Prevention Of Substance Use Research Articles

Suicide Attempt and Risk of Substance Use Disorders Among Female Youths

Suicide attempts are prevalent among female youths, yet little is known about the subsequent development of substance use disorders. To assess the association between suicide attempts among females before 20 years of age and future risk of substance use disorders. In this longitudinal cohort study, females aged 8 to 19 years (hereafter referred to as youths) who attempted suicide were matched with female youths with no attempt between April 1, 1989, and March 31, 2019, in Quebec, Canada. The cohort was followed up for 31 years, for a total of 2 409 396 person-years, to identify subsequent substance use disorders. Confirmed suicide attempts among females 8 to 19 years of age. The main outcome measure was hospitalization for a substance use disorder later in life. Hazard ratios (HRs) and 95% CIs for the association of suicide attempt with substance use disorders were estimated using Cox proportional hazards regression models adjusted for baseline age, mental illness, resource-limited socioeconomic status, and year at start of follow-up. Among 122 234 female youths (mean [SD] age, 15.6 [1.9] years), 5840 (4.8%) attempted suicide and 4341 (3.6%) developed a substance use disorder. Compared with the 116 394 matched female youths who did not attempt suicide (95.2%), those who attempted suicide had a greater risk of hospitalization for any substance use disorder during the follow-up period (HR, 6.03; 95% CI, 5.39-6.77), especially sedative or hypnotic use disorders (HR, 32.24; 95% CI, 23.29-44.64). Suicide attempt was associated with the development of sedative or hypnotic use disorders up to 5 years (HR, 66.69; 95% CI, 34.72-128.09), although risks remained elevated up to 3 decades later for all substances. Compared with those without suicide attempt, female youths with 3 or more suicide attempts had 21.20 (95% CI, 13.53-32.90) times the risk of substance use disorders, whereas female youths with 1 attempt had 5.70 (95% CI, 5.08-6.41) times the risk of these disorders. In this cohort study, female youths who attempted suicide had increased risk of subsequent substance use disorders compared with female youths who did not attempt suicide. These findings suggest that closer management and prevention of substance use among female youths who attempt suicide may be beneficial.

Neighborhood social environment change in late adolescence predicts substance use in emerging adulthood.

This study examines associations of changes in perceived and objective (census-based) neighborhood social environment variables during adolescence with alcohol and marijuana outcomes in emerging adulthood using two waves of data (2013-14 and 2019-20) from a cohort in Southern California (n=1249). Increasing perceived disorganization predicted greater alcohol consequences and socialization with peers using marijuana. Decreasing objective neighborhood SES predicted fewer alcohol consequences and greater socialization with peers drinking alcohol. Unexpectedly, both decreasing and increasing perceived social cohesion predicted fewer alcohol consequences. Increasing perceived social cohesion predicted lower solitary alcohol use. Findings identify potential environmental targets to prevent substance use during the transition to emerging adulthood, but more research is warranted to understand the complex findings for alcohol consequences.

Evaluation of forensic autopsy cases with substance use detected in Izmir, Turkey

Using postmortem toxicological analyses, we aimed to determine the origin and cause of death and type of substance used in substance use-related deaths. A total of 7475 autopsies were performed between January 2015 and December 2017 in İzmir, Turkey. In our retrospective analysis, substance use was detected in 449 (6.0%) autopsies. The majority (96.4%) were male. The most frequent deaths (18.5%) occurred in the 25–29 age group. Of the 55.2% of the cases that died of unnatural causes, accident-related events (22.9%) were most frequent. Trauma/injury caused death in 37.0% of cases and substance intoxication in 24.7%. Cannabis use was detected in 34.3% of the samples, and multiple substance use in 25.4%. Accordingly, It is thought that a multidisciplinary approach can be successful in preventing substance use and related problems.

Study protocol of a randomized controlled trial comparing two linkage models for HIV prevention and treatment in justice-involved persons

BackgroundPersons involved in the justice system are at high risk for HIV and drug overdose upon release to the community. This manuscript describes a randomized controlled trial of two evidence-based linkage interventions for provision of HIV prevention and treatment and substance use disorder (SUD) services in four high risk communities to assess which is more effective at addressing these needs upon reentry to the community from the justice system.MethodsThis is a 5-year hybrid type 1 effectiveness-implementation randomized controlled trial that compares two models (Patient Navigation [PN] or Mobile Health Unit [MHU] service delivery) of linking justice-involved individuals to the continuum of community-based HIV and SUD prevention and treatment service cascades of care. A total of 864 justice-involved individuals in four US communities with pre-arrest histories of opioid and/or stimulant use who are living with or at-risk of HIV will be randomized to receive either: (a) PN, wherein patient navigators will link study participants to community-based service providers; or (b) services delivered via an MHU, wherein study participants will be provided integrated HIV prevention/ treatment services and SUD services. The six-month post-release intervention will focus on access to pre-exposure prophylaxis (PrEP) for those without HIV and antiretroviral treatment (ART) for people living with HIV (PLH). Secondary outcomes will examine the continuum of PrEP and HIV care, including: HIV viral load, PrEP/ ART adherence; HIV risk behaviors; HCV testing and linkage to treatment; and sexually transmitted infection incidence and treatment. Additionally, opioid and other substance use disorder diagnoses, prescription, receipt, and retention on medication for opioid use disorder; opioid and stimulant use; and overdose will also be assessed. Primary implementation outcomes include feasibility, acceptability, sustainability, and costs required to implement and sustain the approaches as well as to scale-up in additional communities.DiscussionResults from this project will help inform future methods of delivery of prevention, testing, and treatment of HIV, HCV, substance use disorders (particularly for opioids and stimulants), and sexually transmitted infections for justice-involved individuals in the community.Trial registration: Clincialtrials.gov NCT05286879 March 18, 2022.

Summary findings from Tracks surveys implemented by First Nations in Saskatchewan and Alberta, Canada, 2018-2020.

The Public Health Agency of Canada's integrated bio-behavioural surveillance system-Tracks surveys-assesses the burden of HIV, hepatitis C and associated risks in key populations in Canada. From 2018-2020, Tracks surveys were successfully implemented by First Nations Health Services Organizations in Alberta and Saskatchewan. First Nations-led survey teams invited community members who identified as First Nations, Inuit or Métis to participate in Tracks surveys and testing for HIV, hepatitis C and syphilis. Information was collected on social determinants of health, use of prevention services, substance use, sexual behaviours and care for HIV and hepatitis C. Descriptive statistics are presented. Of the 1,828 survey participants, 97.4% self-identified as First Nations and 91.4% lived in an on-reserve community. Over half (52.2%) were cisgender female, average age was 36.3 years, 82.5% lived in stable housing, 82% had access to primary healthcare and 73.8% reported having good to excellent mental health. Most participants (97%) had a family member who had experienced residential school. High proportions experienced stigma and discrimination (65.6%), financial strain (64.3%) and abuse in childhood (65.1%). Testing for HIV (62.8%) and hepatitis C (55.3%) was relatively high. Prevalence of HIV was 1.6% (of whom 64% knew their infection status). Hepatitis C ribonucleic acid prevalence was 5% (44.9% of whom knew their current infection status). Historical and ongoing experiences of trauma, and higher prevalence of hepatitis C were identified, reaffirming evidence of the ongoing legacies of colonialism, Indian Residential Schools and systemic racism. High participation in sexually transmitted blood-borne infection testing and prevention reflect the importance of First Nations-led culturally sensitive, safe and responsive healthcare services and programs to effect improved outcomes for First Nations peoples.

The 7-Year Effectiveness of School-Based Alcohol Use Prevention From Adolescence to Early Adulthood: A Randomized Controlled Trial of Universal, Selective, and Combined Interventions.

Alcohol use is a leading cause of burden of disease among young people. Prevention strategies can be effective in the short-term; however little is known about their longer-term effectiveness. The aim of this study was to examine the sustainability of universal, selective, and combined alcohol use prevention across the critical transition period from adolescence into early adulthood. In 2012, a total of 2190 students (mean age, 13.3 years) from 26 Australian high schools participated in a cluster randomized controlled trial and were followed up for 3 years post baseline. Schools were randomly assigned to deliver the following: (1) universal Web-based prevention for all students (Climate Schools); (2) selective prevention for high-risk students (Preventure); (3) combined universal and selective prevention (Climate Schools and Preventure [CAP]); or (4) health education as usual (control). This study extends the follow-up period to 7-years post baseline. Primary outcomes were self-reported frequency of alcohol consumption and binge drinking, alcohol-related harms, and hazardous alcohol use, at the 7-year follow-up. At 7-year follow-up, students in all 3 intervention groups reported reduced odds of alcohol-related harms compared to the control group (odds ratios [ORs]= 0.13-0.33), and the Climate (OR= 0.04) and Preventure (OR= 0.17) groups reported lower odds of hazardous alcohol use. The Preventure group also reported lower odds of weekly alcohol use compared to the control group (OR= 0.17), and the Climate group reported lower odds of binge drinking (OR= 0.12), holding mean baseline levels constant. This study demonstrated that both universal and selective preventive interventions delivered in schools can have long-lasting effects and reduce risky drinking and related harms into adulthood. No added benefit was observed by delivering the combined interventions. The CAP Study: Evaluating a Comprehensive Universal and Targeted Intervention Designed to Prevent Substance Use and Related Harms in Australian Adolescents; https://www.anzctr.org.au/; ACTRN12612000026820.

Developing and implementing a community-based substance use prevention program in Iranian adolescents (SUPPIA): A study protocol

ABSTRACT Objective As substance use disorders are globally among the top causes of preventable mortality and morbidity among adolescents, there is a need for developing effective prevention programs to address the rising prevalence and the associated health consequences. The main aim of this study is to develop a community-based study protocol for preventing substance use in Iranian adolescents. Methods and results An ecological approach, mobilizing for action through planning and partnership (MAPP), was used to develop a study protocol for preventing substance use among 14–18-year-old adolescents participating in this study. Participants were randomized to the intervention (n = 70) or control (n = 70) groups. The intervention group was exposed to eight individual sessions by two qualified trainers over eight weeks to stimulate (1) positive outcome expectations, (2) self-efficacy, e.g., to resist social pressure, (3) self-regulation, e.g., by self-monitoring of stress and emotions. Outcomes were assessed by the percentage reduction in substance use after six, 18, and 24 months after the intervention. Discussion In this study, we have been to outline and explain the steps of developing and implementing a community-based study protocol. This protocol, if practical and effective, could be easily implemented in various settings and would reach large numbers of young people cost-effectively.

Preventing Youth Substance Use Using Creative Problem Solving-Cognitive-Behavioural Skills Enhancement Approach

Objectives: The purpose of this study was to assess the effectiveness of creative problem solving-cognitive-behavioural skill enhancement approach on the prevention of substance use among youth. Study Design: A quasi-experimental study was used. Methods: The study involved 327 youth (mean age 19.1 ± 3.4 years) of the Catholic Archdiocese of Ibadan, Nigeria in various secondary and tertiary institutions across Nigeria who gathered for an annual programme. A self-reporting questionnaire was administered pre and post eliciting information about participants’ demographics, knowledge of effects of substance on the brain, attitude towards substance usage, decision making behaviour, satisfaction about the training/resolve to share information acquired and creative problem solving skills. 327 participants completed the pre-test but 208 (mean age 19.2 ± 2.9) completed the post-survey. This accommodated a cross-sectional analysis of the results. Results reflect a comparison of all pre-evaluations with all post-evaluations. This prevented a pre- and post-evaluation paired-test analyses. Results: There is a significant difference in each post assessment result of the variables among participants: knowledge of how the brain helps make decision p (0.001) <.05 level of significance; attitude towards substance use p (0.003) <.05 level of significance; decision-making p (0.005) <.05 level of significance; satisfaction and willingness to share information and skills acquired with friends p (0.003) <.05 level of significance; creative problem solving skills p (0.002) <.05 level of significance. Conclusion: A combination of creative problem solving and cognitive-behavioural skills enhancement influenced youth’s decision against substance use. The result suggests that the enhancement technique is appropriate, effective and feasible for youth deterrence from substance usage encouraging further research.

Misleading News Coverage of Research Findings Poses a Risk to Youth Mental Health and Safety

Misleading News Coverage of Research Findings Poses a Risk to Youth Mental Health and Safety

In what ways do emerging adults with substance use problems experience their communities as influencing their personal recovery processes?

Applying the multiple psychological sense of community concept (MPSOC), this study explored how emerging adults with substance use problems experience the influences of various senses of community and communities on their personal recovery processes. Semi‐structured interviews with 21 emerging adults from different urban contexts in Norway were analysed using a collaborative, seven‐step, deductive, and reflexive thematic approach. MPSOC is shown to be a key concept for achieving a broad, in‐depth understanding of emerging adults' senses of community and personal experiences of community influences on recovery processes from substance use. Positive and negative senses of community in geographical, relational, substance use‐related and ideal communities influence the potentials and challenges in emerging adults' recovery processes. Supportive and motivating community relationships, meaningful activities with peers, and distance from recovery‐impeding communities were identified as important recovery components. To promote recovery and prevent substance use in emerging adults, community approaches and tools applied in substance use treatment have to take into account and utilise multidimensional and age group‐specific aspects of belonging.

Risk and Resilience Among Families in Urban AI/AN Communities: the Role of Young Adults.

Urban American Indian/Alaska Native (AI/AN) young adults and their families are often geographically or socially distant from tribal networks and traditional social support. Young adults can be especially vulnerable to cultural and social disconnection, so understanding how AI/AN family functioning can augment resilience and protect against risk is important. This research precedes a preventive substance use intervention study and explores urban Native family functioning, emphasizing the role of young adults by analyzing data from 13 focus groups with urban AI/AN young adults (n = 32), parents (n = 25), and health providers (n = 33). We found that young adults can and want to become agents of family resilience, playing active roles in minimizing risks and strengthening family functioning in both practical and traditional ways. Also, extended family and community networks played a vital role in shaping family dynamics to support resilience. These resilience pathways suggest potential targets for intervention.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-022-01240-7.

The Unplugged program in Chile (\u201cYo S\xe9 Lo Que Quiero\u201d) for substance use prevention among early adolescents: study protocol for a randomized controlled trial

BackgroundSubstance use is among the main contributors to disease among children and adolescents in the Americas region. The call for effective prevention of substance use among adolescents has resulted in numerous school-based programs, and particularly the Unplugged program has been proved to be successful in reducing the prevalence of different substances in seven European countries. The purpose of this study is to test the effectiveness of the Unplugged program in Chile (“Yo Sé Lo Que Quiero”).MethodsThis is a cluster randomized controlled trial, parallel-group type, where “Yo Sé Lo Que Quiero” is compared to standard school preventive curricula in control schools. A total of 70 schools and 8400 adolescents are expected to be randomized with 1:1 allocation. During formative work, the Unplugged program was culturally adapted to Chile, and the instrument to assess the primary and secondary outcomes was validated. The effectiveness of this program will be assessed using the European Drug Addiction Prevention Trial Questionnaire (EU-Dap), measuring substance use prevalence and risk and protective factors in baseline, post-intervention, and four months after the end of the intervention.DiscussionThe proposed study will be the first to test the effectiveness of a school-based substance use prevention program in Chile in a cluster randomized control trial and the first study evaluating the Unplugged program in Spanish-speaking Latin America. A model for disseminating the Unplugged program inside Europe already exists and has been implemented successfully in several countries. Thus, if the effects of the program are positive, wide implementation in Chile and Latin American countries is possible soon.Trial registrationClinicalTrials.govNCT04236999. Registered on January 17, 2020.

Engagement With a Mobile Phone-Based Life Skills Intervention for Adolescents and Its Association With Participant Characteristics and Outcomes: Tree-Based Analysis.

BackgroundMobile phone–delivered life skills programs are an emerging and promising way to promote mental health and prevent substance use among adolescents, but little is known about how adolescents actually use them.ObjectiveThe aim of this study is to determine engagement with a mobile phone–based life skills program and its different components, as well as the associations of engagement with adolescent characteristics and intended substance use and mental health outcomes.MethodsWe performed secondary data analysis on data from the intervention group (n=750) from a study that compared a mobile phone–based life skills intervention for adolescents recruited in secondary and upper secondary school classes with an assessment-only control group. Throughout the 6-month intervention, participants received 1 SMS text message prompt per week that introduced a life skills topic or encouraged participation in a quiz or individual life skills training or stimulated sharing messages with other program participants through a friendly contest. Decision trees were used to identify predictors of engagement (use and subjective experience). The stability of these decision trees was assessed using a resampling method and by graphical representation. Finally, associations between engagement and intended substance use and mental health outcomes were examined using logistic and linear regression analyses.ResultsThe adolescents took part in half of the 50 interactions (mean 23.6, SD 15.9) prompted by the program, with SMS text messages being the most used and contests being the least used components. Adolescents who did not drink in a problematic manner and attended an upper secondary school were the ones to use the program the most. Regarding associations between engagement and intended outcomes, adolescents who used the contests more frequently were more likely to be nonsmokers at follow-up than those who did not (odds ratio 0.86, 95% CI 0.76-0.98; P=.02). In addition, adolescents who read the SMS text messages more attentively were less likely to drink in a problematic manner at follow-up (odds ratio 0.43, 95% CI 1.29-3.41; P=.003). Finally, participants who used the program the most and least were more likely to increase their well-being from baseline to 6-month follow-up compared with those with average engagement (βs=.39; t586=2.66; P=.008; R2=0.24).ConclusionsMost of the adolescents participating in a digital life skills program that aimed to prevent substance use and promote mental health engaged with the intervention. However, measures to increase engagement in problem drinkers should be considered. Furthermore, efforts must be made to ensure that interventions are engaging and powerful across different educational levels. First results indicate that higher engagement with digital life skills programs could be associated with intended outcomes. Future studies should apply further measures to improve the reach of lower-engaged participants at follow-up to establish such associations with certainty.

Protective Factors for Decreasing Nicotine, Alcohol, and Cannabis Use Among Adolescents with a History of Adverse Childhood Experiences (ACEs)

Adolescents who have experienced adversity have an increased likelihood of using substances. This study examined if individual-, family-, school-, and community-level protective factors were associated with a decreased likelihood of substance use. Data from the Well-Being and Experiences Study (the WE Study) collected from 2017 to 2018 were used. The sample was adolescents aged 14 to 17 years (N = 1002) from Manitoba, Canada. Statistical methods included descriptive statistics and logistic regression models. The prevalence of past 30-day substance use was 20.5% among boys and 29.2% among girls. Substance use was greater among adolescent girls compared to boys. Protective factors associated with an increased likelihood of not using substances included knowing culture or language, being excited for the future, picturing the future, sleeping 8 to 10 h per night (unadjusted models only), participating in non-sport activity organized by the school, having a trusted adult in the family, frequent hugs from parent, parent saying “I love you” (unadjusted models only), eating dinner together every day, mother and father understanding adolescent’s worries and problems, being able to confide in mother and father, feeling close to other students at school, having a trusted adult at school, feeling a part of school, having a trusted adult in the community (unadjusted models only), volunteering once a week or more, and feeling motivated to help and improve one’s community. Knowledge of protective factors related to decreased odds of substance use may help inform strategies for preventing substance use and ways to foster resilience among adolescents.

Development and pilot-testing of a skill-based intervention to prevent psychoactive substance use among college students: A study from Bangalore, India.

Psychoactive substance use among college youth is increasing in low- and middle-income countries like India. However, there are few systematically developed interventions for this vulnerable group. The aim of this study was to develop a skill-based intervention to prevent substance use among college students (or enable them to quit, if already initiated use). The skill-based intervention was informed by focus group discussions with college students regarding the kind of help they perceived would be useful. The intervention was pilot-tested for its appropriateness and acceptability in this population, and revised based on their inputs. The feedback received from the students was incorporated and the intervention was suitably revised. The final intervention adopted a disease prevention and health promotion approach, by addressing psychoactive substance use as a risk factor for several major illnesses, and providing practical guidance on how to overcome use. The intervention consisted of four sections: (i) Health effects of substances, with realistic depictions through computer graphics (e.g., to illustrate arterial blockage, brain shrinkage, lung damage, erosion of gastric mucosa, impaired sexual performance, premature aging); Clarification of Myths, Providing Medical Facts, (ii) How to Overcome Substance Use, with practical strategies for quitting, (iii) Quitting Substance Use as part of a Healthy Lifestyle, (iv) Conclusion, portraying life after quitting substances, with motivational messages. The skill-based intervention received positive feedback regarding its applicability and acceptance among college students. An experimental trial can be planned to examine the efficacy of the intervention in bringing about improvement in specific outcomes.

Современные психолого-педагогические практики по профилактике употребления обучающимися психоактивных веществ

Современные психолого-педагогические практики по профилактике употребления обучающимися психоактивных веществ

Feasibility and acceptability of incorporating social network visualizations into a culturally centered motivational network intervention to prevent substance use among urban Native American emerging adults: a qualitative study

BackgroundCoupling social network visualizations with Motivational Interviewing in substance use interventions has been shown to be acceptable and feasible in several pilot tests, and has been associated with changes in participants’ substance use and social networks. The objective of this study was to assess acceptability and feasibility of an adaptation of this behavior change approach into a culturally centered behavior change intervention for American Indian/Alaska Native (AI/AN) emerging adults living in urban areas. AI/AN populations experience high rates of health disparities and substance use. Although 70% of AI/AN people live outside of tribal lands, there are few culturally tailored health interventions for these AI/AN populations. Social networks can both increase and discourage substance use. Leveraging healthy social networks and increasing protective factors among urban AI/AN emerging adults may help increase resilience.MethodsWe conducted thirteen focus groups with 91 male and female participants (32 urban AI/AN emerging adults ages 18–25, 26 parents, and 33 providers) and one pilot test of the three workshop sessions with 15 AI/AN emerging adults. Focus group participants provided feedback on a proposed workshop-based intervention curriculum that combined group Motivational Interviewing (MI) and social network visualizations. Pilot workshop participants viewed their own social networks during group MI sessions focused on substance use and traditional practices and discussed their reactions to viewing and discussing their networks during these sessions. We used a combination of open coding of focus group and workshop session transcripts to identify themes across the group sessions and content analysis of comments entered into an online social network interview platform to assess the extent that participants had an intuitive understanding of the information conveyed through network diagrams.ResultsFocus group and pilot test participants reacted positively to the intervention content and approach and provided constructive feedback on components that should be changed. Themes that emerged included feasibility, acceptability, relevance, understandability, and usefulness of viewing personal network visualizations and discussing social networks during group MI workshops. Workshop participants demonstrated an intuitive understanding of network concepts (network composition and structure) when viewing their diagrams for the first time.ConclusionsSocial network visualizations are a promising tool for increasing awareness of social challenges and sources of resilience for urban AI/AN emerging adults. Coupled with Motivational Interviewing in a group context, social network visualizations may enhance discussions of network influences on substance use and engagement in traditional practices.Trial Registration: ClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020

A Community-Academic Approach to Preventing Substance Use Disorders.

The coronavirus disease 2019 pandemic and activism against structural racism heightened awareness of racial-ethnic disparities and disproportionate burden among the underserved. The opioid crisis further compounds these phenomena, increasing vulnerability for substance use disorders (SUD). Community-based participatory research can facilitate multidisciplinary collaboration, yet literature on these approaches to prevent and reduce SUD and associated stigma remains limited. Discrimination, stigma, and multiple crises with health care and systemic barriers increasingly marginalize the underserved, specifically around SUD. The Detroit Area Mental Health Leadership Team (DAMHLT, since 2015), aims to optimize SUD prevention, enhance resiliency and advocacy to advance knowledge on SUD research and influence community-level research and practice. DAMHLT's approach on bidirectionality, community level access to real-time epidemiological data, advocacy (i.e., institutional responsiveness) and dissemination may be translational to other partnerships. As we move through an ever-changing pandemic, DAMHLT's lessons learned can inform partnership dynamics and public health strategies such as hesitancy on public health response.

Adolescent Attachment Profiles Are Associated With Mental Health and Risk-Taking Behavior.

This person-oriented study aimed to identify adolescents’ hierarchical attachment profiles with parents and peers, and to analyze associations between the profiles and adolescent psychosocial adjustment. Participants were 449 Finnish 17–19-year-olds reporting their attachments to mother, father, best friend, and romantic partner and details on mental health (internalizing symptoms, inattention/hyperactivity, and anger control problems) and risk-taking behavior (substance use and sexual risk-taking). Attachment was measured with Experiences in Close Relationships – Relationship Structures (ECR-RS); internalizing, inattention/hyperactivity, and anger control problems with Self-Report of Personality — Adolescent (SRP—A) of the Behavior Assessment System for Children, third edition (BASC-3); substance use with the Consumption scale of the Alcohol Use Disorders Identification Test (AUDIT-C) and items from the Finnish School Health Promotion Study; and sexual risk-taking behavior with the Cognitive Appraisal of Risky Events (CARE). Latent profile analysis identified five attachment profiles: “All secure” (39%), “All insecure” (11%), “Parents insecure – Peers secure” (21%), “Parents secure – Friend insecure” (10%), and “Parents secure – Partner insecure” (19%). “All insecure” adolescents showed the highest and “All secure” adolescents the lowest levels of mental health problems and substance use. Further, parental attachment security seemed to specifically prevent substance use and anger control problems, while peer attachment security prevented internalizing problems. Our findings help both understand the organization of attachment hierarchies in adolescence and refine the role of specific attachment relationships in psychosocial adjustment, which can be important for clinical interventions in adolescence.

Upstream: Opportunities for structural intervention research to prevent substance use and harms.

Upstream: Opportunities for structural intervention research to prevent substance use and harms.