Risk and Promotive Factors Related to Cannabis Use Among American Indian Adolescents.

Reservation-dwelling American Indian adolescents are at exceedingly high risk for cannabis use. Prevention initiatives to delay the onset and escalation of use are needed. The risk and promotive factors approach to substance use prevention is a well-established framework for identifying the timing and targets for prevention initiatives. This study aimed to develop predictive models for the usage of cannabis using 22 salient risk and promotive factors. Models were developed using data from a cross-sectional study and further validated using data from a separate longitudinal study with three measurement occasions (baseline, 6-month follow-up, 1-year follow-up). Application of the model to longitudinal data showed an acceptable performance contemporaneously but waning prospective predictive utility over time. Despite the model's high specificity, the sensitivity was low, indicating an effective prediction of non-users but poor performance in correctly identifying users, particularly at the 1-year follow-up. This divergence can have significant implications. For example, a model that misclassifies future adolescent cannabis use could fail to provide necessary intervention for those at risk, leading to negative health and social consequences. Moreover, supplementary analysis points to the importance of considering change in risk and promotive factors over time.

Youth Exposure to Recreational Cannabis Legalization: Moderation of Effects by Sex and Parental Cannabis Use during Adolescence.

OBJECTIVE: Few studies of recreational cannabis legalization (RCL) have assessed adolescents both before and after RCL or considered moderators of RCL effects. The present study tested whether RCL was more strongly associated with cannabis use for girls and among youth whose parents had a history of cannabis use during adolescence. METHOD: Data were pooled from 940 adolescents from three intergenerational studies that began in Washington (where RCL was enacted in 2012), Oregon (RCL year = 2015), and New York (RCL year = 2021). Youth were assessed repeatedly from ages 13 to 18 years (k = 3,650 person-years) from 1999 to 2020 (prior to RCL in New York). Parent cannabis use at or before age 18 years (yes/no) was assessed prospectively during the parent's adolescence. Multilevel models focused on the between-subjects effects of years of youth exposure to RCL on adolescents' mean cannabis use likelihood, and interactions with child sex and parent use history. RESULTS: Child exposure to RCL was associated with a higher likelihood of cannabis use if their parents had a history of adolescent use, (Estimate [SE] = 0.67 [0.25], p = 0.008), versus no such history (Estimate [SE] = -0.05 [0.28], p = 0.855). RCL effects were not moderated by child sex. CONCLUSIONS: The effects of RCL on adolescents' cannabis use may depend on their parents' history of using the drug. Identifying other moderators of RCL effects, and understanding the mechanisms of these risks and the ways that parents and communities can offset them, are prevention priorities.

(1) Adolescents' use of cannabis may have intergenerational consequences, making it more likely their future offspring will use cannabis. (2) Whether or not recreational cannabis legalization influences adolescents' cannabis use may depend on their parents' cannabis use history. (3) Parenting in a state with liberalized cannabis policies may present new challenges and require that novel prevention resources be developed.

Nonmedical Prescription Drug Use Among Female Adolescents: The Relative Influence of Maternal Factors, Social Norms, and Perceptions of Risk and Availability.

Increasing understanding of the risk and protective factors for adolescent nonmedical use of prescription drugs (NMUPD) could inform prevention efforts. Several correlates have been identified, including parental factors, perceptions about use and accessibility, social norms, and age. However, these constructs have rarely been simultaneously examined using paired data from parents and adolescents. We aimed to examine the relative influence of these correlates among dyads (N=349) of mothers and adolescent daughters. Using multiple logistic regression, daughters' past NMUPD and inclination for future NMUPD were regressed onto descriptive norms for friend use, perceived drug accessibility and risk of harm from use, daughter age, mothers' disapproval about use, mothers' past NMUPD and inclination for future NMUPD, and the mother-daughter relationship quality. Akaike weights and lasso regressions were also estimated to evaluate the relative importance of each correlate. Higher descriptive norms for friend use, older age, and mothers' inclination for NMUPD were risk factors for daughters' NMUPD, while a closer mother-daughter relationship and mothers' disapproving attitudes towards NMUPD were protective factors. The three analysis approaches were corroborative. Results suggest friend descriptive norms, mother-daughter relationship quality, and mothers' attitudes about NMUPD are important prevention targets.

The joint development of externalizing and internalizing behaviors in black and Hispanic youth and the link to late adolescent substance use.

There is a need to understand how the joint development of externalizing and internalizing behaviors is related to substance use, particularly among historically understudied and often disadvantaged populations. Latent class models were used to estimate patterns of externalizing behaviors and internalizing behaviors in the form of depressive and anxious symptoms from age 6 to 14 among 390 Black and Hispanic youth. Then, growth curve models of substance use between the ages of 15 and 19 were estimated as a function of joint latent class membership. Only elevated levels of externalizing behaviors were associated with higher levels of substance use through age 18. Internalizing behaviors appeared to serve as a protective factor among those with moderate displays of externalizing behavior only. Additionally, growth in substance use from ages 15 to 19 was slower among those who displayed the highest level of externalizing behaviors, and internalizing behaviors appeared to moderate growth (and serve as protective factor) among those who displayed moderate levels of externalizing behaviors. The findings underscore the importance of pattern profiles based on observations of the joint development of problem behaviors to assess risk for substance use, particularly in understudied populations where risk/protective factors may operate in a unique manner.

Heavy episodic drinking in adolescence and alcohol-related problems in adulthood: A developmental approach to alcohol use across the life course.

Heavy episodic drinking (HED) is a major public health concern, and youth who engage in HED are at increased risk for alcohol-related problems that continue into adulthood. Importantly, there is heterogeneity in the onset and course of adolescent HED, as youth exhibit different trajectories of initiation and progression into heavy drinking. Much of what is known about the etiology of adolescent HED and alcohol-related problems that persist into adulthood comes from studies of predominantly White, middle-class youth. Because alcohol use and related problems vary by race/ethnicity and socioeconomic status, it is unclear whether previous findings are relevant for understanding developmental antecedents and distal consequences of adolescent HED for minoritized individuals. In the current study, we utilize a developmental psychopathology perspective to fill this gap in the literature. Using a racially and economically diverse cohort followed from adolescence well into adulthood, we apply group-based trajectory modeling (GBTM) to identify patterns of involvement in HED from age 14 to 17 years. We then investigate developmental antecedents of GBTM class membership, and alcohol-related distal outcomes in adulthood (∼ age 31 years) associated with GBTM class membership. Results highlight the importance of adolescent alcohol use in predicting future alcohol use in adulthood.

Effects of Engagement with a Social Media Campaign for Mothers to Prevent Indoor Tanning by Teens in a Randomized Trial.

In a social media campaign aimed at reducing mothers' permissiveness for indoor tanning (IT) by their teenage daughters, a secondary analysis of campaign engagement effects on IT outcomes was performed. Mothers (n = 869) with daughters aged 14-17 were recruited in 34 states that did not ban IT by minors under age 18 for a randomized trial with follow-up at 12 months (end of intervention) and 18 months (6 months after intervention) post-randomization. Daughters' (n = 469) baseline and follow-up responses were analyzed too. Mothers received a Facebook feed on adolescent health topics that included posts about preventing IT (intervention) or prescription drug misuse (control). Engagement was measured by extracting reactions (e.g., like, sad, etc.) and comments posted by mothers to the campaign posts. Overall, 76.4% of posts received a reaction and/or comment. Mothers who engaged with IT posts were less permissive of daughters' IT immediately at the conclusion of the campaign (permit IT: -0.39, p < .05; facilitate IT: -0.29, p < .05) and 6 months after intervention (permit IT: -0.32, p < .05; facilitate IT: -0.31, p < .05) than mothers who did not engage with posts. Engagement with posts was essential to the success of a social media campaign for preventing IT by minors by reducing mothers' permissiveness.

School-related Promotive Factors Related to Cannabis Use Among American Indian Adolescents.

Reservation-dwelling American Indian adolescents are at exceedingly high risk for cannabis use. Prevention initiatives to delay onset and escalation of use are needed. School engagement and student's positive experiences at school have been identified as key promotive factors against cannabis use in the general population of adolescents, but little work has examined these factors among American Indian youth. Seven school-related promotive factors were examined as predictors of past 30-day cannabis use (measured 6 months later), controlling for previous onset of cannabis use as well as a set of relevant potential confounders. Models were tested using 280 adolescents in 6th or 7th grade at the start of the study from two reservation-based schools in the US. Students were surveyed three times, with 6 months in between each survey. The average age at the start of the study was 11.99 years (SD = 0.87) and 54% of participants were female. Using a cumulative logit model to predict past 30-day use, American Indian youth who reported greater school bonding, academic aspirations, proclivity to endeavor in their studies, and interest in school at Wave 2 reported less 30-day cannabis use at Wave 3 (controlling for onset of cannabis at Wave 1 and several other control variables). No evidence of an effect of self-reported grades, perceived safety, or participation in school-related extracurricular activities was found. Given substantial deterioration of these school-related promotive factors over time, and the effect of the school-related promotive factors on subsequent cannabis use, efforts to design and test interventions to promote school engagement as a protective measure against cannabis use is warranted.

The Comparative Roles of Mentor Self-Efficacy and Empathy in Fostering Relationship Quality with Youth.

Youth mentors' efficacy beliefs and relational skills should both influence the quality of their connections with their mentees, but a lack of research based on large, dyadic and longitudinal samples limits understanding of how mentor characteristics impact relationship quality. This study used three staged and process-focused structural equation models to (1) investigate the mutually reinforcing effects of mentor self-efficacy and empathy over time; (2) compare the longitudinal effects of mid-program mentor efficacy and empathy on end of program mentor and mentee perceptions of relationship quality; and (3) test a similar comparative model using cross-sectional end of program assessments to account for developmental changes in these variables over time. The sample consisted of 664 college-age mentor (76.5% female; [Formula: see text] age = 24.5, range = 21-53; 23.5% non-White) and youth mentee (41% female; [Formula: see text] age = 14.1, range = 10-19; 41.9% non-White) dyads. Mentor empathy predicted mentor perceptions of relationship quality at both time points and mentee perceptions at the end of the program. Mentor efficacy only predicted mentor reported relationship quality at the end of the program. The findings emphasize the importance of investing in empathy training for mentors to support both partners' positive evaluation of the relationship. Program support to increase mentor self-efficacy should also have added value for mentors.

Follow-Up Analyses From a Wait-List Controlled Trial of Occupational Therapist-Delivered Cognitive-Behavioral Therapy for Insomnia Among Veterans With Chronic Insomnia.

IMPORTANCE: Veterans often experience chronic insomnia, and professionals capable of delivering effective interventions to address this problem are lacking. OBJECTIVE: To evaluate the efficacy of the Restoring Effective Sleep Tranquility (REST) program, an occupational therapist-led cognitive-behavioral therapy for insomnia (CBT-I) intervention to treat sleep problems among post- 9/11 veterans. DESIGN: Wait-list controlled trial with 3-mo follow-up. SETTING: Community-based veteran support program in a Mountain West university. PARTICIPANTS: Fifteen post-9/11 veterans with sleep disturbances who were assigned to either the REST intervention or a wait-list control group. Outcomes and Measures: Sleep-related, health-related, and participation-related patient-reported outcomes (PROs) and daily sleep diary variables. RESULTS: Wait-list controlled trial benefits included improved sleep-related (e.g., sleep disturbance), health-related (e.g., depression), and participation-related (e.g., meaningful activity) PROs. Findings were confirmed after participants in both the intervention and the control groups (n = 13) received the REST intervention, including improved daily sleep diary outcomes (e.g., sleep efficiency). All gains were maintained at 3 mo. CONCLUSIONS AND RELEVANCE: Occupational therapy practitioners with advanced training in CBT-I have the potential to safely deliver an effective CBT-I intervention to veterans with sleep disturbances in a community-based setting. What This Article Adds: Occupational therapy practitioners with sleep-related education and training can positively affect the well-being of their clients through improving sleep participation.

Racial/Ethnic Differences in 30-Year Trajectories of Cannabis Use among Males.

Background: Given that cannabis is the most commonly used illicit substance in the US, continuous research on patterns of cannabis use over the life course can help to ensure progress towards improving public health and reducing health inequalities across race/ethnicity. Thus, we examine racial/ethnic differences in cannabis use trajectories among males across two overlapping stages of the life course. Methods: We use data from two companion studies, the Rochester Youth Development Study (RYDS - a longitudinal cohort study that followed participants from adolescence into adulthood), and its intergenerational extension - the Rochester Intergenerational Study. For Life Stage 1, we consider cannabis use during the transition from adolescence to adulthood (spanning ages 13 to 33; 439 Black, 128 White, and 125 Hispanic males). Among these males who became fathers, we consider cannabis use during fatherhood (Life Stage 2 -spanning the period of time when their firstborn child was between the ages of 7 and 17-217 Black, 55 White, and 56 Hispanic males). Ordinal generalized estimating equations were specified to examine cannabis use trajectories during both stages of the males' lives. Results: No significant differences in cannabis use as a function of racial/ethnic group were found during the transition from adolescence to adulthood (Life Stage 1). All groups had a peak of cannabis use in the early to mid-20's followed by a decline in use. During fatherhood (Life Stage 2), cannabis use was stable for all groups, but Black fathers reported more frequent cannabis use on average than Hispanic fathers. Conclusions: The increase in cannabis use well past adolescence for all groups suggests the potential importance of intervention initiatives during the transition to adulthood. The more frequent use of cannabis by Black fathers warrants further study given the impact parental cannabis use can have on offspring.

Maternal Substance Abuse and the Mother-Child Relationship in Late Childhood.

This study examines the relationship between maternal substance abuse and various aspects of the mother-child relationship in late childhood while accounting for mental health and comorbid substance abuse and mental health among a predominantly racial minority sample.Using 369 mother-child dyads from the Rochester Intergenerational Study (64% Black, 17% Hispanic, and 8% mixed race/ethnicity), multilevel generalized linear models examined the effects of a maternal substance abuse history, a history of clinical depression, and comorbid substance abuse and depression histories on both maternal and child reports of five aspects of the mother-child relationship (i.e. warmth, consistent discipline, maternal knowledge, involvement, and conflict). RESULTS: A maternal substance abuse history alone was unrelated to each aspect of the mother-child relationship as perceived by the mother or child, with the exception of child perceptions of maternal knowledge of behavior. Alternatively, a history of depression or comorbid histories of substance abuse and depression was negatively related to warmth, consistent discipline, involvement, and conflict but only as perceived by the mother. CONCLUSIONS: This study reinforces the need for integrated treatment programs for women with substance use problems, particularly programs that incorporate mental health and parenting components. Moreover, it highlights specific targets for intervention that can reduce subsequent maternal substance abuse and improve offspring outcomes. The divergence in observed effects across reporter also suggests that future research should use multiple reporters to examine the interpersonal consequences associated maternal substance abuse.

How Early Is Too Early? Identification of Elevated, Persistent Problem Behavior in Childhood.

We inquire how early in childhood children most at risk for problematic patterns of internalizing and externalizing behaviors can be accurately classified. Yearly measures of anxiety/depressive symptoms and aggressive behaviors (ages 6-13; n = 334), respectively, are used to identify behavioral trajectories. We then assess the degree to which limited spans of yearly information allow for the correct classification into the elevated, persistent pattern of the problem behavior, identified theoretically and empirically as high-risk and most in need of intervention. The true positive rate (sensitivity) is below 70% for anxiety/depressive symptoms and aggressive behaviors using behavioral information through ages 6 and 7. Conversely, by age 9, over 90% of the high-risk individuals are correctly classified (i.e., sensitivity) for anxiety/depressive symptoms, but this threshold is not met until age 12 for aggressive behaviors. Notably, the false positive rate of classification for both high-risk problem behaviors is consistently low using each limited age span of data (< 5%). These results suggest that correct classification into highest risk groups of childhood problem behavior is limited using behavioral information observed at early ages. Prevention programming targeting those who will display persistent, elevated levels of problem behavior should be cognizant of the degree of misclassification and how this varies with the accumulation of behavioral information. Continuous assessment of problem behaviors is needed throughout childhood in order to continually identify high-risk individuals most in need of intervention as behavior patterns are sufficiently realized.

Maternal Depressive Symptoms and Adolescent Health Risk Problems: The Role of School Engagement.

Maternal depressive symptoms disrupt positive youth development, though the pervasiveness of this disruption is understudied. Additionally, it remains unknown whether prosocial factors such as adolescent school engagement may buffer against this risk factor. Using multigenerational, longitudinal data spanning ten years from an ethnically diverse sample of mother-child dyads (66% Black, 17% Hispanic, and 17% White), this study examines the effect of maternal depressive symptoms in late childhood (ages 8-13) on the development and progression of offspring depressive symptoms, substance use, and delinquent behavior during adolescence (ages 14-17). Further, the study examines whether school engagement moderates the ill effects of maternal depressive symptoms. Mother-son (n = 212) and mother-daughter (n = 215) dyads are compared to assess for similarities and differences between male and female offspring. The results indicate that offspring of mothers with greater maternal depressive symptoms are more likely to display higher levels of depressive symptoms, substance use, and delinquency throughout adolescence, although important nuances emerge across outcome and child sex. Additionally, while school engagement itself is associated with reduced depressive symptoms, substance use and delinquency among adolescents, it is not profound enough to offset the risk posed by maternal depressive symptoms. The findings of this study reinforce the pervasive, negative, intergenerational impact of maternal depressive symptoms and has implications for prevention and intervention efforts for adolescent health risk problems.

Correction to: Does Organizing Mentor-Mentee Matches into Small Groups Enhance Treatment Effects in a Site-Based Mentoring Program for Adolescents? Results of a Randomized Controlled Trial.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Does Organizing Mentor-Mentee Matches into Small Groups Enhance Treatment Effects in a Site-Based Mentoring Program for Adolescents? Results of a Randomized Controlled Trial.

Formal youth mentoring is an effective intervention strategy for healthy development during adolescence. Modest and varied effects across programs, however, demonstrate a need to identify factors that can reliably improve outcomes for mentored youth. The purpose of this randomized controlled trial was to test the relative impact of embedding mentee-mentor matches in small groups on youth outcomes and to examine whether this effect was mediated by the quality of the program setting and mentoring relationship quality. Participants included 676 adolescents (Mage = 14.21, range = 11-18; 41.6% female) enrolled in Campus Connections, a site-based youth mentoring program. Most measured outcomes in both conditions (i.e., mentoring groups and a control condition in which pairs were not embedded in a group) were significantly better at post-intervention as compared to pre-intervention. The hypothesis that mentoring groups would have stronger impact, however, was not supported. The results imply that organizing mentor-mentee matches in small groups offer no advantage or disadvantage and that youth may be able to garner benefit from both structures.

Protective and Health-Related Factors Contributing to Resilience Among Student Veterans: A Classification Approach.

IMPORTANCE: Occupational therapists can foster student veterans' resilience, but targets for intervention must be developed. OBJECTIVE: To explain factors influencing student veterans' successful adaptation to past combat exposure, we hypothesized that participants with high life meaning would have greater levels of protective factors and lower levels of health conditions than those with low life meaning. DESIGN: Longitudinal panel study with two measurements. Participants were classified by level of combat exposure (high-low) and life meaning (high-low) at follow-up, yielding four possible classifications (e.g., resilient group: high combat exposure, high life meaning). Linear mixed models were fit to obtain adjusted means of protective factors and health conditions for each classification; independent-samples t tests were used to examine differences between classifications. SETTING: Community. PARTICIPANTS: Convenience sample of 153 combat-exposed student veterans. OUTCOMES AND MEASURES: Psychometrically sound measures of combat exposure, life meaning, protective factors (social and instructor autonomy support, coping ability, academic self-efficacy, social-community participation, and meaningful activity), and health conditions (posttraumatic stress [PTSD], depression, somatic symptoms). RESULTS: Groups with high life meaning at follow-up in response to both levels of combat exposure reported greater meaningful activity and coping ability and fewer depressive symptoms. Participants with high life meaning in response to low combat exposure had greater social support and fewer somatic symptoms; participants with high life meaning in response to high combat exposure had lower PTSD. CONCLUSIONS AND RELEVANCE: Occupational therapists may foster student veterans' resilience by promoting meaningful activity, social support, and coping ability while managing symptoms of health conditions. WHAT THIS ARTICLE ADDS: To the best of our knowledge, this study is the first to offer empirical support for potential targets of occupational therapy intervention that address student veterans' successful adaptation to combat exposure. Findings suggest that researchers should develop and test interventions that facilitate successful engagement in meaningful and shared activities and that occupational therapists should work within multidisciplinary teams to bolster coping ability and manage symptoms of combat-related health conditions.

The reproduction of child maltreatment: An examination of adolescent problem behavior, substance use, and precocious transitions in the link between victimization and perpetration.

Growing evidence suggests that maltreatment is reproduced across generations as victims of maltreatment are at an increased risk for maltreatment perpetration. Unfortunately, little information about mediating pathways exists to provide an explanation for why maltreatment begets maltreatment. We use the number of types of maltreatment experienced to predict later maltreatment perpetration and then examine two developmental pathways that may serve as bridges between maltreatment victimization and perpetration: adolescent problem behaviors and precocious transitions to adulthood. With prospective, longitudinal data from the Rochester Youth Development Study, we assess the relevance of these pathways for the number of maltreatment experiences as well as the number of maltreatment victimization experiences by developmental period (i.e., childhood and adolescence). Our results demonstrate a significant relationship between maltreatment victimization and maltreatment perpetration. Adolescent delinquency and two precocious transitions, dropping out of school and independent living, as well as the accumulation of precocious transitions and problem behaviors, serve as mediators of this intergenerational relationship. Furthermore, the relationship between the number of types of maltreatment and subsequent perpetration is primarily driven by experiences of maltreatment during adolescence. We discuss the implications of these results and set an agenda for the development of programs and policies to interrupt the cycle of maltreatment.

Using Job Analysis Techniques to Understand Training Needs for Promotores de Salud.

Despite the value of community health worker programs, such as Promotores de Salud, for addressing health disparities in the Latino community, little consensus has been reached to formally define the unique roles and duties associated with the job, thereby creating unique job training challenges. Understanding the job tasks and worker attributes central to this work is a critical first step for developing the training and evaluation systems of promotores programs. Here, we present the process and findings of a job analysis conducted for promotores working for Planned Parenthood. We employed a systematic approach, the combination job analysis method, to define the job in terms of its work and worker requirements, identifying key job tasks, as well as the worker attributes necessary to effectively perform them. Our results suggest that the promotores' job encompasses a broad range of activities and requires an equally broad range of personal characteristics to perform. These results played an important role in the development of our training and evaluation protocols. In this article, we introduce the technique of job analysis, provide an overview of the results from our own application of this technique, and discuss how these findings can be used to inform a training and performance evaluation system. This article provides a template for other organizations implementing similar community health worker programs and illustrates the value of conducting a job analysis for clarifying job roles, developing and evaluating job training materials, and selecting qualified job candidates.

The Harmful Effect of Child Maltreatment on Economic Outcomes in Adulthood.

OBJECTIVES: To examine the effect of maltreatment during childhood on subsequent financial strain during adulthood and the extent to which this effect is mediated by adolescent depressive symptoms, adolescent substance abuse, attenuated educational achievement, and timing of first birth. METHODS: We specified a multilevel path model to examine the developmental cascade of child maltreatment. We used data from a longitudinal panel study of 496 parents participating in the Rochester Intergenerational Study, in Rochester, New York. Data were collected between 1988 and 2016. RESULTS: Child maltreatment had both a direct and indirect (via the mediators) effect on greater financial strain during adulthood. CONCLUSIONS: Maltreatment has the capacity to disrupt healthy development during adolescence and early adulthood and puts the affected individual at risk for economic difficulties later in life. Maltreatment is a key social determinant for health and prosperity, and initiatives to prevent maltreatment and provide mental health and social services to victims are critical.

Is cortisol production in response to an acute stressor associated with diurnal cortisol production during adolescence?

The goal of the current study was to examine the extent to which cortisol responding to an acute stressor is related to diurnal cortisol patterns during adolescence. Participants were 105 adolescents (10-17 years of age) who experienced a robust social-evaluative stressor and provided saliva samples (before and immediately after, as well as 10, 20, and 30 min after the stressor) to assess both cortisol reactivity and recovery and also provided saliva samples (at wake-up, 30 min after wake-up, 4 pm, and at bedtime) on two consecutive days to measure diurnal cortisol production. Dual process latent growth curve models, one for cortisol reactivity and one for diurnal cortisol, indicated that dampened cortisol reactivity and prolonged cortisol recovery (i.e., less cortisol produced during reactivity but more cortisol produced during recovery) were associated with dampened decreases in cortisol production across the day, suggesting that adolescents are likely to show attenuation in multiple components of HPA axis functioning.