Racial and Ethnic Disparities, Referral Source and Attrition From Outpatient Substance Use Disorder Treatment Among Adolescents in the United States.

The following study examined the association between race, ethnicity, referral source, and reasons for attrition from substance use treatment in a sample of 72,643 discharges of adolescent youth in the United States from 2014 to 2016. Black and Hispanic adolescents were more likely to be discharged due to incarceration and termination by the facility compared to White adolescents. Adolescents referred by probation, diversion, other juvenile justice organizations, health care providers, community agencies, and individual referrals were significantly more likely to be discharged due to incarceration and terminated by the treatment facility compared to youth who were referred by schools. Findings suggest that enhancing linkage to treatment from systems in the social environment may play a role in attenuating racial and ethnic disparities in rates of attrition from substance abuse treatment among adolescent youth in the United States.

Racial Associations Between Gambling and Suicidal Behaviors Among Black and White Adolescents and Young Adults.

PURPOSE OF REVIEW: Suicide is the second leading cause of death among Black youth ages 10-19 years. Between 1991 and 2017, rates of suicide among Black youth have been increasing faster than rates among any other race/ethnic group. There are many factors that may explain this increase, with gambling being suggested as one such potential risk factor. This review examines the association between gambling and suicide behaviors, and how these associations may vary between Black and White youth and young adults. The current review examines these associations using data from the Missouri Family Study (MOFAM). RECENT FINDINGS: Recent findings have revealed distinct patterns of substance use initiation and gambling behaviors between Black youth and White youth. While strong links between gambling and suicide behaviors have also been reported, whether the associations were consistent across race/ethnicity groups was not investigated, nor in these cross-sectional analyses was it possible to determine whether the gambling behaviors preceded or followed suicidality. Thus, there is a need to investigate whether there are differences in the associations of gambling and suicide behaviors at the race/ethnicity level in tandem with data that examine the sequence of the behaviors. The current report focuses on racial/ethnic differences using data that allow for sequencing the occurrence of the behaviors via the age of first gambling experience, and of first suicidal symptom, to better distinguish the nature of the association. SUMMARY: The current findings revealed that gambling initiation predicted suicide ideation among Black youth, while no significant association was found among White youth. This is of major public health concern, given the rising rates of suicide among Black youth, and the increased availability of gambling. The report did not find a link between gambling and suicide attempts. Culturally tailored interventions should be considered among schools, families, and clinicians/providers, to highlight the risk of adolescent gambling, particularly among Black youth.

Does the Andersen Behavioral Model of Health Services Use predict college students' use of on-campus mental health services?

Objective: 10-50% of college students meet the diagnostic criteria for one or more mental illnesses; unfortunately, less than half seek treatment. This study assessed the predictive power of specific variables on students' use of on-campus mental health resources using the American College Health Association's National College Health Assessment (ACHA-NCHA) II. Participants: Respondents included undergraduate and graduate students ages 18-35 years (n = 96,121). Methods: We analyzed data from the ACHA-NCHA II Fall 2014 and Spring 2015. Andersen's Behavioral Model of Health Services Use enabled selection of predisposing, enabling, and need predictor variables; these were analyzed individually and collectively. Results: Predisposing, enabling, and need variables accounted for 9%, 2.3%, and 17% of the overall variance. Significant variables associated with a student's decision to access on-campus mental health services accounted for 23% of variance total. Conclusions: This insight could allow universities to better recognize students at-risk for needing but not accessing mental health services.

Stress, stressors, and substance use: Differential risk for hookah use among African American college students.

Using differential, multivariable risk models, we assessed the contribution of substance use and stress/traumatic events to hookah use among African American college students (n = 1,402) using data from the Fall 2012 American College Health Association-National College Health Assessment (ACHA-NCHA) II. Lifetime hookah use was 24.8%, with 34.2% of lifetime users having done so in the past 30 days. Compared to nonusers, hookah users had significantly higher use rates of alcohol, marijuana, other tobacco, and other drugs. Furthermore, hookah use was more likely among those with cumulative stress, yet less likely among older students. An implication is that prevention messages may need to be tailored for African American college students and particularly target younger students, substance users, and those with cumulative stress. These findings also inform policy discussions regarding hookah use on college campuses.

Patterns of gambling and substance use initiation in African American and White adolescents and young adults.

The focus of the current investigation is to examine the temporal relationship of gambling onset and alcohol, tobacco, and cannabis initiation in adolescents and young adults (M age = 20.3 years) by examining the prevalence and pattern of onset for each substance and gambling pairing and the associated risk between gambling and each substance use. Data were drawn from the multiwave Missouri Family Study (n = 1,349) of African American (AA; n = 450) and White families (n = 317) enriched for risk for alcohol use disorder and includes those who were assessed for gambling behaviors and problems: AA (360 males, 390 females) and White (287 males, 312 females). Findings indicated racial differences in the overall prevalence of gambling behaviors and substance use as well as patterns of initiation-particularly within gambling/alcohol and gambling/tobacco for males. Survival models revealed some similarities as well as differences across race and gender groups in associations of gambling with initiation of substances, as well as substances with initiation of gambling. Alcohol use (AA males only) and cannabis use (AA males and White females) elevated the hazards of initiating gambling. In contrast, gambling significantly elevated the hazards of initiation alcohol across 3 of 4 groups and of cannabis use in AA males only. The results highlight some overlapping as well as distinct risk factors for both gambling and substance use initiation in this cohort enriched for vulnerability to alcohol use disorder (AUD). These findings have implications for integrating gambling prevention into existing substance use prevention and intervention efforts-particularly but not exclusively for young AA males. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Risk Factors Associated With Gambling Involvement among a National Sample of African American and European American Young Adults.

In the current research, we examined the association of key risk and protective factors for gambling involvement from the domains of family environment, conduct problems/delinquency, substance use, and depressive psychopathology in a nationally representative sample. The sample was comprised of 13,291 young adults (ages 18-26; Meanage = 22.8) self-identifying as European American (n=9,939) or African American (n=3,335) who participated in Wave III (n = 15,170) of the restricted-use National Longitudinal Study of Adolescent to Adult Health. We used separate logistic regressions to study participation in specific gam bling categories (lottery games, casino-type games, other games). Childhood neglect, physical discipline, and current alcohol use was associated across each of the three gam bling categories. Our results also revealed differences between European American and African American subjects. Current cannabis use was associated with all three categories among African Americans, while current cigarette use was associated among European Americans for lottery games, and depression (female) was associated with other games. We also applied multinomial logistic regression to study gambling involvement based on the number of gam bling categories that the participant engaged in 2 or more (referent), only 1, or none at all. Our results revealed that delinquency/conduct symptoms (AOR=0.83) along with cannabis use (African American; AOR =0.66), cigarette use (European American; AOR =0.83), current alcohol use (AOR=0.66) were associated with gambling in two categories vs. gambling in one category. Childhood physical discipline (AOR=0.75) and childhood neglect (AOR=0.75) were associated with gam bling in two categories vs. no gambling. Further are needed to investigate the developmental pathways leading to increased gam bling involvement among African American and European American adolescents and young adults.

The Impact of Traumatic Experiences on Risky Sexual Behaviors in Black and White Young Adult Women.

BACKGROUND: Trauma exposure has been linked to risky sexual behavior (RSB), but few studies have examined the impact of distinct trauma types on RSB in one model or how the association with trauma and RSB may differ across race. PURPOSE: The objective of the current study was to examine the contribution of trauma exposure types to RSB-substance-related RSB and partner-related RSB identified through factor analysis-in young Black and White adult women. METHODS: We investigated the associations of multiple trauma types and RSB factor scores in participants from a general population sample of young adult female twins (n = 2,948). We examined the independent relationship between specific traumas and RSB, adjusting for substance use, psychopathology, and familial covariates. All pertinent constructs were coded positive only if they occurred before sexual debut. RESULTS: In Black women, sexual abuse was significantly associated with substance-related and partner-related RSB, but retained significance only for partner-related RSB in a fully adjusted model. For White women, sexual abuse and physical abuse were associated with both RSB factors in the base and fully adjusted models. Witnessing injury or death was only associated with RSBs in base models. For both groups, initiating alcohol (for Black women), alcohol, or cannabis (for White women) before sexual debut (i.e., early exposure) was associated with the greatest increased odds of RSB. CONCLUSIONS: Data highlight the contribution of prior sexual abuse to RSBs for both White and Black women, and of prior physical abuse to RSBs for White women. Findings have implications for intervention after physical and sexual abuse exposure to prevent RSB, and thus, potentially reduce sexually transmitted infection/human immunodeficiency virus infection and unintended pregnancy in young women.

Factors Associated with Human Papillomavirus Vaccination Status at U.S. Colleges and Universities.

Human papillomavirus (HPV) vaccination rates remain low, but college student vaccination could offset this trend. This study identifies characteristics that could enhance HPV vaccination among U.S. college students. Data were from the National College Health Assessment II survey (fall 2012, N = 18,919). Univariate and logistic regression analyses were used to examine associations among demographic characteristics, college region and size, health status, receipt of health services, sexual health information, and HPV vaccination status. Among women, ethnic minorities, students attending schools in the South, those not receiving routine gynecological care in the past 12 months, and those unsure of when they last received gynecological care were less likely to report HPV vaccination. Among men, African Americans, students attending schools in the South and West, and those receiving sexually transmitted infection information were more likely to report vaccination. Data suggest that college health education can help to improve U.S. HPV vaccination rates. Campus health practitioners providing sexual health information and referrals are positioned to assist in this effort.

Hookah and Cigarette Smoking Among African American College Students: Implications for Campus Risk Reduction And Health Promotion Efforts.

OBJECTIVE: To identify individual and institutional risks and protections for hookah and cigarette smoking among African American (AA) college students. PARTICIPANTS: AA college students (N = 1,402; mean age = 20, range = 18-24 years; 75% female) who completed the Fall 2012 American College Health Association-National College Health Assessment II. METHODS: Respondents were stratified into 4 mutually exclusive groups by last-30-day smoking status: cigarette-only use (5.1%), hookah-only use (5.9%), dual use (2.4%), and nonuse (86.6%). Multinomial logistic regression models identified the relative odds of exclusive and dual hookah and cigarette smoking. RESULTS: Current hookah and cigarette smoking rates were comparably low. Age, gender identity, current substance use, interest in tobacco use information, and student population prevailed as risks and protections for hookah and cigarette smoking. CONCLUSIONS: Campus health promotion campaigns may need to tailor messages to AA students, particularly those who use substances, to underscore the health risks of hookah and cigarette smoking.

Gambling behavior and problems among older adults: a systematic review of empirical studies.

OBJECTIVES: With the rapid aging of the population and the increased availability of gambling facilities over the past three decades, older adults may gamble more and may be increasingly at risk for problem gambling (PG) or pathological gambling disorder (PGD). To facilitate a better understanding of gambling behavior among older adults that will inform preventive strategies, this article systematically examined empirical studies on issues related to older adults' gambling. METHOD: This article reviewed 75 empirical studies including data on the distribution and determinants of PG and PGD and the outcomes of gambling. RESULTS: This review used the broad term of "disordered gambling" as a means to explain a continuum of problems caused by PG and PGD. The analyses covered seven topics concerning older adults' gambling behaviors: Participation rates for gambling, prevalence rates of disordered gambling, motivation for initially beginning to gamble, risk and protective factors for disordered gambling, and negative and positive health outcomes from gambling. DISCUSSION: Based on research gaps identified in the review, this article proposes six recommendations for future studies focusing on well-being of older adults who gamble, research method issues, and taking into account older adults' inspirations and adjustment to the aging process in the 21st century.

Substance use and mental health disorders among heterosexual identified men and women who have same-sex partners or same-sex attraction: results from the national epidemiological survey on alcohol and related conditions.

This study examined sexual orientation discordance, a mismatch between self-reported sexual identity and sexual behavior or sexual attraction, by describing the characteristics, substance use disorders, and mental health risks of heterosexual identified individuals who endorsed this pattern of sexual identification, behavior, and attraction. Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we created three groups based on participants' reported sexual identity and either their sexual behavior or sexual attraction: heterosexual concordant, homosexual concordant, and heterosexual discordant. Bivariate models assessed the relationship of discordant status and demographic correlates, lifetime substance use disorders, and mental health diagnoses. Logistic regression models tested associations between both behavior discordance and attraction discordance and the likelihood of having lifetime disorders of substance use, major depression, and generalized anxiety. Results of this study provided evidence of varying levels of substance use and mental health disorder risk by gender, discordance status, and discordance type. Behavioral discordance was associated with increased risk of mental health and substance use disorder among women (compared to heterosexual concordance). Findings among men were less consistent with heightened risk of alcohol and inhalant use only. Attraction discordance was notably different from behavioral discordance. The odds of substance use and mental health disorders were the same or lower compared with both the heterosexual and homosexual concordance groups. Future research should begin to test theoretical explanations for these differences.

Differential item functioning of pathological gambling criteria: an examination of gender, race/ethnicity, and age.

This study tested for the presence of differential item functioning (DIF) in DSM-IV Pathological Gambling Disorder (PGD) criteria based on gender, race/ethnicity and age. Using a nationally representative sample of adults from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), indicating current gambling (n = 10,899), Multiple Indicator-Multiple Cause (MIMIC) models tested for DIF, controlling for income, education, and marital status. Compared to the reference groups (i.e., Male, Caucasian, and ages 25-59 years), women (OR = 0.62; P < .001) and Asian Americans (OR = 0.33; P < .001) were less likely to endorse preoccupation (Criterion 1). Women were more likely to endorse gambling to escape (Criterion 5) (OR = 2.22; P < .001) but young adults (OR = 0.62; P < .05) were less likely to endorse it. African Americans (OR = 2.50; P < .001) and Hispanics were more likely to endorse trying to cut back (Criterion 3) (OR = 2.01; P < .01). African Americans were more likely to endorse the suffering losses (OR = 2.27; P < .01) criterion. Young adults were more likely to endorse chasing losses (Criterion 9) (OR = 1.81; P < .01) while older adults were less likely to endorse this criterion (OR = 0.76; P < .05). Further research is needed to identify factors contributing to DIF, address criteria level bias, and examine differential test functioning.

Volunteerism among homeless persons with developmental disabilities.

People with developmental disabilities have been historically excluded from mainstream society. Using the strength-based perspective, volunteerism was explored among homeless persons with self-reported developmental disabilities. It was hypothesized that volunteerism would be associated with indicators of healthy community integration. This would include volunteerism associated with unemployment due to disposable time and desire to gain job-related skills. Nearly half volunteered (n = 29), were older, visited friends or family monthly, and reported employment status that was associated with volunteerism. Logistic regression indicated that visiting with friends or family monthly increased volunteering, but unemployment decreased volunteering. Volunteerism might be a way "to give back" to agencies assisting them. Similarly, visiting family or friends suggests maintenance of social and community ties, suggesting healthy community integration.

An empirical typology of lifetime and current gambling behaviors: association with health status of older adults.

PURPOSE: Despite the low prevalence of gambling problems, older adults experience poorer health status given certain vulnerabilities associated with aging. Thus, we aimed to classify lifetime (LPG) and current (CPG) problem gambling patterns, identify determinants of gambling patterns, and examine their association with current health status. METHODS: Using older adult gamblers (n = 489) in the Gambling Impact and Behavior Study, Latent Class Analysis classified LPG and CPG subgroups based on 10 DSM-IV criteria: preoccupation, tolerance, withdrawal, loss of control, escape, chasing losses, lying, illegal acts, relationship impairment and financial bailout. RESULTS: A two-class solution was the best fitting for LPG and CPG groups. Except for illegal acts, the remaining criteria endorsed the distinguishing patterns. We observed 10.8% LPGs, 8.4% CPGs and 2.2% with both. Participation in religious services was protective of both groups. Gambling for excitement and to win money were related to CPG. Further, CPG was significantly related to worse self-rated health. IMPLICATIONS: Although problem gambling is strongly characterized by number and type of diagnostic criteria, findings support a focus to include targeted assessment of additional clinically meaningful gambling correlates. Research on the moderator of participation in faith-based communities on problem gambling is also warranted.

The capacity to give informed consent in a homeless population with developmental disabilities.

This study examined homeless persons with developmental disabilities and their ability to understand the informed consent process for research using a capacity-to-consent screener. Bivariate associations with the inability to pass the screener on the first attempt were noted with three factors: an eighth grade or less in education, chronic homelessness, and mental retardation diagnosis. With multiple regression, the only outcome associated with inability to pass the screener on the first attempt was an eighth grade or less education. This study indicates the need for consideration of developmental disabilities when homeless and mental health providers are working with the homeless community.

Towards DSM-V: considering other withdrawal-like symptoms of pathological gambling disorder.

Despite clinical reports of other withdrawal-like symptoms, the DSM-IV considers only restlessness/irritability as a withdrawal-like criterion comprising pathological gambling disorder (PGD). We explored whether this criterion should be broadened to include other gambling withdrawal-like symptoms.Community-recruited adult gamblers (n = 312) participated in telephone interviews about gambling and related behaviors as a part of a larger psychometric study. Frequency and chi-square analyses described the association of gambling withdrawal-like symptoms by gambling disorder status. Multinomial forward selection logistic regression obtained a multivariate model describing the simultaneous relationship between these symptoms and gambling disorder status.One-quarter of the sample experienced the DSM-IV PGD criterion of restlessness/irritability. However, 41% experienced additional gambling withdrawal-like symptoms when attempting to quit or control gambling. A model including restlessness/irritability and three additional non-DSM-IV withdrawal-like symptoms (i.e. feelings of anger, guilt, and disappointment) is a stronger model of gambling disorder (chi(2) = 217.488; df = 8, p < 0.0001; R(2) = 0.5428; p < 0.0001) than restlessness/irritability alone (chi(2) = 151.278; df = 2, p < 0.0001; R(2) = 0.4133). The overlap of gambling withdrawal-like symptoms with substance use withdrawal (11%) and depressive symptoms (34%) failed to fully account for these associations with gambling disorder status.Future PGD conceptualization and potential criteria revisions for DSM-V may warrant a broader inclusion of gambling withdrawal-like symptoms.

The association between gambling pathology and personality disorders.

Research supports increased risk of problem gambling (PG) and pathological gambling disorder (PGD) among individuals with substance abuse/dependence and psychiatric disorders, but studies considering personality disorder comorbidity have not adjusted for confounding relationships with other Axis I disorders. Using targeted advertising, we enrolled 153 gamblers (55% female; 32% minority; Mean age=47; SD=18.2) in a clinical validation study of the newly developed computerized gambling assessment module (C-GAM). For these analyses, we classified gamblers into three groups based on their endorsement of DSM-IV PGD: Non-gamblers (0 criteria; n=64; 44%); PG (1-4 criteria; n=60; 41%); and PGD (5-10 criteria; n=22; 15%). We evaluated PG and PGD risk associated with personality disorder pathology using the computerized structured clinical interview of DSM-IV Axis II (SCID-II). Using multinomial logistic regression, we found increased odds of PGD among individuals with greater symptoms of borderline personality disorder after adjusting for socio-demographics, substance abuse/dependence and other personality disorders significant at the bivariate level. Yet after adjusting for depressive symptoms, borderline personality disorder criteria were nonsignificant, suggesting a complex relationship between personality pathology, depression, and gambling. These findings bolster the position that further investigation is needed regarding the association of gambling pathology with personality disorders and depressive symptoms.

A Latent Class Analysis (LCA) of problem gambling among a sample of community-recruited gamblers.

Problem gambling rates are relatively low (2%-4%), yet these gamblers experience multisystemic negative consequences, high comorbidity, and low treatment utilization. We aimed to characterize variations in gambling patterns to inform prevention and intervention efforts. Using community advertising, we recruited a diverse sample of lifetime gamblers (n = 312) for telephone interviews for a psychometric study of the newly developed Computerized-Gambling Assessment Module. Latent Class Analysis enumerated and classified gambling subgroups by distinctive gambling patterns, based on 8 composite scales functioning as validators of latent class membership (i.e., diagnostic gambling symptoms, reasons for gambling, gambling "withdrawal-like" symptoms, problem gambling perceptions, gambling venues, financial sources for gambling, gambling treatment/help-seeking, and religiosity/spirituality). Based on a distinguishing clustering pattern driven by 6 of 8 factors, we found a 6-class solution was the best-fitting solution. Gambling severity is most strongly characterized not only by symptomatology but also by the number of gambling treatment/help-seeking sources used.

Racial/ethnic variation in the reliability of DSM-IV pathological gambling disorder.

Racial/ethnic disparities in mental disorders, including pathological gambling disorder (PGD), may be either real or artifacts of how they are conceptualized and measured. We aimed to assess racial/ethnic variation in the reliability of self-reported lifetime PGD determined by meeting > or = 5 criteria of the Diagnostic and Statistical Manual of Mental Disorders. Using community advertising, we recruited 15-85-year-old Caucasians (n = 225) and African (American/other minorities (n = 87), who had gambled more than 5 times lifetime), for 2 interviews, held 1 week apart, about gambling and associated behaviors. Results indicate substantial to almost-perfect DSM-IV PGD reliability for Caucasians (kappa = 0.82) and African Americans/other minorities (kappa = 0.68). Reliability for symptoms and for game-specific disorders was fair to almost perfect (kappa = 0.37-0.90). After adjusting results for confounding variables and multiple comparisons, racial/ethnic variation in PGD and game-specific reliability failed to persist. Implications exist for increased attention to screening and prevention efforts critical to reducing racial/ethnic disparities in PGD prevalence.

Problem gambling and violence among community-recruited female substance abusers.

Problem gambling (PG) may be associated with depression, victimization, and violence characterizing a substance-abusing lifestyle. The study explored associations of PG with these correlates among heavy-drinking and drug-using out-of-treatment women recently enrolled in 2 National Institutes of Health-funded, community-based HIV prevention trials. Female substance abusers with PG (n = 180) and without PG (NPG; n = 425) were examined according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). Whereas PGs had higher rates of each correlate than did NPGs, significant associations existed for antisocial personality disorder, specifically for violent tendencies. Logistic regression indicated that substance abusers with violent tendencies were about 3 times as likely as those without such tendencies to be PGs, after controlling for sociodemographics. Future research addressing whether underlying constructs, confounding variables, or interactions exist will further specify PG risk and inform prevention and intervention efforts.