Developmental Differences in the Association of Peer Relationships with Traumatic Stress Symptoms.

Although childhood trauma exposure has a high incidence, traumatic stress often goes untreated in children and youth. We investigated peer relationship quality as a prevention strategy for reducing traumatic stress across different developmental periods. We analyzed longitudinal data from the National Survey of Child and Adolescent Wellbeing (NSCAW I) using a time-varying effect model (TVEM) to investigate the association between peer relationship quality and traumatic stress symptoms across ages 8-17 years. We controlled for a robust set of confounders identified through a Directed Acyclic Graph (DAG). The unique association between peer relationship quality and traumatic stress symptoms was negative and significant from ages 8 to 8.5 years, and again from ages 9.4 to 10.9 years and at age 16.4 to 16.8 years, with maximum associations of - 1.45 T score points at age 8.5 years (95% CI = [- 2.87, - 0.40]), - 1.57 at age 9.4 years (95% CI = [- 3.13,- 0.01]), and - 1.89 at 16.7 years (95% CI = [- 3.70, - 0.09]). Peer relationship quality protected against traumatic stress during specific times during adolescent development. Our results suggest that helping youth establish and maintain positive peer relationships may be a useful prevention approach for helping them cope with trauma experiences.

In Utero Exposure to Opioids: An Observational Study of Mothers Involved in the Child Welfare System.

BACKGROUND: Women are underrepresented in the current substance abuse research; however, women are a particularly vulnerable population when it comes to opioid use and abuse. Pregnant women are even more so, because of the potential that exists for in utero exposure (IUE) to substances. OBJECTIVES: To identify trends in IUE to opioids in order to ensure that resources are allocated effectively to address the current opioid epidemic and to assist the populations most affected by it. METHODS: This study draws on 15 years' worth of clinical assessment data collected from 3598 child welfare-involved mothers to assess for trends in IUE to substances over time. Data from the last 5 year period (N = 852) are then analyzed to identify recent demographic correlates associated with IUE to opioid substances. RESULTS: A substantial increase in the rates of IUE to opioids over the past 15 years is observed among child welfare-involved mothers. Moreover, we find that race is a significant correlate of IUE to opioids. CONCLUSION: Study findings are consistent with other recent research that demonstrates racial differences in the populations that are most affected by the opioid epidemic; however, more research is needed to determine how these racial differences in rates of IUE to opioids affect child welfare outcomes.

Child Welfare and the Transition to Adulthood: Investigating Placement Status and Subsequent Arrests.

Studies of the transition to adulthood in child welfare focus almost exclusively on youth in foster care. Yet, research indicates that maltreated children who remain in the home may display similar risks as compared with their peers in formal foster care settings. Utilizing administrative data from child welfare, juvenile justice and adult corrections, the current study fills a gap in the literature by analyzing justice outcomes for older adolescents involved with the child welfare system regardless of their placement status. We focus on both intact family cases and formal foster care placements. The diverse sample (11% Hispanic, 8% African American, 6% Native American, 9% multi-racial, 56% female) included open child welfare cases involving 17 year olds (n = 9874). Twenty-nine percent of adolescents were associated with a long term out of home placement and 62% were associated with an intact family case. Event history models were developed to estimate the risk of subsequent offending. Adolescents associated with long term foster care placement were significantly less likely to experience a subsequent arrest as compared with adolescents associated with a long term intact family case. Males, African Americans and adolescents associated with neglect were also more likely to experience a subsequent arrest. Limited focus on the intact family population in child welfare represents a lost opportunity to support critical developmental gains and facilitate a smooth transition to adulthood.

Trends in the disapproval and use of marijuana among adolescents and young adults in the United States: 2002-2013.

BACKGROUND: Despite policy changes related to the use and distribution of marijuana in cities and states across the country, few studies have examined changes in disapproval and use of marijuana among American youth. OBJECTIVES: To examine trends in disapproval and use of marijuana among adolescents and young adults in the United States. METHOD: We employed nationally representative data spanning the period of 2002-2013. Analyses were based on self-reported measurements from 105,903 younger adolescents (aged 12-14); 110,949 older adolescents (aged 15-17); and 221,976 young adults (aged 18-25). RESULTS: Between 2002 and 2013 the proportion of adolescents aged 12-14 reporting "strong disapproval" of marijuana use initiation increased significantly from 74.4-78.9%. Concurrently, a significant decrease in past 12-month marijuana use (OR = 0.98, 95% CI = 0.97-0.99) was observed among younger adolescents. No significant trend was observed for marijuana use disapproval among adolescents aged 15-17 between 2002 and 2013. Yet a significant (OR = 0.99, 95% CI = 0.98-0.99) decrease in the past 12-month marijuana use was observed (2002 = 26.2%, 2013 = 21.9%) among this group. Among young adults (aged 18-25), a substantial decrease - from 40.5% in 2002 to 22.6% in 2013 - was observed in the proportion reporting "strong disapproval" of marijuana use initiation; however, increases in the past 12-month use were relatively small among young adults (Δ = 2.21) but statistically significant (OR = 1.02, 95% = 1.01-1.02). CONCLUSIONS: Changes are underway in the perception and use of marijuana among American youth. However, changes differ in important ways among youth from distinct developmental subgroups.

Collaborative chronic care models for mental health conditions: cumulative meta-analysis and metaregression to guide future research and implementation.

OBJECTIVE: Prior meta-analysis indicates that collaborative chronic care models (CCMs) improve mental and physical health outcomes for individuals with mental disorders. This study aimed to investigate the stability of evidence over time and identify patient and intervention factors associated with CCM effects to facilitate implementation and sustainability of CCMs in clinical practice. METHODS: We reviewed 53 CCM trials that analyzed depression, mental quality of life (QOL), or physical QOL outcomes. Cumulative meta-analysis and metaregression were supplemented by descriptive investigations across and within trials. RESULTS: Most trials targeted depression in the primary care setting, and cumulative meta-analysis indicated that effect sizes favoring CCM quickly achieved significance for depression outcomes, and more recently achieved significance for mental and physical QOL. Four of 6 CCM elements (patient self-management support, clinical information systems, system redesign, and provider decision support) were common among reviewed trials, whereas 2 elements (health care organization support and linkages to community resources) were rare. No single CCM element was statistically associated with the success of the model. Similarly, metaregression did not identify specific factors associated with CCM effectiveness. Nonetheless, results within individual trials suggest that increased illness severity predicts CCM outcomes. CONCLUSIONS: Significant CCM trials have been derived primarily from 4 original CCM elements. Nonetheless, implementing and sustaining this established model will require health care organization support. Although CCMs have typically been tested as population-based interventions, evidence supports stepped care application to more severely ill individuals. Future priorities include developing implementation strategies to support adoption and sustainability of the model in clinical settings while maximizing fit of this multicomponent framework to local contextual factors.

Prevalence and correlates of truancy in the US: results from a national sample.

Truancy has been a persistent problem in the United States for more than 100 years. Although truancy is commonly reported as a risk factor for substance use, delinquency, dropout, and a host of other negative outcomes for youth, there has been surprisingly little empirical investigation into understanding the causes and correlates of truancy using large, nationally representative samples. Using the adolescent sample (N = 17,482) of the 2009 National Survey on Drug Use and Health (NSDUH), this study presents the prevalence of truancy and examines individual, school engagement, parental, and behavioral correlates of truancy. Overall, 11% of adolescents between the ages of 12-17 reported skipping school in the past 30 days. Results from multinomial logistic regression models indicate skipping school was robustly associated with an increased probability of reporting externalizing behaviors, less parental involvement, and engagement and lower grades in school. Implications for theory, prevention, and policy are discussed.

Complex, Co-occurring Needs Patterns and Evidence-Based Service Planning for Families Involved in Foster Care: A Map for Research and Practice.

This study described the complexity of service need co-occurrence among foster care-involved families and identified prevalent patterns of needs to inform future evidence-based service planning research. We utilized state administrative child maltreatment records, and restricted data to cases where the child entered foster care in 2019 and the caseworker indicated the presence of at least one need from the Family Assessment of Needs and Strengths (FANS; n = 1631). We extracted all unique combinations of needs (i.e., needs profiles), and we used association rule mining to identify patterns within these profiles. A total of 780 unique needs profiles emerged among the 1631 cases, which we condensed into 78 patterns. Although the variability and complexity of needs profiles makes evidence-based service planning difficult, the present analysis mapped prevalent needs patterns to guide future research intended to assist caseworkers in this task. Identification of maltreatment determinants among families involved in foster care, and future research into the needs within different needs patterns that might undermine treatment effectiveness, may result in a better balance between parsimonious service plans and a full consideration of co-occurring service needs.

Use of Salvia divinorum in a nationally representative sample.

BACKGROUND: Salvia divinorum has known hallucinogenic effects and is legal in most parts of the United States. Given that this psychoactive substance has a potential of misuse and abuse, further data regarding the clinical and psychosocial factors associated with use are needed. OBJECTIVES: To examine the clinical and psychosocial characteristics associated with use of salvia. METHODS: The study uses data from the National Survey on Drug Use and Health, 2008 (N = 55,623). RESULTS: The results of this study suggest that salvia use is most common among young adults aged 18-25 years as well as individuals who had engaged in risk-taking behaviors (selling illicit drugs, stealing) or illicit drug use (especially other hallucinogens/ecstasy). Self-reported depression and anxiety were also associated with salvia use. CONCLUSIONS/SCIENTIFIC SIGNIFICANCE: The results provide evidence that salvia use is part of a broader constellation of psychosocial and behavioral problems among youth and young adults. The accessibility, legal status, and psychoactive effects of salvia can be a potentially complicating health risk to young people, especially among those with existing substance use problems.

Religiosity profiles of American youth in relation to substance use, violence, and delinquency.

Relatively little is known in terms of the relationship between religiosity profiles and adolescents' involvement in substance use, violence, and delinquency. Using a diverse sample of 17,705 (49 % female) adolescents from the 2008 National Survey on Drug Use and Health, latent profile analysis and multinomial regression are employed to examine the relationships between latent religiosity classes and substance use, violence, and delinquency. Results revealed a five class solution. Classes were identified as religiously disengaged (10.76 %), religiously infrequent (23.59 %), privately religious (6.55 %), religious regulars (40.85 %), and religiously devoted (18.25 %). Membership in the religiously devoted class was associated with the decreased likelihood of participation in a variety of substance use behaviors as well as decreases in the likelihood of fighting and theft. To a lesser extent, membership in the religious regulars class was also associated with the decreased likelihood of substance use and fighting. However, membership in the religiously infrequent and privately religious classes was only associated with the decreased likelihood of marijuana use. Findings suggest that private religiosity alone does not serve to buffer youth effectively against involvement in problem behavior, but rather that it is the combination of intrinsic and extrinsic adolescent religiosity factors that is associated with participation in fewer problem behaviors.

A text-based approach to measuring opioid-related risk among families involved in the child welfare system.

BACKGROUND: The public health significance of the opioid epidemic is well-established. However, few states collect data on opioid problems among families involved in child welfare services. The absence of data creates significant barriers to understanding the impact of opioids on the service system and the needs of families being served. OBJECTIVE: This study sought to validate binary and count-based indicators of opioid-related maltreatment risk based on mentions of opioid use in written child welfare summaries. DATA AND PROCEDURES: We developed a comprehensive list of terms referring to opioid street drugs and pharmaceuticals. This terminology list was used to scan and flag investigator summaries from an extensive collection of investigations (N = 362,754) obtained from a state-based child welfare system in the United States. Associations between mentions of opioid use and investigators' decisions to substantiate maltreatment and remove a child from home were tested within a framework of a priori hypotheses. RESULTS: Approximately 6.3% of all investigations contained one or more opioid use mentions. Opioid mentions exhibited practically signficant associations with investigator decisions. One in ten summaries that were substantiated had an opioid mention. One in five investigations that led to the out-of-home placement of a child contained an opioid mention. CONCLUSION: This study demonstrates the feasibility of using simple text mining procedures to extract information from unstructured text documents. These methods provide novel opportunities to build insights into opioid-related problems among families involved in a child welfare system when structured data are not available.

Patterns and correlates of drug-related ED visits: results from a national survey.

PURPOSE: Drug treatment can be effective in community-based settings, but drug users tend to underuse these treatment options and instead seek services in emergency departments (EDs) and other acute care settings. The goals of this study were to describe prevalence and correlates of drug-related ED visits. BASIC PROCEDURES: This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions, which is a nationally representative survey of 43,093 US residents. MAIN FINDINGS: The overall prevalence of drug-related ED visits among lifetime drug users was 1.8%; for those with a lifetime drug use disorder, 3.7%. Persons with heroin dependence and inhalant dependence had the highest rates of ED visits, and marijuana dependence was associated with the lowest rates. Multivariate analyses revealed that being socially connected (ie, marital status) was a protective factor against ED visits, whereas psychopathology (ie, personality or mood disorders) was a risk factor. CONCLUSIONS: Significant variability exists for risk of ED use for different types of drugs. These findings can help inform where links between EDs with local treatment programs can be formed to provide preventive care and injury-prevention interventions to reduce the risk of subsequent ED visits.

Heat maps: a technique for classifying and analyzing drinking behavior.

Heat maps are presented here as an innovative technique for evaluating longitudinal drinking outcomes. The Life Transitions Study followed alcohol dependent individuals for 2.5 years during 2004-2009 in a Midwestern city (N = 364). The TimeLine Follow-Back obtained drinking information. Heat map results were compared with those obtained using growth mixture modeling. Heat map classes differed significantly on baseline clinical and demographic indicators. Data were gathered with support from NIAAA R01AA014442.

Volatile substance misuse in the United States.

Volatile substance misuse (VSM) is prevalent in the United States and associated with manifold deleterious outcomes. This review summarizes research on: (1) the prevalence of VSM in the United States and its trends since 1975, (2) population subgroups at an elevated risk for VSM, (3) key correlates of VSM, (4) psychosocial consequences of VSM, including emerging public health threats, and (5) etiological and contextual considerations of VSM use. Implications for future research and practice with volatile substance misusers in the United States are identified.

Suicide by asphyxiation due to helium inhalation.

Suicide by asphyxiation using helium is the most widely-promoted method of "self-deliverance" by right-to-die advocates. However, little is known about persons committing such suicides or the circumstances and manner in which they are completed. Prior reports of suicides by asphyxiation involving helium were reviewed and deaths determined by the North Carolina Office of the Chief Medical Examiner to be helium-associated asphyxial suicides occurring between January 1, 2000 and December 31, 2008 were included in a new case series examined in this article. The 10 asphyxial suicides involving helium identified in North Carolina tended to occur almost exclusively in non-Hispanic, white men who were relatively young (M age = 41.1 T 11.6). In 6 of 10 cases, decedents suffered from significant psychiatric dysfunction; in 3 of these 6 cases, psychiatric disorders were present comorbidly with substance abuse. In none of these cases were decedents suffering from terminal illness. Most persons committing suicide with helium were free of terminal illness but suffered from psychiatric and/or substance use disorders.

Predictors of membership in Alcoholics Anonymous in a sample of Successfully remitted alcoholics.

This study identifies factors associated with Alcoholics Anonymous (AA) membership in a sample of 81 persons who have achieved at least one year of total abstinence from alcohol and other drugs. Forty-four were AA members, 37 were not. Logistic regression was used to test the cross-sectional associations of baseline demographic, substance-related, spiritual and religious, and personality variables with AA membership. Significant variables from the bivariate analyses were included in a multivariate model controlling for previous AA involvement. Having more positive views of God and more negative consequences of drinking were significantly associated with AA membership. This information can be used by clinicians to identify clients for whom AA might be a good fit, and can help others overcome obstacles to AA or explore alternative forms of abstinence support.

Service use and treatment barriers among inhalant users.

Inhalant use is a serious global problem with consequences equal to or surpassing those of other drugs. Regrettably, few prior studies have examined inhalant users' patterns of service and treatment utilization. The purpose of this study is to identify factors associated with service use and barriers to treatment among a nationally representative sample of inhalant users. Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) reveal that among inhalant users problem severity and substance use disorder comorbidity were associated with substance abuse treatment barriers and service usage. These findings can help improve the service delivery system to provide effective treatments and reduce the risk of emergency department usage, which is among the most expensive and least effective ways to deal with substance abuse.

Psychiatric correlates of behavioral indicators of school disengagement in the United States.

The current study examined relations between behavioral indicators of school disengagement and psychiatric disorders. Data was derived from a nationally representative sample of U.S. adults (N = 43,093). Indicators of school disengagement and diagnoses of personality, substance use, mood, and anxiety disorders were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV-version. Findings from multinomial logistic regression analyses revealed that cumulative school disengagement is associated with increased odds of reporting a lifetime psychiatric disorder and general antisociality. Behavioral indicators of school disengagement such as absenteeism and cutting class are potentially important signs of psychiatric distress and conduct problems. In addition to attending to academic achievement outcomes school disengagement prevention strategies should consider targeting these psychiatric conditions in order to reduce school dropout.

Characteristics of Abstainers from Substance Use and Antisocial in the United States.

PURPOSE: Whether lifetime abstainer's antisocial behavior are maladjusted or well-adjusted is unresolved. The aim of this study was to compare abstainers (defined as persons with no lifetime use of alcohol and other drugs and non-engagement in antisocial or delinquent behavior) with non-abstainers across a range of sociodemographic and mental health characteristics in the United States. METHODS: Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of U.S. adults. Structured psychiatric interviews (N = 43,093) using the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV version (AUDADIS-IV) were completed by trained lay interviewers between 2001 and 2002. RESULTS: The prevalence of abstaining was 11%. Abstainers were significantly more likely to be female, Asian and African-American, born outside the U.S., and less likely to be unemployed. Multivariate logistic regression analyses revealed that abstainers were significantly less likely to evidence lifetime mood, anxiety, or personality disorder compared to non-abstainers. CONCLUSIONS: Findings indicate that abstainers are not maladapted and are comparatively more functional than non-abstainers.

The Severe 5%: A Latent Class Analysis of the Externalizing Behavior Spectrum in the United States.

OBJECTIVE: Criminological research consistently demonstrates that approximately 5% of study populations are comprised of pathological offenders who account for a preponderance of antisocial behavior and violent crime. Unfortunately, there have been no nationally representative epidemiological studies characterizing the severe 5% group. MATERIALS AND METHODS: Data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 43,093 non-institutionalized U.S. residents aged 18 years and older were analyzed using latent class analysis to assess sociodemographic, psychiatric, and behavioral characteristics. RESULTS: Four-classes of respondents were identified vis-à-vis lifetime externalizing behaviors. A normative class (66.1% of respondents) demonstrated little involvement in antisocial conduct. A low substance use/high antisocial behavior class (20.7% of respondents) and high substance use/moderate antisocial behavior (8.0% of respondents) class evinced diverse externalizing and psychiatric symptoms. Finally, a severe class (5.3% of respondents) was characterized by pathological involvement in more varied and intensive forms of antisocial and externalizing behaviors and extensive psychiatric disturbance. CONCLUSIONS: The current study is the first nationally representative epidemiological study of criminal careers/externalizing behavior spectrum in the United States and validates the existence of the 5% pathological group demonstrated by prior research.

Identification of Domestic Violence Service Needs Among Child Welfare-Involved Parents With Substance Use Disorders: A Gender-Stratified Analysis.

The current study examined the prevalence and associations of a need for domestic violence services among child welfare-involved mothers and fathers with substance use disorders. Data were drawn from 2,231 child welfare-involved parents in Illinois with an identified substance use disorder. Approximately 42% of mothers and 33% of fathers with a substance use disorder had a concurrent need for domestic violence services. The sample was stratified by gender and logistic regression models were fit to determine the adjusted odds of an identified need for domestic violence services. For both mothers and fathers, the strongest association was an additional need for mental health services. Age, education status, alcohol use, marijuana use, and a reported history of physical violence victimization were also associated with a need for domestic violence services among mothers, while race, age, marital status, annual income, alcohol use, cocaine use, and a reported history of physical violence perpetration were associated with a need for domestic violence services among fathers. The findings of this study make clear that domestic violence is a commonly co-occurring service need for child welfare-involved parents with identified substance use disorders, and that associations with this need vary by gender.