Ethnic Differences in Cigarette Use Trajectories and Health, Psychosocial, and Academic Outcomes.

PURPOSE: Cigarette smoking among youth is associated with poorer health and psychosocial outcomes. However, few studies address how smoking may differentially relate to the emergence of disparities in functioning across races/ethnicities over adolescence. METHODS: Youth (n = 2,509) were surveyed eight times from ages 11 to 18. We measured cigarette use, academic and social functioning, mental and physical health, and delinquency. Sequelae of change models controlled for sociodemographic factors, and tested whether intercept and slope for smoking trajectories were associated with outcomes at the end of high school, and examined racial/ethnic differences in outcomes assuming similar smoking trajectories across groups. RESULTS: Youth were 45% Hispanic, 20% Asian, 20% white, 10% multiethnic, 2% black, and 1% other ethnicities. Higher average probability of smoking and steeper slopes of smoking trajectories were associated with poorer outcomes in multiple domains. Controlling for smoking trajectories, we observed the following disparities (vs. white youth; all p's < .05): black, Hispanic, and multiethnic youth reported lower academic performance; Asian, black, and multiethnic youth reported higher academic unpreparedness; Asian and multiethnic youth reported poorer mental health; Asian, Hispanic, and multiethnic youth reported poorer physical health; and Asian youth reported higher delinquency and poorer social functioning. CONCLUSIONS: Statistically adjusting for similar smoking trajectories, racial/ethnic minority youth demonstrated poorer outcomes in multiple domains compared with white peers. Smoking may be a particularly robust marker for risk of negative outcomes in racial/ethnic minority youth. Screening for cigarette use and intervening on smoking and associated risk behaviors among minority youth may help reduce disparities in functioning.

To Educate or To Incarcerate: Factors in Disproportionality in School Discipline.

The school-to-prison pipeline describes the process by which school suspension/expulsion may push adolescents into the justice system disproportionately based on race/ethnicity, socioeconomic status, and gender. The current study moves the field forward by analyzing a survey of a diverse sample of 2,539 students in 10th to 12th grade in Southern California to examine how demographic, individual, and family factors contribute to disparities in office referral and suspension/expulsion. African Americans, boys, and students whose parents had less education were more likely to be suspended/expelled. Higher levels of student academic preparation for class, hours spent on homework, and academic aspiration were associated with less school discipline. Findings suggest that helping students engage in school may be protective against disproportionate school discipline.

A pilot study comparing in-person and web-based motivational interviewing among adults with a first-time DUI offense.

BACKGROUND: Driving under the influence (DUI) is a significant problem, and there is a pressing need to develop interventions that reduce future risk. METHODS: We pilot-tested the acceptance and efficacy of web-motivational interviewing (MI) and in-person MI interventions among a diverse sample of individuals with a first-time DUI offense. Participants (N = 159) were 65 percent male, 40 percent Hispanic, and an average age of 30 (SD = 9.8). They were enrolled at one of three participating 3-month DUI programs in Los Angeles County and randomized to usual care (UC)-only (36-h program), in-person MI plus UC, or a web-based intervention using MI (web-MI) plus UC. Participants were assessed at intake and program completion. We examined intervention acceptance and preliminary efficacy of the interventions on alcohol consumption, DUI, and alcohol-related consequences. RESULTS: Web-MI and in-person MI participants rated the quality of and satisfaction with their sessions significantly higher than participants in the UC-only condition. However, there were no significant group differences between the MI conditions and the UC-only condition in alcohol consumption, DUI, and alcohol-related consequences. Further, 67 percent of our sample met criteria for alcohol dependence, and the majority of participants in all three study conditions continued to report alcohol-related consequences at follow-up. CONCLUSIONS: Participants receiving MI plus UC and UC-only had similar improvements, and a large proportion had symptoms of alcohol dependence. Receiving a DUI and having to deal with the numerous consequences related to this type of event may be significant enough to reduce short-term behaviors, but future research should explore whether more intensive interventions are needed to sustain long-term changes.

Pay-for-performance schemes that use patient and provider categories would reduce payment disparities.

Providers that care for disproportionate numbers of disadvantaged patients tend to perform less well than other providers on quality measures commonly used in pay-for-performance programs. This can lead to the undesired effect of redistributing resources away from providers that most need them to improve care. We present a new pay-for-performance scheme that retains the motivational aspects of standard incentive designs while avoiding undesired effects. We tested an alternative incentive payment approach that started with a standard incentive payment allocation but then "post-adjusted" provider payments using predefined patient or provider characteristics. We evaluated whether such an approach would mitigate the negative effects of redistributions of payments across provider organizations in California with disparate patient populations. The post-adjustment approach nearly doubled payments to disadvantaged provider organizations and greatly reduced payment differentials across provider organizations according to patients' income, race/ethnicity, and region. The post-adjustment of payments could be a useful supplement to paying for improvement, aligning the goals of disparity reduction and quality improvement.

The effects of purchasing alcohol and marijuana among adolescents at-risk for future substance use.

BACKGROUND: Among high-risk youth, those who may be at increased risk for adverse alcohol and other drug (AOD) use outcomes may benefit from targeted prevention efforts; how youth acquire AOD may provide an objective means of identifying youth at elevated risk. METHODS: We assessed how youth acquired alcohol and marijuana (purchasing vs. other means), demographics, AOD behaviors/consequences, and environment among adolescents referred to a diversion program called Teen Court (N = 180) at two time points (prior to the program and 180 days from baseline). Participants were predominantly White and Hispanic/Latino(a). RESULTS: In cross-sectional analyses among alcohol and marijuana users, purchasing marijuana was associated with more frequent marijuana use and consequences, time spent around teens who use marijuana, higher likelihood of substance use disorders, and lower resistance self-efficacy compared to non-purchasers. Teens who purchased both alcohol and marijuana experienced similar outcomes to those who purchased only marijuana, and also reported more frequent and higher quantity of drinking, greater alcohol-related consequences, time spent around teens who use other drugs, and prescription drug misuse. Longitudinally, purchasing alcohol and marijuana at baseline was associated with more frequent and higher quantity of drinking compared to non-purchasers at follow-up. Marijuana only purchasers had a greater likelihood of substance use disorders at follow-up compared to non-purchasers. CONCLUSIONS: In an era where drinking is commonplace and attitudes towards marijuana use are becoming more tolerant, it is essential to evaluate how accessibility to AOD and subsequent purchasing behaviors affect youth consumption and intervene accordingly to prevent future consequences.

The cost-effectiveness of depression treatment for co-occurring disorders: a clinical trial.

The authors aimed to determine the economic value of providing on-site group cognitive behavioral therapy (CBT) for depression to clients receiving residential substance use disorder (SUD) treatment. Using a quasi-experimental design and an intention-to-treat analysis, the incremental cost-effectiveness and cost-utility ratio of the intervention were estimated relative to usual care residential treatment. The average cost of a treatment episode was $908, compared to $180 for usual care. The incremental cost effectiveness ratio was $131 for each point improvement of the BDI-II and $49 for each additional depression-free day. The incremental cost-utility ratio ranged from $9,249 to $17,834 for each additional quality adjusted life year. Although the intervention costs substantially more than usual care, the cost effectiveness and cost-utility ratios compare favorably to other depression interventions. Health care reform should promote dissemination of group CBT to individuals with depression in residential SUD treatment.

A longitudinal examination of alcohol, marijuana, and cigarette perceived norms among middle school adolescents.

BACKGROUND: Adolescents tend to overestimate the prevalence of substance use among their peers and these perceived norms are associated with their current and future use. However, little is known about how perceived norms change over time during middle school, a developmental period when adolescents are at-risk for initiating substance use. METHOD: We examined changes in perceived norms of alcohol, marijuana, and cigarettes over a two-year period among a large and diverse sample of 6th and 7th grade youth (N=6097; 50.1% female; 54% Hispanic). Participants completed a baseline survey and two subsequent annual surveys. Participants estimated the percentage of their peers they believed used each substance, as well as indicated levels of personal use, offers to use from peers, and exposure to peers who were using each substance. RESULTS: Perceived norms of all three substances increased over time. Increases were somewhat attenuated when controlling for demographic factors, personal use, and peer factors, but remained significant. Female adolescents and those reporting non-Hispanic White ethnicity experienced the greatest increase in perceived norms over time. CONCLUSION: Normative perceptions of substance use increase greatly during the middle school years, an effect which cannot be fully explained by demographics, personal use, or peer factors. Given that perceived norms are often associated with personal use, early interventions with middle school youth are warranted to prevent the growth of these influential factors during this developmental period.