Translating the nuanced risk for substance use among adolescents treated for attention-deficit/hyperactivity disorder (ADHD) into clinical practice: a commentary on McCabe et al. (2023).

In their recent examination of the Monitoring the Future (MTF) data, McCabe et al. (Journal of Child Psychology and Psychiatry, 2023) address the complex, longstanding, and clinically valuable questions of whether and how stimulant medication treatment for adolescents with ADHD relates to their risk for substance use. Here, we expand on the authors' interpretations of their nuanced findings of increased risk for illicit stimulant use and non-prescribed stimulant medication use for youth with later age of medication treatment initiation and shorter treatment duration. We particularly focus on highlighting tangible clinical implications, and we recommend ways future research can build on the authors' findings to further clarify this important issue.

Change in Adolescents' Perceived ADHD Symptoms Across 17 Days of Ecological Momentary Assessment.

OBJECTIVE: To test whether adolescents' perceived ADHD symptoms may improve while monitoring them throughout the day. METHOD: In a sample of 90 adolescents (Mage = 14.7; 66% boys, 34% girls; 76.7% White, 13.3% Black or African American, 8.9% more than one race, 1.1% "other") treated for ADHD by their pediatricians, this study examined: (1) whether self-rated ADHD symptoms decreased across 17 days of 4 times daily ecological momentary assessment (EMA) of symptoms and (2) whether completing versus missing an EMA survey was associated with lower self-rated ADHD symptoms in the subsequent hours. RESULTS: Multilevel regression analyses showed that, on average, adolescents' perceived ADHD symptoms (inattention, hyperactivity, impulsivity, and total across domains) decreased across 17 days of EMA. Within person, symptoms were lower following completed versus missed EMA surveys. Significant moderating effects showed that the effect of completing the prior EMA survey weakened across the day and over the course of the 17 days. CONCLUSIONS: This study is the first to document acute improvements in self-rated ADHD symptoms using EMA in adolescents' naturalistic environments. Symptom monitoring throughout the day may help adolescents improve their day-to-day ADHD, at least acutely, and holds promise as one component of mobile-health ADHD interventions.

Persistent attention-deficit/hyperactivity disorder predicts socially oriented, but not physical/physiologically oriented, alcohol problems in early adulthood.

BACKGROUND: Although individuals with histories of childhood attention-deficit/hyperactivity disorder (ADHD) report more alcohol-related problems in adulthood than those without ADHD, it is unknown whether there are group differences in certain types of alcohol problems. We tested whether the nature of alcohol problems differed for individuals with and without childhood ADHD, as well as adulthood-persistent ADHD, to facilitate a personalized medicine approach for alcohol problems in this high-risk group. METHODS: Data were drawn from a prospective, observational study. Children diagnosed with ADHD and demographically similar individuals without childhood ADHD were followed prospectively through young adulthood (N = 453; 87.6% male). ADHD symptom persistence was assessed using self-reports and parent reports. Alcohol problems and heavy drinking were assessed repeatedly from 18-30 years old to construct lifetime measures. RESULTS: Full-sample confirmatory factor analyses identified 5 alcohol problem "types:" interpersonal problems/risky behaviors, occupational/academic impairment, impaired control/treatment seeking, tolerance/withdrawal, and drinking to blackout. Latent class analyses of items within each type yielded the best fit for 3-class solutions for all sets of items except blackout drinking, for which 2 classes emerged. Children with ADHD were more likely than those without ADHD to belong to high-risk latent classes for interpersonal problems/risky behaviors, occupational/academic problems, and impaired control (the high-risk class that indexed treatment-seeking behavior). These effects were driven by individuals whose ADHD symptoms persisted into adulthood. Few group differences emerged for tolerance/withdrawal and blackout drinking, except that individuals with only childhood ADHD (no persistence) were more likely to belong to the low-risk groups than those with adulthood-persistent ADHD and without ADHD. CONCLUSIONS: Individuals with ADHD histories whose symptoms persist into adulthood may be more likely to experience socially oriented alcohol problems and impaired control/treatment seeking than individuals without an ADHD history and those with childhood ADHD only. Tailored alcohol prevention and treatment programs may benefit this high-risk population.

A measure of functioning in adults With ADHD: Psychometric properties of the general life functioning scale-parent version.

OBJECTIVE: The General Life Functioning Scale (GLF) was developed to provide a complementary alternative to existing measures of impairment. We examined the psychometric properties of the GLF-Parent version (GLF-P), given the known value of informant ratings. METHODS: The GLF-P was administered to parents of adults with attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood and a nonADHD comparison group in the Pittsburgh ADHD Longitudinal Study. GLF-P ratings described 334 participants (ADHD = 186; comparison = 148) rated at age 25 (Mage = 24.80 years, SDage = 0.46, range = 24-26) and 401 participants (ADHD = 237; comparison = 164) rated at age 30 (Mage = 29.30, SDage = 0.64, range = 28-33). Exploratory (EFA) and confirmatory (CFA) factor analyses were used. RESULTS: EFAs suggested and CFAs confirmed a five-factor solution. We found measurement invariance across diagnostic and age groups, satisfactory internal consistency, construct validity, and known-group validity. CONCLUSION: Psychometric results suggest the GLF-P as a helpful adjunctive measure of functioning. Further research is needed to determine the utility of the GLF across diverse settings.

What Happens After School? Linking Latino Adolescents' Activities and Exposure to Community Violence.

Although community violence and the deleterious behavioral and psychological consequences that are associated with exposure to community violence persist as serious public health concerns, identifying malleable factors that increase or decrease adolescents' risk of exposure to community violence remains a significant gap in our knowledge base. This longitudinal study addresses this research gap by investigating adolescents' endorsement of familismo values and participation in three types of after-school activities, specifically home-, school-, and community-based activities, as potential precursors to adolescents' risk for experiencing community violence. The sample consists of 416 Latino high school students (53% female) with a mean age of 15.5 years (SD = 1.0) and with 85% qualifying for free and reduced school lunch. Cross-sectional results demonstrated that adolescents' endorsement of the Latino cultural value of familismo was associated with lower rates of personal victimization. The frequency of non-structured community-based activities and part-time work were concurrently associated with higher rates of witnessing community violence and being personally victimized by violence. Only the frequency of non-structured community-based activities was related to witnessing more community violence and greater victimization one year later while controlling for prior exposure to violence. These findings underscore the importance of providing structured, well supervised after-school activities for low-income youth in high-risk neighborhoods.

Beers with Peers: Childhood ADHD and Risk for Correlated Change in Perceived Peer and Personal Alcohol Use Across Young Adulthood.

BACKGROUND: ADHD poses risk for problematic alcohol use through adulthood. Perceived peer alcohol use, one of the strongest correlates of individuals' own alcohol use, is especially salient for adolescents with ADHD. The extent to which this risk extends into young adulthood is unknown, as well as how change in these constructs is associated throughout young adulthood. METHODS: In the Pittsburgh ADHD Longitudinal Study, 358 individuals with childhood-diagnosed ADHD and 239 without were prospectively followed from ages 18 to 29. Piecewise, bivariate longitudinal growth modeling was used to examine the change in both peer alcohol use and individuals' heavy drinking (binge-drinking frequency), their between-person associations, and differences by ADHD group. The addition of structured residuals probed within-person year-to-year change in peer and personal alcohol use and their prospective associations. RESULTS: Perceived peer alcohol use and individuals' heavy drinking frequencies changed together over time concurrently-from ages 18 to 21 (piece 1) and 21 to 29 (piece 2). Prospectively, individuals who increased the most in heavy drinking from ages 18 to 21 reported more friends using alcohol at age 29, regardless of ADHD history. Within-person increases in personal alcohol use likewise predicted increased perceived peer use the subsequent year within each age group (piece), regardless of ADHD history. However, while decreasing perceived peer use from ages 21 to 29 was related to more frequent heavy drinking at age 29 for those without ADHD, increasing perceived peer use from ages 18 to 21 predicted more frequent heavy drinking at age 29 for those with ADHD. CONCLUSIONS: Young adult heavy drinking changes in tandem with perceived peer alcohol use across individuals and predicts selection of alcohol-using peers from year to year within individuals, further into adulthood than previously documented. Findings suggest the centrality of relationships with alcohol-consuming friends in relation to one's heavy drinking, especially for young adults with ADHD histories, through the twenties.

The role of relationship proximity to witnessed community violence and youth outcomes.

AIMS: This study examines whether the relational proximity to the victim or perpetrator of witnessed community violence is associated with youth symptoms. METHODS: Data come from the Longitudinal Studies of Child Abuse and Neglect, a national high-risk sample. The sample included 12-year-old youth (N = 720) who had witnessed violence in their lifetimes. Ordinary least squares (OLS) regressions tested whether relationship proximity differentiated youth functioning (social competency, withdrawal, anxiety/depression, delinquency, and aggression), and whether gender moderated these effects. RESULTS: Witnessing violence toward a parent was associated with greater withdrawal, delinquency, and aggression symptoms. Witnessing violence perpetrated by a stranger was associated with lower social competency, higher anxiety/depression, and higher delinquency. Two perpetrator associations differed by gender. CONCLUSION: Findings suggest important differences in outcomes based on relational proximity to victims and perpetrators. The particularly widespread associations between witnessing violence against a parent and youth functioning underscore the importance of targeting interventions toward youth with parent victims.

In-the-Moment Drinking Characteristics: An Examination Across Attention-Deficit/Hyperactivity Disorder History and Race.

BACKGROUND: Adults with a history of childhood attention-deficit/hyperactivity disorder (ADHD) and Black drinkers are at elevated risk for alcohol problems and alcohol use disorder. Processes that increase risk for these distinct populations have not focused on in-the-moment behaviors that occur while drinking. The present study examined in-the-moment drinking characteristics (i.e., location, social context, day, time, drink type, speed of consumption) that may differ for individuals with and without ADHD histories or for Black and White drinkers. We also examined the interplay among these in-the-moment drinking characteristics to further understanding of contexts when risk may be momentarily increased. METHODS: As part of a larger study, 135 individuals (Mage  = 27.81, 69.6% male, 45.9% ADHD, 69.6% White) completed a 10-day ecological momentary assessment protocol that included self-initiated reports following consumption of an alcoholic drink. Hypotheses were tested using multilevel modeling. RESULTS: Controlling for multiple demographic covariates, Black drinkers drank significantly more quickly than White drinkers and were more likely to consume hard liquor-containing beverages. Differences in drinking speed remained significant when adjusting for Black drinkers' greater likelihood to consume liquor-containing beverages and momentary experience of discrimination; however, Black drinkers' increased likelihood to consume liquor-containing beverages was no longer significant when adjusting for momentary experience of discrimination. Individuals with ADHD histories did not differ from those without ADHD histories in any in-the-moment drinking characteristics. ADHD and race did not interact to predict any drinking characteristic. CONCLUSIONS: Differences in speed of alcohol consumption and propensity to consume liquor-containing beverages may contribute to increased risk for alcohol problems experienced by Black drinkers compared to White drinkers.

Cigarette Smoking Progression Among Young Adults Diagnosed With ADHD in Childhood: A 16-year Longitudinal Study of Children With and Without ADHD.

INTRODUCTION: Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for smoking cigarettes, but there is little longitudinal research on the array of smoking characteristics known to be prognostic of long-term smoking outcomes into adulthood. These variables were studied into early adulthood in a multisite sample diagnosed with ADHD combined type at ages 7-9.9 and followed prospectively alongside an age- and sex-matched local normative comparison group (LNCG). METHODS: Cigarette smoking quantity, quit attempts, dependence, and other characteristics were assessed in the longitudinal Multimodal Treatment Study of Children with ADHD (MTA) eight times to a mean age of 24.9 years: ADHD n = 469; LNCG n = 240. RESULTS: In adulthood, the ADHD group had higher rates of daily cigarette smoking, one or more quit attempts, shorter time to first cigarette of the day, and more severe withdrawal than the LNCG. The ADHD group did not appear to have better smoking cessation rates despite a higher proportion quitting at least once. Smoking quantity and nicotine dependence did not differ between groups. The ADHD group reported younger daily smoking onset and faster progression from smoking initiation to daily smoking across assessments. Finally, ADHD symptom severity in later adolescence and adulthood was associated with higher risk for daily smoking across assessments in the ADHD sample. CONCLUSIONS: This study shows that ADHD-related smoking risk begins at a young age, progresses rapidly, and becomes resistant to cessation attempts by adulthood. Prevention efforts should acknowledge the speed of uptake; treatments should target the higher relapse risk in this vulnerable population. IMPLICATIONS: Although childhood ADHD predicts later smoking, longitudinal studies of this population have yet to fully characterize smoking behaviors into adulthood that are known to be prognostic of long-term smoking outcome. The current study demonstrates earlier and faster progression to daily smoking among those with a childhood ADHD diagnosis, as well as greater risk for failed quit attempts. Prevention efforts should address speed of smoking uptake, while treatments are needed that address smoking relapse risk. The current study also demonstrates ADHD symptom severity over development increases daily smoking risk, implicating the need for continuous ADHD symptom management.

Fathers with Childhood ADHD, Parenting, and Their Young Children's Behavior: Offspring of the Pittsburgh ADHD Longitudinal Study (PALS).

Despite high heritability, no research has followed children with ADHD to parenthood to study their offspring and parenting behaviors. Given greater prevalence of ADHD in males and lack of research involving fathers, this study evaluated offspring of fathers with and without ADHD histories for ADHD and disruptive behavior and compared fathers' parenting behaviors. Male fathers (N = 29) from the Pittsburgh ADHD Longitudinal Study (PALS) participated with their preschool-aged offspring. Fathers completed self-reported measures, and father-child dyads completed an interaction task. ADHD offspring had elevated ADHD symptoms and behavior dysregulation. All fathers displayed positive parenting. ADHD fathers reported lower supportive responses to their child's negative emotions than comparison fathers, yet rated their parenting as more efficacious. ADHD offspring were distinguishable as early as age 3; thus, earlier diagnosis and intervention may be feasible for this at-risk population. Future research should investigate the acceptability and efficacy of parent training for fathers with ADHD.

The role of academic mentors for Latino/a adolescents exposed to community violence.

AIMS: We examined the protective role of academic mentors for Latino/a youth exposed to community violence. We tested whether the mentor facilitation of positive growth and mentor school involvement moderated the relations between exposure to violence and Latino/a youth's educational values, school effort, and academic efficacy. METHODS: We used hierarchical linear regressions to examine these relations among 210 Latino/a high school students. RESULTS: Witnessing violence and personal victimization was negatively related to all three educational outcomes. Mentor school involvement was positively related to all three educational outcomes, whereas mentor facilitation of growth was positively related to educational values only. A significant interaction between witnessing violence and mentor school involvement indicated that the negative relation between witnessing violence and educational values weakened at high levels of mentor school involvement. CONCLUSION: We discuss the benefits of academic mentoring and exploring effective mentoring characteristics with Latino/a youth exposed to violence.

Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study.

BACKGROUND: Inconsistent findings exist regarding long-term substance use (SU) risk for children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The observational follow-up of the Multimodal Treatment Study of Children with ADHD (MTA) provides an opportunity to assess long-term outcomes in a large, diverse sample. METHODS: Five hundred forty-seven children, mean age 8.5, diagnosed with DSM-IV combined-type ADHD and 258 classmates without ADHD (local normative comparison group; LNCG) completed the Substance Use Questionnaire up to eight times from mean age 10 to mean age 25. RESULTS: In adulthood, weekly marijuana use (32.8% ADHD vs. 21.3% LNCG) and daily cigarette smoking (35.9% vs. 17.5%) were more prevalent in the ADHD group than the LNCG. The cumulative record also revealed more early substance users in adolescence for ADHD (57.9%) than LNCG (41.9%), including younger first use of alcohol, cigarettes, marijuana, and illicit drugs. Alcohol and nonmarijuana illicit drug use escalated slightly faster in the ADHD group in early adolescence. Early SU predicted quicker SU escalation and more SU in adulthood for both groups. CONCLUSIONS: Frequent SU for young adults with childhood ADHD is accompanied by greater initial exposure at a young age and slightly faster progression. Early SU prevention and screening is critical before escalation to intractable levels.

The role of perceived parent drinking motives on alcohol use among adolescents with and without childhood attention-deficit/hyperactivity disorder.

OBJECTIVE: Parent history of alcohol-related problems and antisocial behaviors contribute to adolescent alcohol use and are associated with offspring attention-deficit/hyperactivity disorder (ADHD). Youth with ADHD may be susceptible to intergenerational transmission of alcohol-related cognitions, which may model drinking motives that enhance risk for adolescent alcohol use. We examined whether childhood ADHD and parent history of alcohol use disorder, with or without antisociality, were associated with adolescents' perceptions of their parents' drinking motives and whether these perceptions predicted their alcohol use behaviors. METHOD: Adolescents (N = 199; 56% with ADHD; Mage = 15.73) completed the Drinking Motives Questionnaire regarding perceptions of their parents' drinking motives. Participants subsequently reported their past-year alcohol use behaviors (Mage = 16.95). Parents reported their history of alcohol-related problems and antisocial symptoms. Covariates included adolescent gender (7% girls), race (9% self-identified Black), and parental education and marital status. RESULTS: Perceived parent drinking motives were highest for social and lowest for conformity motives, consistent with adult self-reports in the literature. Parent alcohol use and antisociality history predicted perceptions of parent drinking motives, and child ADHD only predicted perceptions of parent social drinking motives. Perceived parent drinking motives predicted adolescent alcohol use, but only among youth without ADHD. CONCLUSION: Findings reflect the potential importance of assessing adolescent perceptions of parent drinking motives for adolescents without ADHD and a possible need for supporting parents in communicating about their own alcohol use. Future research should consider alternative strategies (e.g., assessing implicit cognitions) for studying the link between alcohol-related cognitions and behaviors for adolescents with ADHD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Characteristics and Predictors of Fluctuating Attention-Deficit/Hyperactivity Disorder in the Multimodal Treatment of ADHD (MTA) Study.

Objectives: Recent studies report a fluctuating course of attention-deficit/ hyperactivity disorder (ADHD) across development characterized by intermittent periods of remission and recurrence. In the Multimodal Treatment of ADHD (MTA) study, we investigated fluctuating ADHD including clinical expression over time, childhood predictors, and between- and within-person associations with factors hypothesized as relevant to remission and recurrence.Methods: Children with DSM-5 ADHD, combined type (N = 483), participating in the MTA adult follow-up were assessed 9 times from baseline (mean age = 8.46) to 16-year follow-up (mean age = 25.12). The fluctuating subgroup (63.8% of sample) was compared to other MTA subgroups on variables of interest over time.Results: The fluctuating subgroup experienced multiple fluctuations over 16 years (mean = 3.58, SD = 1.36) with a 6- to 7-symptom within-person difference between peaks and troughs. Remission periods typically first occurred in adolescence and were associated with higher environmental demands (both between- and within-person), particularly at younger ages. Compared to other groups, the fluctuating subgroup demonstrated moderate clinical severity. In contrast, the stable persistent group (10.8%) was specifically associated with early and lasting risk for mood disorders, substance use problems in adolescence/ young adulthood, low medication utilization, and poorer response to childhood treatment. Protective factors were detected in the recovery group (9.1%; very low parental psychopathology) and the partial remission group (15.6%; higher rates of comorbid anxiety).Conclusions: In the absence of specific risk or protective factors, individuals with ADHD demonstrated meaningful within-individual fluctuations across development. Clinicians should communicate this expectation and monitor fluctuations to trigger as-needed return to care. During remission periods, individuals with ADHD successfully manage increased demands and responsibilities.Trial Registration: ClinicalTrials.gov identifier: NCT00000388.

Marginal structural models for estimating the longitudinal effects of community violence exposure on youths' internalizing and externalizing symptoms.

OBJECTIVE: Longitudinal observational data pose a challenge for causal inference when the exposure of interest varies over time alongside time-dependent confounders, which often occurs in trauma research. We describe marginal structural models (MSMs) using inverse probability weighting as a useful solution under several assumptions that are well-suited to estimating causal effects in trauma research. METHOD: We illustrate the application of MSMs by estimating the joint effects of community violence exposure across time on youths' internalizing and externalizing symptoms. Our sample included 4,327 youth (50% female, 50% male; 1.4% Asian American or Pacific Islander, 34.7% Black, 46.9% Hispanic, .8% Native American, 14.3%, White, 1.5%, Other race/ethnicity; Mage at baseline = 8.62, range = 3-15) from the Project on Human Development in Chicago Neighborhoods. RESULTS: Wave 3 internalizing symptoms increased linearly with increases in Wave 2 and Wave 3 community violence exposure, whereas effects on externalizing symptoms were quadratic for Wave 2 community violence exposure and linear for Wave 3. These results fail to provide support for the desensitization model of community violence exposure. CONCLUSION: MSMs are a useful tool for researchers who rely on longitudinal observational data to estimate causal effects of time-varying exposures, as is often the case in the study of psychological trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Quantifying Potential Bias Resulting From Child Age on Screening for Hyperactive/Impulsive Presentations of ADHD.

OBJECTIVE: This study aims to quantify the potential age bias in screening of hyperactive/impulsive presentations of ADHD in children ages 5 to 12 through comparison of age-based and overall percentiles in screening. METHOD: A referred clinical sample of 307 children ages 5 to 12 with behavioral concerns completed the Vanderbilt Attention Deficit-Hyperactivity Disorder Diagnostic Parent Rating Scale (VADPRS) and were formally evaluated for ADHD with a diagnostic interview. Analysis utilizing logistic regression and receiver operating characteristic (ROC) curves was performed to compare the screening performance of agebased and overall percentiles. RESULTS: The age-based percentiles demonstrated no improvement in the analyzed models compared to overall percentiles in hyperactive presentation ADHD screening. This finding was present in the overall sample and in the sub analysis of the 5 to 6 year old children. CONCLUSIONS: This study identifies no improvement in modeling of hyperactive/impulsive ADHD screening when considering a child's age using age-based percentiles.

Association Between Stimulant Treatment and Substance Use Through Adolescence Into Early Adulthood.

Importance: Possible associations between stimulant treatment of attention-deficit/hyperactivity disorder (ADHD) and subsequent substance use remain debated and clinically relevant. Objective: To assess the association of stimulant treatment of ADHD with subsequent substance use using the Multimodal Treatment Study of ADHD (MTA), which provides a unique opportunity to test this association while addressing methodologic complexities (principally, multiple dynamic confounding variables). Design, Setting, and Participants: MTA was a multisite study initiated at 6 sites in the US and 1 in Canada as a 14-month randomized clinical trial of medication and behavior therapy for ADHD but transitioned to a longitudinal observational study. Participants were recruited between 1994 and 1996. Multi-informant assessments included comprehensively assessed demographic, clinical (including substance use), and treatment (including stimulant treatment) variables. Children aged 7 to 9 years with rigorously diagnosed DSM-IV combined-type ADHD were repeatedly assessed until a mean age of 25 years. Analysis took place between April 2018 and February 2023. Exposure: Stimulant treatment of ADHD was measured prospectively from baseline for 16 years (10 assessments) initially using parent report followed by young adult report. Main Outcomes and Measures: Frequency of heavy drinking, marijuana use, daily cigarette smoking, and other substance use were confidentially self-reported with a standardized substance use questionnaire. Results: A total of 579 children (mean [SD] age at baseline, 8.5 [0.8] years; 465 [80%] male) were analyzed. Generalized multilevel linear models showed no evidence that current (B [SE] range, -0.62 [0.55] to 0.34 [0.47]) or prior stimulant treatment (B [SE] range, -0.06 [0.26] to 0.70 [0.37]) or their interaction (B [SE] range, -0.49 [0.70] to 0.86 [0.68]) were associated with substance use after adjusting for developmental trends in substance use and age. Marginal structural models adjusting for dynamic confounding by demographic, clinical, and familial factors revealed no evidence that more years of stimulant treatment (B [SE] range, -0.003 [0.01] to 0.04 [0.02]) or continuous, uninterrupted stimulant treatment (B [SE] range, -0.25 [0.33] to -0.03 [0.10]) were associated with adulthood substance use. Findings were the same for substance use disorder as outcome. Conclusions and Relevance: This study found no evidence that stimulant treatment was associated with increased or decreased risk for later frequent use of alcohol, marijuana, cigarette smoking, or other substances used for adolescents and young adults with childhood ADHD. These findings do not appear to result from other factors that might drive treatment over time and findings held even after considering opposing age-related trends in stimulant treatment and substance use.

Momentary associations between stress and alcohol craving in the naturalistic environment: differential associations for Black and White young adults.

BACKGROUND AND AIMS: Black drinkers compared with White drinkers experience more alcohol-related problems. Examination of social determinants of inequities in alcohol problems is needed. The current study measured (1) associations between acute stress and alcohol craving in the naturalistic environment for self-identified Black and White individuals who drink alcohol and (2) whether a history of attention deficit hyperactivity disorder (ADHD) moderated these associations. DESIGN AND SETTING: Observational study using ecological momentary assessment (EMA) to collect data from participants at six semi-random time-points throughout the day during a 10-day period. A series of three-level multi-level models examined between- and within-person associations for stress and alcohol and tested if these associations differed for Black and White adults. PARTICIPANTS: Participants were 229 adult drinkers (aged 21-35 years) who completed a larger study examining alcohol response for Black and White adults with and without a history of childhood ADHD. MEASUREMENTS: Momentary stress and alcohol craving, ADHD history and socio-demographic characteristics (i.e. racial identity, sex, age, current education level, household income) were assessed. Participants were required to self-identify as either 'African American or Black' or 'European American or White'. FINDINGS: Significant racial identity × stress interactions indicated that associations between stress and craving were stronger for Black compared with White adults across the 10-day period (between-person: B = 0.14, P = 0.007), concurrently within a given EMA time-point (within-person: B = 0.04, P = 0.001) and prospectively from time-point to time-point (within-person: B = 0.05, P = 0.001). Results remained while accounting for income × stress interactions. CONCLUSIONS: Acute stress appears to be more strongly related to alcohol craving in self-identified Black compared with self-identified White individuals. This provides support for policy changes to eliminate structural inequities that increase stress exposure and the development of just-in-time culturally responsive interventions focused on coping with acute stress for Black individuals.

Examination of cross-group contact at work and school in relation to acute and retrospective discrimination experiences and drinking to cope for Black and White young adult drinkers.

Black drinkers experience more alcohol problems compared to White drinkers at comparable levels of alcohol use (Mulia et al., 2009; Witbrodt et al., 2014; Zapolski et al., 2014). Research has found that Black compared to White drinkers endorse drinking to cope more frequently via retrospective report (Bradizza et al., 1999; Cooper et al., 2008). Additional research is needed to understand contributors to these racial differences. The primary aim of the present study was to examine how quality and frequency of cross-group contact at work and/or school relates to experiencing discrimination and, in turn, drinking to cope. Seventy-two young adult drinkers (Mage = 25, 72% female, 28% male; 64% Black, 36% White) completed baseline questionnaires and a subset (n = 50) completed a 17-day ecological momentary assessment (EMA) protocol. Cross-group contact frequency and quality was assessed at baseline while discrimination and coping motives were assessed via retrospective report at baseline and acutely via EMA. Accounting for sociodemographic covariates, path analyses utilizing retrospective measures revealed a significant indirect pathway from race to coping motives through quality of work/school cross-group contact and discrimination experiences related to assumptions of inferiority. Identical path analyses utilizing the acute EMA data revealed a significant indirect pathway from race to coping motives through quality of work/school cross-group contact. Improving cross-group contact at work and school may reduce drinking to cope. Additional research examining multiple domains of discrimination, quality of cross-group contact, and alcohol problems over time is needed to further understanding of social determinants of health inequities in alcohol problems. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Smoking-Specific Risk Factors in Early Adulthood That Mediate Risk of Daily Smoking by Age 29 for Children with ADHD.

OBJECTIVE: To test whether smoking-specific risk factors in early adulthood mediate prediction to daily smoking from childhood ADHD. METHODS: Participants were 237 with and 164 without childhood ADHD. A smoking risk profile score comprising smoking-specific factors measured between ages 18 to 25 (e.g., craving severity) and age of initiation was tested as mediator of the association between childhood ADHD and age 29 daily smoking. RESULTS: Childhood ADHD predicted age 29 smoking (ß = -.15, p = .019), 35% of ADHD versus 17% of nonADHD, and the profile score (ß = -.07, p = .004), which in turn mediated prediction to age 29 daily smoking (ß = -.03; p = .007). When tested individually, three profile variables (# cigarettes/day, difficulty concentrating during abstinence, and nicotine dependence) were significant mediators (ps = 0.005-0.038), above and beyond early adult smoking, ADHD persistence, and delinquency. CONCLUSIONS: These behavioral smoking characteristics help explain later daily cigarette smoking for adults with ADHD histories and may need to be targeted in intervention.