CalYOUTH respondents had experienced some form of IPV at age 23, with emotional abuse and bidirectional violence being the most commonly reported types of IPV. Females reported emotional abuse, as well as bidirectional violence, at nearly double the rates of their male counterparts. Self-identified sexual minority youth (SMY; lesbian, gay, bisexual, transgender, queer, or questioning) were more likely to report IPV victimization, IPV perpetration, and bidirectional violence than their non-SMY peers. Youth with histories of emotional abuse, caregiver IPV victimization, sexual abuse in foster care, placement instability, substance use, anxiety, and incarceration were also at heightened risk of IPV involvement. Emotional abuse was most prevalent with SMY. The findings contribute to the growing research on IPV among transition-age foster youth with important implications for future research, practice, and policy.

Individual and community level predictors of women’s autonomy in health care decision-making among youth in East African countries: a multilevel analysis

ObjectiveThe autonomy of young women in healthcare decision-making has been reported to be lower, particularly in low-income and middle-income countries. This study was conducted to estimate the magnitude and the...

Supporting intersecting cultural needs of gender and age by increasing cultural safety and humility for Housing First initiatives

BackgroundTo sufficiently house and support persons experiencing homelessness (PEH), deeper understandings of the cultural appropriateness and responsiveness of community resources and the service delivery system is essential. In the case of Metro Vancouver, Canada, the cultural appropriateness and responsiveness of Housing First as a service model for supporting PEH was explored.MethodsLocal service providers and stakeholders (n = 52) participated in three full day service-mapping workshops to identify Housing First supports for older adults, youth, and women experiencing homelessness, as part of a municipal-wide participatory and action-oriented study. Data were analyzed using a structured framework thematic analysis approach and cultural safety and humility lenses.ResultsWe generated three key themes: (i) insufficient built environments create challenges across gender and age, (ii) cultural safety and humility concerns at the intersection of gender and age, and (iii) implications for a culturally-responsive Housing First implementation.ConclusionsFindings informed the development of a Culturally-Responsive Planning resource to support housing, health, and social service providers who are implementing Housing First initiatives.

Why do children cooperate with police? The nexus of the authority relations and cognitive developmental perspectives

Police must rely on the public’s cooperation; however, youths’ views of police are historically low. To understand the dynamics of these intergroup relations, this study integrates two theoretical perspectives: the cognitive developmental perspective, which posits that age-graded cognitive enhancements enable children to begin critically evaluating police; and the group engagement model, which suggests that views of police impact law-related behavior. Utilizing a sample of 424 community youth (37.97% Hispanic/Latinx, 19.81% Native American), this study tested four novel hypotheses: H1: Age is negatively associated with youths’ willingness to cooperate (WTC) with police; H2: Age is negatively associated with normative alignment with police; H3: Normative alignment is positively associated with WTC; and H4: Normative alignment is more strongly associated with older youths’ WTC. All four hypotheses were supported. The article discusses the implications of both the integration of these theoretical perspectives and the findings for understanding the effects of these intergroup dynamics.

Reviewing the Literature on the Impact of Gun Violence on Early Childhood Development.

To examine the impacts of gun violence on early childhood development including early childhood mental health, cognitive development, and the assessment and treatment of survivors. The literature reflects that gun violence exposure is often associated with significant mental health outcomes including anxiety, post-traumatic stress, and depression in older youth. Historically, studies have focused on adolescents and their exposures to gun violence through proximity to gun violence within their communities, neighborhoods, and schools. However, the impacts of gun violence on young children are less known. Gun violence has significant impacts on mental health outcomes of youth aged 0-18. Few studies focus specifically on how gun violence impacts early childhood development. In light of the increase in youth gun violence over the past three decades with a significant uptick since the onset of the COVID-19 pandemic, continued efforts are needed to better understand how gun violence impacts early childhood development.

Addressing the Surge in Unaccompanied Migrant Children

Unaccompanied migrant children (UMC) account for a growing share of apprehensions along the US-Mexico border. Contrary to past UMC flows, which were primarily comprised of older youth fleeing violence in Mexico, recent UMC flows include children of all ages escaping life-threatening conditions in Central America's Northern Triangle. To manage the growing influx of UMC, the Biden Administration established surge facilities, which rely on emergency standards to house and care for the children. We show that surge facilities created capacity in traditional shelters, enabling them to accommodate tender-age children and reducing the number of children in foster care.

Peer-elicited alcohol craving in adolescents and emerging adults: Bridging the laboratory and natural environment.

Although peers figure prominently in developmental models of alcohol use, our understanding of the influence of peer social context in cue reactivity paradigms with adolescents and emerging adults in the human laboratory and the natural environment is limited. This study tested associations between alcohol craving among youth in the human laboratory using alcohol-related images, with and without peers, and in the natural environment using ecological momentary assessment (EMA). Data for this preregistered secondary analysis were collected prior to randomization in two medication trials (N=115). Participants completed an image cue exposure paradigm at the baseline laboratory session followed by approximately 7 days of EMA. In the laboratory, model-based mean comparisons from multilevel models (MLMs) showed that all drinking images elicited greater craving than neutral images. No differences were observed across the three image categories containing alcohol. Image category by age interactions demonstrated that, compared to older youth, younger youth displayed lower craving in response to neutral versus social drinking context with peers images and older, compared to younger, youth displayed higher craving in response to nonsocial drinking images versus social drinking contexts with peers images. In the natural environment, craving was greatest when youth were in the presence of alcohol-using peers and alcohol-related cues, regardless of age. Laboratory craving to alcohol images was positively associated with craving in the natural environment. For youth, peers are a salient social context associated with increased craving, particularly in the natural environment. Laboratory cue reactivity to alcohol images predicted real-world craving, further supporting the ecological validity of this paradigm in youth.

Family, mental health, and placement outcomes of a low-cost preventive intervention for youth in foster care

This study assessed secondary outcomes of Connecting, a low-cost, self-directed, family-based prevention program for families with youth placed in their care by state child welfare agencies. Families caring for youth aged 11 to 15 years within Washington State were recruited and randomly assigned into either the Connecting program (n = 110) or a treatment-as-usual control condition (n = 110). The program included a 10-week sequence of self-directed family activities and DVDs with video clips. Survey data were collected from caregivers and youth at baseline, immediately post-intervention, and at 12 and 24 months post-intervention; placement data was collected from the child welfare department as well. Intention-to-treat analyses focused on 5 classes of secondary outcomes at 24 months post-intervention: caregiver-youth bonding, family climate, youth risk behavior attitudes, youth mental health, and placement stability. There were no intervention effects in the full sample. In subgroup analyses, among older youth (ages 16–17) but not younger youth (ages 13–15), the Connecting condition (vs. controls) yielded more frequent caregiver-reported bonding communication, bonding activities, warmth, and positive interactions, as well as less favorable youth attitudes towards early initiation of sexual behavior and substance use, and fewer youth self-injurious thoughts. Consistent with the social development model, the divergent outcomes between younger and older youth suggests Connecting’s driving mechanisms involve social processes that undergo critical shifts between early and mid-adolescence. Overall, the Connecting program showed promise in older youth for long-term promotion of caregiver-youth bonding, healthy behaviors, and mental health, but did not demonstrate long-term efficacy in facilitating stable or permanent placement of youth in care.

Co-Regulation as a Support for Older Youth in the Context of Foster Care: a Scoping Review of the Literature.

Co-regulation is a relatively new theoretical framework for interventions that connects developmental science to adolescent needs and provides strategies that can be applied across contexts. It also has value in shifting the focus of interventions to the role of relationships and interactions with caring adults, as well as supportive environments. This framework may be particularly salient for older youth with foster care experience whose relationships with adults and availability of developmental supports are disrupted. To understand how co-regulation aligns with current understanding of needs and supports for this population, we conducted a scoping review that involved systematically searching four databases, coding and charting relevant information, and actively engaging expert consultants and other stakeholders. Across 46 primarily descriptive articles, co-regulation was discussed most often in relation to relationships, as expected (89% of articles). Despite theoretical and empirical evidence of the benefits of supportive environments and intentional day-to-day interactions in promoting developmental skills and competencies, these two domains of co-regulation were referenced much less (39% and 28%, respectively). Results highlight opportunities for co-regulation supports that can be provided to older youth with foster care experience by caring adults and near-aged peers in a wide range of roles. Notable limitations in the literature were identified in applying co-regulation within the context of employment and career readiness, healthy relationships, and teen parenting. Also under-researched is the role of adult self-regulation skills and co-regulation approaches for youth from diverse backgrounds, including those who identify as LGBTQ or have disabilities. Considerations for practice and future research are provided.