Helping individuals with firearm injuries: A cluster randomized trial.

BACKGROUND: Patients with firearm injuries are at high risk of subsequent arrest and injury following hospital discharge. We sought to evaluate the effect of a 6-month joint hospital- and community-based low-intensity intervention on risk of arrest and injury among patients with firearm injuries. METHODS: We conducted a cluster randomized controlled trial, enrolling patients with firearm injuries who received treatment at Harborview Medical Center, the level 1 trauma center in Seattle, Washington, were 18 years or older at the time of injury, spoke English, were able to provide consent and a method of contact, and lived in one of the five study counties. The intervention consisted of hospital-based motivational interviewing, followed by a 6-month community-based intervention, and multiagency support. The primary outcome was the risk of subsequent arrest. The main secondary outcome was the risk of death or subsequent injury requiring treatment in the emergency department or hospitalization. RESULTS: Neither assignment to or engagement with the intervention, defined as having at least 1 contact point with the support specialist, was associated with risk of arrest at 2 years post-hospital discharge (relative risk for intervention assignment, 1.15; 95% confidence interval, 0.90-1.48; relative risk for intervention engagement, 1.07; 95% confidence interval, 0.74-2.19). There was similarly no association observed for subsequent injury. CONCLUSIONS: This study represents one of the first randomized controlled trials of a joint hospital- and community-based intervention delivered exclusively among patients with firearm injuries. The intervention was not associated with changes in risk of arrest or injury, a finding most likely due to the low intensity of the program. LEVEL OF EVIDENCE: Care management, level II.

Prevalence of marijuana and other substance use before and after Washington State's change from legal medical marijuana to legal medical and nonmedical marijuana: Cohort comparisons in a sample of adolescents.

BACKGROUND: A growing number of states have new legislation extending prior legalization of medical marijuana by allowing nonmedical marijuana use for adults. The potential influence of this change in legislation on adolescent marijuana and other substance use (e.g., spillover or substitution effects) is uncertain. We capitalize on an ongoing study to explore the prevalence of marijuana and other substance use in 2 cohorts of adolescents who experienced the nonmedical marijuana law change in Washington State at different ages. METHODS: Participants were 8th graders enrolled in targeted Tacoma, Washington public schools and recruited in 2 consecutive annual cohorts. The analysis sample was 238 students who completed a baseline survey in the 8th grade and a follow-up survey after the 9th grade. Between the 2 assessments, the second cohort experienced the Washington State nonmedical marijuana law change, whereas the first cohort did not. Self-report survey data on lifetime and past-month marijuana, cigarette, and alcohol use were collected. RESULTS: Multivariate multilevel modeling showed that cohort differences in the likelihood of marijuana use were significantly different from those for cigarette and alcohol use at follow-up (adjusting for baseline substance initiation). Marijuana use was higher for the second cohort than the first cohort, but this difference was not statistically significant. Rates of cigarette and alcohol use were slightly lower in the second cohort than in the first cohort. CONCLUSIONS: This exploratory study found that marijuana use was more prevalent among teens shortly after the transition from medical marijuana legalization only to medical and nonmedical marijuana legalization, although the difference between cohorts was not statistically significant. The findings also provided some evidence of substitution effects. The analytic technique used here may be useful for examining potential long-term effects of nonmedical marijuana laws on adolescent marijuana use and substitution or spillover effects in future studies.

Washington State recreational marijuana legalization: parent and adolescent perceptions, knowledge, and discussions in a sample of low-income families.

BACKGROUND: In November 2012, Washington State and Colorado became the first states in the United States to legalize recreational marijuana use for adults, and Uruguay became the first country to allow the cultivation, distribution, possession, and use of marijuana. One possible consequence of these changes is increased adolescent marijuana use. Parents may mitigate this adverse consequence; however, whether parents and adolescents have accurate knowledge about the laws and are discussing marijuana use in light of the law changes is unknown. OBJECTIVE: We examine perceptions, knowledge, and parent-child discussions about Washington State's recreational marijuana law in a sample of low-income families. METHODS: Participants were a subset of families (n = 115) in an ongoing study that originally recruited parents and adolescents from middle schools in Tacoma, Washington. In summer 2013, when students were entering the 11(th) grade, students and their parents were asked questions about the recreational marijuana law. RESULTS: Participants perceived that their marijuana-related attitudes and behaviors changed little as a result of the law, and displayed uncertainty about what is legal and illegal. Most parents reported discussing the new law with their children but only occasionally, and conversations emphasized household rules, particularly among parent lifetime marijuana users compared to non-users. Conclusions/Importance: Results suggest that there should be a public health campaign focused on families that provides clear information about the recreational marijuana laws.

Educational Paths and Substance Use from Adolescence into Early Adulthood.

This study examined how substance use trajectories from ages 15 to 23 in a community sample (N=921) were related to educational pathways. Rates of heavy drinking converged across different paths, but starting college at a 2-year college before transferring to a 4-year college was related to later increase in drinking after high school. Higher future educational attainment was negatively associated with high school marijuana use, but marijuana use increased after high school for individuals who went to 4-year colleges compared to those who did not. Noncollege youth had the highest rates of daily cigarette smoking throughout adolescence and early adulthood, while college dropouts had higher rates of smoking than college students who did not drop out. The findings support the need for universal prevention for early adult heavy drinking, addressing increases in drinking and marijuana use in 4-year colleges, and targeting marijuana use and cigarette smoking interventions at noncollege youth and college dropouts.

HPV vaccination among a community sample of young adult women.

OBJECTIVES: Despite the high efficacy of the human papillomavirus (HPV) vaccine, uptake has been slow and little data on psychosocial barriers to vaccination exist. METHODS: A community sample of 428 women enrolled in a longitudinal study of social development in the Seattle WA metropolitan area were interviewed about HPV vaccine status, attitudes, and barriers to HPV vaccination in spring 2008 or 2009 at ∼age 22. RESULTS: Nineteen percent of women had initiated vaccination, 10% had completed the series, and ∼40% of unvaccinated women intended to get vaccinated. Peer approval was associated with vaccine initiation (adjusted prevalence ratio (APR) 2.1; 95% confidence interval 1.4-3.2) and intention to vaccinate (APR 1.4; 1.1-1.9). Belief the vaccine is <75% effective was associated with less initiation (APR 0.6; 0.4-0.9) or intention to vaccinate (APR 0.5; 0.4-0.7). Vaccine initiation was also less likely among cigarette smokers and illegal drug users, whereas intention to vaccinate was more common among women currently attending school or with >5 lifetime sex partners, but less common among women perceiving low susceptibility to HPV (APR 0.6; 0.5-0.9). CONCLUSIONS: HPV vaccination uptake was low in this community sample of young adult women. Increasing awareness of susceptibility to HPV and the high efficacy of the vaccine, along with peer interventions to increase acceptability, may be most effective.

Romantic relationship status changes and substance use among 18- to 20-year-olds.

OBJECTIVE: Changes in romantic relationship status are common in emerging adulthood and may be linked to changes in substance use. This study tested the hypothesis that entry into relationships or transitioning to a more committed status leads to decreases in substance use and that dissolution of relationships or transitioning to a less committed status results in increases in substance use. METHOD: Data were from a community sample of 939 individuals. Substance use (heavy drinking, marijuana use, and cigarette smoking) and relationship status (single, in a romantic relationship but not cohabiting, cohabiting, or married) were assessed at the beginning and end of three 6-month intervals between the ages of 18 and 20 years. Models were estimated to assess the association between transitions in relationship status and substance use, adjusting for prior levels of use. RESULTS: There were increases in heavy drinking, marijuana use, and cigarette smoking associated with dissolution of a romantic relationship, as well as increases in marijuana use and cigarette smoking associated with switching partners within a 6-month interval. Mediation analyses found some support for increases in both depressive symptoms and exposure to substance-using peers partially accounting for these associations. Decreases in substance use were not found for individuals entering into a new relationship or transitioning to a more committed relationship status. In fact, cigarette smoking increased among those who went from being single to being in a romantic relationship compared with those whose relationship status did not change. CONCLUSIONS: Emerging adults who experience dissolution of romantic relationships or quickly move from one relationship to another experience increased substance use. Both depressive symptoms and changes in peer environments may partially account for these changes in use.

Parental and peer influences on teen smoking: Are White and Black families different?

INTRODUCTION: The health risks associated with smoking disproportionately burden Blacks, and Black adults are more likely to smoke than are White adults. Most adult smokers have their first smoking experience as teenagers; however, rates of smoking initiation during adolescence remain lower among Black compared with White youth. METHODS: The level and impact of family and peer risk and protective factors on adolescent smoking across both groups were modeled prospectively from 8th to 10th grade in a sample of 331 (Black n = 162, White n = 168) families using data from self-administered computer-assisted questionnaires. Predictors included parent smoking, guidelines against substance use, monitoring, consistent discipline, attachment to parents, and association with deviant peers. RESULTS: Mean-level differences indicated greater risk for Black teens in some cases and higher protection in others. Multiple-group structural equation modeling indicated no race differences. Several factors affected both groups: (a) parenting factors reduced association with deviant peers, (b) association with deviant peers increased the risk of smoking in the 10th grade, and (c) teens were more likely to smoke if their parents smoked. DISCUSSION: Reduced smoking among Black teens compared with White teens may be due to the protection of clear parental guidelines about substance use and clearly stated consequences for failure to observe those guidelines.

A randomized trial of Parents Who Care: effects on key outcomes at 24-month follow-up.

This study was designed to test the efficacy of Parents Who Care (PWC), a seven-session universal prevention program which includes parenting, youth, and family components designed to prevent substance use and other problem behaviors. Using an intent-to-treat experimental design, this study tests the program efficacy across race within a balanced sample of European American (EA) and African American (AA) youth and their parents (n = 331 n AA = 163; n EA = 168). Families were recruited, randomly assigned to three conditions (group-administered [PA], self-administered with telephone support [SA], and no-treatment control) and the intervention was administered when the adolescents were in the eighth grade. Analyses on key teen outcomes of the Parent's Who Care program at 24-month follow-up are reported here and include perceptions of drug use harm; favorable attitudes about drug use; delinquent and violent behavior; and initiation into cigarette, alcohol, other drug use, or sexual activity. Repeated measures mixed model regressions found no effect of the intervention on rate of change in attitudes about drug use or frequency of delinquent or violent behavior. Regression analyses with multiple imputations for missing data detected group differences in means at 24-month follow-up. Both program formats reduced favorable attitudes toward drug use among youth (SA d = 0.39, PA d = 0.22); and AA youth in the self-administered intervention reported significantly less violent behavior than their control counterparts (d = 0.45). No effects were found for drug use harm or delinquency. Finally, logistic regression predicting a combined outcome measure of initiation of alcohol, tobacco, drug use, and/or sexual activity found AA youth in both the group- and self-administered intervention conditions significantly less likely to initiate substance use and/or sexual activity than those in the control condition. Odds ratios indicated the chances of initiating sex or substance use were reduced by almost 70% (OR = 0.31) for AA teens in the SA condition compared to controls, and 75% (OR = 0.25) for the AA teens in the PA compared to controls.

Increases in alcohol and marijuana use during the transition out of high school into emerging adulthood: The effects of leaving home, going to college, and high school protective factors.

OBJECTIVE: This study examined the effects of leaving home and going to college on changes in the frequency of alcohol use, heavy episodic drinking, and marijuana use shortly after leaving high school. We also examined how protective factors in late adolescence predict post-high school substance use and moderate the effects of leaving home and going to college. METHOD: Data came from subjects (N = 319; 53% male) interviewed at the end of 12th grade and again approximately 6 months later, as part of the Raising Healthy Children project. RESULTS: Leaving home and going to college were significantly related to increases in the frequency of alcohol use and heavy episodic drinking from high school to emerging adulthood but not to changes in marijuana use. Having fewer friends who used each substance protected against increases in the frequency of alcohol use, heavy episodic drinking, and marijuana use. Higher religiosity protected against increases in alcohol-and marijuana-use frequency. Higher parental monitoring protected against increases in heavy episodic drinking and moderated the effect of going to college on marijuana use. Lower sensation seeking lessened the effect of going to college on increases in alcohol use and heavy episodic drinking. CONCLUSIONS: To prevent increases in substance use in emerging adulthood, interventions should concentrate on strengthening prosocial involvement and parental monitoring during high school. In addition, youths with high sensation seeking might be targeted for added intervention.

Adolescent substance use outcomes in the Raising Healthy Children project: a two-part latent growth curve analysis.

Raising Healthy Children (RHC) is a preventive intervention designed to promote positive youth development by targeting developmentally appropriate risk and protective factors. In this study, the authors tested the efficacy of the RHC intervention on reducing adolescent alcohol, marijuana, and cigarette use. Ten public schools, which comprised 959 1st- and 2nd-grade students (54% male students, 18% minority, 28% low socioeconomic status), were matched and assigned randomly to either intervention or control conditions. A 2-part latent growth modeling strategy was used to examine change in both use-versus-nonuse and frequency-of-use outcomes while students were in Grades 6-10. Results indicated significant (p < .05) intervention effects in growth trajectories for frequency of alcohol and marijuana use but not for use versus nonuse. These findings provide support for preventive interventions that take a social development perspective in targeting empirically supported risk and protective factors and demonstrate the use of 2-part models in adolescent substance use research.