Peer Recovery Coaches Perceptions of Their Work and Their Implications for Training, Support and Personal Recovery.

The peer recovery workforce, including individuals in sustained recovery from substance use, has grown rapidly in the previous decades. Peer recovery coaches represent a scalable, resource-efficient, and acceptable approach to increasing service delivery, specifically among individuals receiving substance use services in low-resource communities. Despite the potential to improve access to care in traditionally underserved settings, there are a number of barriers to successfully integrating peer recovery coaches in existing recovery services. The current study presents results from two focus groups composed of peer recovery coaches. Findings suggest that peer recovery coaches report discordance between their perceived role and their daily responsibilities and experience both inter- and intrapersonal challenges that impact their own recovery processes. These results point to several promising policy and structural changes that may support and enhance this growing workforce.

Interpersonal Trauma Exposure and Interpersonal Problems in Adolescent Posttraumatic Stress Disorder.

Traumatic experiences have been differentiated as interpersonal (i.e., the direct result of actions by other people) or noninterpersonal (i.e., other life-threatening events, such as severe accidents). Interpersonal trauma exposure generally has been shown to be associated with more severe posttraumatic stress disorder (PTSD) symptoms than noninterpersonal trauma exposure. Interpersonal problems also tend to be associated with trauma exposure and PTSD symptoms, but it is unclear whether a mediating association exists between trauma type, interpersonal problems, and PTSD symptoms. A clinical sample of 4,275 adolescents (age range: 12-18 years) from the National Child Traumatic Stress Network Core Data Set were classified as having experienced interpersonal trauma, noninterpersonal trauma, or both. Interpersonal problems were operationalized by social problem behaviors (e.g., immature and dependent behaviors) and aggressive behaviors on the Child Behavior Checklist. The results of path analyses showed that cumulative interpersonal trauma exposure was both directly and indirectly associated with PTSD symptoms via social problem behaviors but not aggressive behaviors, total effect ß = .20, 95% CI [.17, .23]. In a second model, path analyses showed that cumulative interpersonal trauma exposure was associated directly and indirectly via PTSD symptoms with social problem behaviors, total effect ß = .15, 95% CI [.11, .18], and aggressive behaviors, total effect ß = .13, 95% CI [.09, .17]. These findings suggest that during adolescence, interpersonal problems play an important role in the association between interpersonal trauma exposure and PTSD symptoms.

Longitudinal pathway from violence exposure to firearm carriage among adolescents: The role of future expectation.

INTRODUCTION: Exposure to violence is a risk factor for firearm carriage. Youth exposed to violence also have difficulty envisioning positive future outcomes (e.g., educational outcomes), which can increase the likelihood of firearm carriage over time. Researchers, however, have not yet examined whether changes in exposure to violence over time can influence the developmental trajectories of firearm carriage. To address this gap, we (1) examined the longitudinal association between exposure to violence and firearm carriage (grades 9 to 12) and then (2) examined whether changes in future expectations mediated this longitudinal association. METHOD: The longitudinal association between exposure to violence and firearm carriage through future expectations was examined among 850 adolescents from the Flint Adolescent Study. Participants were recruited from four high schools in a midwestern city in the United States. Parallel latent growth models and latent growth mediation models were estimated. RESULTS: A positive association was observed between the rate of change in exposure to violence and firearm carriage. Exposure to violence also indirectly increased the risk for firearm carriage over time by decreasing future expectation in the 9th grade. CONCLUSIONS: Our results support the idea that helping youth develop positive attitude about educational success may help reduce firearm carriage. Increasing positive expectations about future may help prevent firearm carriage within the context of violence exposure.

Feasibility and acceptability of a future-oriented empowerment program to prevent substance use and school dropout among school-disengaged youth.

OBJECTIVE: To evaluate the feasibility and acceptability of a health promotion program to prevent school dropout and substance use among middle school-aged youth who display early warning signs of school disengagement. INTERVENTION: Youth Empowerment Solutions for Positive Futures (YES-PF), an intensive, theoretically driven, 5-week summer enrichment program, aims to prevent school dropout and substance use by promoting youth empowerment, school engagement, and future orientation. DESIGN AND SAMPLE: Using a pre-post-intervention design, we test feasibility and acceptability with 6th and 7th grade students (n = 43) who exhibited early warning signs for school disengagement (e.g., chronic absenteeism) in two school districts. MEASURES: Program evaluation components included: (a) program session forms completed by facilitators; (b) post-program interviews with facilitators; (c) post-intervention program evaluation surveys with youth; (d) attendance; and (e) baseline and post-intervention surveys with youth to assess behavioral and psychosocial outcomes. RESULTS: Facilitators routinely delivered core component lesson activities. Acceptability and program satisfaction were evidenced in strong program attendance by youth. Youth participants reported higher levels of leadership efficacy (p < .05) and a greater sense of control over their lives and potential problems (p < .01). CONCLUSIONS: YES-PF was feasible and acceptable to school personnel and youth. Program refinement, based on implementation findings, is discussed.

Examining contextual and relational factors influencing perceptions of societal and interpersonal mattering among rural youth.

Researchers have shown that interpersonal and societal mattering have important implications for adolescent development. Yet, few researchers have focused on what predicts mattering, particularly societal mattering, and even fewer have studied mattering among rural youth. Thus, the purpose of this study is to explore how perceived contextual and relationship factors affect rural youths' perceptions of societal and interpersonal mattering. Participants for this study were 381 middle school youth from two rural school districts in Michigan. Using structural equation modeling, we found that more positive perceptions regarding opportunities for youth involvement, availability of community resources, student input in decision-making at school, and support for autonomy at school were associated with greater perceptions of societal mattering. In addition, greater support from friends, higher quality parent-child communication, and more parental involvement were associated with a greater sense of interpersonal mattering. This study identifies important relational and contextual factors that can be enhanced in an effort to foster greater perceptions of interpersonal and societal mattering among rural youth, and ultimately help us to promote positive youth development.

Age-Specific Associations Between Violence Exposure and Past 30-Day Marijuana and Alcohol Use.

Using data from a cohort study of students at risk for high school dropout, we examined associations between violence exposure and past 30-day alcohol and marijuana use. We used varying-coefficient regression with person-level fixed effects to estimate how those associations changed within-person across ages approximately 14-23. Generally, violence perpetration was most strongly associated with substance use, within-person. Substance use became increasingly associated with both observed violence and violence perpetration during early/middle adolescence; this increase continued longer into development (age 18+) for alcohol use. Across most of the age range studied here, violence victimization was minimally associated with within-person changes in substance use. Results indicate age-specific associations between violence exposure and alcohol and other drug use, which may be useful for informing prevention strategies.

Purpose and mastery as predictors of perceived health and substance use problems.

We explored whether purpose in life and mastery predicted perceived physical health and problematic substance use among a sample of emerging adults who reported ever using alcohol or drugs. We examined perceived stress and coping as potential mediators of these associations and explored whether parental support moderated any of these associations. In a sample of emerging adults from across the United States (N = 2,564; M age = 20.87, standard deviation = 1.75; 49.6% male), purpose in life and mastery were associated with better-perceived health and fewer negative consequences of drug use via lower perceived stress and coping. In addition, parental support modified the relationship between purpose in life and stress and coping. The findings suggest potential health benefits associated with a greater purpose in life and mastery and indicate that parental support may enhance these associations.

Racial discrimination and cortisol in African American emerging adults: The role of neighborhood racial composition.

OBJECTIVES: African American (AA) emerging adults may become more vulnerable to the consequences of racial discrimination (discrimination) as many begin to occupy racially mixed contexts. Little is known, however, about whether the effect of discrimination on cortisol concentration varies by neighborhood racial composition. We evaluated whether the percentage of White neighbors qualified the association between discrimination and overall cortisol concentration. METHOD: We used self-report data from the Flint Adolescent Study and block-level census data linked to the participant's home address. Our sample consisted of 241 AA emerging adults (56.8% Female; 19-22 year olds). We used multilevel regression analyses to evaluate whether the percentage of White neighbors modified the association between discrimination and overall cortisol concentration. RESULTS: Discrimination experienced in the past year, but not chronic discrimination was linked to lower cortisol concentrations among AA emerging adults living in neighborhoods with a high concentration of White neighbors. Specifically, past year discrimination was negatively associated among AAs residing in neighborhoods with 46.9% of White residents or higher. CONCLUSIONS: Our results lay the foundation for future research on racial health disparities by suggesting that contextual factors such as neighborhood racial composition can shape the influence race-based discrimination has on health. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A Longitudinal Analysis of the Indirect Effect of Violence Exposure on Future Orientation Through Perceived Stress and the Buffering Effect of Family Participation.

Exposure to violence (ETV) during adolescence has been associated with negative effects in later life, and may negatively affect an individual's future orientation. Future orientation has important health implications and warrants being studied. Yet, few researchers have examined how ETV affects an individual's future orientation as a young adult. The purpose of this study was to examine the indirect effect of ETV during adolescence on future orientation as a young adult through perceived stress. We also tested the moderating effect of family participation on the relationship between perceived stress and future orientation. Longitudinal data from a sample of 316 African American participants (42.10% male and 57.90% female, Mage = 14.76 at Wave 1) from low socioeconomic backgrounds recruited from a Midwestern school district were used in the analysis. Multigroup structural equation modeling (SEM) was used to test our hypotheses. Our findings indicated that greater ETV during adolescence is associated with higher levels of perceived stress and, in turn, a more negative outlook on one's future as a young adult. This indirect effect occurred for individuals with lower family participation, but was not evident for individuals with greater family participation. These findings provide important implications for youth development interventions.

Measuring the Implementation of Youth Empowerment Solutions.

Scholars have increasingly emphasized the importance of using evidence-based programs to promote health and prevent disease. While theoretically and empirically based programs may be effective in carefully controlled conditions, many fail to achieve desired outcomes when implemented in real-world settings. Ensuring high-quality implementation of health promotion programs is critically important as variation in implementation is closely associated with program effectiveness. The purpose of this article is to present methods used to document and assess the implementation of the Youth Empowerment Solutions (YES) program. We collected process evaluation data on 25 YES groups from 12 schools over a period of 4 years. The evaluation assessed four key aspects of delivery: fidelity, dose delivered, dose received, and program quality. We found wide variations in delivery for some measures, while others were more consistent across groups. These indicators of program delivery provided a strong basis for evaluating program implementation, taking actions to improve it, and ultimately, deepening understanding of program effectiveness. The study suggests a model for using multiple methods to collect and analyze data about aspects of program delivery to guide future implementations.

More Than Just Keeping Busy: The Protective Effects of Organized Activity Participation on Violence and Substance Use Among Urban Youth.

Violence and substance use disproportionately affect African American youth in urban, disadvantaged communities. Expanding positive peer and adult connections is a mechanism by which organized activity participation may reduce risk of negative outcomes. We assessed if organized activity participation decreases the likelihood of later negative outcomes through expanding positive social connections using a parallel mediation model (Wave 1: N = 681; 50% female; Mage = 14.86 years; SD = 0.65). We found indirect effects from participation to cigarette use (b = -0.04, 95% CI: -0.07, -0.01) and violent behavior (b = -0.04; 95% CI: -0.07, -0.01) through positive peer connections. We did not find indirect effects through positive adult connections. This may be because of the notable influence of peers on negative outcomes during adolescence. Organized activities can help youth expand positive peer connections, which, in turn, reduces risk of later negative outcomes. Implications for prevention are discussed.

Organized Activity Participation and Relational Aggression: The Role of Positive Youth Development.

Relational aggression among early adolescents is a pervasive problem that negatively influences the health and well-being of youth. Strength-based approaches such as positive youth development (PYD) are a promising way to reduce risk of detrimental outcomes such as relational aggression. Participation in organized activities is a key way that youth build assets related to PYD. Yet, few researchers have examined empirically assets related to PYD as a mechanism by which organized activity participation may help reduce risk of relational aggression. In this study, we used structural equation modeling to investigate if assets associated with PYD mediate the relationship between organized activity participation and relational aggression using survey data from a diverse, school-based sample of early adolescents (N = 196; mean age = 12.39 years; SD = 0.52; 60% female; 45% African American, 27% White, 21% multiracial, and 7% other, 71% economically disadvantaged). We tested 2 competing models, 1 with decomposed PYD factors and 1 with an integrated PYD factor. Our results suggest that PYD better fit as an integrated versus decomposed construct, providing support for the notion that youth benefit most from assets related to PYD when they operate collectively. Our results also provide support for PYD-related factors as a mechanism by which participation may reduce risk of relational aggression. Limitations of this study, and implications for prevention are discussed.

Exposure to Violence during Adolescence as a Predictor of Perceived Stress Trajectories in Emerging Adulthood.

Early exposure to violence during adolescence is related to negative psycho-social outcomes later in life. In the present study, we examined the influence of cumulative exposure to violence during adolescence and trajectories of perceived stress in emerging adulthood in a sample of at-risk urban youth (N = 850; 80.1% African American; 50% female). Growth curve modeling indicated an overall decrease in reported stress as individuals aged. Baseline levels of violence exposure (Mage = 14.9) were associated with higher perceived stress levels in emerging adulthood (Mage = 20.1), but also slightly more negative perceived stress slopes from adolescence into emerging adulthood (Mage = 15.9-22.1). Individuals reporting increased violence exposure over time during adolescence also reported higher perceived stress levels in emerging adulthood (Mage = 20.1). Associations held after controlling for demographics and baseline functioning variables. The results suggest that violence exposure may disrupt normative adaptation to daily stressors in emerging adulthood.

Diversion of ADHD Stimulants and Victimization Among Adolescents.

OBJECTIVE: To examine whether a recent prescription for stimulant medication is associated with peer victimization among youth with attention deficit/hyperactivity disorder (ADHD). METHODS: Data from 4,965 adolescents attending five public schools who completed an annual web survey over 4 years were used to examine recent stimulant medication prescription and self-reported frequent victimization. RESULTS: Adolescents with ADHD and recent stimulant prescription reported more victimization than those without ADHD, but similar to adolescents with ADHD and no recent prescription. Adolescents with ADHD and past 12-month diversion of their prescribed stimulants were at greatest risk of 12-month frequent victimization compared with adolescents without ADHD and adolescents with ADHD but no recent prescription. Youth approached to divert reported more victimization than youth not approached. Youth who diverted reported more victimization than those who did not divert. CONCLUSIONS: Close parent-prescriber collaboration is needed to ensure effective medical treatment for ADHD without greater risk for victimization and treatment failure.

Characteristic substance misuse profiles among youth entering an urban emergency department: neighborhood correlates and behavioral comorbidities.

BACKGROUND: Little is known about characteristic profiles of substance use - and their individual- and neighborhood-level correlates - among high-risk youth. OBJECTIVES: To identify characteristic substance misuse profiles among youth entering an urban emergency department (ED) and explore how those profiles relate to individual- and community-level factors. METHODS: Individual-level measures came from screening surveys administered to youth aged 14-24 at an ED in Flint, Michigan (n = 878); alcohol outlet and crime data came from public sources. Binary misuse indicators were generated by using previously established cut-points on scores of alcohol and drug use severity. Latent class analysis (LCA) identified classes of substance use; univariate tests and multinomial models identified correlates of class membership. RESULTS: Excluding non-misusers (51.5%), LCA identified three classes: marijuana-only (27.9%), alcohol/marijuana (16.1%), and multiple substances (polysubstance) (4.6%). Moving from non-misusers to polysubstance misusers, there was an increasing trend in rates of: unprotected sex, motor vehicle crash, serious violence, weapon aggression, and victimization (all p < .001). Controlling for individual-level variables, polysubstance misusers lived near more on-premises alcohol outlets than non-misusers (RRR = 1.42, p = .01) and marijuana-only misusers (RRR = 1.31, p = .03). Alcohol/marijuana misusers were more likely to live near high violent crime density areas than non-misusers (RRR = 1.83, p = .01), and were also more likely than marijuana-only misusers to live in areas of high drug crime density (RRR = 1.98, p = .03). No other relationships were significant. CONCLUSION: Substance-misusing youth seeking ED care have higher risk for other problem behaviors and neighborhood-level features display potential for distinguishing between use classes. Additional research to elucidate at-risk sub-populations/locales has potential to improve interventions for substance misuse by incorporating geographic information.

Trajectories of Organized Activity Participation Among Urban Adolescents: An Analysis of Predisposing Factors.

Organized activity participation provides important opportunities for adolescents to develop assets and resources related to positive youth development. Predisposing factors, in addition to sociodemographics and self-selection factors, may influence how youth participate over time. In this study, we used growth mixture modeling with longitudinal data from African American adolescents attending urban high schools in Flint, MI to identify subgroups of participation trajectories (Wave 1 N = 681, mean age at Wave 1 = 14.86 years, 51% female). We measured activity participation using psychological and behavioral engagement across multiple contexts over the 4 years of high school. We examined how predisposing risk and promotive factors were related to these trajectories, accounting for sociodemographic and self-selection factors. The results indicated three participation trajectories: a low group decreasing over time (74%), a moderate, consistent participation group (21%) and a moderate, increasing group (5%). More substance use was associated with lower odds of being in the moderate/consistent versus low/decreasing participation group. More parental support was associated with lower odds of being in the moderate/increasing versus the moderate/consistent group. Our results suggest that addressing predisposing factors such as substance use may help facilitate participation over time.

Grade-Level Differences in Future-Oriented Self-Concept During Early Adolescence: Potential Relevance to School Nursing.

The middle school and early high school years are a time of significant development, including an increasing ability to envision oneself in the future. Little is known about how adolescents' future-oriented self-concept (i.e., possible selves) differs across grade levels, although this knowledge may aid in establishing rapport with students and building effective health promotion and risk reduction interventions. Therefore, this study explored grade-level differences in hoped for and feared possible selves in a sample of sixth- to ninth-grade students (n = 2,498; M age = 12.72, SD = 1.15; 51.3% female). Findings suggest that adolescents list a variety of possible selves, and the content differs according to grade level. These findings offer helpful insight for intervention work aimed at improving student outcomes and preventing risk behavior. Understanding what adolescents hope and fear for themselves in the future may be particularly beneficial for school nurses in identifying the unique challenges students experience and tailoring health promotion efforts.

Future Expectations, Attitude Toward Violence, and Bullying Perpetration During Early Adolescence: A Mediation Evaluation.

BACKGROUND: Hopeful future expectations have been linked to positive developmental outcomes in adolescence; however, the association between future expectations and bullying perpetration has received less attention. OBJECTIVES: We examined the relationship between future expectations and physical and relational bullying perpetration and tested a mediation model that linked future expectations with bullying through attitude toward violence. METHODS: Structural equation modeling was used to examine the relationship between future expectations and bullying perpetration (relational and physical) and to test whether these relationships were mediated by attitude toward violence in a sample of U.S. seventh-grade students (Mage = 12.86 years, N = 196, 60% female, 46% African American). RESULTS: Attitude toward violence fully mediated the relationship between future expectations and physical bullying (indirect effects = -0.08, 95% CI [-0.15, -0.01], R = .17). The relationship between future expectations and relational bullying was partially mediated by attitudes toward violence (indirect effects = -0.07, 95% CI [-0.14, -0.002], R = .20). DISCUSSION: Our findings suggest that future expectations can play a role in reducing attitude toward violence and physical and relational bullying perpetration among youth. Interventions that help support the development of future goals and aspirations could play a vital role in bullying prevention efforts.

The role of feared possible selves in the relationship between peer influence and delinquency.

This study explores the impact of a feared delinquent possible self on the relationship between exposure to negative peer behaviors and violent and non-violent self-reported delinquency. Previous research strongly supports that deviant peers influence adolescents' delinquent behavior. Yet, few studies have explored intrapersonal factors that may moderate this influence. Possible selves include what one hopes, expects and fears becoming and are believed to motivate behavior. Thus, it was hypothesized that adolescents who were exposed to deviant peers and also feared engaging in delinquency would be more likely to self-report delinquency. Seventh grade students (n = 176) identified feared possible selves in the future, their exposure to negative peer behavior and self-reported violent and non-violent delinquent behavior. Findings suggest that exposure to negative peer behavior is associated with self-reported delinquent behavior. For violent behavior, possessing a feared delinquent possible self moderates this relationship. Implications and suggestions for future research are discussed.

Predicting violent behavior: The role of violence exposure and future educational aspirations during adolescence.

Few researchers have explored future educational aspirations as a promotive factor against exposure to community violence in relation to adolescents' violent behavior over time. The present study examined the direct and indirect effect of exposure to community violence prior to 9th grade on attitudes about violence and violent behavior in 12th grade, and violent behavior at age 22 via 9th grade future educational aspirations in a sample of urban African American youth (n = 681; 49% male). Multi-group SEM was used to test the moderating effect of gender. Exposure to violence was associated with lower future educational aspirations. For boys, attitudes about violence directly predicted violent behavior at age 22. For boys, future educational aspirations indirectly predicted less violent behavior at age 22. Implications of the findings and suggestions for future research are discussed.